Clinical material

Background

A 10-year-old white British boy who I am calling Cameron has been coming for weekly individual psychotherapy for just over one year. Cameron is the youngest of four siblings, all removed from their birth family. The eldest two, a boy and a girl, are known to have been subject to extreme neglect, physical abuse and sexual abuse. Their home was described as chaotic and squalid. Cameron was removed at 10 months and it is not known what he was or was not subjected to, other than extreme neglect. He was placed with the next youngest child, Jessica, who has moderate learning difficulties, in a foster placement, which lasted for two and a half years, until an adoptive couple was found for them together.

Cameron's (and Jessica's) adoptive parents are a white British couple. Their mother works for an insurance company. Their father, an engineer, runs his own engineering firm. Both parents are deeply committed to their two children, wish to understand them better and are supportive of therapy. Jessica also attends once-weekly therapy and the parents attend regular parent work alongside. Their mother is very anxious about both children and often overwhelmed by their needs; their father is talkative and friendly, though can struggle with his temper.

Referral

Both children were referred to the clinic two years ago, having previously had a period of art therapy at their school. The children were initially seen at the clinic with their parents for family therapy, before being referred for individual psychotherapy. There was also some input from psychiatry. Though Cameron's difficulties were understood in relation to his earliest experiences, he was diagnosed with ADHD and prescribed medication. However, this was discontinued at his mother's request when Cameron reacted to the medication by becoming very tearful and depressed and struggled to function.

Cameron's hyperactivity, and sometimes hyper-vigilance, was one of his parents' concerns; the feeling that he was always on