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Peter is 6 years old and has been attending psychotherapy three times a week for 18 months. This takes place in a clinic context in which child psychotherapy is struggling to establish itself and due to problems within the service no ongoing work with parents is currently being offered, apart from the therapist meeting with the parents for reviews. When he was 2½ years old, Peter's baby sister died soon after birth from a non-treatable medical condition. His parents felt that they were emotionally unavailable for Peter at the time.
Peter was referred to the local Child and Adolescent Mental Health Service a couple of months after he started school at the age of 5. The parents described Peter as a physical, active and strong-willed baby and as a determined and stubborn young child. They felt that they adapted to his wishes and did not feel there were significant problems until he started school. He was physically aggressive to himself, to children, staff and particularly his parents. Peter was unable to concentrate and was described as ‘overactive’.
Although there is an occasional outburst in response to an unbearable emotional pain, physical aggression is no longer a major problem. He continues to need full-time, one-to-one support in school to support his attention to task and listening. Colleagues have discussed with his parents a possible diagnosis of ADHD. However, his parents do not want to pursue a diagnosis or use medication at this stage.
After months of repeatedly building and smashing up Lego in sessions, Peter came to view me as his persecutor and his fear, hatred and aggression were directed towards me. Following a period of a hide-and-seek game, Peter seemed to see me as a more benign and helpful figure, and this session comes at the beginning of a new stage of symbolic play.
I went down to collect Peter and he was in the corridor getting a drink of water. Peter took a little drink, placed his cup on top of the water coole