Correspondence

Letter to the Editors from Mrs Anne Alvarez, Child and Family Department, Tavistock Clinic, London

I wanted to make only one or two comments on Gabriella Pansini's rich and fascinating paper, ‘The Structure of Internal Space: conditions for change in a six-year-old girl with severe developmental delay’, Journal of Child Psychotherapy, 23(1), 25-49. The concept of the structural deficit in Benedetta's notion of three-dimensional space is beautifully explored by Pansini herself, so I simply wish to underline the idea that the baby could not sit up and reach out to life nor the child listen with interest to the words of others, until her object was sufficiently valuable, interesting, quiet and powerfully human to attract her interest. Betty Joseph has been writing for years, and John Steiner more recently, about the need to contain, without prematurely returning, the projective identifications of borderline patients. But, Pansini's moving example goes further: it is interesting that the child saw her therapist's wordless sorrow first, and only then did she ask for, and listen to, an explanation. It is also interning that the therapist did not say ‘you feel that I am worried’. She said ‘Because I am worried about you’. This raises the important issue of when and whether a ‘you’ interpretation can overload and overwhelm a patient who is confused about I-you differentiations, has little self-reflective capacity, and little sense of self. Often I think we overwhelm a patient at such moments when we locate the feeling too firmly in them. Harold Sears and Bryce Boyer, both experts in work with adult psychotics, have used a similar method of owning countertransferences fully. It may not seem like psychoanalysis, but does that matter if it works? Or should we stretch our definitions of psychoanalysis when we work with patients who cannot think?

Yours sincerely

Anne Alveres, Child and Family Department, Tavistock Clinic, 120 Belsize Lane London NW3 5BA