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Educational Therapy &
Therapeutic Teaching
the Journal of the Caspari Foundation. Issue 13.
editors: Sue Davies and Lee Marsden
CONTENTS
Editorial
5
Jenny Dover
Work With A Hard-To-Reach Child
7
Vicky Rowland
A Boy Lost In Time And Space
16
Irene Oromí
Psychoanalytic Contributions To The
Understanding Of Psychosis
And Its Mechanisms In Children
29
Barbara Lyndon
What Is Important When You Are Four Years
Old And Starting At School Or Nursery
A Commentary On Two Nursery Observation Essays
47
Trisha Waters
Therapeutic Storytelling
In The Junior School
62
Book Reviews
67
Contributors
73
Notes For Contributors
74
published by The Caspari Foundation
for educational therapy and therapeutic teaching
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Editorial
As always, the 2004 edition of Educational Therapy and Therapeutic Teaching reflects
the thinking and clinical practice of the Caspari Foundation.
Jenny Dover is well known to our members and students on the training course, and all
will welcome her paper, which presents a case study of work with an emotionally fragile
child. The focus is on how the skilful use of metaphor within the structured educational
therapy session enabled the child to think and learn. The paper is based on lectures
given in Norway in 2002 and at the Caspari Foundation in 2003.
Vicki Rowlands presents another case study, again showing the effective use of metaphor
in her work. She demonstrates how this enabled her to work with a child at deeper,
unconscious levels thus helping him to cope with otherwise unbearable experiences. His
progress is detailed as he slowly manages the learning process.
More examples of clinical work are given in the following paper by Irene Oromi. She
outlines work with children identified with various kinds of learning disability. The
cases come from a variety of settings in which she has worked over time, using different
kinds of clinical interventions that draw on one of several therapeutic and psychoanalytical trainings.
In the next paper, Barbara Lyndon highlights a distinctive feature of the Caspari
educational therapy training; the study of learning in nursery aged children, based on
detailed observation of a child in a nursery setting. Using extensive examples from two
papers written for this part of the training, she compares the learning styles and
interactions of two different children and shows how thoughtful discussion of the detailed observations made is a powerful learning experience for the educational therapy
students themselves.
In our final paper, Trisha Waters describes how she has developed the use of a particular
style of therapeutic storywriting as a model for use in schools by teachers or counsellors.
This was the focus of her research based MA and she was supported in this work with a
Best Practice Research Scholarship from the DfES. This approach has been taught to over
fifty teachers in eight education authorities, where the response has been positive as it
addresses both emotional literacy and national curriculum issues. The model is intended
for use with a group of children and attention is drawn to ways in which this differs from
techniques used by educational therapists. The writer also makes clear that there are some
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children for whom her model may not be suitable. The description of these children
may suggest to educational therapists likely candidates for individual educational therapy
or possibly for psychotherapy.
We are grateful to our book reviewers for contributing their thoughts about some recent
publications, all of which may be of interest to readers. Willing reviewers are warmly
encouraged to make themselves known to the editors for forthcoming editions.
Sue Davies and Lee Marsden
Editors
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Work With A Hard-To-Reach Child
Jenny Dover
Nine-year old Matthew, recently received into Care, was playing a board game with me
in his educational therapy session. The card he picked up demanded an answer to the
question: “When I need a hug I go to…” Matthew looked anxious. Then he brightened.
“I know,” he said, “I won’t need a hug!” This was his solution to a world where adults
proved unreliable and unresponsive to his needs.
Although bright and potentially able, Matthew was seriously underachieving at school.
His teacher described him as ‘preoccupied, distant and rather lifeless.’ Matthew neither
sought nor welcomed help with his work, preferring to struggle alone, and she was left
feeling intrusive and rejected.
In terms of Ainsworth’s attachment typology (1969), Matthew might be considered an
avoidant anxiously attached child. He would have been an infant who turned away from
the rejecting mother – defending against emotional pain through an imagined self- sufficiency.
I am going to describe an aspect of my individual work with Matthew in a Child and
Family Consultation Service. I hope to demonstrate the way in which the relatively structured
nature of educational therapy, with its emphasis on indirect exploration of experience and
on the task, was a particularly helpful intervention for this child.
Figure 1 – Matthew’s family
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Six months into the therapy Matthew was still unable to remember my name and frequently
confused it with names of an array of social workers that had peopled his life in the last
few years. By forgetting my name and confusing me with others, he gave me a flavour
of what it felt like to be in a foster home with a large number of other children who
came and went.
Matthew’s ‘family’ drawing (figure 1 – previous page) depicted a sofa with a row of identical
heads, seen from behind, watching a blank television set. Studies on the distinctive features
of family drawings relating to patterns of attachment, suggest that it is typical of an avoidant
child to draw his family showing little relation to each other or individuality. If a mother is
included in the drawing, she may be hidden or disguised. Resistant or enmeshed children,
in contrast, might draw figures close together or separated by a barrier of some sort. Secure
children tend to differentiate family members and to show them interacting. (Goldberg 2000)
Figure 2 – Two examples of typical drawings
Matthew seemed surprised when I showed interest in his place in the family and I asked
which head depicted which child. His sense of individuality was poorly developed. He
found it hard to think about his own preferences or habits or to tell me about his current
or past experience outside of the therapy room. The difficulty in expressing a coherent
narrative of life typifies children who are insecurely attached.
When Matthew drew a picture of himself (figure 3), his body was in profile, as if attempting
to escape notice. His facial portrait was minimalist – although chilling in what it unwittingly
revealed. Although Matthew showed no affect when producing the picture, I felt horror.
There was no mouth and a strikingly phallic nose. Matthew had not spoken about his
father’s oral sexual abuse – but his brother had done so.
Drawings can be a useful source of information in several ways. The graphic sexual quality
of Matthew’s self portrait suggested that the experience of abuse remained unprocessed.
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It was more like a flashback or reproduction of the
experience. Children who have processed the
experience more successfully tend to find symbolic
ways of indicating abuse. For example, they may draw
attention to the genital area by drawing hearts and
bows on the clothing
Ears were also omitted in Matthew’s picture and it was
likely that his distress in the past had largely gone
unheard. The absence of ears may also suggest the
desire not to hear painful things. The blank TV screen
too made me wonder about Matthew’s desire to blank
out memories and feelings. It seemed likely that the
abuse compounded Matthew’s early attachment
difficulties.
Matthew was the second of three brothers who had
lived with his learning disabled, schizophrenic mother
and alcoholic father. The children, whilst living with
their parents, suffered from serious neglect, and
neighbours reported that the father would send his
small sons out into the streets to forage for food. They
were punished severely if they returned empty handed.
Figure 3 – Matthew’s self-portrait
and full body picture
The boys’ father was violent and unpredictable and
the boys were afraid of him. In care, the eldest boy wet
himself on an occasion when he glimpsed him in the
street. Monitored visits with the father were terminated
when he abused his youngest son in the toilet on one
occasion. After this their father harassed the new carers
and the foster family moved to a new address to escape
his threatening visits.
Davies and Cummings (1995,8) wrote “Domestic violence is a particularly potent source
of developmental problems precisely because the fear of harm coming to the parent leads
to anticipations of unavailability, confirmed by the inaccessibility of the mother at moments
of acute marital conflict”.
Research suggests too that the early experience of chronic violence and abuse may also
have consequences for brain development when parts of the brain responsible for activating
survival mechanisms become over-developed and sensitised – at the expense of the more
thoughtful, reflective ones.
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Nonetheless, during their assessment by the social services, all three boys expressed a
desire to be returned to their father’s care, demonstrating how powerful attachment to an
abusive parent can be.
All three boys showed signs of emotional disturbance. Matthew was said to be undemanding
and well behaved but he suffered nocturnal enuresis and was extremely reserved and
uncommunicative. His social worker quickly abandoned the attempt to do ‘life story’
work with him. He was also reluctant to engage with staff in school where, as described
earlier, he tended to make himself ‘invisible’ and reject help.
Interestingly, Matthew’s foster mother, usually a warm and caring woman, found herself
enraged by the enuresis, experiencing it as an aggressive act. She may have been re-enacting
an inability in his birth mother to bear his negative feelings. Learning demands the
comfortable use of aggression and Matthew’s passivity, inside and outside of the therapy,
was striking. It may be that he communicated his experience of rejection by eliciting these
feelings in his foster mother. Wetting the bed when his guard was down at night seemed
the closest he came to tears.
Matthew’s foster mother said she found his silence intolerable – describing him as ‘looking
at her funnily.’ I wondered about his birth mother’s mental illness. What did Matthew see
when he looked at her? Children learn about mental states by exploring the mind of the
caregiver – but if what they see there is incomprehensible, terrifying or painful, they
may repudiate this knowledge.
Bowlby suggested that different patterns of attachment affect the degree of access to certain
kinds of thoughts, feelings and memories. For example avoidant models of attachment
permit only limited access to attachment-related thoughts. Avoidant children tend to trust
cognition/logic more than resistant children because, unlike them, they can predict parental
response that has been consistently rejecting.
It seemed that Matthew’s unconscious memory of past repeated interactions with his
parent was being re-enacted in his relationships with adults – foster mother, teacher,
and myself.
In the early sessions Matthew made no spontaneous communication and clearly found
being alone in the room with me a strain. I was struck by his need to keep me at arm’s
length. He seemed to erect a ‘brick wall’ between us and quickly made me feel terribly
intrusive and a bit like a persecutor. He was more comfortable with a task or activity on
which to focus. His preference was for factual science books although he appeared to
listen very intently when I chose to read fairy stories or myths. He was compliant and
inexpressive, showing no frustration when, for instance, the wooden house he was building
came to pieces.
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I tried not to be over-bright in an attempt to enliven Matthew and to consider carefully what
he could tolerate. In view of the chronic abuse he had suffered it seemed important to provide
an experience of non-intrusiveness and control in the therapy. (Ann Alvarez 1992)
I, therefore, had two aims in my work with Matthew:
• to find a comfortable and tolerable way of ‘communicating with the past’
and processing experiences
• the second – and perhaps more important – was the task of giving him
a different experience of ‘self with other’. (Stern)
The opportunity for this presented itself one day when, instead of offering a stimulus or
a suggestion for writing a story, I wrote ‘Once upon a time….’ and said, “Over to you.”
To my surprise Matthew was willing – even eager – to decide on the themes of his own
stories and, provided I did not interfere in any way, to dictate them to me.
This activity was to be the vehicle for our work – the story providing a ‘buffer’ between
us that seemed important.
Story making is only one of many projective techniques in an educational therapist’s
armoury. It can be extraordinarily useful in a number of ways, apart from allowing fragile
children to explore and express experience in the metaphor.
Stories can provide information about a child’s inner world, characteristic conflicts and
preferred defensive adaptations. Secure children’s stories differ from insecure children’s
insofar as they tend to contain realistic strategies, be peopled by well-meaning, responsive
adults and have appropriate feeling and resolution. The ways in which they change during
therapy enable us to evaluate children’s progress.
Story making with Matthew related to my two aims. The content of the stories allowed
an indirect means of reflecting safely on his past experience. The process of creating them
alongside me gave him a new way of being with an adult.
Matthew chose the story-making activity every week and the sessions gained a sense of
continuity, routine and safety.
At first I played little part in creating the stories apart from sometimes noticing aloud and
scribing as Matthew dictated them. It felt rather as if I was just an extra limb – an extension
of him. I added nothing of my own but each week, as we began, I recalled the previous
week’s events in the story linking past and present.
In my sessions with Matthew I hoped to recreate the conditions favourable for early
learning within a relationship. Winnicott (1971) proposed that a child needs to play alone
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in the presence of the mother if a stable true sense of self is to emerge. She must be sufficiently
unobtrusive for the child to forget her and focus on self-exploration that lies at the root
of solitary play.
Winnicott said that there were three conditions for the evolution of symbolic functioning
in the transitional space between infant and caregiver:
• A sense of safety associated with experiencing the inner world
• An opportunity for the infant deliberately to limit concern with external
events
• An opportunity to generate spontaneous creative gestures
This corresponds to Bowlby’s concept of a secure base.
There is a lot of support for the view that therapeutic change is not so much a consequence
of insight or reflection on episodic memory but as a consequence of repeated experiences
that change procedural (implicit) memory. Stern suggests these experiences are the building
blocks of internal working models.
There were many stories in Matthew’s repertoire but the theme was always similar. The
following story (which I paraphrase here) seemed key:
There were three princes who lived with their parents, the king and queen,
in their palace.
The king was an angry man. He sent the princes out into the forest to
search for treasure. He told them that if they returned without the treasure
they would be killed.
The forest was dark and horrible and full of terrible dangers.
The princes had to struggle with dragons, snake pits, wild animals,
witches etc. in order to reach the treasure. Getting back to the palace was
beset with difficulties.
Matthew had found a metaphor for his own experiences.
I was struck by the extraordinary contrast between the richness, imagery and movement
in these stories and the empty, bleak material he produced in response to being asked about
himself directly.
Matthew’s stories clearly contained elements of fairy tales. Bettelheim (1978) wrote about
the very special meaning that these have for children.
He said “In order to master the psychological problems of growing up – overcoming
narcissistic disappointments, oedipal dilemmas, sibling rivalries: becoming able to relinquish
childhood dependencies; gaining a feeling of self worth, and a sense of moral obligation
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– a child needs to understand what is going on within his conscious self so that he can also
cope with that which goes on in his unconscious. He can achieve this understanding, and
with it the ability to cope, not through rational comprehension of the nature and content
of his unconscious, but by becoming familiar with it through spinning out daydreams –
ruminating, rearranging, and fantasizing about suitable story elements in response to
unconscious pressures. By doing this, the child fits unconscious content into conscious
fantasies, which then enable him to deal with that content.”
Through the stories Matthew and I were able to explore a number of issues in his experience
– perhaps reliving the trauma in the only safe way available. Some of these issues were the
huge struggle for survival – unsupported and against huge odds; the princes’ desire to
please the king whom they both loved and feared; the need to develop new survival
skills and to manage impossible situations; the power struggle but need for cooperation
between the three brothers.
The relative lack of emotion in these stories was striking. The description of the princes’
struggle was largely on a physical and not a psychological level. There was little reference
to feelings in the characters.
This is reminiscent of adults who describe past abuse with total lack of affect. They are
at greatest risk of revisiting their abusive past histories on their children. Fonagy (1994)
said “the caregiver’s capacity to reflect the child’s psychological experience provides him
with part of the mental equipment necessary to establish his own reflective self…”
It seems that by enabling children to experience our thinking about them – their intentions
and their feelings – they can be forced to create internal working models of themselves as
thinking and feeling individuals.
A recurring theme in Matthew’s stories was ‘finding a way back’. Often he would illustrate
these by drawing complex mazes leading back to the castle. This seemed linked to Matthew’s
expressed desire to return to his father but also a sense of having lost something important
early on and the painful difficulty of relocating it. Later I wondered if this also related
to the weekly gap in the therapy sessions.
Another theme that came up repeatedly was about a queen trapped in a tower with a
terrible monster and needing to be rescued by the princes. This may have reflected Matthew’s
anxiety about his learning disabled mother who was now alone with his father.
A story about a young hedgehog that was attacked by a larger one seemed to relate to
Matthew’s threatening father. Interestingly, the saviour, an owl who swoops down and
removes the young hedgehog from harm, is seen as a punitive character. (Possibly his foster
mother or me).
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At first in the stories the princes rely on magical solutions. For example the heroic second
prince develops super powers killing off everyone at a stroke. Children like Matthew,
who have never experienced a sense of powerfulness or potency, may need to experience
this imaginatively. Later, a wizard who granted him wishes, albeit unreliably, comes
to his aid. I hoped this meant that Matthew was gaining a sense of outside support.
As time went on there was a gradual feeling of writing being a useful tool and a developing
capacity in Matthew to allow me some of my own thoughts if they married with his
overall ideas. He insisted we distinguish our ideas by using different coloured pens
for this. I began to wonder aloud what the princes might decide to do – how they might
plan a way to get out of a fix – in an attempt to emphasise a sense of agency in the
princes. We began to debate suggestions about the action.
Incorporating my ideas into Matthew’s imaginative world felt like the beginning of
mutual play. We were co-constructing a shared experience and view of the world through
the narrative. Some months into the work, Matthew agreed to share the scribing.
Over time there was an interesting shift in the stories. Now the princes had to rely on
‘cunning and trickery’ rather than magic and to find their own strategies and solutions.
The second prince puzzles, “What can I use which won’t melt in the volcano. I know…”
I felt Matthew had a corresponding growing sense of his own intelligence and ability.
We now entered a period where it felt comfortable enough to disagree about actions
and how someone might behave – and it felt important to acknowledge openly with
Matthew that we could have different ideas and ways of seeing things. I felt that this
separation was possible because we had in some sense come together.
Interestingly, at the end of the story, the prince notices that the wizard’s shoes are the
same as the king’s and that they are one and the same person. Perhaps Matthew was
developing a more integrated view of a father who was both good and bad.
The use of Matthew’s story for reading purposes and using key words from his story
for spelling gave Matthew a sense of control over his learning and increased his sense
of himself. His preference for making up his own stories – rather than using existing
ones – fitted better with his need for self sufficiency and protection against intrusion.
