Psychotic States in Children

Views: 801
Ratings: (0)

Developments in the understanding and psychotherapeutic treatment of children and adolescents suffering from psychotic levels of disturbance are dealt with in this work, from the Tavistock Clinic Series. The book is chiefly concerned with children troubled in their behaviour, relationships, and communication.There is something extremely unsettling about the disturbed behaviour of sexually abused and severely troubled children. In spite of a sometimes exasperating measure of perversion and destructive wilfulness, these children manage to communicate a clear plea for help - a plea which deeply affects those in their immediate surroundings who find themselves struggling to make sense of these contradictory messages. This book describes significant new developments in the understanding and treatment of children and adolescents suffering from psychotic levels of disturbance.Each chapter contains a clinical description of a child emerging from a psychotic state, creating a useful collection of case histories. Part One concerns sexually abused children, Part Two discusses psychotic children with severe developmental delay, and Part Three describes the treatment of children whose difficulties have both internal and external roots. Each part is followed by an authoritative critical commentary. A glossary of terms is included at the end of the book.

List price: $25.99

Your Price: $20.79

You Save: 20%

 

12 Slices

Format Buy Remix

1. Finding a Safe Place: A Four-Year-Old Child's Recovery from Sexual Abuse

ePub

A Four-Year-Old Child’s Recovery from Sexual Abuse

Deborah Sussman

Introduction

This chapter looks at material from a period of intensive psychotherapy with a four-year-old girl who had been sexually abused and severely neglected.

The therapist links Jennifer’s earliest experience of sexual abuse, neglect and deprivation with the development of a psychotic part of herself, at first terrified, later attracted and at times addicted to perversion.

In the first year of her treatment, Jennifer was terrified of being destroyed, of being abused, or of falling apart. She perceived her therapist as a persecutor and abuser and would retreat into fantasies of violence and perversion that seemed to be her means of defence against feelings of helplessness. Her fantasies reflected her past experience but also served to ‘hold her together’ in the face of chaos and terror.

Later in the treatment Jennifer would allow more and more glimpses of a fragile, infantile, dependent part of herself but would suddenly swing to being in projective identification with a narcissistic, perverse object that enabled her to avoid feelings of closeness, vulnerability and dependency. She would either become the abuser, trying to seduce the therapist into her world of dirt and brutality, or the neglectful mother who allows moments of closeness only to cast the baby away.

 

2. The Difficulty of Establishing a Space for Thinking: The Therapy of a Seven-Year-Old Girl

ePub

The Therapy of a Seven-Year-Old Girl Lynda Miller

In this chapter the interweaving of internal and external factors in one year of therapy of a very damaged, sexually abused child is described. In particular I want to focus upon the unbearable states of confusion experienced by this little girl when her external situation too closely replicated her internal world, and the effects of this on her therapy.

Her state of mind for much of the time during therapy could be described as psychotic. I would suggest that this was engendered by traumatic past events and further exacerbated by contemporary environmental factors.

Rosenfeld (1950), developing Melanie Klein’s concept of paranoid-schizoid functioning, describes infantile states of confusion as states of disintegration associated with extreme anxiety. He suggests that ‘… under certain external and internal conditions when aggressive impulses temporarily predominate, states may arise in which love and hate impulses and good and bad objects cannot be kept apart and are thus felt to be mixed up or confused.’ In such states of mind the destructive impulses seem to threaten to destroy the libidinal impulses and the whole self is felt to be in danger of being destroyed. If the capacity to differentiate between love and hate cannot be regained, splitting mechanisms become reinforced.

 

3. Survival of the Self: A Sixteen-Year-Old Girl's Search for a Good Object

ePub

A Sixteen-Year-Old Girl’s Search for a Good Object

Chriso Andreou

Introduction

This Chapter explores the search of an adolescent girl for a good object and her struggle to preserve her sanity. Her experience of early deprivation and the subsequent trauma of sexual abuse had left her very fragile. As her external circumstances changed she was faced with the threat of psychic disintegration. This paper concentrates on the first two years of therapy when the patient, after beginning to overcome these experiences of disintegration, had to resist the attempt by perverse and psychotic parts of the personality to dominate the self. The clinical material illustrates how her sense of abandonment affected the nature and intensity of the transference relationship.

Background

Information about Mary’s background and family history is very sketchy. She was born to a very young adolescent mother. A brother was born two years later. Shortly after this second birth the mother abandoned the children who were then looked after by their grandmother. When Mary was three years old, both children were taken into care due to physical neglect and placed in a residential nursery. Mary reported good memories of this home, but vividly remembered her jealousy of the other children including her brother who was thought of as attractive and loveable and received a lot of attention.

