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Violent, aggressive, acting-out children and adolescents constitute a major problem for all who work in the helping professions, as we constantly encounter them in our daily work. In the school context such children have to be dealt with by teachers and constitute a serious threat to the daily functioning of the school; they cause managements problems with their destructive outbursts in the social context of the peer group as well as in the teaching context because of the major learning difficulties that most of them exhibit independently of their IQs—often very high.
When referred to child guidance for therapy, such children are difficult to contain within the structure of once-weekly treatment and the psychotherapeutic setting. They often break out of treatment, tend to attack themselves or the therapist physically, or perform violent destructive acts against the world outside the session and between sessions, so that treatment breaks down because of the necessity for more drastic and intensive social containment and care such as is provided by day hospitals, day centres, in-patient departments and even borstals for the delinquent cases. Suicide can also occur at times. As for the analysts, four or five sessions per week of such an acting-out child, which is the specific subject of this paper, bring up the same difficulties, which have to be managed so that the treatment can perform the containing and transformative function which might eventually enable the child to manage his own extreme impulses and express them symbolically.
In her paper on acting out, Hubback writes: ‘In acting out there is too little thinking, let alone hard thinking, as well as too little appreciation of meaning’ (HUBBACK 5). Freud, in the context of Dora's