Clinical commentary

The following clinical commentary continues the theme of discussing work done by child psychotherapists in a variety of contexts by describing psychotherapeutic work undertaken in a school setting. The discussions that follow are able to describe what is ordinarily psychotherapeutic about such work, as well as the ways in which technique and thinking about practice might or might not be altered by work in settings where direct clinical work is less usual.

Clinical material

Background

Sam is a 14-year-old boy, whom I have been seeing for once-weekly psychotherapy at his school. I have been working with him for two and a half years.

Sam lived with his mother, mother's partner and younger half-brother until he was six years old. Sam's mother and her partner were drug-addicted alcoholics, who were involved in domestic violence towards each other and the children, especially Sam. Sam felt responsible for his sibling and tried to protect him. Sam would rarely attend school, often went hungry and was frequently living in fear for his and his mother's life. Sam was eventually removed from his mother's care, to live with his father with whom he had had intermittent contact throughout his life. Sam currently lives with his father, father's partner and their three-year-old son. This home provides him with stability and basic care, but falls far short of providing for him emotionally. Sam has no contact with his maternal half-brother. Sam has intermittent contact with his mother, who continues to abuse alcohol and he constantly worries about her.

He was referred by a psychotherapist from the specialist unit he had previously attended. This was due to severe emotional and behavioural difficulties that inhibited him accessing the academic and social curriculum. There had been some anxiety from the referrer that he was borderline psychotic. He was seen in school as his father would not engage with mental health professionals and would not have brought him to a clinic.

Sam engaged very