Clinical Commentary

Background

Jane is 8 years old. She has been looked after by the same carers, Julie and David, since she was 4 years old. She is to remain in their permanent care.

Jane is one of a large group of siblings who suffered severe abuse and neglect culminating in all but one child being removed from the mother's care. The children and their mother had been residing in accommodation, having fled from the father's many violent episodes towards the mother (though not the children). Contact with birth mother is infrequent and poor, with the social worker identifying the many ways in which Jane would be treated abusively by her mother.

Presenting Problems

At the time of assessment, when Jane was 5 years old, she presented with extensive difficulties relating to containment. Easily frustrated, Jane would frequently erupt into major outbursts of violence and aggression, which, due to being a danger to herself, would necessitate her being held physically. She would often wreck her room destroying her toys and other items she valued, while hitting out viciously at anyone who was close by. She was described as unable to play normally either with peers or with toys, and constantly clingy and demanding of attention. Her carers were exasperated and exhausted by their experience of being ‘drained’ by her. There were additional aspects of Jane's functioning I came to discover in that Jane had profound difficulty separating fantasy from reality. I learned her play was at that stage not a symbolic representation and expression of her states of mind or the struggles in her inner world, but rather activity in which fantasy was at times psychotically confused with reality. Moreover, it became apparent in sessions that Jane had severe difficulty in experiencing or perceiving me as separate from her, instead seeming to believe that either I magically knew what was in her mind, or vice versa, without it having to be communicated.

Session (last one before Easter break)

Jane to my surp