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2. Borderline Children: Differentiating Disturbance and Deficit

Emanuela Quagliata Karnac Books ePub

Anne Alvarez

INTRODUCTION

Before introducing what is the subject of this chapter, it may be important to say something about what it is not. It is not about deciding which borderline psychotic, psychopathic, or psychotic children, are able to ‘use’ psychotherapy. This is, first, because it is extremely difficult to predict degree of improvement. A lesser degree of improvement may have as much to do with our own failure, as the patient’s therapist, to understand the nature of his communications, as with his actual original level of pathology. External factors, too, may intervene for good or ill. I think we are constantly being surprised at how well very damaged children or adolescents do do in treatment: the third assessment session, or, for that matter, the thirty-third treatment session, may be vastly different from the first or second, in terms of revealing new sensitivities in an apparently hardened child. Alternatively, it may reveal new horrifying areas of madness in an apparently only neurotic but slightly odd child, so it is dangerous to predict too much. It may, however, be possible to say something, by the end of a few assessment sessions, about the level and type of illness, by attending to three major areas of functioning i.e. the level of ego development, the nature of the sense of self, and the nature of the ‘internal object’ or ‘representational other’. This may cast some light on where the child is on the neurotic-psychotic continuum (already an oversimplification) and possibly on the degree of overwhelming anxiety, persecution, paranoia, despair, the degree of impulsivity, psychopathy, perversion, addiction, the degree of thought disorder, and perhaps, on the chronicity or acuteness of all or any of these. Such assessment may give some indication of how far the child may have to go to reach normal development; unfortunately it may give little idea of how fast he and his therapist may travel, nor how circuitous the road ahead may have to be.

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Content

Emanuela Quagliata Karnac Books ePub
Medium 9781855756441

7 Work with vulnerable families

Jonathan Bradley Karnac Books ePub

Fadumo Osman Ahmed

In this chapter I describe the work I do in a community centre, responding to the needs of refugees. Unusually, both staff and clients originate from the same country, most having come to this country within the past 10–12 years. For many, adapting to new circumstances has led to many emotional and exposing moments. It is a community that has experienced loss in a profound way: most of the clients are “single” mothers struggling to bring up 5 or 6 children on their own. It is a life made worse by not knowing what has happened to their husbands, homes, financial assets, and even other children who had become separated in the panicky flight from danger.1

There was a paradox in the way the community as a whole dealt with these shocking events: they produced traumatic reactions, but it was difficult for them to be fully acknowledged. I will describe my own attempts to understand quite complex feelings. I became aware that both staff and clients disregarded mental illness, and in fact it seemed to me that the staff deprived their clients of the mental health services they needed, perhaps because it was too painful to face up to these issues.

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3 What';s happening? Some thoughts on the experience of being in a work discussion group

Jonathan Bradley Karnac Books ePub

Katie Argent

A

rriving at my first work discussion seminar, I had some idea, gleaned eagerly and anxiously from conversations with other students, about this seminar being to do with conscious and unconscious communication in work with children or young people. I was aware of feeling relieved that as a consequence of my own hard-won experience as a patient in psychoanalytic psychotherapy, I thought I knew a thing or two about unconscious processes that I could now put to good use in what I comfortably imagined would be a fairly abstract though not, of course, impersonal discussion. In other words, I did not arrive with the expectation that this would be a seminar that would touch me emotionally, let alone play a part in changing my perspective on and approach to working life.

As we introduced ourselves in the seminar group, the first surprise was what varied working backgrounds we came from, with widely differing kinds of experience and levels of expertise in work with children and families in areas such as education, health, mental health, social services, and community development. I quickly realized that the array of notepads and pens with which I had armoured myself would not be particularly useful. Rather than studiously taking down references and making notes, we were going to be looking in detail at each other's descriptions of interactions with children and other members of staff in our workplaces, including descriptions of the way in which we ourselves behaved and expressed ourselves in these interactions. Not safely theoretical, then.

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5 - An Observation of a Young Asian Child with Feeding Difficulties, Conceived Via Assisted Reproductive Technology

Simonetta MG Adamo Karnac Books ePub

Anjali Grier

In this chapter I discuss my observation of a 3-year-old boy, whom I shall call Suraj. He is the second child of Asian parents and has a 7-year-old sister. His parents are both immigrants, having arrived in this country in their early adulthood, and appear to be in their early forties.

Both Suraj and his sister were conceived with the help of fertility treatments after their parents endured several years of painful disappointment at being unable to conceive naturally. His sister was conceived through IVF (in vitro fertilization), and Suraj was described as being a GIFT (gamete intrafallopian transfer) child. At our first meeting his mother poignantly described the great difficulty with which Suraj was conceived: the repeated disappointments of unsuccessful IVF treatments over three years, and their decision finally to accept the alternative of a GIFT baby—implying that the “gift” was possibly both the donation of an egg, as well as the miracle of their much-wanted second child, for whom they were deeply grateful.

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