Even quite a long way into the work he preferred creating stories to hearing others.
Matthew remained a reserved individual who was guarded in his relationships. But his
sense of himself as a learner and thinker increased and the school began to report a
greater interest and curiosity academically.
I hope this paper has demonstrated the usefulness of using metaphor in the work with
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an emotionally fragile child. It enabled him to communicate and think about painful
past experience indirectly and to regulate the distance from the teacher/therapist through
the structure of the task.
BIBLIOGRAPHY
Ainsworth M.D.S and Wittig, B.A. (1969) Attachment and Exploratory Behaviour of 1 year olds in a
strange situation. In Foss B.W. (ed.) Determinants of Infant Behaviour 1v. London. Methuen
Alvarez A. (1992) Live Company. Routledge. London.
Barrett, M and Trevitt J. (1991) Attachment Behaviour and the Schoolchild. London. Routledge
Bettelheim B. (1978). The Uses of Enchantment. Penguin Books.
Bion W.R. (1962) Learning from Experience. London; Heinemann Medical
Brandell J.R. (2000) Of Mice and Metaphors. Therapeutic Storytelling with Children. Basic Books
Cummings E.M and Davies P. (1994) Children and Marital Conflict. New York. Guildford Press
Fonagy P. (1994) The Emanuel Miller Memorial Lecture. The Theory and Practice of Resilience. Journal
of Child Psychiatry.
Freud A. (1965) Normality and Pathology in Childhood. The Writings of Anna Freud Vol.6. New York.
International Press.
Goldberg S. (2000) Attachment and Development. Arnold, London.
Harris D.B. (1963) Children’s Drawings as Measures of Intellectual Maturity. NY Harcourt. Brace and
World
Moore M.S. (1990) Understanding Children’s Drawings; Developmental and Emotional Indicators in
Children’s Figure Drawings. Journal of Educational Therapy 3 (2), 35-47.
Stern D. (1998) The Interpersonal World of The Infant. Karnac Books, London.
Winnicott D. (1965) The Maturational Processes and the Facilitating Environment. London. Hogarth
Press.
Winnicott D. (1971) Playing and Reality. London. Tavistock
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A Boy Lost In Time And Space
Vicki Rowland.
Joshua’s mother bowed her head and began to cry softly as she described her son’s
behaviour: he was out-of- control at home, often in fights with his siblings, almost
impossible to get ready for school. The most painful thing for her was that he swore
at her when he was being defiant.
‘He shouldn’t be speaking like that to his mother,’ she said to a co-worker and me at
the clinic. With a look of humiliation, she told how she was frequently called to school
because of his disruptive and hurtful behaviour. Her hope was that Joshua would learn
to read and that his behaviour would improve during educational therapy.
Joshua’s teachers despaired: he had a long history of aggression with peers, verbal
and physical abuse of staff, and ‘an inability to see the consequences of his actions.’ An
experienced teacher said that there was something ‘very dark and powerful’ about him,
and he was described as ‘a very unhappy child.’ His attainment was poor and teachers
reported that he was working at a level more appropriate for a Nursery child rather
than an eight year old. His National Curriculum levels were recorded as working towards
level 1. They saw that he undermined the learning of others in crafty ways and that
he often hid under worktops.
The school sought a Statement of Special Educational Needs, and as things did not seem
to improve for Joshua, he was excluded on several occasions. The SENCO persuaded
Joshua’s mother to let him refer Joshua to the local Child and Adolescent Mental Health
clinic, and this was supported by a school counsellor who was very concerned and
described his needs as urgent.
It was decided that Joshua could no longer cope in a mainstream school on a fulltime basis. He began a shared week. On Mondays and Tuesdays he attended his
mainstream school and for the rest of the week he attended a school for pupils with
emotional and behavioural problems.
THE SCARIEST BOY IN THE WORLD
During our first session, Joshua meekly cut out photographs of footballers and produced
a poster, making the occasional polite requests for me to help him, but declined my
request to draw a picture of himself and his family.
In the second session, the use that Joshua made of the space in our room seemed bizarre.
He drowned out my attempts to talk (and I think probably his own thoughts) by opening
and closing windows, turning on and off a reading lamp, drumming noisily with pencils,
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and shouting. Joshua jumped from one piece of furniture to another with fury–driven
agility. He made verbal threats, saying that he felt he could make people do as he wished
by hurting them. Any kind of thinking and learning were impossible.
I noticed that as well as seeming to be ‘lost in space,’ Joshua could not make any sense
of time. He found it impossible to give a simple, cohesive account of the events of his
day. He could not understand the meaning of ‘next week’ and he could not hold in his
head how long our sessions would be, or even what a minute in time felt like.
Only his anger offered continuity between the first few sessions: I wondered if that was
what was ‘holding him together. I wondered what Joshua’s experiences of being
‘contained‘ (Bowlby, 1979) had been like when he was a baby. In our sessions together,
Joshua felt to me as though he was ‘the scariest boy in the world.’ He truly was projecting
a great rage: I remembered the feeling of ‘something dark and powerful’ that his teacher
had mentioned. After one of the early sessions, when he had behaved in a particularly
threatening way, and while we waited for his mother, Joshua quietly said to me, ‘I scared
you though, didn’t I?’ in quite a calculating way.
BEGINNING TO UNDERSTAND JOSHUA
Watching Joshua with his mother was fascinating. In the waiting room they were never
in the same place. Joshua’s mother would usually be sitting silently in one of the alcoves.
Joshua could be found rocking crazily on a large plastic toy, sometimes standing up,
legs braced apart, flailing his arms around in his attempts to keep balance. Occasionally,
he would fall, twisting his body in order to land on his feet. Joshua’s movements reminded
me of a description of images caught by a new ‘hi-tech’ scanner: ‘the foetus leaping,
turning and jumping at 11-12 weeks’ of pregnancy. (The Guardian, Saturday 13th 2003)
Things had not gone well for Joshua and his mother just before or during the pregnancy.
Joshua’s mother had travelled to London with her husband, two young daughters, and
a seriously ill older boy, William. They had been desperate to get medical attention
for the boy. Joshua’s mother remembered how the next few years were full of anxiety
and struggle; her eldest boy survived, but I wondered about the quality and consistency
of baby Joshua’s care. When Joshua was four, the marriage had broken down, and
Joshua’s mother told me, in a very final way, that ‘he never saw his father after that.’
Joshua’s representation of his family in the first picture he made in educational therapy
offered more clues. He drew first himself and a rather large, looming mother. In the
drawing, both have curiously large heads in relation to bodies in a baby-like way, and
Joshua does not have arms or feet, showing perhaps, a sense of powerlessness. That was
all that Joshua wanted to draw, just himself and his mother, and I think this says a lot
about his preoccupations. His mother does not have a strong, steady stance, but wobbly,
‘rubbish shoes’ he said. It was only with reluctance and at my prompting that he went
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on to draw his older brother, William,
confounding his teacher’s evaluation of
a non-writing boy by writing, as a speech
bubble next to his brother’s picture, ‘I
went to Italy, Joshua’ (figure 1).
I thought Joshua looked sad and confused
as he wrote, and in answer to my
question, Joshua said he did not know
when his brother would be back. ‘He
might be coming tonight,’ he said, ‘But
nobody told me.’ Joshua had put circles
around the ends of some words and the
beginnings of the next. I thought that he
might be representing his sadness and
confusion about the loss of his brother,
and that it made him feel ‘in pieces’. It
demonstrated how his preoccupations
could intrude in his writing. Joshua drew
his sisters with more prompting. He drew
them as stick people, apart from their
bulbous heads. He expressed great
hostility towards them both, and stabbed
his pencil into their eyes.
Figure 1 – Joshua’s family
At the beginning of sessions, there were no mother-son ‘goodbyes’ as we made our way
out of the waiting room, but whining pleas for ‘sweets’ from Joshua, and silence or gruff
refusals from his mother. Joshua’s pleas for ‘nourishment’ would continue as we reached
our room, and he would dash to the window, open it as far as the safety catch would
allow and shout down to his mother.
MAKING THE FIRST MOVES
It felt very important to provide a safe, containing environment for Joshua in educational
therapy. I made sure that our room was set out carefully before he arrived, with a variety
of playthings and books, that his box was ready with equipment and that I tried to
collect him and take him downstairs at the same times.
When attempts to speak to him were lost in a whirl of hyperactivity, my reaction was
to sit quietly and very calmly, watching him closely, responding occasionally with words
which showed ‘nurturing care’ and observation (Bennathan and Boxall, 1997), and I
attempted to link his actions with his possible feelings. For example, I would say, ‘Keep
yourself safe, Joshua,’ as he flew around, and, ‘You seem to be moving as though you
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might be very angry today.’ Gradually, this
seemed to have an effect. I wished to offer
him a ‘different kind of experience’ (High,
2002) from ones I thought he might be
having at home. His mother had reported
that their interactions often ended in her
beating him when she felt he was out-ofcontrol (and it seemed that she was also).
Although Joshua was very afraid of being
taught, he now proved himself able to bear
the relationship between us enough to carry
out some of the tasks I asked him to do. He
was able to make up a story that I scribed,
as he refused to write. The story included
the brutal breaking in of a front door with
his door number on it, and battles between
gangs of hero figures and the police. At the
same time, Joshua was worrying that his
box would be taken from the clinic, that
the door to the cupboard could be broken
down. I did my best to reassure him that
the box would be in a safe place.
Figure 2 – Joshua’s squiggle game
MAKING A SPACE
There came the day when Joshua became angry with the box; ‘a shit box’ he shouted.
Soon after, his anger was transferred to me. He demanded to take home all his work,
and when I refused, he started a battle of wills which lasted several sessions.
‘Joshua pulled his work out of the folder in a fury, scrunched it up in his hands, threw
his pictures of his family, his dictated story and other work onto the floor and jumped
on it all. He angrily threw his work in the bin.
His tantrums seemed like those of a much younger child, testing the boundaries between
himself and his carer, working out ‘where he ended, and another person began,’ as
though he was finding ‘potential space’ in which to develop. (D.W.Winnicott, 1971).
We played the ‘squiggle game,’ made famous by Winnicott, and I remembered how
Joshua mirrored my shapes and ideas, so that we ended up with an enmeshed couple of
caterpillar creatures. (figure 2) .
During these early months, despite a good deal of anger and mistrust, Joshua began
to show attachment. He wished that he ‘could come to this school all the time’ and
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attempted to negotiate extra sessions. He touched my hair gently and tickled my feet,
in another session, behaving again like a much younger child. Joshua tried to find out
where I lived, and said that he had been looking for me in the holidays; I noted that
he seemed to be searching for a trusted adult.
At the end of the second term, Joshua wrote a sticker for me. It simply said, ‘Vicki love
Joshua.’ I am not sure if this was an appeal or a plain statement of fact as he saw things.
TIME AND SPACE
Because Joshua seemed to be lost in time and space, one of the tasks I asked him to do
every session was to look at the calendar and mark the date with a pen. We would then
count the number of times I had seen him, count the days until the next session, or look
forward to holidays, birthdays and Christmas, including any event that was significant
to Joshua. It seemed vital to help Joshua make a ‘cohesive’ story, to help him to see that
he had, ’a present, a future, and a past.’ This activity ran all the way through to the last
sessions of educational therapy two years later. At first, Joshua understood nothing
about this symbolic representation of time, but as events passed and were talked about,
he began to develop an understanding.
Also, as a way of helping Joshua begin to tell his story, I had provided a simple diagram
of the session in a circular shape, showing ‘coming to educational therapy,’ ‘time to
do tasks’, ‘Joshua’s choosing time’ and ‘time to go down.’
Joshua found it very difficult to say anything at first, and so every session I modelled
it for him, moving his finger along as I ‘told the story’ of his therapy session. The circular
movement and regularity of this activity, and probably my touch, seemed to soothe him
when he was feeling particularly restless and lost.
Events were added to suit Joshua. I began to include ‘leaving your mum’ and ‘going
down to your mum,’ as these were often the trickiest times for him. Joshua asked if
he could tell it himself eventually. He had terrific difficulty at first, mixing up the events,
putting them in the wrong order, struggling to find the vocabulary and getting very
cross. I had to be careful how I intervened, as he feared being taught and the relationship
appeared to feel humiliating for him.
There was a general move towards a cohesive ‘story’ over the two years. I came to regard
this as a marker of emotional resilience. At times when events at home or school had
really upset him, he fell back into confusion, and he then needed help again. I felt in
some way that Joshua’s mother ‘loomed large’ in controlling the direction of therapy.
In the third session, as we left her, she spoke to me in a way that sounded like an order,
‘Joshua is to read a book, not play.’ I recalled how she had angrily stared at Joshua as
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he played in the waiting room. ‘Stop’ she had said sternly, and he had immediately
frozen, looking afraid. I also remember how she had complained bitterly about him,
‘playing, doing baby things’ instead of reading in the half term holiday. Joshua had
defied her and she had hit him.
I wondered what her own experiences of babyhood had been like, and if she had missed
out on play; the whole thing seemed so painful for her to watch when her son played.
Perhaps her relationship with Joshua had been disturbed by ‘intruders from the parental
past’ (Fraiburg, 1980.) It seemed vital that the central importance of play in Joshua’s
learning should be understood.
I said to Joshua that I did not feel that he was ready ‘to read a book’ and that I would
explain to his mother that we could begin by reading just a few words, and that word
games would be useful. I explained this to Joshua’s mother, feeling a grudging acceptance
and so I felt that we had made a little ‘time and space’ of our own.
‘LEARNING TO PLAY’ AND THEN ‘PLAYING TO LEARN’ (Winnicott. 1982)
Joshua appeared to be playing in a way that much younger children do; his play tended
to be solitary. I was an observer, rather than a playmate. He created battle scenes in which
a young creature searched for ‘a dad.’ He called out, ‘Where are you, Dad?’ in a pitiful
way, suggesting a most intensely painful loss. (Bowlby, 1980) His play included the murder
of whole families of animals, and wars between the animals. It allowed him ‘permission
to know and to feel what may previously have been forbidden’. (Bowlby. 1979)
Increasingly, Joshua allowed my presence. He did not invite me to play, but he said, ‘you
watch me,’ and he did begin to ask my opinion about soldiers and barriers in the ‘battles.’
Joshua seemed ‘delighted and relieved’ I noted, after the battle play. As he went out with
his mother after one particularly satisfactory play, he beamed at me and said, ‘Don’t
forget the battle,’ in the cheeriest manner.
THE ADVENTURES OF ‘LITTLE DOG
‘Little Dog’ first appeared in Joshua’s imaginative play during the first term of our work
together. He appeared to be working through feelings of being banished in some way.
In playing with the doll’s house, he made a ‘little dog’ sleep in the bath while, ‘mum and
dad dog’ enjoyed a vigorous sexual relationship in a proper bed. Little Dog was sent
out to sleep in the yard, and could not get back in.
At about the time that ‘Little Dog’ had been banished, and his situation had been
understood and empathised with in talk, Joshua began to confide in me about events
at home. During a particularly hot time in the summer, he said he had been sent outside
to the ‘yard’ ‘to sleep, with his blankets and everything,’ and was not let in until the
morning. The worker supporting Joshua’s mother had told me that the family were
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desperately short of space and beds, and that Joshua often had to share a bed with his
mother, not always happily, because he kicked her.
BEGINNING TO READ
During the first two terms, Joshua was able to use play in beginning to read. I remembered
how ‘in pieces’ he seemed to be. I asked him to use letter tiles with the letters of his name
and to mix them up, and then reassemble them. The act of ‘putting himself together’ in
this way did seem to have a therapeutic effect.
We moved on in exactly the same way to work on the names of people in his family,
adding in ‘dad’ when he searched for ‘a dad’ in his play. When Joshua could reassemble
and read these important names, we linked them together. The first time Joshua made
a line of words that made sense it went like this…..‘mum and dad and William and Mary
and Eve and Joshua’. The effect of ‘putting a family back together’ in this way appeared
to be important for Joshua, especially at a time when, in his imaginative play, families
of animals were being obliterated.
Throughout the therapy, I chose books to read with him that dealt with issues close to
his heart. In the book, Juice the Pig, the main character had to use qualities like courage,
patience, and kindness to solve problems, in the face of his mother’s doubts about his
resourcefulness. During the second term, we read The Spooky Tree a story of three little
bears leaving their mother for a dangerous adventure. Joshua matched a small number
of important words from the story and then reassembled letter tiles to make up the words.
He was able by this time to make a simple sentence with the familiar words.
‘A SHAMEFUL FAMILY SECRET’
Joshua declared that after the Christmas holiday he was going to read and I was astounded
when he read the book, Not Now, Bernard with some preparation. I wondered if Joshua
hid his ability to read, and if it was somehow ‘dangerous’ to be a reader in his family.
Joshua missed the next session. His mother said that she did not want to bring him any
more. It was ‘too hard’ to get him to school or to educational therapy. I tried to reassure
her that Joshua was doing really well with his reading but that he found the whole thing
very scary indeed, and we needed to be patient with him. This did seem to have some
effect and Joshua’s mother continued to bring him.
