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In this extract we are told about Max and his family. Max has hemiplegic cerebral palsy and has been having ‘aggressive outbursts in which he physically attacked his mother and destroyed his own valued objects.’ Max’s parents are seeking help, but when asked why Max might be so distraught they express that they recognise Max ‘was in great distress but could genuinely think of nothing that he might be distressed about.’
This background context to the individual psychotherapy sessions very helpfully illuminates what follows.
As a reader, the cause for Max’s distress seems immediately apparent and jumps out of the page. We see a boy consistently trying to communicate to the adults around him a sense of what it’s like to live with cerebral palsy. Interestingly, what appears so immediately to the reader, in the position of ‘outsider looking in’, does not appear to be recognised by the key players in the drama, Max’s parents. There seems to be a ‘blind spot’ for his parents, as if they need to maintain a stance of ‘determined positivity’ in the face of Max’s disability. This position does not appear to leave space for any of the family to express more ambivalent expressions of regret, disappointment, anger or loss. This collective ‘blind spot’ is fascinating and suggests a powerful unconscious group dynamic in process. It is this dynamic that I wish to focus on below, to illustrate how the therapist and the application of the outcome measurements appear to get caught up in this dynamic too.
In their assessment, the clinicians thoughtfully insist that fortnightly parallel work with the parents should take place ‘to help them explore and tolerate the reality of their son’s emotional life, including the ongoing loss and pain of having the bad luck to be born with an impairment of this kind, and the anxiety of not knowing how disabled he might be as an adult.’ The dilemma for Max’s family is clearly stated along with an implicit idea that unless Max’s parents can tolerate and ex