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IWANT TO START WITH A CLINICAL VIGNETTE FROM THE FIRST SESSION of a five-year-old boy. I aim to use it to reflect on how we construct our understanding of the child from various strands that include the child's early history, the early psychological environment and parental state of mind, and finally, our direct experience of the child.
Kevin was referred to the clinic because he was said to be very slow. He struggled to follow simple conversations and could not easily concentrate or remember. His social life suffered, and at school he needed special help. Various assessments ruled out learning difficulties and a low IQ. There was a question about whether he was on the autistic spectrum, but not enough convincing evidence to make a conclusive decision. Kevin was an enigma, and his mother wanted him to be helped out of an underachieving and isolated existence.
During the assessment sessions, Kevin sat with his mother the entire time. He played with a Spiderman figure he had brought with him, and when the therapist made interested comments he was indeed very slow to respond. But at the end of the last assessment session, he waved goodbye to the therapist in a friendly way.
On the following week the therapist went to pick up Kevin for his first session, and he separated from mother without difficulty. He walked slightly ahead of the therapist, clearly eager to get to the room. Once in the room, he stopped in his tracks as if paralyzed. The therapist encouragingly
pointed out his new box of toys, which was on a small child's table. Kevin did not seem to follow her explanation and then very suddenly darted toward the corner of the room, picked up the plastic rubbish bin (shaped like a bucket), and put it on his head. “I am Spiderman!” he shouted, his voice reverberating from inside the bin, and before the therapist could respond, he ran wildly ahead, tripped, and fell down. As he fell, the rubbish bin toppled to the floor, and Kevin's head narrowly missed th