Clinical Commentary

Clinical material

Background

The child presented, J., has just turned 4 years of age. He was referred to the clinic when he was 3 years old with concerns regarding his disruptive behaviour at home, which took the form of being overactive and excessively boisterous. J.'s nursery teacher found him difficult to manage and reported that he was occasionally hostile to the other children. J.'s parents also expressed concerns about the impact of their preoccupation with his older brother, who received a diagnosis of autistic spectrum disorder, during J.'s infancy.

J. comes from an intact, loving family. Both parents are professionals.

A child and adolescent psychotherapist assessed J. and recommended once-weekly individual psychoanalytic psychotherapy. Once-weekly therapy commenced when J. was 3½ years old; his mother was also seen regularly, and his brother was in treatment elsewhere.

J.'s play during therapy

In the first half of the first term of work, J. seemed to make a good connection with the male therapist. He was keen to get to the therapy room. In his play he consistently and consciously used the vehicles to represent specific people: the yellow van represented himself, the red fire engine the therapist, the yellow plastic car his mother and the red plastic car his father. J.'s brother was conspicuous by his absence. J. often used the fire engine to rescue the yellow van. In the second half of this first term, J. began to communicate more primitive anxiety through his play. For example, he would repeatedly tip the teddy bear from the waste paper bin into the lap of the therapist.

During the second term, and after his first break in the therapy, J. found it increasingly difficult to leave his mother in the waiting room. In his play, J. covered different animals and vehicles with glue; he cut paper in two and glued the two pieces back together; on a number of occasions, J. attempted to stick the therapist to the chair with sellotape. J.'s feverish play at this time had a