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It is not easy - and sometimes feels presumptuous - to comment on a session in the middle of a therapy that has continued for a considerable time. Jane is not an easy child, neither for her carers nor for her therapist, and all of these adults should be
congratulated on having sustained such permanency for her, especially given her early life experience. It is, moreover, a very false situation: there is much more to Jane and to her therapy than one session can possibly indicate.
It is essential to keep in mind the trauma this child has suffered and how this might be enacted in the present and in the transference. Jane experienced ‘severe abuse and neglect’ in her family of origin. There was marital violence. In addition there are many ways in which Jane continued to be treated abusively by her mother at the ‘infrequent and poor’ contact visits. Such a history makes us alert to the developmental insult Jane must have suffered. Over the period when we would expect the healthy child, with a ‘good enough’ experience, to be developing an ego ideal, to be dealing with oedipal issues and resolution and to be in the early stages of superego development, Jane was faced with parents whose relationship seems dominated by the violence between them - they are unlikely therefore to have had the children in mind - and with a situation where identification either with an abused mother or a violent father seemed fraught options. An early experience of violence, especially at a pre-verbal, pre-representational stage, will have been overwhelming to the immature ego. Such children often cathect the body and do not move on from this readily. The body thus remains a recourse when the ego is further overwhelmed by external trauma. We should, therefore, expect acting out with the body - and, if we are Winnicottians, seek ways of according ‘positive value’ to it (Winnicott, 1963: 210). Moreover, we should also expect a heightened vulnerability in suc