Clinical Commentary

Clinical material

Background

Finn is a fostered boy aged eight, seen three times a week for psychotherapy. He and an older sibling were removed from his parents when Finn was aged five, and placed with the current foster carers. The placement has periodically been jeopardised by his chaotic and destructive behaviour, which includes instances of harming a neighbour's pets. In Finn's home of origin, he and five older siblings formed a feral gang whose activities went unmonitored by his parents, often absent. In his first five years, he was exposed to the sadism and drug taking of his eldest brother and friends. He was physically neglected and often went hungry, since he was dependent on older siblings to procure him something to eat. He was referred because of his sadism towards animals, his destructive behaviour and a relentless preoccupation with food. He has intermittent contact with his parents, which he anticipates with both excitement and distress.

Finn's foster mother is seen every two weeks by a social worker colleague, but she continues to find it hard to put herself in his shoes, or to see that there is a relationship between his current behaviour and his early history. There are also regular and productive network meetings involving social workers and teachers, which have played a role in making his placement more stable. Finn attends an EBD school, where there is intermittent concern about his distractibility and disruptive behaviour. He has friends, but tends to become a ringleader and involves them in his comic misdemeanours. Aside from this, he is a bright, imaginative child who is reading and writing well for his age.

In his sessions, Finn is endearing, funny and affectionate, but can become extremely chaotic, physically aggressive and destructive when he is anxious. Shifts of mood take place with disconcerting rapidity and unpredictability, and in the countertransference I experience these transformations as both frightening and hurtful. Early sessions w