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My first impression on reading this case was of the wealth of material. The richness of the description felt at times rather overwhelming. I wonder if this was also the experience of Karl. The second impression was of how closely my impressions of the session were confirmed by Karl's intervention. I did however feel that I have a few things to add.
The description of Cameron as laid out in the section ‘Referral’ seems to describe a fairly typical presentation of a child who has experienced serious neglect in his infancy. In fact, he reminds me of a patient of mine who like Cameron was removed from his birth mother in infancy. The features of hyper-vigilance, sometimes hyperactivity (often mistakenly labelled as simple ADHD), ‘shallow nature of attachment’ and ‘lack of emotional contact’ I have often seen in children with this kind of history. Furthermore, the aggression, the ‘loneliness deep inside’ and the lack of trust seem to me often to characterise these children.
I will now look at the session with this description of this child in mind. At the beginning, Cameron’s statement that “something stinks” tells of how he feels that the setting, maybe the whole therapy, had somehow changed, probably as a result of the break in therapy: the setting was felt to have gone bad. At the same time, he tells about his difficulties of holding his therapy in mind without it going bad. I think Cameron felt that the therapist had not protected the therapy and the setting enough. “It had gone mouldy”. This makes Cameron angry and he retaliates by spilling his water. This gradually produces a state of mind in Karl, of anger and irritation (projective identification). The task Cameron sets for Karl unconsciously is how to process these feelings of anger and irritation. I believe that these dynamics then continue to dominate this session, something that Karl soon became aware of.
The sequence early on in the session starting with Cameron telling Karl about his collectable rubber-edged