The authors discuss an application of Bion's conceptualisation of thinking and non-thinking states (K and -K links) to the treatment of a nine-year-old girl. The authors consider Bion's interrelated concepts such as K and -K, container/contained, maternal reverie, and the development of thinking through alpha function to be highly applicable to…

As psychotherapists in hospitals, they need as holistic an understanding as possible of the organisation, its anxieties, defences and ways of splitting and projecting what is unbearable, frightening, incomprehensible, and besides this, they need to understand they fit in. In this article, the author shares her comments on a clinical extract…

This paper shows a child psychotherapist learning and developing her technique as she attempts to make contact with a child who is extremely hard to reach. It is based on the first two years of three-times-weekly intensive psychotherapy of a latency girl who had little faith in a helpful therapeutic relationship. Her defences against such a…

This paper describes the once-weekly psychoanalytic psychotherapy of a girl, called Ellie, aged eight at the start of her treatment. Ellie had a learning disability and displayed difficult behaviour at school and at home. In her therapy, Ellie grew in emotional intelligence, more in touch with and able to express her feelings. Her behaviour…

This article discusses the importance of good primal splitting as the basis for the child's emotional and cognitive development. A theoretical introduction analyses the possible pathologies of primal splitting, as they were first pointed out by Melanie Klein and then by some post-Kleinian authors, in particular Donald Meltzer. This is followed by…

The objective of this study was to evaluate the outcome of child psychoanalytic psychotherapy in a clinical outpatient setting in a city in southern Brazil. Three psychological tests (Rorschach, Bender and WISC III) were administered to 23 children, aged 6-11 years old, and the Child Behaviour Check List (CBCL) was completed by the parents. All…

In a former study (Fonseca and Bussab, 2006, "Self, other and dialogical space in autistic states", "International Journal of Psycho-Analysis", 87:1-16), the author hypothesised that in autistic disorders there is a distortion in the construction of what she defined as dialogic space. Such a space, in which self and other define each other…

Playing checkers, football or more recently, computer games, is an important part of the latency child's culture. The ability to play games demands a level of emotional development similar to that needed to cope with the emotional/developmental demands characteristic of latency. A game shared by the therapist and child provides a picture of the…

Despite the fact that it has long been recognised that narcissism can contribute to depression, we have become accustomed to referring to depression mostly in terms of a neurotic disturbance. The author highlights the difference between the narcissistic elements in depression, which is based on guilt, and the graver narcissistic depression, which…

The author revisits her experience of supervision with Esther Bick, which took place over 30 years ago. The patient discussed was a seven-year-old boy whose disturbance dated from the very beginning of his life. His difficulties had severe implications for the development of his capacity to feel emotionally contained and for the development of a…

This paper describes the first two years of intensive psychotherapy with a six-year-old boy diagnosed with autism. I explore the many ways in which he retreated from reality, most frequently by taking refuge inside the maternal body or flying off into an imaginary space world. He fragmented his identity and that of his objects by using the…

In this paper, I describe the first 2 years of intensive psychotherapy of a multiply traumatized 5-year-old girl. I explore some of the ways in which violent and traumatic experiences were re-lived in the therapy and how they impacted on both patient and therapist. Within the discussion and illustrated by clinical vignettes, I consider the…