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Clinical commentary by William Solodow, Ph.D., who has a private psychotherapy practice in New York City and consults to the Riverdale Country School. He is on the faculty at the Columbia University Psychoanalytic Center and teaches in the Child and Adolescent Psychotherapy Training Program of the William Alanson White Institute
In trying to understand case material I often like to look for ‘a red thread’ that runs throughout the material and serves as a unifying force for making sense of what occurs during the session (Anthony, 1986). To find this thread I will take the perspective of Lewis and try to see events through his eyes. There are then various developmental theories that I will use to shape my surmises about Lewis.
Lewis is surrounded by adults who cannot seem to do the right thing. His mother's heroin addiction, his father's disappearance and the grandfather's rage (as described in the play material) are seemingly enough to convince any child that adults are difficult, if not impossible, to trust. The people who do try to do the right thing – those attempting to treat him – can end up taking him away, yet again, from the only family that he knows.
From the perspective of attachment theory, we have the makings of a disorganised type of connection to others (Ainsworth et al., 1978). I realise that Lewis is now six years old, but I find that the continuing patterns of how unstable his ties to others have remained over the years make the ideas contained in Ainsworth's observations very helpful. When first observed, Lewis is running backwards and forwards in an uncontrolled way in the waiting room – he has no reaction to separation; he does not say good-bye to his grandmother nor say hello to the therapist whom he is now seeing for the second time; as he approaches the therapy room, he suddenly dashes away and th