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Clinical commentary by Martin Lyon, consultant child and adolescent psychotherapist on Merseyside
I enjoyed reading this session five months into David's psychotherapy. It begins with David's provocative and aggressive behaviour that threatens escalation towards a sense of catastrophe (or breakdown), a feeling that the therapist links to the straw house in the fairy tale of the Little Pigs. I would guess that this is a spiral of interaction that both David and his therapist know well. However, as the session progresses, something more playful and symbolic emerges as David reflects on his anxieties both about the reliability of the structures around him and the destructiveness of his anger.
My view of this clinical moment is filtered by my own experience working with a busy local authority adoption team where I am involved in assessing children like David. I am involved in discussions about placement needs (including the match) and in adoption support, usually through meeting parents. The dynamics observed in the early part of this session are not unusual, as the children's anxieties about close relationships can be played out in controlling, provocative and aggressive behaviour that can hook new parents into negative spirals. These children can be extremely vigilant, because of early trauma, but also through compromised executive functioning and they can be highly reactive, often misreading their new parent's tentative responses. The emotional impact of this behaviour and pattern of relationships can trigger primitive anxieties in the parents and in the professional network. David's description of two separate prisons aptly describes the way that both children and parents can find it hard to escape from these negative spirals.
For David, the idea of separate and parallel prisons may be a description of internal object relationships, possibly linked to his early experience with a mother who one can only guess may have been at times self-preoccupied and scary. I wanted