Joshua said that he had ‘lied’ to his mother ‘about reading’ and he scrunched up a
copy of the miscue analysis in a fury, declaring that he could not read ‘because (his) mum
had said so.’
In talking to Joshua’s mother, James had come across a ‘family secret,’ which seemed
to her a ‘shameful’ one. Her eldest son, William, could not read, and his attempts to
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learn while he was away appeared to have ended in a humiliating failure for him. I learnt
from Joshua’s learning mentor at school that his mother could not read either. I felt that
in a family of strict hierarchies like Joshua’s, it may have been very difficult for him to
admit that he had begun to read.
William attended, with his mother and Joshua, for a review before the end of therapy.
Joshua’s mother wished to know if William could attend clinic also, ‘to help him to
read.’ We regretted that William was now too old at twenty to attend, but I sent
application forms for a Literacy course, and heard later that he was doing well.
CHANGES
From this time on, I felt that things began to change. Joshua worked through feelings
of fear and humiliation in the relationship of learner to teacher, and also in a much
deeper way, between child and adult, in role play with me. I was now his play partner.
He directed me to be ‘a little girl’ and he would play the role of a hostile, punitive
headteacher, who was too furious to write properly and produced furious ‘scribbles’
about the naughty girl’s behaviour.
I felt that the play revealed the core of his rage and allowed the fear and humiliation to
be felt first by me in play, and then by him when I sympathised with the feelings of
the ‘little girl’. Much later, it was possible to speak in an understanding way about
the feelings of the ‘little girl’ and relate them openly to Joshua’s feelings when his teachers
(and his mother) could not cope with him, and lost control of their tempers.
While playing the Squiggle game, he identified an omnipotent, destroying figure that
he named first of all as himself, and then by another name, which had the effect of
splitting off the ‘bad’ side of himself, from the ‘good.’ Now the ‘creature’ could be
thought about. The ‘creature destroyed others with powerful beams’, and I made a
remark about how scary it must feel to be that powerful. This remark seemed to mean
a good deal to Joshua. I was sure that in the past, Joshua’s phantasies of control and
omnipotence over adults had frightened both the adults and Joshua.
The play seemed to have the effect of dissipating the infantile rage that was so typical
of him when I first knew him. I never felt again that he was totally lost in rage. It also
seemed to free him to have a ‘sense of agency’ to apply in games, and in learning. We
read the book Angry Arthur about a child whose anger escalated into a rage, and shook
the world. I pointed out that however infuriated Arthur became, there was a faithful,
little dog, who was always present, and ‘stuck by him’.
The feeling of splitting into ‘good’ and ‘bad’ aspects of himself, I believe, continued
in a dictated story. ‘Little Dog’ had developed into the story of ‘Joshua’s Dog,’ Joshua
told his story in parts each week. It was about a dog who had lots of monsters and
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wild animals to fight. He made a character with my name to help him. ‘Joshua’s Dog’
was not alone.
Joshua’s Dog part 1
Joshua went to the park and this dog came to Joshua’s dog and Joshua’s
dog bit his leg.
And Joshua’s dog got arrested, but he ran away to a big growly bear in
the forest. He went under the bear’s leg, and jumped up and bit his belly.
It was 6 o’clock, and………
Part 2 is coming up…………
Part 2
‘I know what you did last summer’, said Joshua in a furious voice!
Vicki came with a big, electric machine gun. ‘Trrr…trr…trr…’
And a scary, scary, murderous monster came (Yes, he really murders
people!) and Vicki killed it!
And we went to the park, we saw a big, enormous dinosaur and…….
Part 3 is coming…………………
Joshua’s teachers reported a definite improvement in behaviour and reading in this third
term of educational therapy.
WINNING AND LOSING – TAKING A CHANCE
For the first time now, Joshua chose to play a board game with me, and this allowed
the possibility of him winning or losing. I noted that at first, as we played draughts,
he could not bear to lose. He seemed like a much younger child and I had to continually
help him make his moves, and let him win.
An example of this happened towards the end of one game when he already had three
‘kings’, and he was in a strong position. I wondered aloud what would happen if I got
myself a ‘king’. Joshua immediately panicked, and went ‘to pieces’ and he could no
longer think. I imagined that this could happen if he should come across something (or
someone) challenging, in a learning situation.
As we played on through several sessions, I recorded that ‘he would tell me off for helping
him, but then declare that I must help him sometimes. I suggested that he should ask
for help when he needed it. Joshua found this very hard to do. I still had to be aware of
his fear of losing.’
Within months, I noted another important development. In a game of noughts and
crosses he started to show his mastery and I realised that for the first time I could play
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with Joshua as an equal opponent. He accepted either winning or losing in a goodnatured way. I felt that this was a really important step for him. Joshua always sat next
to me, but in order to play games properly, it became usual to sit round the corner from
him. A very important ‘space’ had developed between us.
Before the next holiday, after a year of therapy, Joshua started to tell ‘the story of his day’
with a ‘night time’ included in it. He agreed that we should have a new diagram that
included ‘night time’ and I expected something important would be added to the story.
A ‘SHAMEFUL SECRET’ OF HIS OWN
I noted that, ‘Joshua seemed uncomfortable, fidgeted and fiddled with the light switch and
equipment as he had done many times in the past. He said he wanted to go with his mum,
and he could not concentrate. When I asked if there was anything we could do to help him,
he asked if he could put the dolphin soft toy in the water, and I suggested the plastic animals
might be better because the dolphin might take a long time to dry. Joshua played with
the plastic animals in the water, and then surprised me by saying, ‘Let’s do some learning.’
As we talked through the diagram of night time and day time, Joshua told me about a
situation which I am sure had caused him a good deal of pain, humiliation and anxiety.
I was staggered by the quiet, matter-of-fact way in which he told his story. All the agitation
and fiddling stopped, and the effect was of poignancy and sadness.
Joshua said that he often had to keep himself awake at night; he wet the bed and
could not seem to control it. Because his mum hit him when she saw the wet bad, he
had been trying to hide it by changing the sheets in the night secretly, or even by the
desperate means of hanging the sheet out of the window to dry. This caused extra
problems for him as once the sheet fell down and he crept outside to retrieve it. It had
fallen onto his mother’s flowers and damaged them. He had cried alone.
The trouble for Joshua intensified when his big brother was back home and he had to
share a bedroom with his sisters. It seems he would go to extraordinary lengths to keep
it a secret from them, as ‘they made fun’ of him every time it happened. He said how
difficult it was if he fell asleep before he had managed to get things dry. Joshua drew
each bedroom in the house as he talked and set the pictures out like a map.
I felt appalled by his suffering and offered comfort by listening and conveying an
understanding of his feelings. I also reassured him that it was not his fault, that perhaps
his body was not working quite as it should, and a visit to his doctor might help. I
also said that the worry about it might be the very thing that was prolonging it.
I suggested that to manage this all alone was too much for a young boy. I suggested
we should talk about it to the family worker and his mother, in order to get help, and
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to persuade his mother to treat him differently. Joshua was totally against it and resisted
all my attempts to persuade him in the next few sessions. He eventually accepted that
I felt it was the best thing to do, but he felt that I had breached his trust and confidentiality,
which was painful for us both.
The effect of this session seemed to be immediate and lasting. In the waiting room Joshua
did something which he had never done before. He shifted the big rocker so that it faced
me, sat down very quietly and made eye contact as we talked quietly waiting for his
mother. In the next session, Joshua was affectionate and trusting, exuberant and easily
teachable, happy in a carefree way which I had not seen before. He hugged me as he
came into the room.
Joshua’s mother reported some months later that he had not wet the bed from the time
that James had spoken to her about it, apart from an incident around Christmas time.
A report from school next term showed progress. He proudly presented a folder with
all his certificates from school. One of them was for ‘the most improved pupil’ in
behaviour and work for the term.
The family worker had noted that the family was developing a network of support.
Joshua’s mother now felt able to leave him in the care of her friends next door while she
went to see her mother. My co-worker was also pleased to see, by chance, through
the window, how Joshua’s mother had offered her hand as they crossed a busy road,
and Joshua had accepted it. I noted that it was now common to find Joshua and his
mother sitting together, talking quietly, when I came down to fetch him. Perhaps it was
indicative of a more ’secure base’ (Ainsworth, 1967)
WORKING TOWARDS A GOOD ENDING
Joshua now made good use of therapy to reflect on issues. In school he worked on
how young people can best keep themselves safe. Joshua had listened carefully and
he described in detail how best to keep himself safe in five or six tricky or dangerous
situations. For example, if a person should steal your mobile phone. He could also
say why a course of action might prove wiser than another. I felt he was now able
to make choices, and to reflect on cause and effect, a very interesting development,
and of great benefit.
Joshua revisited the things that were in his box, and this had the effect of reviewing
all the activities we had done in two years. He wished for a photocopy of ‘Joshua’s Dog’
to take with him when he left. Joshua discussed his feelings about me ‘telling’ about
him wetting the bed. I was able to say how sorry I was, but explained again why I felt
it was necessary, and he accepted it. Joshua tried to negotiate more time for educational
therapy, insisting that ‘he could not read properly yet’ and he needed another year. I
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reminded him that he could now learn from his teachers at school, and he was certainly
on his way to being a better reader.
Joshua did not like to look at the calendar for a few sessions, as it was painful for him
to think about the end of therapy. He gave me sad looks and refused to talk about it. In
one poignant moment, he sat on the window sill hugging his knees, and remembered
how sad he had been to leave his primary school for part of the week and start at his
other school. He said he had ‘felt like crying’ but he had not cried. I think he was
comparing it to leaving therapy.
Joshua arranged a massive battle with all the soldiers and animals. He was thoughtful
about it being fair, making sure I had enough soldiers and that they were of the same
types as he had. There was a herald to announce ‘the war’ and a place to put ‘the dead’.
We played the game with great satisfaction and care: Joshua accidentally touched my
hand with his ‘eagle bomber,’ and immediately said he was sorry in a caring way. As the
game progressed I noticed out loud that in the battle he had said that he wished to kill
me, and yet in reality he had taken great care of me, and how interesting that the two
could be felt together, and at the same time. Joshua reacted extremely well to this,
and seemed even happier.
I read Amos and Boris about a whale and a mouse who get very close to each other, but
actually have to part because they have different things to get on with. Joshua could
not listen to the parting at first. Eventually he listened, and accepted that therapy must
come to an end. Later, Joshua went to the end of the table to read; he was preparing
to read alone.
During the last session, Joshua expressed his love for me and hoped that I would not
forget him, and I told him that I would not forget him. He cried and sat on my knee for
a moment and then went down to his mother for the last time.
BIBLIOGRAPHY
Ainsworth, M.D.S. (1967). Infancy in Uganda: Infant Care and the Growth of Attachment. Baltimore.
John Hopkins University Press.
Barrett, M. and Trevitt,J. (1991) Attachment Behaviour and the Schoolchild. London. Routledge.
Bennathan, M. and Boxall, M. (1997). Effective Intervention in the Primary School- Nurture Groups.
London. David Fulton Publishers Ltd.
Berenstain, S & J. (1978). Spooky Old Tree. New York. Bright and Early Books. Random House.
Bowlby, J. (1980). Loss: sadness and depression. In: Attachment and Loss 3. London. Hogarth Press.
Bowlby, J. (1988). On knowing what you are not supposed to know and feeling what you are not supposed
to feel. In A Secure Base: Clinical Applications of Attachment Theory. London. Routledge.
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Fraiberg, S.(Editor), Adelson, E. and Shapiro, V. (1980). Chapter VII. Ghosts in the Nursery: A
Psychoanalytic Approach to the Problems of Impaired Infant –Mother Relationships. Clinical Studies
in Infant Mental Health. London. Tavistock.
High, H. (2002). ‘Processes in Educational Therapy’. Notes from a Seminar at the Caspari Foundation
for Educational Therapy and Therapeutic Teaching. The Angel, Islington, London. N1 8HQ.
Mckee, David. (1991). Not Now Bernard. Ingham Yates.
Oborne, M & Scheffler, A. (1996). Juice the Pig. London. Macmillan Children’s Books.
Oram, H. Angry Arthur. (1993). Red Fox Picture Books.
Steig, W. Amos and Boris. (1992). Farrar Strauss Giroux
Winnicott, D.W. (1982). Playing and Reality. London. Penguin Education. Harmondsworth.
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Psychoanalytic Contributions To
The Understanding Of Psychosis
And Its Mechanisms In Children
Irene Oromí
This paper was first published in the Catalan Journal of Psychoanalysis. The editors
are grateful for permission to republish here.
This paper will deal with children who undergo a tension resulting from human growth
in a body experienced as hostile or uncomfortable. These children do not develop mental
capacities in an ordinary way which would allow them to think about their anxieties and
to digest them. They are children who live with the stress of uneasy parents concerned
about their own difficulties and about the trauma generated by their child’s illness. These
children shun reality and retreat into themselves, becoming preoccupied with bodily
sensations and fantasies.
The mental development of these children becomes more or less irrevocably impaired
according to the precocity or prevalence of the pathological mechanisms at work at a key
moment in the development of their mental constitution. Sometimes, the developmental
process is arrested or it does not start, as in the case of some autistic children. Sometimes,
the illness distorts the mental organisation, leaving drives free without transforming them
into fantasies which can be thought about later on. Alternatively, fantasies may become
diverted through channels which do not lead to contact with the object but which, on the
contrary, move the child away from reality, changing thinking into action. An essential
feature of psychotic functioning is the child´s difficulty in developing symbolic thought.
As a result, a great variety of psychopathological conditions can be observed, as Dr.
Corominas’s article Polimorfisme clínic de la psicosi infantil (1991) points out. Dealing
with the same subject, Dr. Viloca stresses the psychotic child’s difficulty in accepting
metaphors – one of the expressions of symbolic thinking – in some of the analyst’s
interpretations.
There are many research projects geared to understanding the deep sources of childhood
psychosis (biochemical, neurological, sociocognitive) but I will focus on how, from the
seed planted by Freud, psychoanalysis has conceived theories and concepts to understand,
treat and relieve infantile suffering; and on how it promotes mental growth starting from
the capacities the child has and is able to use. I will also take into account that human
beings learn through experience.
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I will refer to these psychopathological and human facts in relation to my experience in
different settings. First, I will write about my work in a day care centre for psychotic
and autistic children, then I will draw on my work as an educational therapist and, finally,
I will refer to my experience in psychoanalytical treatments of children. Through different
case histories, I will try to show how the psychotic functioning is expressed, as well as
how it relates to the developmental processes and to learning.
APPLYING PSYCHOANALYSIS IN A DAY CARE CENTRE
Institutional Development
In 1980, I started to work for the Barcelona County at Vil. la Joana School for children
with learning difficulties. The work I was requested to undertake as a clinical psychologist
was to contain the families and to help teachers prepare their educational work for the
children. This combination of work with families and with children was particularly
interesting for me. I thought I would use what I had learnt about dynamic theory to
help parents talk about their pain. On the other hand, I believed my studies in genetic
psychology (Geneva school, Piaget) would prove fundamental in understanding the
“cognitive dynamic” of each child. I thought in this way I would be able to help teachers
devise tasks relevant to the children’s stage of development and make appropriate
educational recommendations. What I did not guess when I decided on this approach was
where it would all lead.
There are some outstanding principles in genetic psychology that I thought would be useful
in order to establish an educational framework for these children. For example, according
to Piaget, mental life has to be understood as a continuous exchange between the subject
and the world. This functional exchange is thought of as an extension of the material
exchanges characteristic of organic regulations (Piaget, 1967). The specialised organ is
human intellect which, as a regulator of these exchanges, allows each time a broader and
more balanced adaptation of the subject to the environment; this manifests itself as a
constant cognitive process.
Another essential point is Piaget’s explanation of symbolisation as stemming from the
internalisation of sensory-motor actions. Among these actions, he stresses the relationship
of the baby with the nipple. This relationship is established through a series of actions
which allow the baby to establish basic relations such as cause-effect, spatial and temporal
relations. All this knowledge which, at the beginning, has a sensory-motor quality, becomes
internalised thanks to the symbolic function.
The same year that Piaget presented the revision and elaboration of his ideas about
epistemology, his collaborator, Barbel Inhelder, published her book, Reasoning Diagnosis
in Mental Disability (1943). In this book, she explains that while the same reasoning
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processes occur, the reasoning of learning disabled children is slow and shows fixations
and incompleteness, as well as abnormal oscillations. The author indicates that this occurs
in children with learning difficulties, whereas psychotic children are under an affective
ambivalence which produces withdrawal, therefore, they do not admit confrontation with
the other and there is no evolution. These are children who present a lack of differentiation
between the affective and the cognitive levels. An affective core exists which prevents
cognitive progress.
These ideas helped me as a support in some of my interventions with the children. However,
as I kept on working with their families and on the diagnosis of the children’s abilities, I
got entangled with complex anxieties and it became evident that I needed to stress
comprehension of their emotional lives. In this way, therefore, I came closer to an
understanding of the mechanisms and functioning of the affective core which, in the
children I was dealing with, was stuck at very primitive stages.
