Living in a storm : an examination of the impact of deprivation and abuse on the psychotherapeutic process and the implications for clinical practice
Many deprived and abused children living in the care system have had life experiences that have pushed the boundaries of their knowledge, endurance and ability to cope to the limit and beyond. Psychotherapy with these children can be very stressful and the 'ordinary acceptable environment' (Hartman 1939) can be replaced by an environment of extreme threat and hostility. The normal boundaries of work may be questioned and the normal structure of psychoanalytic technique may be difficult to maintain. The aim of this research is to examine how these children and young people present in the consulting room and the impact this has upon clinical practice. In this study I describe in detail my work with five children, each with a history of abuse and deprivation and living in foster care. These children present extremely problematic behaviour which is difficult to manage and understand. I describe the psychic reality of these children and explore the difficult process of bringing about psychic change. When working with these children it is necessary to think about the impact of each child's history upon his/her development. The psychotherapist's task is to provide an environment which will enable the child to develop a more secure and flexible frame of mind in which toxic internal representations are replaced with more benign internal representations of the self and more benign internal object relationships. In doing this, the therapist has to simultaneously acknowledge both the patient's separation and intrusive anxieties and has to maintain contact with the patient, whilst also allowing the necessary distance to develop between the therapist and the patient to enable his/her interventions to be of benefit. In trying to achieve this task, I suggest that it is useful for the therapist to think about the therapeutic management of the clinical process.