Living in a storm: an examination of the impact of deprivation and abuse on the psychotherapeutic process and the implications for clinical practice.

Many deprived and abused children living in the care system have had life experiences that
have pushed the boundaries of their knowledge, endurance and ability to cope to the limit and
beyond. Psychotherapy with these children can be very stressful and the 'ordinary
acceptable environment' (Hartman 1939) can be replaced by an environment of extreme
threat and hostility. The normal boundaries of work may be questioned and the normal
structure of psychoanalytic technique may be difficult to maintain. The aim of this research is
to examine how these children and young people present in the consulting room and the
impact this has upon clinical practice.
In this study I describe in detail my work with five children, each with a history of abuse and
deprivation and living in foster care. These children present extremely problematic behaviour
which is difficult to manage and understand. I describe the psychic reality of these children
and explore the difficult process of bringing about psychic change.
When working with these children it is necessary to think about the impact of each child's
history upon his/her development. The psychotherapist's task is to provide an environment
which will enable the child to develop a more secure and flexible frame of mind in which toxic
internal representations are replaced with more benign internal representations of the self and
more benign internal object relationships. In doing this, the therapist has to simultaneously
acknowledge both the patient's separation and intrusive anxieties and has to maintain contact
with the patient, whilst also allowing the necessary distance to develop between the
therapist and the patient to enable his/her interventions to be of benefit. In trying to achieve
this task, I suggest that it is useful for the therapist to think about the therapeutic management
of the clinical process.

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