Clinical commentary by Francesca Calvocoressi, Head of Training at the Scottish Institute of Human Relations

This carefully detailed account of a session with a 10-year-old adopted boy, following a three-week break, allows the reader to follow closely the ups and downs of the interaction between the child, Cameron, and the therapist, Karl. On first reading, the interesting material or content of the session itself is engrossing; however, on second reading it is the rhythm, cadence, harmony and dissonance of the communication that I find myself focussing on. Cameron is a boy who is clearly engaged with his therapy, and from this account one can see that Karl equally is committed to his patient. And yet from the vantage point of a reader after the event, one can reflect on the minute-by-minute small misunderstanding, misattunement (Stern, 1973) and missed opportunities in the course of the session, and the sense of

relief when understanding and a state of being understood are achieved. This brings to mind Donald Meltzer's well-known paper ‘Temperature and distance’ (Meltzer, 1976), and the difficult task that we all have as child psychotherapists of being emotionally available in sessions when thinking is under attack, and of finding ways moment by moment of listening and responding to the child, at the ‘right’ time, at the ‘right’ pace, in the ‘right’ way.

The beginning of the session is filled with expectancy: the therapist is checking to see whether Cameron will turn up after a three-week absence, and then surprisingly Cameron and his father, who normally arrive five minutes late, are early. They are each, therapist and patient, surprised and ‘thrown’, as if they have each been found out as being over-anxious or over-keen to get together. Cameron is certainly not going to show his relief at finding that his therapist is not only expecting him, but on the lookout for him. In the room he observes that something ‘stinks’ and that there is a mouldy smell. From the subsequent material I think that it is possible to see that Cameron is communicating a deep-seated fear of othe