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Nr 18. 2008 sid. 45–59
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In this fascinating session, the reader gets a detailed account of the therapist’s efforts to help a six year old boy to hold together the many very disparate parts of his internal world. Peter seems to experience himself as exploding under the pressure of all he is trying to hold inside himself, and destroying everyone around him in the process. He feels that shrapnel-like projections of all the ‘shit’ and violence he finds it so impossible to contain within him, frighten his parents, teachers and children so much that the police need to be called in, and he needs to be put into some kind of safe custody. The precariousness of the way Peter feels inside, is vividly por-trayed through the game of pick-up-sticks which he manages to play by the end of the session after the therapist has helped him to feel less frightened that he is going mad. How does the therapist manage to contain these very violent and frightening feelings so that the session ends in such a different way to the chaos that threatens to take a hold in the middle of the session? The therapist provides a vivid account of the escalation of out-of-control and wilfully destructive behaviour that Peter quickly spirals into. She feels that Peter is ‘losing the grip’ on himself in front of her eyes and that he is ‘quite recklessly out of his mind’. This parallels his seriously deteriorating behaviour in school and at home which now has been brought powerfully into the therapy session and the transference relationship. Peter tries, with brief success, to calm himself a bit using the pouring of water and this seems to soothe some of his distressed agitation. But this respite doesn’t last long and he becomes unable to keep the lid on his fury. He starts to attack his therapist’s com-puter and phone and here he hits the ‘outer limits’ of what he is allowed to attack in the therapy room. These are clearly stated to him and the therapist needs to take him firmly by both hands to stop him from any further destructive actions. Throughout, she seems to have struggled and succeeded in remaining calm in the midst of Peter’s chaos and destructiveness. Thankfully, this eventually pays off as momentarily she feels that Peter is listening to what she is saying and is possibly interested and even surprised by the way in which she is not responding as those in his everyday life do when he is out of control – by be-coming angry and frightened themselves. This opens the window for therapeutic change to take place. It is when the therapist does not respond in the way that the patient transferentially expects her to, that something new can be experienced in the patient’s internal and external worlds.
Background The family has recently moved to a new area and Peter has just started school in an environment unfamiliar to him. He has been in once weekly therapy for about a year and as things got totally out of control, when he started school, I agreed to see him twice weekly. He has been quite an obsessive, rigid little boy, and when all frames and scaffolding surrounding him disappeared he became totally out of his mind. As soon as he gets a notion that he might be dangerous he starts laughing in an absurd pitch, saying he likes hurting others and that he wants to become a terrorist. This mean spiral of his goes on and on, scaring both his parents and teachers. When it has ceased its grip on him, he can talk about what has happened in an adequate way and even explain why he got so angry and is full of remorse. Session He is accompanied to the waiting room by someone he calls grandpa. Peter says grandpa is 95 and grandma 98 and they live in X (another part of the country, which I know is true). But it’s difficult for me to believe that they are so old (and Peter surely knows their proper age) and that grandpa is actually here. This is my first problem: how to address him, when he wants to be heard in his dreadful tramping noise and is actually lying to me? He mentions a surname that certainly can’t be his paternal grandparents’ and I choose to address him saying that today he’s using a “contrary-language”. He smiles and seems to like this comment. He says that he wants to use the sand-tray. He doesn’t have the same kind of outbursts in the sand as last week, when he tried to fling sand all around. He starts building with some explosions saying he has an “expedition” in him, corrects himself and says “no, an explosion”. He puts a little baby-doll on the explosion and says “no this instead” and takes out a miniature fire and puts the baby on top of it. “A dad is going to kill the baby”. I ask him if he thinks that his mum and dad are so cross with him that they would like to kill him. He looks up, meets my eyes, looking as if he is reflecting upon this, but says nothing. Instead he walks out of the back door and fetches some water for the sand-tray. Just like last session everything accelerates in a rapid crescendo. He does one thing after the other, half-heartedly. Impulses like pouring and throwing things right out into the blue without any direction is the theme – everything in the material is linked to destroying or fragmentation of links. One episode after the other occurs which are impossible to remember, since everything goes on so quickly and with the sole aim of destroying even my private things in the room (this has never happened before). However, there seems to be some kind of control and delay in his behaviour today, compared to last week’s session. We are all the time in some kind of dialogue, but with an extreme effort on my part to limit his behaviour. He takes out lots of things in a haphazard way, using the things destructively, laughing hysterically at himself – he’s really losing grip on himself before my eyes. There’s a leakage of belching, farting and other internal liquids evaporating out of him. He seems to be taken by surprise when his bodily functions appear in this way. ...
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Copyright: Allt material ©
MELLANRUMMET 2011-10-29 |
Monica
Lanyado, psychologist and psychotherapist, was founding course organizer
of the child and adolescent psychotherapy training in Scotland and is
currently a training supervisor at the British Association of
Psychotherapists. She is joint Series Editor of the EFPP Book Series.
Her publications include journal papers on many subjects, and the books
The Presence of the Therapist: Treating Childhood Trauma (2004)
and, co-edited with Ann Horne, The Handbook of Child and Adolescent
Psychotherapy: Psychoanalytic Approaches (1999, 2008 second edition
(in press), and A Question of Technique (2006).
