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There is much to admire in this book. It is about the application of psychoanalytic knowledge to the treatment of children and adolescents with severe emotional disturbances. The strain and struggle of dealing with the unremitting assault of their psychopathology and the remarkable energy with which the author tests the limits of treatability is powerfully conveyed. Throughout, he holds on to the hope of change and keeps an abiding faith in the importance of self-awareness gained through the psychotherapeutic relationship, even in the face of appalling human tragedy and catastrophe.
Work with the destructive, fragmented and depressed sides of the patients may move the patient out of a quagmire of regressions and
Page 273regressive disturbance and may lead them back to something more lively and restored, bringing relief to patients and staff. (p. 115)
The author is a child psychotherapist and the book consists of numerous accounts of the ways he has worked with children of different ages with different levels of disturbance in a variety of contexts, including outpatient and inpatient settings, a surgical ward and a children's day centre. The book is divided into three parts. Parts I and 2 are on children, Part 3 is on adolescents in both group and individual treatments. The first chapter provides a useful map of the direction of the book and a clarification of key theoretical concepts that inform so much of the therapeutic work, such as transference, countertransference, phantasy, containment and psychic growth.
The span of the book is wide and it is difficult to capture in a brief review the breadth of the author's experience. His work with young children is at times quite lovingly perceptive and well portrayed. He describes, for example, a first meeting with a 6-year-old girl:
… she drew a picture of a fishtank, with a bullet like frog in it, along with a vacant looking fish. Outside, a pig looked on in the garden with fruit around. Patrolling the house was a rather shrunken