The teachers’ team felt more anxious as we all became aware of the complexity of the
population we were trying to help: we realised that children described as having severe
learning difficulties had more capabilities than assumed. Although they refused to play
or to relate to the teacher, and they behaved violently or in unexpected ways, they also
experienced unaccountable fears and anxieties. Their parents felt lost, yet unknowingly
they colluded with their children’s confusion. With or without their learning difficulties,
we could say these children were affected by infantile psychosis.
The children who looked more retarded due to their singular stereotyped and repetitive
behaviour, turned out to be autistic. Also, they did not show any evidence of organic
problems. Their parents felt helpless.
The rest of the children, perhaps affected by a chromosome abnormality for example,
wanted to learn or to play but they did not have the ability. They were sad because they
felt limited and different, and their parents felt guilty and ashamed.
This is a very simplified description and it can easily be figured out that the emotional
turbulence in the teachers’ team and in myself was complex. In short, we decided to
differentiate two units, one called the School for Severe Learning Difficulties and another
called the Day Care Centre, for psychotic or autistic children.
In the Day Care Centre, we tried to generate a therapeutic environment which showed an
understanding of the child. In addition, we tried to help the family to feel contained.
The aim of the professionals involved was to understand the reasons for and the functioning
of the child’s emotional disorder. We had moved a long way from the divisions I mentioned
between support to families and research into cognitive strategies in order to improve
abilities. Now, the therapeutic containment implied an integration of the family’s and the
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child’s world with the connective thread of the research into the psychopathological
dynamics and their technical adaptations.
It was a change of paradigm. At this point, the axis of the research was understanding the
mechanisms and the mental functioning which impaired thinking, and the quality of the
anxieties and defences which limited it.
The concepts, models and metaphorical explanations offered by psychoanalysis became
meaningful not only in our daily living with the children, but also in the meetings with
their parents. Melanie Klein, in 1930, described the case of Dick, a boy with an early
inhibition in development. She indicated that psychosis in infancy could present itself in
a disguised and polymorphic manner, underlying symptoms which were apparently normal
in infancy. In 1950, Bion presented his paper The imaginary twin. Further, in his book
Second Thoughts (1967), he referred to the psychotic side and the non psychotic side of
the personality. He described the characteristics of psychotic personality as: prevalence
of destructive impulses, hatred of internal and external reality, annihilation panic, and
formation of premature and sudden object relationships.
In 1972, Frances Tustin published her first book Autism and Childhood Psychosis. The
fear of falling, the anxiety about vanishing and the feeling of a black hole described by
Tustin, as well as the psychotic depression mentioned by both Winnicott (1958) and also
by Tustin, are but different ways of expressing the terrifying nameless dread described by
Bion. As a whole, they are different ways of discriminating the primitive catastrophic
anxieties which affect the psychotic side of the personality. In Klein’s view, they are anxieties
about persecution, annihilation and fragmentation.
To meet Dr. Corominas, her mothers’ and teachers’ groups, and to learn about her ideas
regarding the archaic levels of sensorially unintegrated cognition and emotion, which was
where most of the children were, was a great relief. The attacks on linking described by
Bion (1967), the dismantling, and the bidimensional or unidimensional pattern of the
object relationship mentioned by Meltzer in Explorations in Autism (1975), have helped
us to increase our knowledge of the defensive mechanisms of the psychotic side of the
personality, further developing Klein’s description of the peculiar mechanisms of the
paranoid-schizoid position: splitting, dissociation and massive projective identification.
Meltzer’s classification of autism, presented in the Symposium in Monaco (1984) –
autism, autistic psychoses, learning difficulties and areas of confusion – attaches
importance to the autistic person’s unconscious primitive fantasies whether or not there
is an organic pathology.
As a consequence of all this evolution, my clinical work with children stresses not only
their psychotic mental functioning but also how it affects the developmental and learning
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processes. The following cases will illustrate my work in different technical settings: the
Day Care Centre I have been referring to, educational therapy using psychoanalytical
principles, and, finally, psychoanalytic work.
CLINICAL CASE AT THE DAY CARE CENTRE
I will refer to the case of six year old autistic twins who were admitted to the therapeutic
unit at the end of the 80’s. The family already had other children and were surprised
and annoyed to learn they were expecting twins. At first, the twins attended a mainstream
school, where great efforts were made to help them. The parents then reluctantly accepted
placements at a special school.
The twins were two identical boys who did not speak, although they were emotionally
moving due to the particular quality of their silence. They looked at each other constantly
and they kept active all the time.
According to their mother, they were born small and the problem was that “the milk wasn’t
enough.” In their third week of life, they were admitted to hospital and discharged six
weeks later “because they were hungry, they did not have enough food.......their stomach
did not work, nor did their functions. They moved a lot in their cot, they used to throw
things out.” At seven months, they started to say “pa, ta, ma”, but, thereafter, they did
not say anything else: “They shut up forever.” V. walked before D. and when they were
out in the street they would scream.
I gave the twins toys to play with in two different boxes. They used them to go after
each other and put them together. They made biting gestures when handling some animals
and they played at catching one another.
After the admission process, in a meeting with the parents in my office, we introduced the
boys to the teachers who would be in charge. As they felt the gaze of and the contact with
their respective teachers, they turned their heads and went towards the window to watch
a fly on the pane. When it flew, they spat on the window. Afterwards, they continued
blowing at the fly. The parents cried as they watched their sons’ behaviour. I commented
on how painful it was to see how the boys ignored people. Later on, when the meeting
was over, I thought that the blowing at the fly implied a degree of aggression towards it
and I felt it was a small nucleus, a point in the self around which a feeling could be organised.
The two boys had different teachers, classrooms and classmates, although, due to the
layout of the centre (wide windows, playground, lunchroom, passageways leading to
rooms where different activities, such as handicrafts, psychomotor exercises or school
tasks, took place), they could see each other. The classrooms with their teachers were
where they stayed most of the time. They would only leave to do activities which differed
from those of their own group.
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In their comings and goings, they saw each other doing what had to be done. As they
passed by one another, they looked at each other in surprise, and turned around to continue
looking at each other. The teacher of one of them might make a comment like, “Yes,
he’s your brother. Now he goes to his psychomotor class and you will paint with me. You
enjoy that, don’t you?”
Each boy had a coloured time-table hanging on the wall with pictures which related to the
different activities in the classroom with the teacher or in other rooms with specialists. The
teacher always explained what they were doing and mentioned, looking at the visual timetable, what they would do later, so that they became aware of the structure of the school day.
Some time later, in the lunchroom, they started to look for each other. They would hold
their forks and try to stab each other. Before long, they increasingly accepted holding their
pencils to draw and to make shapes linked to sounds.
The regular time-tables generated a certain sequence of spatial and temporal exchanges
which, together with the relationship with the teacher and the containment of the family,
helped the boys to enter a more communicative stage. They did not talk yet, but through
looks and gestures, they showed some wish to communicate. They also started to show
some interest in what they did.
Eight months later, in the meeting we held regularly with the parents and the teachers, one
of the teachers explained that she was giving out sweets in the classroom and, before
V’s turn, he said: “Me too.” It seemed as if the voice had fallen down from the sky. The
class became silent. In the meeting, as we heard the story, we felt very moved. When we
met to talk about D, his teacher mentioned that one day D did something very well,
then she approached him to embrace him and he said, “No.” After the long months of
silence, described by one teacher as “unbearable and very violent” and by the other as
terribly distressing because it felt “as if nobody was in front of you,” these two utterances
were certainly heard with great emotion.
Eventually, the two boys went into psychotherapy. For their schooling, they continued to
attend Vil. la Joana and an ordinary school part-time. Eventually, they were able to talk.
The Day Care Centre enabled the parents to remake a bond they had lost with each
son. What I have briefly described is but a small sample of the many moments of interaction
the boys, the family and the professionals experienced.
We understood some of these interactions and this was what allowed each boy to experience
a self differentiated from that of his twin, since we suggested meaning in what he did and
felt. It allowed the parents to give meaning to many emotions, among them a great rage,
which they had not felt able to be in touch with because of the sorrow and terrible guilt
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which brought about impotence and frustration.
As a clinical psychologist in the Day Care Centre, I was not able to reach a deep
understanding of the pathology because I had neither experienced the transference directly,
nor could I treat it. Nevertheless, I did reflect on everything I observed and experienced.
I would like to mention now the hypothesis I considered.
Probably, the boys could not relate to the breast, and the mother became impenetrable,
feeling she “could not give them the milk”. The boys avoided direct contact with their
mother. “If you question them directly, they never answer,” said the teachers. The unexpected
separation from the family due to hospitalisation was possibly experienced as a breakdown
of the bonds already established. When they left the hospital they could not differentiate
themselves. They were both fed the milk recommended at the hospital. “They were brought
up together and they were very handsome.”
In the course of normal development, twins become aware of not being the other one when
they are about three months old. The expected competition between them should have
appeared through the primary relationship with the breast, physically at first, and later, with
the mother as the first object (Davison, 1992). The substitution of the relationship between
them for the primary relationship with the mother was what impaired their mental progress.
The relationship with the other – the twin – was the fight, not in the sense of competition
bringing about development, but as a kind of excited fight promoting the lack of
differentiation between them, at the expense of each boy’s self (The imaginary twin (Bion,
1950)). On a different level, before being contained in the Day Care Centre, their feeling
a little bit separated may have meant panic and persecution.
I believe the regular time-tables and the different activities offered at the Centre, together
with the strong bond with the teacher, facilitated their progressive differentiation and,
at the same time, enabled them to connect dismantled sensations and perceptions again.
This time, however, the connection was made starting from each one of them. As we were
working on that, the parents, as I mentioned, could acknowledge their aggression and
guilt towards the boys, so that they were able to move forward the circular projections of
one boy towards the other (the father used to confuse them) and to approach each son’s
idiosyncrasy. This was accomplished through meetings where they talked about their fears
in the face of the mother’s deep depression, and the violence and impoverishment of the
nuclear family. The meetings also afforded a possibility of rescuing and widening the
family’s wish for a fuller life.
I recalled Piaget’s observations regarding the importance of perceiving and feeling the
physical qualities of the nipple as a starting point for intelligent adaptations. In this
case, the boys, who were breast fed for three weeks, probably could not attach themselves
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enough to their mother. The unexpected separation and hospitalisation possibly meant
a sudden break and an adhesion to the twin. In the Day Care Centre, when they began,
once again, to connect experiences and perceptions, they started to accept learning related
tasks which demand connecting perceptions related to different senses. They did that with
the help of the teacher who firmly showed the work to be done, and, at the same time,
each started to look at the other twin who was becoming more differentiated.
The efforts to help them prior to their arrival at the Day Care Centre (schooling, language
lessons) were surely very important in preventing further harm to the boys’ development.
Notwithstanding, it was necessary not only to get in touch with their emotions and to treat
the anxiety raised by the primary conflicts they had suffered, but also to get into the affective
nucleus threatened by autistic mechanisms they had developed to fend off terrible anxieties.
EDUCATIONAL THERAPY
Cases requiring a broad approach cannot always be helped in a Centre, nor can the family’s
emotional, social and financial vulnerability always allow psychoanalytical work. In
the case I am going to describe, the family, probably due to the feeling of being faced with
an extensive and difficult problem, wanted only to solve their son’s learning difficulties.
After reading the teacher’s and social worker’s detailed reports, I met the boy. I decided
to start exploring his learning difficulties from a psychoanalytic perspective.
The boy had a borderline mental functioning, on the verge between psychosis and neurosis.
He was eight years old when we met. Sometimes, he seemed to be inside the object,
sunk in his fantasies and anxieties, caught up in them and, at other times, he seemed outside
the object, allowing a possibility of getting in touch with his difficulties, and able to defend
himself rationally from what was happening to him. He was the son of an immigrant
working class family. His teacher and the school psychologist thought he had a serious
problem. He was not learning, he seemed very unsure, “in another world”. Some days,
the only thing he could say in school was “I don’t know”. He was unable to read a three
letter word and he did not want to use a pencil. The family followed the advice given by
the school and made an appointment with me. The social worker had sought financial
support to pay for the treatment which would last a limited time period.
On the first day, I met the mother and the boy. The father was working and could not
attend. I felt the boy, with expressive eyes and a friendly look, was very anxious. He
was moving his fingers and hands all the time. The mother said he could neither read nor
write. He said, “I don’t pay attention.” Then both kept silent. Afterwards, the mother
mentioned she and her husband thought the boy was intelligent.
I asked them to tell the father we would have to meet all together when it was possible for
him, and that the boy and I would meet to try to find out what was happening, what was
preventing him from concentrating, and learning to read and to write.
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Before leaving, the mother, calmer, told me they considered their son was sensitive, he
cried easily. She explained they had arrived in Spain almost three years earlier and they
had left family in their country. Tearfully, she said again she was worried because her son
did not write. I also learned that she had breast-fed him till he was two and a half.
The first day that we met to work on his difficulties, I told him we would do something
together and he took out from his pocket a special pencil which had a cover to hold it. He
mentioned he had brought it because he preferred them soft. I thought about the feeling of
fragility he conveyed. I asked what was happening to him in school. He talked in a confused
way. I told him we could look at what happened when he read a book and he said, “No.”
“You can do a drawing, or write, or make up a story,” I said.
He replied, “Yes, a speechless story.”
I told him for now I could write for him if it was necessary.
Next time we met, he was less frightened. He explained that he had wanted to cut a figure
out in the handicrafts class at school and he had not been able to. I said to him he was
telling me something which had not worked out for him in school. Maybe we could draw
a figure, cut it out and see what happened.
He made Peter Pan and we talked about this powerful boy who does not want to grow
up. We copied and wrote the name, we cut the drawing out, we commented and recalled
the story and read a few words.
Six months later, as we prepared for the Christmas holiday break, a sequence occurred
which I would like to describe. He arrived interested in talking about a film he had seen:
Edward Scissorhands. It was about a character who had scissors instead of hands and
who cut everything, he said. He spoke in an anxious voice, excited, a little bit omnipotent,
and possibly uneasy, restless.
I told him it was very worrying to have hands which cut instead of being able to join things,
and I asked him if he wanted to draw all that. He drew the man in the centre of the paper.
The hands had knives instead of fingers and the mouth had horrendous teeth. Edward’s
name was written perfectly inside the body. (Fig. 1 – overleaf)
During the time I worked with this boy, I often held interviews with his parents in which
very painful biographical details came up. The mother told me she had lived through very
difficult moments during the pregnancy. She had even wondered whether or not to go on
with it. The father was frequently depressed.
Little by little, the boy started to internalise a feeling of security, he dared to talk, he
tried to read and write. These activities no longer seemed so dangerous, his hands could
dare to draw and express violent fantasies like the ones I mentioned.
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Figure 1
The family’s secrets continued to appear in the interviews with his parents, while the
boy and I carried on trying to make meaningful links with the now uncovered pencil. At
school, he started attending a special needs class, where he was more interested and
confident. We took leave of each other, letting the possibility of psychotherapy remain
open.
I would now like to discuss some aspects of this material. We have seen how the boy wanted
a soft pencil. I believe unless it was soft, he felt that an electrifying violence, which cut
everything, would pour out and then, he could not write; or he wanted to cut letters out
of the words in his own way and then he could not read. All this reminds me of the attacks
on linking described by Bion (1967).
Giving him the opportunity to express himself following his efforts to learn, allowed him
to bring up images and stories with a certain metaphorical content – Peter Pan, Edward
Scissorhands – which he spontaneously connected with his problems (High, 1985). He
would have had a very different response to such metaphorical interpretations in
psychotherapy or psychoanalysis. Even though the metaphors psychotic children make
about themselves have a quality of concrete thinking (Searles, 1962), the fact that he shared
them with me and that they were expressed, allowed him to connect them with feelings.
In the sessions, little by little, as he experienced a contained situation in which hands could
be used to symbolise, and as his hands adapted to the perceptuo – motor tasks we were
doing, he was able to feel more confident.
The terrible circumstances experienced by the mother during the pregnancy, the father’s
depressions and the length of time the boy was breast fed, made me think about primitive
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anxieties as the basis of his difficulties. The pencil in his hands, as a penis-nipple, mouthteeth symbolic equation (Segal, 1957) made him powerful but, in fact, it made him tremble.
There was no possibility of writing; he was trapped in psychotic functioning. I believe that
for this boy, hands were also an equivalent to mouth as an expression of the primary
fantasy of fusion, such as Dr. Corominas (1991) shows in her article about the oralisation
of the hand.
I remember how he shifted his hands when we met, inducing an excited tactile sensation.
I think our work gradually connected auditory, visual and tactile perceptions. These intersensory links, together with the emotional contact with me, maybe helped him to reconstruct
at some level the feeling of a mother’s body (Klein, 1930), experienced as very persecutory
and, also, to improve his introjective capacities a little. Bringing the meaning of his fantasies
out into the open involved getting in touch with insane feelings, such as the fear expressed
by the father, the fear of being destroyed which the whole family had experienced and the
whole family still had.
