Correspondence

Dear Editors,

First of all, I would like to congratulate you on the success of the newly introduced Clinical Commentaries. While it had been a Journal aim for some considerable number of years, back to when Monica Lanyado and I were the editors, it had not actually been achieved, and it is very pleasing to be able to read such excellent material, with the appended commentaries, in what is hopefully now a regular feature.

The Commentary in the last Journal [31(2): 239 – 53] was to me of particular interest, and I found each clinician's careful suggestions on reading the sensitive work done by a therapist clearly under some pressure to provide a total package, which as they point out, is indeed a tall order, to be illuminating and in many ways complementary.

Pamela Bartram pointed up the difficulty parents may already have faced with ‘serial assessments’, and the importance of having a professional team working in conjunction rather than serially. This issue about resources and their particular uses, as she so rightly says, then leads the therapist to offer even more of herself – though in this situation it is indeed hard to know what else she might have done that would have felt helpful to the mother.

Caroline Essenhigh takes on the debate and talks of the inevitable levels of uncertainty, and the tension created in trying to address both child's and parents' needs, what she calls ‘the fine balancing act’ with which we are so familiar.

Trudy Klauber too takes up the difficulty of the framework in this case, the oscillations which occur in the parents' minds about differential diagnoses, and the resultant transference implications, which must also have a bearing on the reported feelings of mother about father's relative lack of presence in the day to day running of life at home. In a sense, the therapist is having to work too in a ‘single-parent’ role.

Several different suggestions are put forward about working with this case in terms of treatment frameworks. One which is