Lost for words: difficulty expressing feelings in work with three adolescent boys

Case material of three adolescent boys is considered with regard to thematic similarity around acts of puncture. Their non-verbal communication is seen as a symptomatic acting out of an internal loss of containment. This resulted in psychotic disorganisation in which aspects of language appeared selectively impaired. Each boy struggled to express emotions and feelings, and was at a loss for words in attempting to describe how he felt. Anzieu's concept of the containing function of the skin ego is examined, as this is a useful idea for thinking about puncture of an internal shell, and what happens when it is not able to withstand disturbing internal forces. Bion's theory of alpha function is also explored to understand further a breakdown in emotional communication. Disruption of alpha function can result in bizarre images. In each case, disturbing imagery was a feature of therapeutic breakthrough, which followed incidents of puncture in the outer world. Various meanings of puncture as a clinical phenomenon are considered with regard to language, loss of an ability to express oneself, and the importance of images for regaining what might be regarded as a proto-form of alpha function as well as mending a torn skin ego.