PSYCHOANALYTICAL THERAPY
I would now like to talk about some aspects of psychoanalytic therapy with a five year
old psychotic girl. The pregnancy and delivery were complicated; the girl had been
abandoned and for some time the nurses in the hospital took care of her. She was 14 months
old when she was adopted with a developmental delay that improved after the adoption.
She walked at eighteen months. The couple later adopted a second child.
Her parents were anxious and they explained that she used to injure herself when she was
told off at the nursery school. At school, she did not do her work. She spoke and answered
but she also talked to herself a great deal, as if she was talking with another girl. Sometimes,
she lost control of herself, becoming excited and breaking objects.
During the first period of her treatment, the girl, very pretty and with the capacity to
respond to my interpretations, expressed very dramatically the psychotic part of her
thinking and I understood the parents´ sadness.
She used to scold herself. “Look how messy you are!” she used to say, turning her head
and talking to herself as if she was another girl. She made me think about Bion’s imaginary
twin (1950). One day she started to pretend she was a dog on the floor as a way to organise
a certain defence in the face of the catastrophe caused by her rage which had made her
insult me strongly. Another day, after an interpretation which touched her, she took a
toy sheep and put it inside her mouth saying it would be useful to plug her holes as she
pointed at her mouth, eyes and nose. When she did that, and as she put the sheep in
her mouth, she screamed: “I hate you.” The sheep turned towards her as if it too was
saying to her: “I hate you.” I told her it looked as if, when she sucked, everything turned
bad. I think, at that moment, the rage she experienced had been deposited in the delusional
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object by massive projective identification. The projected hate, which became concrete
and persecutory towards her, myself and the interpretation which touched her, was the
cause of the persecution.
A year and a half after we started the treatment, a sequence began in which the organisation
of excitation as a defence against anxieties about differentiation could be observed. All
this was expressed in the organisation of a primitive oedipus complex.
In the first session of this series, the girl arrived with her father. She came into my room,
looked at her box, took sellotape and, saying to the baby deer (bambi), “Irene’s baby is
sick,” she climbed onto the table and lay on it. She then raised her tracksuit trousers,
caressed her leg and afterwards wrapped it up with sellotape. She said the poor baby was
sick and it had to be taken care of. Later, she wanted to cover her wrists with sellotape.
It was a slow process. First, she caressed her skin, a certain climax built up in which I
felt as if I could not help her. She kept talking: “Look at this sick baby,” and she added,
”Your sick baby.” I told her maybe she felt I would not be able to help her, as if she was
a very lonely baby and that maybe this was how she felt; tied, frightened and sick.
She lay and moved her hands like a baby who puts its hands to its mouth. She moved
her feet, she bit her hands. I felt the emotion of the moment. She sat on the table with a
contemptuous look. She spoke in a way that could not be understood. I told her she
was now experiencing such anxiety that she talked so that I could not understand her and
she could not be with me. She lay back, pretending to be a baby again and started to remove
the sellotape. She climbed down from the table and said, “Bambi,” behaving like a baby
deer. I told her she pretended she was a bambi to show me things she felt when she was
a small child. I added she had me, that she felt tied up and it was difficult to get untied.
She suffered when she was a baby but now she knew she could talk with me.
It looked to me like a revival of her primary trauma; the loss of her biological mother
expressed through the bambi. I believed she had accepted part of my interpretation and
she had been able to get in touch with very painful bambi experiences, which were cut off
from her self.
A short time later, we started to prepare for the holiday break and an eroticised defence
began to appear in the transference: she masturbated, she kissed her hands. First, I interpreted
it as a way of comforting herself but pretty soon the defence tilted towards an aggressive
tone. She said, “I will fuck you with your husband,” and I remembered how she caressed
her own leg before wrapping it up with sellotape in the bambi session. I had not interpreted
the caresses at that time and now I thought it was important. The bambi indicated a
sensation level she had been able to get in touch with through her relationship with me,
but it expressed the bond with me in a concrete way, with sellotape, and, as I had told her,
this made her feel more lonely. But what I did not tell her was that underneath the bond
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which she concretely expressed with the sellotape and which was interpreted by me, there
was the caress and it was this caress she gave herself on a physical level which I had omitted
to interpret. Some time later, I recalled her first session, in which she had asked me if I was
a nurse. She wanted to go to the toilet and she felt she was going to throw up. I wondered
if she had experienced, through her own skin, the changes as different nurses took care
of her in her first period of life at the hospital. To face separation anxieties implied the
emergence of catastrophic anxieties during the changes, the emptiness and the lack of
continuity of the persons who cared for her, with a predominance of physical attention,
and she defended herself with excitation through the caressing.
A few days later, a lot of hatred came up in a session. She told me she did not want me
to talk to her when she was telling me things about her classmates and she started to shout,
“Little pea, where are you?” I told her that when she was a small child, maybe she was
scared when somebody approached her. She felt a little pea, and now another small pea
had arrived at her home. I approached her and talked to her about all that. She said I made
her shiver.
She went to the window, breathed upon the glass and wrote my name, Irene, with her
finger. I told her she could write.
She went to the table and made three circles with paper. She put them on the floor and
jumped between the circles. She jumped over and over as if cutting the bond between two.
She said she was urinating, ran out of the room and defecated in the toilet. “How frightening
it is to become older!” she shouted.
Her breathing upon the glass window looks to me like an expression of bidimensionality.
She wrote my name on a flat surface, without a pencil, only with what came out of
her mouth and with the contact of her skin. To move forward from bidimensionality
to tridimensionality is what is difficult for psychotic children. She had a feeling of the
third one. She made three circles, put them on the floor and attacked the bond between
two and three. Probably, to feel the link with me – alpha psychoanalytic function –
makes her shiver; she recognises me as an Irene sensation and she attacks the thinking
I offer her.
I believe she uses the bambi metaphor and accepts the interpretation which bonds her
with me. But she goes on using her own way of healing herself, that is, wrapping herself
with sellotape. She asked me to take the sellotape off, which was an expression of
her concrete thinking, and we talked. However, she had soothed herself first with
the caresses, which later became physical excitation, masturbation, as a defence. It is
difficult for her to triangulate, as she showed when she breathed upon the window
glass. She expressed this conflict at a very primitive level, that of the bond of mouth,
hand, eye body sensations.
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Figure 2
In the treatments of psychotic children, as we see with this girl, problems are stimulated
by very primitive difficulties, such as physical sensations. Reaching the emotion “mother”
is perhaps, at first, achieved through the physical sensation of swallowing milk. If these
connections are not established, the step from bidimensionality to tridimensionality cannot
be made.
PSYCHOANALYSIS
Very different was the case of a five year old boy whom I treated with an analysis. He
presented a depressive symptomatology (Fillat, 1999). He was a boy with big and very
sad eyes. His mother had to leave him and so he was abruptly weaned at the age of three
months. He was a boy who from the start was attracted to sensory material. However, I
always felt, even though I treated very primitive behaviours, there was a non psychotic
side of his personality in which we could both trust.
He expressed catastrophic anxieties when we had to separate. He used to climb to the top
of the cupboard where I kept the boxes. His face and gestures showed his fear of falling
but we could talk about these anxieties and they could be elaborated. He reproduced
catastrophic anxieties without catastrophe (Viloca, 1999).
But what I would like to demonstrate and to compare with the girl I presented previously,
is how in this case the boy had difficulty in accepting the third; he retreated into primitive
sensations as a defence against his own anxieties tied to the elaboration of the depressive
position, since they involved very troublesome separation anxieties.
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One day, he drew a sun which he identified as “a clown”, nose and mouth united and red,
the eyes round and empty. I asked him if he had drawn a powerful clown. He answered
yes. Then he drew a yellow house, “Like the sun,” he said, and a swimming pool. I told
him it looked as if he had made a house which gave heat out. He looked at me and said,
“Yes.” He drew a ship and coloured it (fig. 2). He drew a sun and said, “I mix up the
colours in the sun.”
“Ah, you’re mixing everything,” I told him.
He replied, “Yes, the ship in the dock, fire, fire.”
I told him that the ship was now burning in the dock. “Burning, burning!”
I spoke to him in an anxious tone, trying to connect with his anxiety.
Firmly, he said he was now colouring a mixed traffic light. I interpreted that, like a traffic
light, I tell him when he can come in to the session and when he cannot but he can draw
what he wants. He can draw a traffic light mixed with the sun, everything as he chooses.
He smiled and said, “Shapes.”
I told him, “Yes, when you draw just as you want to, everything is a shape.”
He paused, then in a relaxed and determined way he made a paper aeroplane. Then he
blew it, anxiously. I noticed that he was drawing attention to his mouth. I told him that
at the moment, I was still with him, but he was going to have to leave the session later,
to go away “on the plane.” He turned towards me and threw the plane at me. I told him
I thought he was upset, feeling mad, because I had spoken to him about leaving, but the
house, the ship and the aeroplane would all be left here, with me. I told him I remembered
when he was small his mother left on a plane.
He took the plane and made it land on another sheet of paper. He started writing letters
and said: “It’s burning, it’s burning.”
“Is the land burning?” I asked him.
“Letters,” he replied. He began to write letters. (Fig. 3 – overleaf)
I said, “Letters, but they look like shapes which scratch the plane when it lands.”
He continued to write letters. When I told him it was time to leave, he looked at a ball
he had drawn and said, “It smells bad”. I told him maybe to go away now smelled bad.
He took a toy fork and pretended to prick himself. I told him perhaps when he leaves he
feels what I say to him stings and smells bad.
On reflection, I believe the boy made a real exploration of his separation trauma. At the
beginning of the session, he drew the mouth and the nose together, but at the end, the nose
remembered the bad smell he possibly experienced when the milk he was fed with changed
at the moment his mother left. To accept the warmth the treatment gives him is also to
land on (or deal with) the difficulties which make him different from his classmates and
which have mobilised his parents to seek treatment.
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Figure 3
With the new food given him by the analyst he cannot draw a mixed traffic light
(bidimensionality). Instead, he has to listen and to think about what I tell him. I am this
third he experiences as a physical sensation which scratches him. The letters appearing in
the landing, in the tridimensionality, prick like forks but they allow him to start to give
a meaning to shapes. He chooses the E for the landing, which is the third, and it pricks
like a fork. Probably it is what he feels when he introjects, a scratchy sensation which
bothers him, but to connect it with the emotion is to be able to confer meaning to written
shapes, that is to say, words.
FINAL COMMENTS
In 1986, the first meeting of the Catalan Psychoanalytical Journal committee was held.
I remember Dr. Torras talked about the indications for treatment in children during a
conference in which Dr. Tous expressed the diagnostic difficulties.
I was impressed by the variety of shades and the cognitive, family and socioeconomic
factors which Dr. Torras pointed out should be considered when facing and deciding on
indications for treatment. She also drew attention to the importance of helping parents
to understand their child’s developmental problem. Those were the years in which, as I
mentioned at the beginning of this report, we too in the Day Care Centre wanted to stir
the conflicts of the institution.
The difficulties of all the children I have talked about started during pregnancy, which
was described in all cases, by the mothers, as conflictual and ambivalent. We did not know
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the level of physical difficulties (biochemical, hormonal) but we did realise, through the
descriptions we had of the first relations, that the mother-child bonding had been difficult.
Edna O`Shaughnessy (1988) speaks of a toxic, envious, empty object.
All these patients needed the therapist’s mental functions to develop their thinking
and they experienced an emotional process which has allowed them to modify their
introjective capabilities.
I was thinking of Piaget’s ideas about the functionality of thought as generator of cognitive
abilities, and of how the structural maturational processes are very easily influenced by
the function. He referred to cognitive explorations. Bion explains how the emotional
experience of the newborn with the mother, which has its roots in the foetus, gradually
transforms what is a physical sensation, into a mental one through fantasies and through
the thinking function. This transformation is what Dr.Corominas demonstrates in the
psychopedagogical outline elaborated in the seminar held in the Pilot Centre. She implies
an alpha synthesising thinking function to help the child to recognise the sensation and
to link it to cognitive and emotional processes.
The idea of a synthesising alpha function, which implies a container (the therapist) able
to lubricate the physical and cognitive experiences with emotion, seems important to me.
That is what we did at the Day Care Centre and with the boy treated with educational
therapy. With the latter, I took advantage of the metaphors the boy had internalised related
to known stories (Peter Pan, Edward Scissorhands) in order to improve his symbolisation
and to improve, with his learning work, the perceptual and motor connections.
In the case in which the setting is that of psychoanalytic work, I made use of the bambi
metaphor the girl brought up, to focus on her experience of the therapeutic relationship
and to interpret it to her. The setting allowed the interpretation with analytic alpha function.
However, it is necessary to take into account the severe problems of the children and to
respect their structural developmental level because, as is also mentioned by the cognitive
specialists of the theory of mind (Uta Frith, 1985), autistic children can neither realise,
nor understand that other people have a mind. To bring them closer to the world of
emotions and thinking is thus a slow process, and more so when this involves reliving
traumatic situations where the emotional contact is experienced with panic and distress.
BIBLIOGRAPHY.
Bion, W. (1950) ‘The imaginary twin’. In: Second Thoughts; Selected papers on Psycho-Analysis, London.
Heinemann.
Bion, W. (1967). Second Thoughts. London. Heinemann.
Corominas, J. (1991). Psicopatologia i desenvolupament arcaic. Barcelona. Espax (2000).
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Davison, S. (1992). Mother, other and self: love and rivalry for twins in their first year of life. Int. Rev.
Psychoanal., 19: 359.
Fillat, N. (1999). Sobre la depressió en el nen. Rev. Catalana de Psicoanàlisi, XVI, 1.
Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21:37 46.
High H. (1985) The use of indirect communication in educational therapy. Journal of Education Therapy.
Vol 1: 318.
Inhelder B. (1943) Le diagnostic du raisonnement chez les débiles mentaux Delachaux et Niestlé.
Neuchatel
Isaacs, S. (1952). The Nature and Function of Phantasy in Psychoanalysis. London, Hogarth Press.
Klein. M. (1930). The importance of symbol formation in the development of the ego. The Writings of
Melanie Klein, vol. 1. London, Hogarth Press.
Martí. E. Construir una mente Paidos. Barcelona (1997).
Meltzer, D. (1975). Exploraciones del autismo. Paidós, (1979).
Oromí I. Educational therapy as a possible way to repair a deficit in the primary relationship. In: Making
links. How Children Learn. Yrkeslitteratur AS. Oslo (1993).
O’Shaughnessy, E. (1988). W.R. Bion’s theory of thinking and new techniques in child analysis. Melanie
Klein Today, vol. 2
Piaget, J. (1967). Biologie et connaissance. Paris, Gallimard
Searles, H. (1962). Différentiation entre pensée concrète et pensée métaphorique. In: Le trouble de penser.
Nouvelle Revue de Psychanalyse, 25. Paris, Gallimard
Segal, H. (1957). Notes on Symbol Formation. Int. J. Psycho-anal., 38: 391-397
Tustin, F. (1972) Autism and Childhood Psychosis. London, Hogarth.
Tustin, F. (1981). Autistic States in Children. London, Routledge
Viloca, L. (1999). L’ansietat catastròfica: de la sensorialitat a la comunicació. Rev. Catalana de Psicoanàlisi,
XV, 1: 35-60
Winnicott, D. (1958) ‘Mind and its relation to the psychosoma’. In: Collected papers: Through Paediatrics
to Psycho-analysis. London, Tavistock (1958)
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What Is Important When You Are Four Years
Old And Starting At School Or Nursery?
A Commentary On Two Nursery Observation Essays.
Barbara Lyndon
Today, a visitor to an under fives setting would not be surprised to see a nursery practitioner
observing a young child. Understanding a child’s development through observation is well
established in early years education. In the wartime nurseries in England, this approach
was pioneered by Anna Freud and Dorothy Burlington. Anna Freud taught observational
skills to the child care staff who worked in these nurseries, and they wrote up daily
observations from memory to discuss in the evening meetings (Colonna, 1995). This
combination of observation and discussion continues in the Nursery Observation Seminar,
a distinguishing feature of the Caspari Foundation Educational Therapy Training.
Throughout one year of their training, students observe a young child for an hour, once
weekly, in a nursery or other under-fives setting. They present their observations in a
weekly seminar group run on the same principles as the infant observation courses familiar
to students of adult and child psychotherapy trainings, and also included in the Caspari
training. At the end of the year, each student writes an account of his or her observations,
looking at all aspects of the child’s development, including the child’s approach to learning.
Two interesting examples of these observation essays were offered to me with a request
to comment on them in ways which might demonstrate aspects of the purpose and
experience of the Nursery Observation Seminars. One of these essays is by Cherry Rowland,
who observed a four year old boy, Billy, in 1987/88. The other is by Ingrid Cleaver, who
observed a four year old girl, Lily, in 2000/01. In this paper, I have selected extracts
from these essays, which I think convey the intensity of the young child’s emotional
experiences in his or her first year in the nursery /reception class.
THE SETTINGS
Both children attended well organised settings where parents were welcomed and children’s
play was encouraged. Billy joined a vertically grouped reception class in a small, combined
infant and junior school.Only one other reception age child started with him. The school
attracted children from middle class and working class families and was described by
Cherry as progressive and child-centred. In Billy’s class, the day started with play. Lily’s
local authority nursery was in a multi-cultural neighbourhood and took children from
diverse social and ethnic backgrounds.The nursery provided a wide choice of creative
activities both in the indoor areas and in the garden and for the first hour the children had
a free choice of activities. Older children also attended a Forest School once a fortnight
to learn about the natural world.
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THE CHILDREN
Billy
Billy lived with his young parents and baby sister Lauren, in a third floor council flat in
a comparatively settled working class community, with close contact with the extended
family. His father was a local policeman and during this observation was, unusually, often
away from home on a training course. His mother was a full time mother who said she
had not ‘felt a need to send Billy to a playgroup.’ She had taught him the alphabet, from
a blackboard on the balcony, and lots of nursery rhymes and she read stories to both
children. Cherry described her as a confident mother, ‘clear about boundaries’ and good
at ‘juggling time between both children’. Sometimes, she worried about her son’s behaviour
in the playground and thought it might be related to his father being away.
Cherry commented, ‘Both parents are devoted to Billy and very involved in all he does.’
He was ‘a bright-eyed, eager little boy.....very out-going, good natured, sure of himself
and well able to cope with the vicissitudes of being one of the youngest in a verticallygrouped infant class.’
Lily
Lily came from a settled, middle class, one parent family. She lived with her mother and
had a close relationship with her maternal grandmother, with whom she sometimes stayed
overnight, without her mother. Her mother had worked as a probation officer, two
days a week, since Lily was six months old. For the first year, a friend of her mother, who
also had a young child, looked after Lily while her mother worked, and then her care was
shared by her grandmother and a male friend of her mother who had known Lily since
she was a baby. Lily has had no contact with her father.
At three years old, Lily went to a playgroup but stopped because, her mother explained,
‘she did not cope well with open-ended play.’ She ‘likes work that is directed by an adult.’
Lily’s mother was anxious about her daughter starting at nursery and also about having
to leave her more often as she became more involved in her career. Ingrid described her
as an attentive mother who shared a ‘rich cultural life’ with her daughter.
These brief summaries of the children’s backgrounds show that both children came from
loving, stable homes. Lily, as an only child, had spent a lot of time with adults, often in a
one to one situation, while Billy had more opportunity to share attention within the family.
Both had parents and carers who were interested in their development and who were able,
in Fonagy’s terms (Fonagy, 2001), to be reflective, to think about their child’s responses to
the world and to reflect on their own state of mind. Fonagy says that research has shown
that the parents’ capacity to be reflective is significant in fostering the child’s self development
and secure attachment bonds. Both are important considerations in the transition from
being a child at home to becoming a member of the nursery/reception class.
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Lily and Billy appeared to be securely attached children and attended good educational
settings but, as the observations show, they had different needs and they encountered
different dilemmas in their entrees to the world of education. Cherry and Ingrid both make
links between their observed child’s early experiences and his or her way of being in the
nursery/reception class. In Internal Landscapes, Gianna Williams (1997), explains this
interaction between the internal and external world. She describes how, when visiting
an exhibition of children’s paintings of a flood in their neighbourhood, she noticed the
different qualities of the paintings. Some were filled with sharks and dangers while others
were of boats and homely objects:
In terms of the internal world, I would like to suggest that at least one of
the reasons why the same experience was portrayed in such different ways
by different children was that it was filtered through an internal frame of
reference: I would take the varied representations of the flood to be a
reflection of differences in the children’s inner reality. (Williams, 1997, p.17)
The different ways in which the two observed children, Lily and Billy, responded to the
opportunities to be with other children, to be with a teacher and to develop their own
approach to learning can also be understood as a reflection of the differences in their inner
reality. It is this understanding which Cherry and Ingrid have developed through their
observations, and their reading of psychoanalytical theories, including work by Freud,
Klein and Winnicott. I hope this understanding will be illustrated in the following extracts.
THE NEW SIGNIFICANT RELATIONSHIP WITH THE TEACHER
In Understanding Your Four Year Old, Lisa Miller (1992) says that a four year old is
still most concerned with the adults in his life, ‘...the child who gets the best from nursery
is the child who has a solid base of trust in friendly adults.’
Billy
Cherry observed that Billy’s teacher, Mary, seemed a good ‘match’ with his mother and
that he quickly established, ‘an easy going, friendly, trusting relationship with her, which
without doubt was a mainstay in coping with his separation anxiety. No matter what
he was doing he was quick to notice her arrival in the room and exchanged a cheery
greeting.’
Cherry noticed that Billy was ‘used to clear boundaries at home and clearly needed to
know that Mary was in charge of the situation and would be able to contain him...when
his emotions got out of hand, as in the following observation in his first term in December:
His mother called him to join her in setting up a row of dominoes to knock
down. After eight minutes of this activity, which he obviously enjoyed, she
said good-bye. He gave first his mother and then his sister an exaggerated
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hug and kiss, pulling his mother over as he did so. (He used this denial defence
of bringing a touch of humorous mockery into the farewell quite a few times.)
After they had gone, Billy moved into another defence, a somewhat
manic mood in which he moved around wildly, jumping up and down
holding a chair. He half hugged Madeline (the other new child) and then
holding her by the shoulders he repeatedly pushed her away and then pulled
her towards him. He repeated this push-pull behaviour, alternating
proximity and distance with Matthew, an older boy. He then made a loud
noise, moving his hand up and down over his mouth. He sat down and
almost immediately fell off his chair.
He then went up to his teacher and greeted her a second time, this time
in rhyme, “Good morning, Mary McClary,” and continued to move around
in an uncontrolled way. Quite soon, Mary went to him and held him and
said, “Calm down,” and suggested an activity. He first needed to break
up a model to get pieces for his own structure. This he did, again somewhat
wildly...There followed yet more rapid movement from and back to the
construction table until he started building and only then did he seem
to settle down.The linking together of the pieces seemed to have a calming
effect, a reminder perhaps of his rejoining of his mother at the end of
the day.
This and the next observation could be understood as showing how his struggle to accept
the separation from his mother stirred up regressive feelings. It is interesting to see how
he drew on his relationship with his teacher but also often found a way of expressing and
containing his feelings through play.
On one occasion, he was part of a group who, with Mary’s help, were playing
with calculators. Billy sat close to Mary, sometimes tapping her upper chest
with the back of his hand to get her attention. She stopped to take the register.
“I want to be in the register,” said Billy and attempted to get inside it as if
he sought containment in the register, or ‘Mary’s book’ (body?).
Mary then moved off and asked the class to clear away. Billy continued
sitting at the table, alone, while everyone bustled around him. He picked
up the rubber and threw it across the table. “I told you to get off. Get off.
Get off!” He addressed it fiercely. Then looking angrily at it again he said,
“I told you the first time, get off.”
Cherry wondered, ‘if his anger with the rubber (Lauren? ) was a result of his failure to
achieve the intimacy he sought with Mary.’ Her observations throw light on aspects of
Billy’s inner turmoil as he confronted feelings of frustration in his relationship with his
teacher, which may in turn have reflected his struggle with his feelings of missing his mother
and having to share his parents’ love with his sister. He also, in his first term, had the
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additional difficulty of missing his father, who was away from home on a police training
course for four months. Cherry wrote,
Billy’s adjustment to separation entered a new phase when his father
returned home in March and thereafter usually brought him to school in
the morning, or at least did so on most observation mornings. It was a
delight to see the easy, affectionate intimacy they shared. Billy was often
oblivious to the noisy activities around him and rarely related to anyone
else as long as his father was there. Even his usual cheery greeting to Mary
fell into abeyance. But his father always had to leave and Billy clearly had
difficulty letting him go, and would find things to show him to delay him
as long as possible.
On one occasion, Billy stuck sellotape on a box as his father was leaving.
On another, he was hammering. “Calm down,” said his father and then,
“Remember to behave yourself,” as he moved off. Billy accidentally (?) hit
his knee and then sucked the hammer. He got up and went to Mary and
intertwined his fingers in hers. Later, the same session, a dreamy look was
followed by more sucking, this time on a corner of a construction piece,
and his gaze fell on Mary. This regression to the oral stage undoubtedly
stemmed from the feelings of insecurity engendered by his long separation
from his much loved father.
Billy, ever resourceful, found a way of coping with the daily reminder
of the separation. During observations, after every good-bye from his father
he would be next to Mary within seconds, reminding himself, no doubt, of
the much needed security his mother’s continuing presence must have given
him during the separation.
Cherry thought that when Billy had, ‘established a secure relationship with Mary in the
first half of the year, he was later able to use the relationship to help him resolve the painful
feelings associated with the repeated reminders of the long separation.’ Later in the
year, she saw that he could go and play with other children, even when his father was still
present, but that he always ran to Mary when he left.
Lily
Lily, like Billy, sought out a close relationship with her teacher and Ingrid likened her
behaviour to ‘how a baby has to work hard to make its needs known’.
Throughout the morning, Lily stayed close to Ann (teacher). Lily’s face was
passive, but she constantly tried to make eye contact with Ann. At one point,
she twisted her head under Ann’s face, trying to look into her eyes. When
the teacher turned her head to speak to another child, Lily positioned herself
between them, but did not speak… Lily had brought in a small wooden
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animal from home, which she clutched and did not let go of. She kept
showing it to Ann without speaking .
Ingrid imagined, ‘her use of a transitional object symbolised the union of two things
that in her mind were now separated, i.e. Lily and her mother’ (Winnicott, 1971). The toy
then represented aspects of the closeness of her relationship with her mother which she
drew on as she encountered different kinds of relationships in the nursery.’
Lily became more confident but Ingrid observed how her mother sometimes found the
separation hard to manage. One morning, before leaving, she drew Lily to the clay activity
table and:
...began pinching out clay and rolling it into balls...Gradually all the
children stopped playing and left the table… The mother spent ten minutes
making balls while Lily watched. She then asked Lily to make some, said
good-bye and left for work… Fifteen minutes later, Lily was looking
vacantly into the distance, mechanically making balls… She gazed at
the children playing outside.
The head teacher sat down at the table and said, “What are you going
to do with all those balls?… His presence and utterance separated and freed
her from what seemed to be a chore… She got up… It was half an hour since
her mother had left… The head teacher then asked Lily if she wanted to
keep the beads… She shook her head… This gave her a choice and allowed
her to detach herself from the task of making these ‘worry beads.’
Lily’s trusting relationship with the head teacher and his unobtrusive questions, which
conveyed his capacity to think about her needs, enabled her to be freed from the anxiety
she appeared to have taken in from her mother. This was similar to the way Billy experienced
being thought about by his teacher, when he was confused by his feelings. Perhaps because
both children felt contained by their teachers they moved on to increasingly express and
contain their feelings by themselves, as extracts in the following section illustrate.
EMOTIONAL DEVELOPMENT AND MANAGING EMOTIONAL DILEMMAS
Billy’s Experiences
Billy used play and expressive activities to demonstrate the conflict and pain he felt in
separating from his mother and adjusting to having a sister. In a January session soon after
the holiday, he ‘reacted with mock crying’ when his mother said good-bye, and he didn’t
watch her and his sister leave. Cherry wrote,
That session was pervaded by his murderous feelings. As with the mock
crying at the time of separation, he used humour to assuage the strength of
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his feelings. In the brief space of 25 minutes, interspersed with other activities,
he had grasped a yellow felt tip like a dagger and, thrusting it back and
forward, said, “You’ll die,” to a girl at his table. He had taken a set circle,
pulled it around Daniel’s head crying, “Aargh, he’s been executed,” as he
tightened it, then, repeating, “Executioner, executioner,” he had approached
another child before ending up putting the circle around his own head,
saying, “I’m going to kill myself.” He had also snipped scissors in my
direction; tightened a vice round a girl’s foot, saying threateningly if gleefully,
“Say your prayers,” despite other children’s cries to loosen it; put his hands
round Daniel’s throat and jumped around with him.
At the end of the session (after the children had been asked to tidy up) he
painted what looked like a fire, using red and yellow paint. When he took
it off the easel, he examined it from the reverse side, and fiercely scrumpled
it up, muttering, “Urgh urgh,” as the paint went all over his hands. He dunked
the scrumpled painting in the water tray, then threw it in the sink and ran off
to the basin to wash his hands. It felt as if he was venting his murderous
feelings in his own creation, thereby punishing and absolving himself .
The following week… he stopped in front of a baby… saying, “Ah ya
ya,” as he made biting movements in the baby’s face.
Cherry imagined ‘three year old Billy behaving like this (or wanting to) with baby Lauren
and perhaps feeling frightened by the vehemence of his sadistic feelings. It was all over in
a moment but the vehemence was real enough.’ Her observations show a passionate child,
struggling with intense feelings of sibling rivalry, but in the family group of the reception
class with his class siblings, he managed his feelings and expressed them in an acceptable
way. Cherry explained that he,
was rarely physically aggressive… preferring to use language to resolve
conflicts. For example, in response to Toby’s, “You’re being really stupid,”
Billy said, “You ‘re being treble stupid.” He also used humour to deal with
aggressive feelings towards his peers as when he announced, “This is what
Edward and Ben and Lee are, big mouths,” holding a hollow, red square
shape in front of his own mouth.
And again, once, after a number of girls had exclaimed, “Oh Billy,
look at your hands!” which were covered with blackish paint, he
approached them, monster-like, waving his hands and shortly after,
proclaimed to another girl, “I’m going to splash paint over everybody,
OK ?” But he didn’t.
These observations fit in with Cherry’s comment, made when Billy started the reception
class, that he had ‘a repertoire of social skills’ that enabled him to ‘survive in confrontations
with his peers.’ It seemed he also often drew on his close identification with his father
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in his exploration of how ‘to be’ in his interactions with his peers, as described in the
following sequence of observations:
Sometimes, his identification with his father was expressed in statements
like, “My favourite colour in the whole wide world is black because my
Dad’s a policeman.”… Sometimes, his identification with the role bordered
on the sadistic as when, in a wilder moment, he cried, “Executioner,
executioner!” to a child (described more fully above)… At other times, the
role veered towards the misuse of power.
Once, when frustrated with not being able to play with dough, he picked
up a rolling pin and banged a puzzle to pieces. Then, saying, “Hallo, Hallo,
Hallo,” to a girl at the table… he brought the roller down with a karate
chop movement. The substitute teacher intervened saying, “We don’t have
a policeman’s truncheon in the classroom.”
Cherry described the struggle within Billy between the ‘good’ and ‘bad’ policeman as ‘a
manifestation of his grappling with the demands of his emerging superego. He is concerned
with “doing the right thing” but his inner controls are still precarious.’ She felt that the
pen had, ‘a very special significance for Billy as a symbol of his close identity with his
father.’
‘The assurance of this symbol of his identity with his father offers Billy potency and
also protection:
…after an older boy made a disparaging remark, Billy immediately picked
up a pen and this seemed to reassure him. Later the same morning , when he
wanted to join a group of children, he chanted, “I want to play. I want to
play.” He put his fists up. “I have some power,” he said, picking up a pen.
“You can be god,” said one of the children.
“Yea,” said Billy, excited. He then wandered off and the pen was replaced
by a sword, which he slowly and carefully constructed from Maths cubes.
He joined the game with his sword upright, intoning, “I am a royal god.”
During the course of this play, with all the children representing various
powerful figures, the blade of Billy’s sword came off a couple of times.
Nonplussed, he put it back again. Mary announced it was time to pack up…
a boy grabbed the ‘blade’ and marched off and put it away. Billy did not
retaliate, but, apparently unperturbed, simply refashioned a smaller sword…
and continued to hold it upright.
This observation led Cherry to think about Billy’s emotional development. She theorised
that ‘his ready acceptance of being “cut down to size”, of being able to tolerate his smallness
in relation to others, also revealed in other situations, suggested a successful resolution of
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the conflicts of the Oedipal phase. ‘Billy, at five, no longer saw himself as omnipotent, nor
having to struggle for a prime position in relation to his mother and father.’
LILY’S EXPERIENCES
Lily started nursery ‘not knowing how to interact with other children’ although she
did not appear a shy or withdrawn child. Ingrid thought that she had taken in her
mother’s ambivalent feelings about her joining the nursery and that, ‘Her lack of interest
in other people seemed to be a way of reassuring her mother that she would not be
replaced.’ Through her observations and comments, Ingrid conveyed a sense of Lily’s
internal struggle as she tried to find ways to relate to other children and remain loyal
to her mother.
In her first term, Lily regressed, silently imitating children, and appeared ‘unusually
taciturn.’ Ingrid thought that Lily needed time to to take in the new experiences in nursery
‘before she entered a verbally productive phase at nursery.’ Ingrid drew on Winnicott’s
ideas stating, ‘It would be through play that emotional relationships would be initiated
and allow her to develop social contacts.’ (Winnicott, 1964) In a group of children singing
with the teacher,
…she scrutinised all the children’s faces and her eyes lit upon an Asian boy,
who had a bi-lingual helper all to himself. A shadow of sadness passed over
Lily’s face… Lily seemed in a world of her own. Soon she began sliding back
and forth on the wooden bench.
