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I would like to start by sharing some of the reactions I had the first time I came into contact with the material Ni Ouya gave us.
My first thought was to wonder why a sixteen-year-old boy, who she calls “Bao”, was using the defence of obsessive-compulsive thoughts and behaviours, which is frequently a main defence mechanism during the latency period of development. Then, Ni Ouya informed us that she could only have the opportunity to see this boy for ten sessions. This seems impossibly short for a treatment of symptomatology that is often severe. However, working as child and adolescent therapists, we know that many times we are only allowed a similarly short opportunity to explore, understand, and help this population.
This underscores the principle that we should always try to work with and involve the parents since, as Ni Ouya wrote, it is crucial to work with them in order that they maintain and support treatment.
Ni Ouya informed us that after Bao visited a psychiatrist, he decided to continue therapy with him. I was wondering if she felt sad, frustrated, or disappointed—feelings that we know are very common during adolescence and that can be transferred to a therapist through projective identification.
I now turn to considerations concerning the clinical work.
About two years before consultation, Bao had started to wash his hands over and over, and he needed to check the garbage constantly. Before his entrance examination, he developed obsessive ideas about “sexual things”, apparently with concerns mainly about the female body. These made him feel unsettled as “if he was hitting a ghost”.
It was interesting that after the first session Ni Ouya was under the impression that it went well, but at the same time, she felt “uneasy”. She was aware of her countertransference, and she felt puzzled as she tried to understand where her inner feelings came from. We could see more about this as the case evolved.
Bao was close to his grandparents during childhood. His grandmother