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Nr 22 2010 sid. 47–66
FROM INTIMACY TO ACTING OUT:
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This chapter describes the referral of a 14 year old boy, the responses engendered by it, and expands on the transference and counter-transference phenomena arising from a presentation of violence and a history of cumulative trauma. The referrer, a Consultant Forensic Child & Adolescent Psychiatrist, requested an assessment that would provide ‘a psychodynamic formulation which we can use to help our continuing efforts to understand Martin and manage his case.’ Subsequent consultation for the team was also required. Funding agreement took five months. [In the UK at that time specialist services were contracted annually by area health purchasers; this referral, however, came from an area that did not have a contract with the clinic where I worked. The local purchasing authority had to agree to pay and, as Martin’s was a special case, central government had also to agree its contribution to the total cost.] The logistics of Martin’s care had changed by then – not unexpectedly as the referral indicated a crisis in understanding and caring for him. Martin was resident in a specialist treatment Centre. Two weeks after this letter was written, the government announced a consultation on the Centre’s future and staff members were informed a week before we visited that it would close – deeply unsettling for the team and for Martin. He had arrived there 2½ years previously, three months before his 12th birthday, having been given a 5 year sentence for two counts of arson and two further counts of arson with intent to endanger life. He was 11 years old when he committed the offences. In addition, four months prior to the referral he had attacked a staff member, a woman to whom he was close, with a plastic baseball bat. The attack was said to have ‘come out of the blue’ (as the referrer’s assessment stated: ‘he has behaved in a very violent manner, including a serious unprovoked attack, when he was apparently calm and content’). The alarm system failed; no-one else was in the unit at the time. Martin shouted, ‘Die, bitch, die!’ amongst other things during a prolonged attack. He received a Conditional Discharge for this offence and is said to have ‘shown no remorse’. Martin’s original sentence was almost over. The staff team was inclined to keep him on, feeling him to be both a risk and at risk. Our recommendations would matter. Three assessments accompanied the referral – one prepared for the original court case and two others compiled very recently, patently arising from the crisis of the attack. ...
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Copyright: Allt material ©
MELLANRUMMET 2011-10-29 |
Ann
Horne trained as a child & adolescent psychotherapist in the
Independent, Winnicottian tradition at the British Association of
Psychotherapists. She is a member of the Scottish Institute of Human
Relations and an honorary member of the Czech Society for
Psychoanalytical Psychotherapy. This paper appears in Horne, Ann &
Lanyado, Monica (eds.) (2009) ‘Through Assessment to Consultation:
Independent psychoanalytic approaches with children and adolescents’,
London: Routledge (pp.110-124), and is reprinted in amended form with
permissions from the publishers. The author explores the unique
perspective that psychoanalysis and psychodynamic theory gives to our
understanding and technical approaches to work with violence and how
consultation from such a theoretical base aids colleagues who have to
care for and treat violent adolescents.
