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Lewis's history is sadly all too familiar to child psychotherapists working in CAMHS and even more so in specialist services for looked-after children. It is hard for clinicians not to have the full horror of the child's external reality in the front of their mind when thinking about the internal reality as revealed in the therapy room. There is obviously a question about his experience of being born heroin-addicted and the long-term neurological effects of going through withdrawal as an infant … as well as the emotional and psychological impact of living with a heroin-addicted mother for the first eight months of his life. Being moved from her care to his grandparent's home, and then back and forth into foster care when he was dropped by an uncle, adds to the trauma which he suffered in the pre-verbal phase of his development.
This is only the second assessment session, a fact I completely lost sight of when reading the process notes. Lewis is so deeply into the session and is treating the room and the therapist as if he has been there forever. The way in which he catapulted himself into the session reminded me of his having been born by caesarean section and moved immediately into special care. There was no ordinary birth process and at best, an interrupted introduction to his mother. The session begins in the waiting room with Lewis reacting to the sight of another therapist with another child. There seems to be an edge of mockery in his imitation of the other therapist, maybe a way of splitting to keep his own therapist ‘good’ in his mind.
The key communication in this session occurs right at the beginning when the therapist attempts to comment on his agitated state of mind. “No, I don't get worried.” These words speak volumes in a boy who goes on to show some of the many ways in which he tries to make sure that he does not feel any worry. It also seems to carry a bit of a