 

4. The Beginnings of Mind: Psychotherapy of a Sexually Abused Six-Year-Old Girl

ePub

Psychotherapy of a Six-Year-Old Girl Ann Wells

It had become a glimmering girl (W.B. Yeats)

Helen was nearly six years old and ‘severely mentally handicapped’ when she was referred to the clinic with her older sister Clare. A diagnosis of chronic sexual abuse had been made nine months previously by the local hospital. When Helen was five, her intellectual level was about eighteen months. She had little language and was not toilet trained. Her violence to other children, extreme mood swings and sexualised behaviour alerted her special school, and an examination under local anaesthetic revealed ‘recent and old’ penetration of the anus, as well as other bruises consistent with physical abuse.

Helen’s mother separated from her co-habitee, the alleged abuser, but the child’s referral for therapy was a constant reminder of the abuse and was very painful for her. She could not accept help for herself, and proved unable to bring Helen three times weekly, both for emotional reasons and because of practical difficulties when she had another baby. However, thanks to an escort, we had fifteen months of reliable once-weekly work before the family suddenly moved away.

 

5. Symbolisation and the Sense of Identity

ePub

Daphne Briggs

This paper is based on the psychotherapy of an adolescent boy whom I shall call Alexis, which began once a week when he was thirteen, was intensive for three years in his middle teens, and continued thereafter on a reduced basis into his early twenties. In it I want to explore the part that his use of symbols has played both in his psychotic functioning and in his recovery. By symbols I mean something - whether a pattern, a thing, or a concept - which is employed to hold emotionally charged meaning that does not intrinsically belong to it. At the simplest level in this sense a symbol simply stands for something else, as Klein typically used it in talking to children (e.g. Klein 1961, p. 24).

Alexis

Alexis was born prematurely, weighing only 3n lbs, and before his mother had actually seen him, was taken as an emergency to an intensive care unit in a big city far from his place of birth, where he spent the next six weeks. Because of the distance and his mother’s condition, his parents were only able to visit him once.

 

6. 'Here I am!': Self and Object in a Developmentally Delayed Boy with Autistic Features

ePub

Self and Object in a Developmental^ Delayed Boy with Autistic Features

Sara Ranee

Introduction

Anthony began intensive psychotherapy at the age of three. Concerns both of his parents and professionals centred on his marked language delay, which, combined with poor social interaction, had given rise to worries about autism. This account of his therapy focuses on the emergence of language and on what this reveals about his growing sense of self and his capacity for object relatedness.1

History

Anthony is the first child of Mr and Mrs M, a professional couple both actively involved in the care of their children. Anthony’s birth was normal, but his mother suffered from severe post-natal depression, and she felt it had been virtually impossible for her to bond with him. Her attempts to breastfeed proved unsuccessful and she became racked by despair, readily blaming herself for Anthony’s difficulties, and feeling immensely isolated despite her husband’s actual presence. It was six months before she received medical help in the form of medication for her depression, which lifted during her second pregnancy, but returned after the birth of Anthony’s brother when Anthony was sixteen months old.

 

7. A Little Boy Who Did Not Want to Learn Anything

ePub

Alex DubinskyIntroduction

This chapter is concerned with an attempt at understanding the psychological component in a child’s severe developmental delay. I first saw this boy, whom 1 will call Paul, when he was three years old. It seemed clear that he was capable of symbolisation and his obstinate fascination with gaining access to enclosed space suggested that the representations of his phantasy life contributed to his lack of cognitive and emotional development. I thought that one should attempt psychotherapy, and not abandon Paul to a future of very severe retardation. After some months when he was seen together with his mother as they refused to separate, he started twice-a-week individual psychotherapy.

During the first years of his long treatment, which has now lasted for eight years, progress was very limited. There was no known medical cause for Paul’s developmental delay, but there remained the possibility that his restricted mental life reflected some great poverty in his cerebral endowment and that he would not develop significantly. Very slowly, however, Paul internalised the emotional containment provided by the therapy. As treatment continued, small changes could be observed. Little by little he became more able to tolerate anxiety. He eventually started to put his words into simple sentences. Gradually, his tiny vocabulary began to expand and indicated a widening of his interests. However slowly, he was responding to the psychotherapy, but I was left with feelings of despondency which reflected some of the helplessness which is at the very root of Paul’s emotional difficulties. Indeed, since he was little, and for a long time, because of this very helplessness, he had taken refuge in phantasies of omnipotence which affected his contact with emotional and external reality to the point of psychosis.

 

8. Psychosis and Autism: Schizophrenic, Perverse and Manic- Depressive States During Psychotherapy

ePub

Schizophrenic, Perverse and Manic-Depressive States during Psychotherapy

Dr Genevieve Haag Translation: Daphne Briggs

This chapter addresses the risk of schizophrenic, perverse, and manic-depressive developments during the treatment of psychotic and autistic children. I shall begin with remarks about three cases: one psychotic, two others autistic. All of them had background anxieties of falling and liquefying, which were followed by overwhelming massive projective identification once relationships had been resumed (especially relating by means of eye contact). This produced swings between dangerous schizophrenic-type outbursts and more organised relatedness in which projective identification was confined to an attempt to induce manic mutual excitement,’ something that could clearly lead into perversion.