Ingrid thought that ‘this physical, perhaps sexual, contact with the bench was a way of
keeping her mind off how she felt on seeing the close relationship between the boy and
the woman.’ Perhaps the physical activity also gave her a feeling of holding herself together
because after this Lily became more aware of the child next to her.
Kuljinder caught Lily’s eye and looked straight at her. Lily looked away.
Eventually, Kuljinder held her gaze and it was almost too much for Lily. She
grabbed a bunch of her hair and stuck it in her mouth. Her anxiety seemed
to lessen and gave over to a kind of curious excitement. Sucking on her hair,
Lily scrutinised Kuljinder’s face.
Ingrid observed that her ‘anxiety was lessened through the sucking and that she was then
freer to engage with her new friend. She copied everything Kuljinder did. She ate, drank
and played outside at the same time. A month later, Ingrid observed how Lily tried to
initiate an activity with Sarah, another child she imitated. Lily said:
What shall we do now? Sarah laughed and mimicked her. Lily looked pained,
but went to get some paper and coloured pens and began to draw. Quietly,
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she described to herself what she was doing, while keeping sight of Sarah
moving around the room.
Ingrid commented how Lily contained herself, ‘keeping anxiety at bay by talking quietly
to herself.’ She also held onto any pictures she made and did not put them on a shelf to be
collected at home time like other children. Ingrid thought of these pictures as being a way
of creating ‘something outside of herself that she could keep with her and stop her feeling
anxious....There was a sense that Lily’s “schoolwork” would demonstrate to her mother
that she had been involved in worthwhile activities that matched what the mother might
have done with her if she were able to stay at home with Lily.’ Lily also chose play activities
such as sitting at a table drawing or writing, where she could be close to an adult, listening
to the adult’s comments and watching other children.
Lily, with her mother’s help, made a friend, Grace, with whom she could talk and laugh
and meet outside nursery.
Grace made direct eye contact with Lily and held her gaze. Grace pulled
funny faces at Lily to make her laugh. She decided what she and Lily would
do and Lily happily went along with this.
As their friendship developed, Lily entered into more exciting play.
One day, Grace and Lily made a huge tower out of wooden blocks. Girls
did not often use this part of the nursery. The boys moved away while
Lily and Grace were building. Their tower became bigger and wider and
when they ran out of wooden blocks, they used big plastic ones, and finally
Styrofoam blocks. They used all the large blocks they could find to build
their monolith. They stood proudly next to it as other children came to
admire it and the adults praised them for it…
Ingrid thought their play, ‘gave them a great sense of potency over their environment. The
tower also seemed to stand for their friendship, a symbol of their union.’ She commented:
Suddenly, Lily grabbed Grace and hugged her tightly. Overwhelmed by
feelings of excitement, she let out a sort of roar. It was not so much a
triumphant roar as a cathartic release of tension or aggression. This task
had in some way helped her to master her feelings of anxiety that were with
her every day from the day she started.’ (Winnicott, 1964)
During the observation period:
Louis, a new three year old, joined Lily and Grace, who were four and a
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half. He was quite articulate, but naturally less sophisticated than they were.
Lily did not take much notice of him. She had only just formed a bond with
Grace. Louis had known Grace and her family before he came to the nursery.
Sometimes, Grace included Louis in her play and this was difficult for Lily.
Louis often tried to get Grace to come and play with him without Lily.
On one occasion, Louis’ persistence paid off and Grace went with him,
leaving Lily alone. Lily went to an easel and started painting with a fedup look on her face. Angrily, she used big, bold brushstrokes and vibrant
colours.
Ingrid commented that, ‘Through painting Lily found a way to express a new and shocking
feeling. She was full of hatred towards Louis for taking Grace away and towards Grace
for abandoning her. “One thing an only child especially lacks is the experience of finding
hate turn up.” (Winnicott, 1964). Just one week later, the three children were working
well together making cards.’
Lily wrote in her cards, “with love from Lily and Jane.” Her mother had
taught her how to write this inscription. Louis was standing next to Lily
and asked her what she was doing. She showed him and then taught him
how to write ‘Jane’.’ She then showed him how to make a star. She described
what he should do and did it with him.
Ingrid suggested that in the same way that her mother had shown her, she was teaching
him like a big sister. ‘Part of her had come to terms with her feeling of hate for him from
the previous week,’ but the following sequence of observations shows how Lily’s rivalrous
feelings persisted and that, as she struggled with these sibling like feelings, she was discovering
a way of being a member of the nursery group.
Grace was sitting on a seesaw out in the garden. Lily and Louis were
grappling for the other seat. Grace’s place was assured and it was always
the other two who had to fight it out to be with her.
Ingrid commented that Grace represented the older sister or the mother and Lily was
learning how to manage sibling rivalry with Louis.
Imitating what Grace had said to the other children, Louis said to Lily, “We
don’t want you.” Grace got off the seesaw and wandered off with Louis.
Lily stood still as though in shock. The other two got on another seesaw.
Lily moved near them and sat down on the grass, as though she still could
not quite take in how callously she’d been treated. She sat quietly watching
and thinking and then Lily stood up, walked away and got onto another
seesaw by herself. Immediately, Grace came running over to join Lily,
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followed closely by Louis. They fought over a place on Lily’s seesaw while
Lily showed no sign of what she was feeling. She did not seem to get angry.
At first, it appeared to Ingrid that Lily had taken over Grace’s position but then she
drew on her reading of Erikson’s Initiative vs Guilt (1967), in which he described the
interplay between rivalrous feelings and the desire for autonomy. She then reached a
different understanding of Lily’s position in this threesome around the seesaws. The intense
rivalry between Louis and Lily remained but, as the older child, Lily showed initiative.
She ‘had the use of superior equipment to gain a favoured position... Louis got into jealous
rages in the threesome...but she was able to think ... and she put herself in an irresistible
position vis a vis Grace. Grace could not bear the thought that Lily could manage perfectly
well without her and rushed over. There was still rivalry between Louis and Lily, the balance
had not shifted...but the way Lily managed her feelings of sibling jealousy was more
sophisticated than Louis’ way.’ It seemed that Lily had shown a sense of self direction and
acted more assertively by finding her own seesaw.
BECOMING A LEARNER IN THE NURSERY/RECEPTION CLASS
True learning and growing is a painful experience. For learning to take place,
a certain amount of frustration is inevitable, the frustration of not knowing
something, or of being confused and anxious about being ignorant. The
capacity to bear these feelings determines the capacity to learn. ( Emanuel,
1995 p.53)
Cherry and Ingrid’s observations have illustrated how their observed children struggled
with painful experiences in their first year in school or nursery, as in their efforts to be more
separate from their parents and to be accepted in their group. Both children appear, however,
to have had the ‘capacity to bear these feelings’ and to become successful learners at school.
Billy
Cherry introduced a detailed observation of Billy’s approach to learning, made half way
through his first year in the reception class. She described him as able to, ‘draw on his own
resources… he has a natural curiosity, is able to concentrate, communicates easily and
is self-reliant but knows when he needs help.’
The class project was on communication and the children had been asked
to bring in an envelope so that they could write just their name and post
code… The observation took place, as usual, during the time for free activities
and play. I saw no other child pursuing the task Billy had set himself during
this time. Despite the noise and movement around him… Billy persisted to
the end.
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As soon as Mary arrived, Billy immediately produced the envelope he had
brought from home and showed it to her. I learned later she had said, “You
need to do your own,” (meaning write your own). Billy went straight to a
cupboard, put the envelope on a shelf and got some paper and scissors. He
folded the paper in four and, squatting on the floor, cut V-shapes in the sides.
He was blocking a narrow route. Other children stepped around him
as he got on with the task. “Why have you got your coat on?” asked an
older child. Billy was oblivious to the remark as he concentrated on cutting.
Daniel came over and talked to him. Billy seemed to be paying attention
but continued with cutting .
He then looked at the still folded paper, put it on the shelf and helped
himself to another piece of paper. He slid his hand into the the envelope
he had brought and examined it. He folded his second piece of paper in two
and drew first a V-shape, then wrote a post code and then his name above
it. He took his second attempt at making an envelope to Mary.Their
conversation was inaudible.
She gave him an envelope and a stamp and he positioned himself at
an empty table nearby. He wrote his name on the envelope, stopped and
stared into space momentarily and then went to find his original envelope
and took it back to the table…
Billy wanted to ask Mary something and stood by her, repeating her
name, but she was seeing to Nadjia who was upset…He came back to the
table, took the stamp and went on his own to a world map in the reading
corner. He held up the stamp against various others on the map and gazed
at them…
He then went back to his envelope and took it and the stamp back to
Mary, who still had Nadjia on her lap… He waited, listening as she talked
and at the first opportunity succeeded in getting her attention. “Where
do you stick it ?” asked Mary. He showed her. “You haven’t got to eat
it,” she said, laughing as he licked it vigorously. “Is it first or second class?”
she asked. He glanced at the stamp. “Second,” he said… He returned with
two envelopes and correctly told Mary they were first class. He took all the
envelopes back to the table studying them as he went.
Billy showed he could bear frustration and, as Cherry explained, could draw on internal
resources when learning. If this observation had been read in Cherry’s seminar group, a
discussion might have opened about the experiences and emotional factors which underlie
Billy’s capacity to be an independent learner. I think a link can be seen between his lively
play, through which he explored emotional dilemmas, and his engagement in learning. In
approaching learning, he took risks and was assertive. He weathered mistakes and he
sought help when needed. These were emotions and experiences that he had also
encountered in his play.
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Billy was clearly an accepted member of the group, as shown by the way children talked
to him, and maybe this sense of being accepted by his peers contributed to his freedom to
concentrate on his interest in the task. He was also in a school where the headteacher
encouraged the teachers to introduce a free choice of activity in the first hour, indicating
an understanding of how a four year old’s interest in learning may be fostered when he or
she is free to choose.
Lily
Before Easter Lily had stayed for a whole day one day a week. She enjoyed
the communal lunch and helping with all the routines and little chores
around mealtimes. Seven children and two staff sat and ate together like
a family. She obviously enjoyed this very much. In the afternoon, she and
the others went to the Forest School.The Forest School teachers conducted
many activities that contributed to Lily’s confidence and knowledge. Lily
enjoyed running around the forest, looking for feathers and twigs and
making a den. She was becoming physically more confident.’
Ingrid’s account showed how much Lily had learnt in her first two terms at nursery. She
had moved from her watchful anxious position outside the group to find a comfortable
place within the group, where she could feel at ease and enjoy the opportunities to learn.
The nursery school also prepared children for the transition to more formal learning at
school by providing a ‘leavers group’ which Lily joined.
The head teacher was teaching high frequency words that they needed to
recognise, words like is, this, and. He had written them on large card and
put them in different parts of the garden. When he said the word, the children
would run to the correct word. Lily always looked in the right direction,
but then would look back at Grace and wait for her to decide where they
would run to.
Ingrid commented that, ‘Lily was one of the most confident readers in the group, but
getting it right was not worth losing a friend.’ Lily’s response to the word game may have
indicated her need for more time to play with her friend, more opportunities to develop
her sense of autonomy, which was seen emerging in the earlier observation around the
seesaws. Ingrid’s observation suggests that in the freer learning environment of the forest
school, Lily had opportunities to follow her interests and hence be more engaged in learning.
CONCLUSION
In this section I have returned to the title, ‘What is important to a child starting in the
nursery or school?’ to see if an answer can be found in the observations, in relation to Lily
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and Billy. What stands out for me is the importance of their relationship with their teacher,
or other early years practitioner, in helping them make the transition from a home
environment, with their mother or carer, to the world of the nursery/reception class. It
seemed that their experience of loving, thoughtful relationships with their parents and
carers provided a base from which this supportive pupil-teacher relationship could evolve.
Their trusting relationship with the teacher helped them to bear painful feelings of separation,
and then to become more independent in managing the many emotions, stirred up in
the new environment. Their increasing feeling of safety or containment, both in the internal
and external world, appeared to underlie their discovery of themselves as learners, and
their growing freedom to express their feelings spontaneously, through creative activities
and play.
We might say that Lily’s excitement in learning to build a tower with a friend and Billy’s
absorption in learning how to make an envelope helped each of them develop emotionally
and become more themselves, or as the following quotation explains:
Learning from experience, as described by Bion, involves participation in
an emotional experience in such a way that a modification of the personality
takes place.’ (Emanuel, 1995 p.53)
Both Ingrid and Cherry’s observations and comments convey a deep interest in
understanding their observed child. Indeed, it seems that the nursery observation course
has also provided an opportunity for learning through experience.
REFERENCES
Colonna, A.(1998) Anna Freud And The Social- Moral Development Of Young Children. In: Ward,
I.(ed.) The Psychology Of Nursery Education 67-84 London. Karnac.
Emanuel, R. (1995) The-child-in-family-in-the-nursery. In: Ward, I.(ed.) The Psychology Of Nursery
Education 43-65 London.Karnac.
Erikson, E. (1967) Childhood and Society. London. Penguin.
Fonagy, P. (2001) Attachment Theory And Psychoanalysis. USA: Other Press.
Miller, L. (1992) Understanding Your Four Year Old London. Rosendale Press.
Williams, G. (1997) Internal Landscapes And Foreign Bodies London. Karnac
Winnicott, D. (1971) Playing and Reality, London. Penguin
Winnicott, D. (1964) The Child,The Family and the Outside World, London.Penguin
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Therapeutic Storywriting
In The Junior School
Trisha Waters
This paper describes the Therapeutic Storywriting model which Trisha Waters, educational
counsellor and therapist, developed to support children with emotional and behavioural
difficulties and which is now being piloted in over 50 schools.
The Therapeutic Storywriting model, which I am currently training other teachers to
implement, grew out of a personal attempt to integrate my training as a counsellor and
therapist with many years experience of working as a teacher in both special and mainstream
schools. It applies psychodynamic insights, basic counselling skills and certain aspects
of Assagioli’s (1965) theory of subpersonalities to story work with emotionally anxious
children. These are often children whose own life stories have been both complex and
difficult. By providing opportunities for playing with different characters, scenes and plots
of which they are the creator, storywriting gives these children a way of exploring who
they are and what they feel within a protected, imaginary world.
While storytelling is widely used by play therapists, Therapeutic Storywriting supports
children in junior schools to tell their own ‘story’ through the process of storywriting.
This model also differs from the one described by Morton (2000), in that it involves each
child as well as the teacher writing their own story, rather than constructing one group
story which is scribed by the therapist.
ADDRESSING BOTH EMOTIONAL AND ACADEMIC LITERACY
In my work with anxious children, I have been continually impressed by how much their
stories reflect their own emotional states. Their intuitive use of metaphor to describe their
inner worlds – whether it be in the form of an overwhelming evil giant, a haunted tower
or an abandoned animal – is often incredibly accurate. What I have also found remarkable,
however, is the way in which the children can become completely focused on their story
writing in a way that is not evident in other literacy work. By using a literacy context in
which to explore emotionally significant issues, it seems that children can also become
increasingly engaged and motivated to write. Given that many anxious children also have
poor academic skills which reinforce an already low self-image, it seemed sensible to work
with these children in a way that could benefit both their emotional and academic literacy.
SUPPORT FOR RESEARCH AND DISSEMINATION OF THE MODEL
Working as a special educational needs coordinator (SENCO) in a large junior school,
I was in a position to develop this way of working and what I termed ‘Therapeutic
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Storywriting’ became the focus of my research-based MA. This was completed at Sussex
University with the support of a Best Practice Research Scholarship (BPRS) from the
DfES. Using a case study methodology, the research showed that this intervention at
Key Stage 2 can support the development of both emotional and academic literacy. A
further BPRS dissemination grant provided time to write a paper (Waters 2002) for
an international journal on this approach and to set up training for a small group of
SEN teachers. Last year the support of the South East Region SEN (SERSEN) partnership
provided a quantum leap in the dissemination of Therapeutic Storywriting by supporting
the writing of a book on the topic and organising a training package delivered to
more than 50 teachers across 8 education authorities. There was a very positive response
from teachers and educational managers who particularly liked the fact that the approach
addresses both emotional literacy and academic literacy issues. SERSEN have recently
commissioned a further research study into the impact of the intervention on children’s
emotional and academic literacy. This evidence-based research will include interviews
with children who have attended a therapeutic storywriting group and will be published
on their website at the end of the year.
THERAPEUTIC TEACHING
Therapeutic Storywriting is a valuable resource for educational therapists or school
counsellors but, in recognition of how scarce such posts are in junior schools, the model
has been designed to be used primarily by teachers who have completed a training course
in Therapeutic Storywriting. Teachers attending the training are generally either special
educational needs teachers based in schools as SENCOs, or teachers working for one of
the external agencies such as a Pupil Referral Unit or a Behaviour in Education Support
Team (BEST). These are all professionals who are currently working with emotionally
anxious and vulnerable children. Teachers attending the training are not required to
become therapists but rather to bring psychological-mindedness into their educational
work and for this reason careful thought has been given to the issues of confidentiality
and boundaries. For example, any interpretation of story content is always kept within
the metaphor and in this way explicit personal issues are not brought into the session.
