Psychotherapy with Severely Deprived Children

Psychotherapy with Severely Deprived Children

Psychotherapy with Severely Deprived Children

Psychotherapy with Severely Deprived Children


This study describes the experience of severely deprived children referred for individual psychoanalytic psychotherapy. Most were living in children's homes, all came from chaotic and disrupted families, and many had been abused or neglected. Children from such backgrounds have previously been considered unsuitable for psychotherapy, and the theorectical and technical issues arising from their treatment are discussed here, and detailed case material is presented.


Since this book was first published, some of the contributors have moved on to develop their work further afield, but the study of severely deprived and abused children has continued at the Tavistock Clinic and has been extended to include adopted children and their families. There have been changes in the child care world; children's homes have closed; many more referrals are now in foster or adoptive families. Much more attention is now paid to ethnic and cultural matching in placements.

Sadly, however, in spite of efforts to provide greater continuity for children in care, this is by no means always achieved in practice. The placement breakdown rate is still high (Berridge & Cleaver 1987). Substitute families are often struggling to cope with the enormous difficulties of parenting disturbed children. Many current referrals are being made when a placement is reaching the point of imminent breakdown, or may be at the end of a long succession of similar crises, sometimes including a return to a children's home, where these still exist. Pressure on long term foster families to adopt sometimes precipitates collapse. Even adoptive placements "disrupt".

The pain and distress of such events for all concerned has not changed. The insight into the inner worlds of the children described in this book is just as relevant today as it was seven years ago. As a society we have recently become more aware of the life long emotional damage which physical and sexual abuse, as well as emotional deprivation, can inflict on children. The need of these young victims for help in order to heal the damage they have suffered is now more widely recognized as urgent if the cycle of abuse and deprivation is not to be the bitter inheritance of yet further generations. The following pages describe one approach to the treatment of this vulnerable group of children.

Follow up and research

How have the children described here fared since stopping psychotherapy? Closures of children's homes, changes of social workers, loss of contact since leaving care all create enormous problems for follow up, so the information we have to date is patchy. In the case of Bobby (Ch. 1), all the people in the supporting network left soon after his therapy finished. The new house father, who knew nothing of Bobby's having had therapy, reported him to be 'quite different from the other children and much more responsible'. Bobby himself told a visiting psychotherapist that therapy had made him 'easier to live with', adding, 'I used not to like milk but I like it now'. Five years later, he told the psychotherapist of another seriously asthmatic child. 'I used to have asthma, but I went to a lady'.

Our expectations for the outcome of the most damaged, institutionalised children were never very high. Eileen (Ch. 3) managed for a time much better than anyone thought she would, making the transition from school to work. She seemed to go downhill when the children's home closed and she was put in a flat with her brother. She was re-referred at 23, pregnant, not thought to be able to look after the . . .

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