This article presents the author's observations on a clinical extract which describes a child psychotherapist working with Maya, a seriously ill child, in a hospital. The author said that the hospital setting raises the question of what it is like to apply child psychotherapists' thinking within a hospital setting, and how they adapt the way they…

This paper explores the idea of possible proto-experiences of the prenatal child in the context of Bion's model of container/contained. The physical configuration of the embryo/foetus contained in the maternal uterus represents the starting point for an enquiry into the unborn child's possible experiences of its state of being contained in a…

This paper draws on my doctoral research study based on consulting work with three primary school Special Educational Needs Co-ordinators (SENCos) that took place in 2008. The study examined the interactions that arose in the consultations with the SENCos and their staff. The findings that emerged from the application of Grounded Theory research…

This paper takes Betty Joseph's concept of "addiction to near death," which describes a clinical situation in which sadism and masochism dominate the relationships of a particular group of patients, and applies it specifically to the case material of a girl in adolescent psychotherapy treatment. A link is made between the patient's retreat from…

This paper examines the relationship between therapeutic progress and the patient's family or residential situation with reference to the intensive treatment of an adolescent boy who had a severe learning disability and moved placement five times within four years. The idea is explored that the capacity to be thoughtful about emotional distress…

This paper describes work with two children, placed for late adoption who have suffered relational trauma. The paper explores the long-term consequences of such trauma, which includes problems with affect regulation, difficulties in generalising from one experience to another and shifts between phantasies of omnipotent control and sudden…

The paper describes the conclusive phase of the psychotherapy of a young man who suffered from Asperger's syndrome. The patient had been referred as an adolescent, at which time he was very isolated and spent most of his life in the company of countless imaginary friends that were quasi-delusional constructs. After several years of therapy, the…

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures--repetitive patterns of interactions between patient and therapist over the course of…

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 article explores the process of consultation to professional networks, teams, groups and individuals concerned with the mental health of children and young people in the care system, and those adopted. Frequently there are significant elements of early trauma suffered by the young people and disruption in the professional organisation. The…

This paper explores some issues that might arise when one considers having a table hockey game in the therapy room, and describes how an autistic boy, aged four-and-a-half when starting treatment, used that game. The unfolding process from withdrawal to separateness, intersubjectivity and playfulness is illustrated by the progress of two years of…

This paper traces the analytic work with a severely traumatised two-and-a-half-year-old girl Phoebe, whose early life was marked by chronic abuse and a violent murder she witnessed a few months prior to the beginning of treatment. Bringing the trauma in the room in a dissociative form, in line with post-traumatic stress disorder presentation, was…

An innovative methodology is presented for describing the therapeutic processes involved in five types of adolescent treatments: psychoanalysis, psychodynamic psychotherapy, cognitive-behavioural therapy, mentalisation-based treatment and interpersonal psychotherapy. Using the "Adolescent Psychotherapy Q-Set" (APQ), 18 experienced clinicians…

This paper charts the journey made towards verbal communication with Mackenzie, a boy who was three years old at the start of treatment and diagnosed with pervasive developmental disorder. In this paper, I bring together diverse areas of research and demonstrate how they inform my clinical practice. Together, these ideas created a multimodal and…

The author describes a sub-group of anorexic patients who present themselves clinically as "invisible" and "insubstantial". The concept of "invisibility" is understood in terms of primitive object relations. The underpinning of this dynamic is a lack of separation and differentiation from mother and a consequent effort to live inside her skin. The…