What the teacher does bring to the session is an ability to hold significant aspects of
the child’s ‘story’ in mind and to make this explicit through active listening – a counselling
skill appropriately transferred to the workplace.
WORKING WITH GROUPS
In order to work with groups, teachers are required to attend a three-day training course.
Here, the relationship between emotional and cognitive development is explored with
particular reference to Bion’s (1962) theory of thinking that states that anxiety needs
to be sufficiently contained in order for thinking to take place. The importance of
providing emotional containment by paying attention to beginnings, endings and
consistency as well as providing empathic reflection through active listening skills is
addressed. Consideration is also given to the self-concept and how significant
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subpersonalities can be worked with through story. The topics covered in the initial
three-day training include:
• The significance of story metaphor
• Setting up a Therapeutic Storywriting group
• Writing the teacher’s story
• Developing an extended emotional literacy vocabulary
• Ways into story
• Characters as a projection of subpersonalities
• Active listening and reflection of children’s stories
• Interpretation within the story metaphor
• Using the teacher’s story to support emotional literacy discussion
• Significance of setting stories in fantasy or external reality
• Addressing specific issues through the teacher’s story
• Assessment and liaison
The ability of the teacher to establish a relationship that is both empathic and containing
is of fundamental importance. Groups have a maximum of six children and time is
given at the beginning of a session for each child to say how they are feeling before writing
work begins. The workplace counselling skill of active listening is a core aspect of the
work. Using paraphrase, the teacher reflects back the feelings shared by each child at
the beginning of the session as well as the feelings of the characters in their written stories.
In this way, the teacher provides the children with an extended emotional vocabulary
which they can internalise and begin to use to think about their own feelings. The use of
active listening also shows the children that they and their stories have been thought about
by a significant other.
Another key element of the Therapeutic Storywriting model is the teacher’s story. The
teacher writes her own story while the children write theirs. The teacher chooses the theme
of her story to reflect emotional issues pertinent for some or all of the group. She asks the
children for suggestions for her own story before the silent writing part of the session. By
including their ideas in her story, the teacher shows the children that their ideas are taken
seriously and as she develops her story, it is used to provide further points for discussion
about pertinent emotional literacy issues. The engagement of the teacher with her own
story also helps establish a focused writers’ environment.
After 10-15 minutes’ silent writing, each member of the group has time to share their story
if they wish. Other members of the group are asked to provide constructive feedback on
each story and children can ask for ideas for the next part of their story as modelled by
the teacher. The teacher’s role is to ensure that all members of the group feel comfortable
during these group interactions. By keeping all comments on stories related to the story
characters, confidentiality issues are minimised. The session ends with a short game
designed to develop listening skills.
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INDIVIDUAL WORK
The group model, described above, may not be suitable for children who have:
• emotional and behavioural difficulties and are also unable to write
independently.
• experienced recent trauma which is getting in the way of their learning.
• significant emotional and behavioural difficulties which are giving serious
on-going concern.
In these cases, it is necessary to adapt the model for individual work and for this there was
additional training provided. Therapeutic Storywriting of all kinds is often central to
the work of educational therapists with both groups and individual children. This particular
model can also be integrated with the work of school counsellors.
EVALUATION OF TRAINING PROGRAMME
By the end of the training programme almost half the teachers had set up a group in their
schools and the other half planned to set one up in the near future. Here is a summary
of the course evaluation:
What teachers found particularly useful about the training:
• Linking psychological theory with practice
• Having time to reflect on the content and meaning of children’s stories
• Having a clear framework for running a group session
• The teacher’s story as a way to initiate discussion about emotional issues
• Ideas for extending the child’s emotional vocabulary
• Working through metaphor
• Reflecting on stories brought in by other participants
• Practising story openings which introduce emotional issues
How the training impacted on teachers’ educational practice:
• Able to reach more troubled, often isolated children
• Used active listening techniques in all aspects of their work
• Used by some participants in their outreach work with other schools
• Felt able to provide a safe forum for children to express concerns
• Provided another strategy to support emotional well-being
• Influenced response to stories written in other settings
• Increased confidence to safely address children’s emotional anxieties
through story
Challenges faced by some teachers included:
• Setting aside a regular time for the group
• Time-tabling issues
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•
•
•
•
Finding a suitable space in which to work with a small group
Sharing the model with other members of staff
Gaining support from management
Funding for groups
Teachers’ evaluation comments
In terms of children’s academic learning, many teachers reported that the approach had
helped reluctant writers engage with the writing process. Evaluation comments from
teachers included:
• ‘His involvement was total and consuming, which led to a greater quantity
of writing than I had previously seen.’
• ‘The progress in writing and ability to tap into their own feelings was
considerable.’
• ‘The children’s self esteem increased and their pride in their work reflected
this change.’
SUPPORTING INCLUSION
The feedback received from teachers who have set up groups in their schools has confirmed
my own experience that Therapeutic Storywriting is an effective way to support the
development of both emotional and academic literacy in these children. Given appropriate
professional development, teachers are able to integrate the required workplace counselling
skills and psychological thinking into their educational work. While the ideal scenario
might be to have an educational therapist or school counsellor working in this way in
junior schools, the reality is that teachers often do not have this support and are struggling
in their efforts to include some very emotionally anxious children. While Child and
Adolescent Mental Health Services (CAMHS) offer an off-site provision for these children,
their waiting lists are long and often parents have difficulty getting time off work to
take their children. There seems to be a real need to provide training for the many teachers
in schools who are working with these emotionally anxious and vulnerable children. In
my experience, these teachers who are used to working professionally with children, are
keen to extend their psychodynamic thinking and are well placed to integrate workplace
counselling skills into the educational context.
REFERENCES
Assagioli, R. (1965) Psychosynthesis: A Manual of Principles and Techniques. London, David Fulton
Bion, W. (1962). A theory of thinking. International Journal of Psychoanalysis
Morton, G. (2000). Working with stories in groups. In: Barwick. N. (ed). Clinical Counselling in Schools
142-158. London. Routledge
Waters, T. (2002) The Therapeutic use of storywriting. In: Psychodynamic Practice Vol. 8, No. 3,
Abingdon. Brunner/Routledge
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BOOK REVIEWS
by Liz Arnesen
Young Minds In Our Schools
by Peter Wilson
Published by Young Minds (2003)
ISBN 0-9545123-5-9
This book is sub-titled ‘a guide for teachers and others working in schools’. Perhaps on
my first reading I did not fully take that in. I had trouble with the format (small chunks
of text, cartoon-like illustrations) and the style (apparent ‘truisms’, and what seemed like
simplistic statements).
But perhaps this initial response of mine reflects poorly on me rather than on the book
itself! So I had another read, this time having in mind its possible uses in our work with
schools (and parents). Sure enough, the second reading revealed many treasures, and I’m
glad that I went back to it.
As Director of ‘Young Minds’, the author is experienced and well-regarded. He writes
with clarity and passion. He offers readable descriptions not only of children’s behaviours,
but also of their teachers as they respond to these behaviours in school. He makes links
between attachment theory, mental disorders, emotional literacy, and the challenges of
separating from home to go to school.
The book falls broadly into five sections, looking at: schools; young minds; teachers;
schools that ‘mind’; and appendices full of additional information for further study.
The text itself is not cluttered with references, but these appear as required at the end of
each chapter.
A couple of quotations go some way towards summing up, for me, the thought-provoking
nature of this book:
“The question is – how interested are teachers in the emotional problems
of their pupils in class?”
“Much depends on the commitment of senior management in schools
together with all staff to sustain a balance between academic and emotional
literacy in the school culture. Much more depends on how schools support
their teachers.”
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As I write this, I can think of at least one SENCO to whom I shall be recommending
this book! It should be a useful ally in her work of developing reflective thinking with
her staff. Not only does it express ideas important for the emotional health of staff and
pupils, but its reference credentials are sound and its author well-grounded in the
metaphorical field!
BOOK REVIEW
by Astrid Axson
The Presence Of The Therapist
Treating Childhood Trauma
by Monica Lanyado
Published by Brunner Routledge (2004)
ISBN 1-58391-298-3
In this new book, Monica Lanyado explores “moments of meeting” in the consulting
room. She suggests that these moments happen between the therapist and her young
patients with or without words, and that both people in the room know that a mutual
understanding and containment has been reached. She examines the affects of these
moments of meeting that are often outside and beyond the psychoanalytic formality.
Here, we have a book useful to new and established therapists. It offers confirmation that
a less formalised therapeutic approach is viable whilst posing honestly expressed questions.
The writing is supported by fascinating material and sound theory. Some readers may find
The Presence of the Therapist a shade too cosy but it provides a helpful read for those
working in a more isolated environment. Lanyado explores an idea rarely written about
with courage and clarity.
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BOOK REVIEW
by Sue Richards-Gray
The Internal and External Worlds of
Children and Adolescents.
Collaborative Therapeutic Care.
Editors, Lesley Day and Denis Flynn
Published by Karnac (2003)
ISBN 1-855-75928-4
This book is the third in the Cassel Hospital monograph series. Essentially, this is a book about
‘joining together’: children, families, staff from different agencies and disciplines and, crucially,
the inner and outer worlds of the children and adolescents of the title. It would be of interest
to anyone working within an inter-agency team formally or informally. There are eight papers
which attempt to ‘join together’ the work done with children and their families at this hospital.
The Cassel Hospital provides intensive, integrated inpatient treatment for people with a
severe personality disorder. In her introduction to the book, Lesley Day, the Head of Cassel
Services, describes the treatment offered at the Cassel as, ‘psychosocial nursing and
psychoanalytic psychotherapy within the therapeutic milieu of the inpatient hospital
community’ it is ‘a very different kind of treatment from that provide by ‘traditional’
psychiatry’. She then goes on to link the work of the Cassel with the wider community,
focussing on the relative youth of child and family mental health services and the paucity of
resources to meet the known need. Day refers to the implications of gender in the way young
people communicate their distress with a result that some mental health problems may remain
hidden. She then highlights the lack of research into mental health services for 12-19 year
olds. The Cassel is currently involved in an evaluation of hospital based treatment of families.
Children with parents who have mental health problems are particularly vulnerable as they
are reliant on those caregivers to be aware of their emotional needs. The next two chapters
consider a particularly extreme example of parental need leading to damage and even death
of their children. In chapter two, Paul Coombe examines psychoanalytic work with a mother
and her baby in a case of Munchhausen syndrome by proxy. He emphasises the vital nature
of support in working with such extreme cases and how the Cassel can provide a multiplicity
of containing structures besides the therapist-patient relationship. These include groups and
individuals all involved in holding the patients’ state of mind.
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Complementary work was carried out by Deirdre Dowling who worked with the child’s
experience also in a case of Munchhausen syndrome by proxy. The child was six years old
and had been poisoned by her mother some years earlier. Dowling demonstrates the effect
of Munchhausen syndrome by proxy on the child, emphasising how the lack of containment
experienced arrests the emotional and cognitive development of the child.
Denis Flynn examines, ‘Psychoanalytic aspects of inpatient treatment of abused children’ in
his paper. He goes into greater detail about the workings of the Cassel and the ability of
the organisation to represent a therapeutic model for living. All aspects of daily life become
part of the therapy and patients are actively involved in their own treatment. Acknowledgement
of the tension which may occur between staff due to the countertransference is made use
of in a weekly ‘strains meeting’. Flynn discusses the different tasks of the psycho-social nurse
and the psychotherapist and the relationship between them in a residential setting. He
particularly emphasises the use of nurse-therapist supervision to develop working alliances
when working with families that have intense disturbances in their lives.
Lee Marsden’s paper,’ School children in the Cassel Community: discovering a place in which
to live and learn’ may be of particular interest to teachers and educational therapists. Marsden
examines the way in which the learning experience can be part of the child’s therapy. The Cassel
Children’s Centre provides a special setting in that work with parents is closely involved
with that of the child. She discusses the use of the transfer meeting as parents bring their children
to the centre, likening it to a transition space, giving an excellent opportunity to consider
attachment behaviour. Marsden describes a case study involving brother and sister, having
earlier noted that the composition of the centre is based on admissions and not any other criteria.
Again we are reminded of the constant need for the professionals to work together and reference
is made to linking with schools, as the children may attend a local school.
The last three chapters of the book focus on work with adolescents. Kevin Healey presents
a general, insightful view of the nature of adolescence with clinical examples from the Cassel
Hospital. He describes adolescence as a transitory time from ‘the serious, playful world of
childhood to the responsible world of adulthood’ and the importance of being able to reach
the latter without losing all recourse to the former. Healey describes the work of the Adolescent
Unit at the Cassel Hospital and uses case studies to demonstrate what he believes are the
three main strands to treatment, namely; the emphasis placed on relationships during treatment,
that adolescents remain responsible for themselves and that they get on with life and face
the ordinary things in living no matter what else is going on for them.
The two final papers are concerned with the treatment of borderline adolescents. Lisa Morice
and Steve McLuskey consider in detail the case of one young woman, Rachel. The difficult
issue of separation is addressed as Rachel re-enacts at each week-end her anxieties about
being lost and abandoned.
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Denis Flynn and Joanne Turner then examine the ‘Containment of borderline adolescents’.
They posit that, ‘some adolescents who have, or have had, temporary psychotic episodes
can, in some circumstances, be contained in a therapeutic community setting, so that their
treatment can proceed without collapse or breakdown, and further improvements can be
made’. There is a particular focus on the thinking of Bion, Tom Main and Maxwell Jones
that neuroses is not simply an individual problem but a problem of the group.
There is something here for workers in all areas of work with children, adolescents and
families. It is thoughtfully and reflectively written throughout and essentially mirrors the
picture on the book cover entitled, ‘Hope’.
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Contributors
JENNIFER DOVER is an educational therapist working in the Child and Family
Consultation Service in Islington, London. She previously taught English in secondary
school before becoming a SENCO. She is on the Programme Board for the MA in
Educational Therapy of the Caspari Foundation. She is also a lecturer and supervisor
on the training.
VICKI ROWLAND was a student at the Caspari Foundation from 1999 – 2003.
She is presently practising as an educational therapist and teaching in a nurture group.
She has been a teacher in London for thirty-one years.
IRENE OROMÍ graduated from Barcelona University with a degree in psychology.
Following a further degree in clinical psychology at Geneva University, she worked as a
clinical psychologist in the children’s mental health service in Barcelona. She has also
trained as a psychoanalyst and is a member of the Spanish Psychoanalytical Society
(Barcelona), She has been a member of FAETT and then Caspari since 1986.
BARBARA LYNDON was a deputy head in a primary school before training to be
an educational therapist and working at The Caspari Foundation. She is a psychoanalytical psychotherapist, a past chair of the Foundation, teaches on the training course
and is the recipient of a grant from Calouste Gulbenkian Foundation to work as an
educational therapist with mothers and children in a school setting. She is a Circle Time
trainer for practitioners working in Early Years Education.
TRISHA WATERS is author of Therapeutic Storywriting, published by David Fulton,
2004. Based in Brighton, she currently works as an independent educational trainer
and consultant.
Contact: [email protected]
Therapeutic Storywriting Training: www.therapeuticstorywriting.com
SERSEN Therapeutic Storywriting Project: www.sersen.uk.net
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Notes for contributors
EDUCATIONAL THERAPY AND THERAPEUTIC TEACHING is an annual publication of the Caspari Foundation. It publishes articles and papers concerning the role of
emotions in education and methods of helping children with emotional blocks to learning,
whether through educational therapy or other therapies, or by expanding the psychological
insight of teachers.
ARTICLES – We invite papers of approximately 5,000 words.
Please address to the editors at Caspari House. Manuscripts should be accompanied by a
disk or sent by e-mail to administrator@caspari house.fsnet.co.uk with clear indication that
they are for the attention of the journal editors. Authors are also requested to send
autobiographical notes of not more than 150 words.
REFERENCES should be in alphabetical order of author’s surname as follows:
BOOKS – Author(s) or editor(s) surname followed by initials, listing all authors;
year of publication (in parentheses); book title (italicised); city of publication;
publisher. Finish all elements with a full-stop. e.g:
Barrett, M. & Trevitt, J. (1991). Attachment Behaviour and the Schoolchild.
London. Routledge.
ARTICLE OR CHAPTER IN AN EDITED BOOK – Author of chapter and year;
article or chapter title; In: editor’s name; book title (italicised); page numbers; city
of publication; publisher. Finish all elements with a full-stop. e.g:
Morton, G. (2000). Working with stories in groups. In: Barwick, N. (ed). Clinical
Counselling in Schools. 142-158. London. Routledge.
PERIODICALS – Author(s) surname followed by initials; year of publication ;
title of paper; title of journal (italicised); volume number; page reference; country
of publication. Finish all elements with a full-stop. e.g:
Geddes, H. (1999). Attachment behaviour and learning: implications for the pupil,
the teacher and the task. Educational Therapy and Therapeutic Teaching (8).
20-34. U.K.
CONTRIBUTORS will receive two free copies of the issue in which their papers appear.
THE JOURNAL is free to members of the Caspari Foundation or £10.00 (including postage
and packing) per copy
Obtainable from: The Administrator, The Caspari Foundation, Caspari House, 1 Noel Road,
The Angel, Islington, London N1 8HQ
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