Clinical commentary

Abstract

Helen is the seventh of 10 children born into a family where abuse and neglect were rife. The oldest sibling, a girl, died in adolescence, and the youngest sibling died as a baby. The family had been known to social services for some time and were described as 'a feral gang'. The neglect in the family was severe, such that in her early years Helen had little or no education, and often went unclothed and unfed.When she was four and a half years old she was placed into foster care, with five of her siblings. She had a number of short-term placements, until at five years of age she was placed with the Saunders family. The Saunders family consists of Mr and Mrs Saunders and Mrs Saunders' daughter, who has special education needs and is two years older than Helen. Mrs Saunders' mother, known as Nan, is closely involved and lives nearby. The family have two pet dogs who are very much part of the family.Once settled into this more long-term placement, Helen was referred to the CAMHS service where I work, although this was still quite a distance from where she lived and she was brought in a taxi, accompanied by Nan.Following assessment, she was offered psychotherapy three times weekly, and by this time she was six years old. A therapist worked with Helen for 18 months, but then unfortunately this therapist left the clinic. I took over the case and began seeing her, also three times per week. This session reported below took place very early on in the therapy; Helen was eight years old at the time.Helen has always engaged passionately with the therapeutic process. She uses everything available in order to communicate her preoccupations -myself, the room, the furniture and her toy box. She has a vivid imagination and is interested in music and drama. The sessions are thus generally highly dramatic in every sense of the word.The major themes she is exploring in therapy are those of deprivation and abuse -key themes from her early life. She is an observant girl, with an excellent memory. She is able to use actual memories of her early abuse and weave them into her 'stories and plays'. I often play the part of the abused victim, where she is in identification with the abuser. In this way, I feel, she attempts to take some control over her damaged internal world.