I would particularly like to explore and attempt to clarify a paradoxical state. This occurs when a child’s constant search for confusion of identities (either by means of massive destructive projective identification in a symbiotic psychosis, or else by adhesive identification, in autistic fashion) coincides with a fear of the normal fusion (normal projective and adhesive identification) that is in fact the only way to establish the feeling that a solid base and boundaries exist. A discussion follows of differences in the origins and history of these two clinically morbid situations (autism and symbiotic psychosis), and of their interplay. In particular, I shall examine the problems of achieving relatedness by means of eye contact, and the process of establishing a sense of body boundaries and internal connectedness. This goes together with a secure sense of self and the construction of spatial relationships.

 

9. Jeremy and the Bitten Roof

ePub

Hitine Dubinsky

I have been seeing Jeremy in individual therapy for three years, twice a week. He is now eleven years old. When he was seven, he was diagnosed as autistic, but after a few months of therapy, he began slowly and hesitantly to communicate in whole sentences.

Jeremy often puts across a deep fear of falling and disintegrating. He recounted mental experiences which we took to be dreams. Although his thinking remained essentially concrete, these dreams were the first representations of his battered internal world which was depicted as a house without a roof, open to the rain and to noise from outside which drove him mad.

Jeremy’s parents are very religious and are active members of their church. Mother had a breakdown during the first year of his life. She says it is the church which has helped and supported her in coming out of her depression. Mrs S is now a loving mother, attentive to her children. Jeremy has a sister, two years younger, with whom he gets on well. Mrs S tends, like her husband, to explain everything to Jeremy in scientific terms, to avoid his becoming anxious. She supports the therapy unconditionally, and is very grateful for it.

 

10. 'The Ghost is Coming': The Fear of Annihilation in a Nine- Year-Old Boy

ePub

The Fear of Annihilation in a Nine-Year-Old Boy

S.M. Sherwin-White

History and Background

Samuel was referred for help at the age of five. His mother described his bad behaviour, unmanageable tantrums, episodes of exposing himself, and spitting. Samuel is the second, much younger child of a second marriage. The pregnancy was unplanned and unwanted. While pregnant, Samuel’s mother was told that her baby’s head was too small, with all the terrifying implications of a brain-damaged child that this conveys. This information may have been a medical error. We know that she was badly depressed during the pregnancy and post-natally. She went back to work one week after Samuel’s birth.

Her personal history is disturbing. She was born abroad, and reports nearly being killed at birth by a relative because she was a girl. As a young teenager she experienced the first of her two marriages, which broke down. She and Samuel’s father are successful, workaholic business people. The father travels frequently in connection with work and is often away from home for considerable periods of time. Samuel misses him badly during these absences, as does his mother.

 

11. Going to Pieces: Autistic and Schizoid Solutions

ePub

Autistic and Schizoid Solutions

Maria Rhode

In this chapter, I shall consider material from three children who experienced separateness as catastrophic fragmentation. Daniel exhibited marked autistic features, including echolalia, to which he turned for protection from a witch felt to be causing his psychotic terrors. Miguel reacted to similar experiences of fragmentation by attacking the outside world; the survival of firm boundaries encouraged him to produce articulate speech. Jonathan attacked the world like Miguel, but then retreated to autistic rituals to protect himself from the consequences. I shall discuss their material in terms of the interaction of differing experiences of fragmentation and of sensation-dominated autistic processes.

Daniel: autism as a protection against psychosis

This ten-year-old boy made very rapid progress in a year of once-weekly psychotherapy. I have few details of his early life, except that he was reported not to be developing normally at the age of two. He was hospitalised with a life-threatening illness at three, but recovered completely. Later, investigations for fragile X-chromosome proved negative. He was the middle of three children. His mother was herself from a deprived background. She rejected contact with professionals, by whom she felt criticised. Looking after herself and the children sounded like a desperate struggle. She had no supportive partner and she was said to suffer from recurrent episodes of rage and despair in which she could become violent. Daniel was taken into care at the age of six, and placed at a school for children with severe learning difficulties. His mother tried to keep in touch with him, but often failed to turn up as arranged. Contact with her during his hospitalisation is likely to have been unpredictable.

 

12. Rigidity and Stability in a Psychotic Patient: Some Thoughts about Obstacles to Facing Reality in Psychotherapy

ePub

Some Thoughts about Obstacles to Facing Reality in Psychotherapy

Margaret Rustin

This chapter is an attempt to think about a particular kind of rigidity in a post-autistic patient who lives simultaneously in a psychotic private world and in the world of relationships and shared meanings. I worked with her for nine years and shall discuss the material of a session some months prior to the end of her therapy. In considering the meaning of our interchange I wish to distinguish between the changes that have been achieved and the ongoing obsessional ruminative power of the psychotic process. I shall try to consider these from two perspectives: the patient’s continuing partial addiction to delusional defensive structures, which she experiences as protective, and the analyst’s countertransference difficulties in facing the limitations of the work. Both of us needed to struggle with anxieties about facing reality; the reality of the approaching end of the treatment brought these into clearer focus.

 

Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781781810866
Isbn
9781781810866
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata