This paper is in a sense a summary of everything I had thought and written up to this point: it is also a statement about the Mulberry Bush School and the people who worked there during an important period. I found this a difficult paper to write (I read the communication in its original form to the Hampstead Child Therapy Clinic): several years passed before I could clarify and arrange the material for publication – I was too emotionally involved to find this an easy task. Had it not been for the skill and endurance of Mrs Elizabeth Irvine I am sure it would never have reached its final form: at which point the paper was published in the ‘Journal of Child Psychology and Psychiatry’.
Winnicott (1958) and others (Little,1960) have postulated a primary state of unity of the mother and her baby. In thinking about emotional deprivation I find it necessary to take as a starting point this state of unity at the very beginning of a baby’s life. Freud (1926) wrote:
For just as the mother originally satisfied all the needs of the foetus through her own body, so now, after birth she continues to do so, though partly through other means. There is much more continuity between intra-uterine life and earliest infancy than the impressive caesura of the act of birth allows us to believe.1
In the course of normal development the separating out of mother and baby is a long and gradual process; at the completion of which the baby exists for the first time as a separate being and an integrated individual, absolutely dependent on the mother, but no longer emotionally part of her. If integration of the personality is to take place (usually by the end of the first year of life) the evolution of this process must not be interrupted. Interruption of this essential process, which mothers and babies work through together in their own time and in their own way, is in my view the trauma which lies at the root of the various types of cases of emotional deprivation referred to us.
The point at which traumatic interruption has taken place determines the nature of the survival mechanisms used by the child: the primitive nature of these mechanisms does not prevent them from being used in a highly complex manner. Winnicott (1963, p. 53) has said:
‘All the rest of mental illness (other than psychoneurosis) belongs to the build-up of the personality in earliest childhood and in infancy, along with the environmental provision that fails or succeeds in its function of facilitating the maturational processes of the individual. In other words, mental illness that is not psychoneurosis has importance for the social worker because it concerns not so much the individual’s organised defences as the individual’s failure to attain the ego-strength of the personality integration that enables defences to form.’
The emotionally deprived child is pre-neurotic, unable to experience guilt or anxiety, and functioning at various primitive stages of development. For a neurotic child there may have been inadequate continuity between the intra-uterine and postnatal phases, but nevertheless he has enough protective and protected environment to make it possible for him to build a separate personality structure, capable of integrating good and bad experiences and his responses to them rather than being helplessly buffeted by them. He is thus able, having reached integration because of ‘good enough infant care’ (Winnicott, 1958, p. 212), to embark on the long voyage of secondary experience. This is not true of the children under consideration here.
The children we select for treatment fall into several categories, depending on the stage at which interruption of primary experience took place.
The most primitive of these categories, that is to say the least integrated, is made up of those whom I have described elsewhere as the ‘frozen’ children who have suffered interruption of primary experience at the point where they and their mothers would be commencing the separating out process, having been as it were broken off rather than separated out from their mothers. They have survived by perpetuating a pseudosymbiotic state; without boundaries to personality, merged with their environment, and unable to make any real object relationships or to feel the need for them.
Such a child must be provided with the actual emotional experiences of progression to separating out; thereby establishing identity, accepting boundaries, and finally reaching a state of dependence on the therapist. This kind of child cannot symbolise what he has never experienced or realised. (A ‘frozen’ child, on referral, will steal food from the larder because he wants food at that moment and for no other reason. The same child in the course of recovery may steal again from the larder, because his therapist is absent; this stealing will now be symbolic.)
The next category consists of those who have achieved the first steps towards integration; so that one could describe them as made up of ego-islets which have never fused into a continent – a total person. For this reason we call them ‘archipelago’ children. These children give the impression of being quite mad whenever they are not being quite sane. They are either wildly aggressive, destructive, and out of touch in states of panic-rage or terror; or they are gentle, dependent, and concerned. They present a bewildering picture till one comes to know them and to understand the meaning of their behaviour. They too need to progress through the process of integration. However, these stormy children are not so difficult to help as are ‘frozen’ children; because the presence of ego-islets amid the chaos of unassimilated experience makes life more difficult for them. They are, from time to time, very unhappy and aware that they need help. The fact that some primary experiences have been contained and realised results in their having a limited capacity for symbolisation, which facilitates communication of a symbolic kind which is not available to ‘frozen’ ones. Where ‘frozen’ and ‘archipelago’ children are concerned, treatment must involve the breakdown of pathological defences, containment of the total child, and the achievement of dependence on the therapist as a separate person. These two groups, in which integration has not been sufficient to establish a position from which to regress, are very different from those in the next category.
Classifying the ‘false-self’ organisations, Winnicott (1960, pp. 142-3) writes:
‘At one extreme: the false-self sets up as real and it is this that observers tend to think is the real person. In living relationships, work relationships, and friendships, however, the false-self begins to fail. In situations in which what is expected is a whole person the false-self has some essential lacking. At this extreme the true-self is hidden.’
Having described other types of false-selves advancing towards health, he continues:
‘Still further towards health: the false-self is built on identifications (as for example that of the patient mentioned whose childhood environment and whose actual nanny gave much colour to the false-self organisation).’
The latter organisation he has described as the ‘caretaker-self’ (Winnicott, 1960). This elaborate defence takes various forms, and is often difficult to recognise, especially because the ‘little self’ part of the child is carefully concealed by the caretaker (for example there may be a delinquent ‘caretaker’ which steals without conflict, on behalf of the ‘little-self’).
The first two groups, that is to say, the ‘frozen’ and the ‘archipelago’ children, do not adapt to demands in the way characteristic of false-selves and caretaker-selves. This is one of the reasons why they prove unmanageable in most residential settings; there is no real little-self to be protected, but there is an embryonic ego capable of evolvement in a containing environment. Both false-self and caretaker-self groups need to regress to the point where development originally came to a standstill, often reaching a state of psychic fusion with therapists, from which they can advance once more to a more adequate integration as whole people.
I think of all these children as pre-neurotic (only integrated people can contain guilt and anxiety). They employ a variety of survival techniques, such as I have already described, which one may perhaps distinguish from defence mechanisms because of their primitive nature. One factor seems common to all: the experience of interruption of an essential illusion (Winnicott, 1958, p. 237), namely the mother-baby unit of the immediate postnatal period, due to premature failure by their mothers or other substitutes in adapting to their needs during the first year of life. With this failure of the containing environment, they have been driven to shoulder the load of their separateness before independence could be achieved. The point at which this disaster has befallen them will determine the means of survival at their disposal.
Such failure can come about in many ways: for example, one mother may be unable to remain preoccupied with her baby for sufficiently long; another may be able to have an initial fused experience with her baby, but can only separate out by withdrawing concern; there may be actual separation of mother and baby, as described by many authors; or again, the father, who would have been the normal protector of the vulnerable unit, may have died or departed.
HANDLING OF THE CHILD
My thesis is that all these groups of children require the provision of primary experience which has, so far, been missing from their lives. There is no question of ego support at such a stage of treatment: the therapist, like the mother of an infant, must provide the total ego of organisation until integration makes it possible for the child to establish his own ego.
The mother normally shares with the newborn baby an illusion that they are part of each other; this fragile illusion is protected by a ‘barrier against stimuli’ (Freud, 1922, p. 33) provided by the father and other helpful members of the household. What is real in this earliest phase is the perfect or near-perfect adaptation which the normal mother makes to her baby’s needs. Disillusionment follows in the natural course of events, through the gradual failure in adaptation and consequent realisation of separateness by both mother and child. All the children I have described have been exposed to some failure of this illusion at the outset of life, and therefore need to experience it, belatedly, before they can develop further.
Our task, then, is to provide such illusionary experience; by which I mean something felt in a here-and-now context which enables the child to make use of symbols in a way that he can fill in the gaps which have till now made continuity of experience impossible. We must provide this in a way which will feel real to ourselves and the children in our care; we can achieve this only by making perfect (although of necessity localised) adaptations to their individual needs. Perhaps this is akin to what Sechehaye (1951) describes as giving the psychotic child ‘symbolic realisation’.
The essential point is that one should be there to meet the child’s indications of possible areas of adaptation, much as Winnicott (1960) describes the mother meeting the baby’s spontaneous gesture. (It would be no use at all for us to think about and decide on an appropriate adaptation for a particular child.)
One day, for example, I was walking down the street with Marguerite. At the time I describe she was ten years old, and had come to us with an elaborate caretaker-self organisation made necessary by early and traumatic separation from a very disturbed mother. Just at this moment she was emotionally exhausted and in the deepest part of a localised regression in which she was involved with me. I remember thinking, ‘If she were really a baby, I’d pick her up and carry her home – as it is, what can I do?’ As if in answer to my thoughts, Marguerite laid her hand in mine in a way that made it clear that in carrying her hand I would be carrying Marguerite herself. In this way she made it possible for me to provide the necessary experience.
It is essential in this kind of work that the therapist should support the child in such a way that the latter has a complete experience. This will not symbolise any previous experience, although it will be symbolised later, following realisation. This experience must be felt as real, and worked through by child and therapist so that eventually the child is able to face and verbalise even the reality of his original deprivation, and to know that nothing can be done about this in objective reality. In order to achieve this, the pain and disillusionment must have been endured by both child and therapist; the former can only tolerate this in the context of a relationship based on complete experience. (The precise nature of such an experience depends on the individual emotional history and needs of each child.) I can illustrate incomplete experience in this sense by referring to that of an isolated child in a rage who eventually falls asleep from sheer exhaustion: the corresponding complete experience is that of a child who is supported through such a rage by his therapist, so that eventually he can be comforted and settled; he can go to sleep at last because he is ready to do so.
Perhaps one might say that in this sort of treatment ‘the complete experience’ may have to take the place of ‘the correct interpretation’. It is impossible to interpret, because there cannot be symbols of a missing experience. This can be seen clearly in the connection of panic fears, panic rages, and panic despairs: the child needs help to go on to the end of the panic so that the experience can be completed.
The essential characteristic of panics which are so typical of these children is incompleteness – in much the same way that a nightmare is incomplete because the dreamer awakes from an unfinished dream. When the dreamer can complete the nightmare and then awake, it will become a bad dream; similarly, when the child in a panic completes the rage, terror, or despair and survives, the panic becomes a bad experience which can be contained, tolerated, and stated.
Babies imaginatively create their own mothers in terms of their individual needs (as described by Winnicott, 1958, p. 238). In the same way pre-neurotic children imaginatively create their own therapists. Both babies and the emotionally ill children I am describing here, follow this creation by annihilation, and then create once more. Only if this process can be tolerated again and again can the next stage be reached, when the objectively real baby can find the objectively real mother.
I remember how individual were the needs of our own four babies. My own experience with each of them was also quite different; they have evolved into four very different people; and I know that subjectively they had, as babies, four different mothers. (Maybe they were also four different babies to begin with; there is much evidence of temperamental differences at birth.)
Vanno Weston, one of the teachers at the Mulberry Bush, had a nine-year-old girl called Pat in her group who expressed this very well. Pat said; ‘At the home where I was before I came here, there were all of us children and the grown-ups who looked after us; here is my group and all the Vanno Westons!’
There is nothing traumatic for the therapist to endure in the process of being ‘created’ by the child: on the contrary, this is a happy experience; obviously the risk of seduction and anti-therapeutic collusion is great in some cases. Very different is the experience of ‘annihilation’, which is so primitively destructive that one cannot talk about anything as personal as hate in this connection, and must be endured if treatment is to succeed. The child simply ‘wipes out’ the therapist; the therapist has to feel wiped out, rather than defend himself against the child. An interpretation in such a context becomes a defence, because it asserts the continued existence of the therapist. A common form of annihilation is for the child to cut off all communication with the therapist. For example, Robert, in this situation, said to me: ‘I’ve had more than enough of you – I’m fed up with you’, and did not come near me for a week. I did nothing about this, because I knew that he had wiped me out. When he returned, he re-created his illusionary me in a slightly different form, and we continued to work together.
Annihilation cannot be planned, any more than can creation; it must simply be endured as what it is felt to be, in terms of the involvement. Presently the child will re-create the therapist once more, because now he is ready to do so; but there will be pain every time annihilation takes place, which may be frequently. Once some degree of differentiation has been achieved there will be the gradual appearance of ambivalence, and now there can be real personal hate in the relationship. None of this can be organised, but providing one is prepared to go through this sort of experience with the child, the phenomena I have described will turn up in good time.
THE THERAPIST AND PRIMARY EXPERIENCE
Much time and patience may be needed before a state of involvement can be reached. There are long periods when we must contain the child within the therapeutic environment of the school, waiting for the beginning of processes like those I have described. In the meantime, we do our best to ensure that those areas of personality which are functioning continue to do so. For example, the occasional child who has no learning problems should not lose ground educationally, although he may be a case of school phobia. He continues his education either through special teaching in a group, or if necessary, through individual tutorials. Marguerite (mentioned above) was able to keep her regression with me localised in this way, continuing her everyday life fairly normally; her education was seldom interrupted.
It will be remembered that caretaker-selves and false-selves need to regress before they can progress healthily, but that ‘frozen’ and ‘archipelago’ children must progress from the start. The first two groups have reached a point from which to regress, the second group must advance to integration, because they have remained either unintegrated or only partially integrated. The progression of an unintegrated child presents greater problems of management, because he does not feel in any way inadequate. He lives entirely in the present; there is no past to make him guilt-conscious, and no future to create anxiety. In the course of progressing to integration this kind of child finds himself unable to function in any field; having abandoned his delinquent survival techniques he feels utterly helpless, and goes through a phase of anaclitic dependence, during which he needs very special care.
John (aged ten years, a ‘frozen’ child who had reached this state) was dependent on Mildred Levius. He found her absence intolerable and talked about this to me, complaining of his feeling of emptiness. At this point it was possible for Mildred to establish adaptations as indicated by John; one of these was a reliable supply of sugar lumps, another was a special sort of reading tutorial combined with a tea in the staff house. John was able to count on this steady provision, and to replace desperate demands with hopeful expectations.
Lynn (aged seven years, a child in Mildred’s group who seemed to have a caretaker-self) had needed for some time a little walk after her lesson group. During this walk, at intervals, she needed Mildred to hold her upside down-virtually on her head. Now, at a slightly later stage, she needed to be brought the whole way round, so that the experience was completed with Lynn on her feet again.
Robert (aged eleven years, a child with a caretaker-self) acquired the nickname of ‘Bedstead’, and in my talks with him he gradually allowed me to meet his little-self, which I suggested could be called ‘Cotstead’. The caretaker part of Robert, the Bedstead part, was severe and harsh: during one of our talks he was able to explain to me that his ears and hands belonged to little Cotstead – that Bedstead had no ears or hands. However, much as we all tried to help Robert, he was unable to have the regression which he so badly needed; until finally in Mildred’s group Bedstead handed over the care of Cotstead to Mildred. Robert managed this by building in his lesson group a model, which he called his ‘four-poster bed’ (this was also Mildred). His hand could be tucked up in the four-poster, and Mildred could look after him. The savage Bedstead caretaker almost disappeared, and Mildred took care of a very small Cotstead, who was at last able to begin to learn (to be ‘fed’).
I have spoken of four groups: the ‘frozen’ ones, the ‘archipelago’ children, the caretaker-selves and the false-selves. I now wish to discuss these groups and the various living-in treatment approaches they need, in more detail.
Provision for ‘frozen’ children
For a ‘frozen’ child who has not integrated, the most important experience to be provided will be the achievement of separateness and the establishment of boundaries to his personality. This is a slow and gradual emotional experience in normal development (just as weaning needs to be slow and gradual); whereas in the case of the ‘frozen’ child, separating out has been sudden and traumatic. The ‘frozen’ child will have survived by preserving the illusion of unintegration, using merging instead of dependent leaning. Because such children have never arrived at the point of disillusionment and acceptance of separateness as individuals; they are perpetually struggling to remain fused with their environment, which, because they have not achieved integration, seems to them to be a normal state of being.
Interruption of mergers with adults or children produces suicidal panic. I have written at some length about ‘frozen’ children elsewhere; here I only want to stress that we have to replace the illusion of being merged with someone else by the experience of finding – as it were – the boundaries of the self.
Peter (a charming, violent little boy of six years) tried for two hours to draw me into his panic rage, as a form of merger. I sat holding on to his hand, while he whirled about on his bed; biting, kicking and clawing me, and shrieking obscenities. This behaviour gradually gave way to isolated statements: ‘I know I’ll be dead by the end of this…’ and ‘Soon you’ll be in a rage too…’ and ‘I know you’ll be so scared you’ll leave me in the middle, and I’ll kill myself…’. I suggested that what he did not know was that he really existed, and had really been born; I also existed and had also been born; because of this we were both real people. I told him that I was not going to leave him to destroy himself; that it was safe to attack me and that I would not allow him to destroy me either; that I valued him; and that I would stay until he was through his terrible ordeal and out on the other side. (These comments I made sometimes in lulls, and sometimes at the top of the storm, when I had to shout to be heard.) Suddenly Peter asked: ‘Like the other bank of the Thames?’ I agreed that it was just like this.
We spoke about the Thames again a few minutes later, and I said that I thought that up to date he had been swept along by the current downstream towards the sea, but that I was asking him to swim across the current: that I knew how hard this was and what a struggle he was going through, but only by doing this was he going to find the other bank for himself, and prove to himself that it really existed.
I suppose that in classical analysis this would be regarded as reassurance made for the analyst’s own benefit, but here was a statement of a primary experience which I made to the child because it needed to be verbalised.
At the end of a two-hour ebb and flow of panic rage, Peter was suddenly able to tell me – by now he was gasping for breath – that he was all right; would I wrap him up and feed him? He said, ‘I am so thirsty.’ I wrapped him in a blanket, in which he curled up exhausted but relaxed; I brought him a whole jug of warm milk, of which he drank every drop. I think that at this moment he established his body ego. Two months later he achieved dependency and a depressed mood.
Provision for ‘archipelago’ children
Provision of primary experience for what we call an ‘archipelago’ child is somewhat different, even though he must also progress to integration.
As I have already said, there are ego-islets which in normal development would gradually fuse into an established ego. In the case of an ‘archipelago’ child the break in development has taken place at the point where the baby was in the process of separating out, but where only some localised integration had taken place. The resulting ‘archipelago’ stage can give the appearance of disintegration, but in fact it is in an early stage of integration and needs very special provision.
When we first knew Anthony he was on the one hand, the gentlest and kindest child, and on the other, the most destructive that I have ever met; the swing was from one moment to the next. Anthony’s father had left home for ever when the mother-child unity still needed total support. Anthony said to me later in treatment, ‘Poochie’ (our little dog who had puppies at the time) ‘is fed and looked after, so that she can look after her puppies. It would be awful if she had to leave them to go and get food for them – there needs to be someone to look after her and her puppies.’
Where Anthony was concerned, the whole team had to work together; each person making contact with whatever bit of Anthony could be reached at that particular moment in each context and by each person. My husband spent six hours sitting on the end of Anthony’s bed one night because the child had asked: ‘Will you stay till I go to sleep?’ and he had answered ‘Yes’.
Faith King took him to see the swan family on the River Windrush, and their talks together about the swans helped him to understand his own and his mother’s problems. Vanno Weston gave him a purple sweet each morning. Joe Weston brought him an orange in bed each night. I had sessions with him ‘on demand’, which usually meant two or three times a week, when Anthony communicated with me in terms of a saga concerning a little mole lost in a labyrinth.
Between such episodes there was no continuity; Anthony would fly round the school attacking other children like a whirlwind, throwing furniture about, smashing windows and screaming abuse at us – quite out of touch with reality. However, the ego-islets began to grow; a nucleus of ego was formed, the areas of havoc became gradually more limited, until within a year of his referral to us Anthony became a more or less integrated person.
I must add one more note about Anthony in connection with the purple sweet. Each child in his group had a special sweet each morning from Vanno Weston, whom her group called Vanno Sunshine because of her warm smile. Anthony’s sweet, as I have already mentioned, was always a purple one. Richard, another child in the group, said one morning: ‘I want a purple sweet!’ Other members of the group said at once: ‘Well, you can’t have it because Anthony always has the purple one.’ Richard sighed and settled for a pink sweet. Anthony was standing in the window through which the sunlight was pouring, holding up his purple sweet against the light. He had, however, noticed what had happened, and called to Richard, saying: ‘Come and hold up your sweet and let the light come through it like I’m doing!’ and when Richard did so Anthony said to him, ‘All the sweets look the same when sunshine comes through them.’
This piece of communication not only showed us Anthony’s use of symbolism, but also his newly found capacity for empathy.
Provision for false-self children
James, who came to us with an adapting façade of good manners, obedience and charm, behind which was tumult and confusion, had been through a period of regression with Faith King and was at the start of synthesis. One morning he asked Faith for a piece of buttered toast at the end of staff breakfast. Faith provided this at once, recognising an appropriate form of adaptation which could be maintained without too much difficulty. James in fact continued to need his piece of buttered toast from his therapist for about eighteen months. Only Faith herself could make this adaptation, and reliability of provision was essential, this continuity having been absent in his babyhood. By the end of the eighteen months he no longer needed the adaptation, and at the end of three years he reached some degree of integration, albeit rather fragile.
Provision for caretaker children
Marguerite, describing her babyhood experiences, said: ‘…the wind blew, the bough broke, the cradle fell. …Why did the mother leave the baby in a cradle on a weak branch? Why didn’t she notice the wind rising? Indeed, she felt that it was only she herself who had taken care of the baby.
She was the first child with whom I attempted a localised regression within the Mulberry Bush. (I had brought children through total regressions in my private work, under very favourable conditions.) The journey down to the bottom of the regression, where the caretaker handed over to me and I was allowed to look after the very small baby – and the synthesis which followed, took about a year to achieve. My provision for her needs consisted of giving her a short session each day; in the course of which she slowly introduced me into her inner world. She described to me in detail a country at the bottom of the sea, where Jane Hook the pirate’s daughter (the delinquent caretaker) and the shrimp (the little-self) lived with the Shaking-hand-fish (myself at the Mulberry Bush) and the Holding-hand-fish (myself alone with Marguerite) in a shell built by the fishes and Jane Hook.
I had to gain the confidence of the caretaker part of Marguerite, so that I was allowed to help to take care of the little-self. At the bottom of the sea, the Holding-hand-fish and the Sharking-hand-fish helped to take care of the shrimp until the caretaker part of Marguerite was able to hand over to me altogether, and the newly integrated Marguerite became wholly dependent upon me for a time. She told me about this in terms of Jane Hook leaving the shell house and allowing the fishes to take over the shrimp.
I find that this kind of communication provides me with the means of making adaptations in a reliable way. I have to be very careful not to be tempted into making interpretations which would be irrelevant or even damaging because they were premature. As a fish I could say all sorts of things to the shrimp which as a person I could not yet say usefully to Marguerite, who was all the time realising and symbolising her experience in her own way.
I used no interpretation in the ordinary sense, at this stage, but really lived through this experience with her. Much later, when the shrimp had become completely dependent on the Holding-hands-fish, Marguerite used to trot behind me whenever I went to the Mulberry Bush, holding my hand, which I had to leave ready behind my back for her to take while doing all sorts of other things around the school. I also bathed her on Sunday evenings (this was when I always worked at the Mulberry Bush in some kind of practical way).
I was able to gain her very troubled parents’ co-operation, without which treatment could not have been successful.
During the regression there was a disaster when I was away for a few days, and the shrimp shrank to a dot. There was another crisis when it fell into its bowl of porridge head first; no help could be obtained because the fishes had not installed a telephone. Annihilation came into the picture: Marguerite (in the Mulberry Bush) cut off all communication with me, and the shrimp announced that the fishes had gone for ever from the shell house and could never return. Of course from Marguerite’s point of view she could really annihilate the fishes – one of the advantages of being prepared to work at the bottom of the sea! Later she recreated myself and the fishes with slight variations.
Eventually came the next great step, when Marguerite told me that the shrimp had grown too big for the shell house, the fishes and the porridge, and was leaving the bottom of the sea. The fishes helped to launch the shrimp, and Marguerite left the Mulberry Bush to go to a boarding school for less disturbed children.
On her last visit to the Mulberry Bush, Marguerite told me that the shrimp had just broken an antique jug which it had owned for years. I said that I felt the jug had served its turn, and could now be safely broken because it was no longer necessary. Later in the session Marguerite said suddenly, ‘Why don’t I feel you are special any more? Why, you are just Mrs D!’. Disillusionment was complete, and I pointed out that now she was really Marguerite this meant that I could be really Mrs D. She replied with a little sigh… ‘We will still know each other, but it will be different…I suppose we will be friends!’
PROBLEMS FACED BY THE PROVIDERS
I want to say a little in conclusion about some of the difficulties faced by the treatment team – the providers.
When an adult becomes deeply involved with a child, both of them are naturally highly sensitive to the impingement of others on their relationship. We have evolved a plan for this stage of treatment which we call ‘trio therapy’; in this the adult-child involvement is supported by a third person, whom we call the ‘catalyst’. The function of this third person is something like that of a father in supporting the mother-baby unity. The provision of this support has proved an emotional economy, and has enabled treatment to proceed much more rapidly than has hitherto been possible. From the child’s point of view, for example, when his own therapist is away the ‘catalyst’ will help him to tolerate this separation and to understand his own rage and misery in this situation. The therapist on the other hand, taking much-needed time off, is liable to feel rather the same as the mother who must at times leave her baby in the care of someone else. This ‘mother substitute’ must be known and trusted by the mother; in the same way, the ‘catalyst’ must be known and trusted by the therapist.
It will be realised that the therapist providing primary experience in a residential unit faces rather special difficulties. It is clear that any one worker can only go through this process with a limited number of children (in ten years I myself have helped twenty ‘frozen’ children to integrate). It is not possible to have more than two or three children going through the first phase of treatment at the same time.
The child will come to know the worker as he or she really is, rather than what the therapist hopes to be like. Such insight can be very painful, and is unavoidable in a context in which the child will be aware of so much – not only of the loved grown-up at his best, but also at his exhausted worst!
The therapist making this provision must face the fact that what can be provided is not only illusionary, but also inadequate, because the experience has to be localised, and because the relationship will inevitably be disturbed by the behaviour of other people. Above all, there is the fact that the therapist, however devoted, is not the child’s own mother. The therapist will also be having an illusionary experience; in an involvement with a child such an experience – so like that of a mother with a baby – can seem very real. It is true that the therapist will have insight, and the support of the ‘catalyst’, but there is no ‘barrier against stimuli’ like that provided by the protection of the father and the home. On the other hand, the therapist will not be hampered by the load of guilt and anxiety felt by the mother of a disturbed child.
The particular emotional problems faced by the therapist who is thus involved with a child are, however, presumably to some extent the problems which would turn up if he or she were actually a parent. For instance, the integrated child may not grow up, as the therapist would hope, into a normal person making satisfactory identifications. The therapist’s adaptations cannot be ideal and there will be limits to his capacity for involvement. For the child there are the early years of emotional deprivation and traumatic experience, and there will be many external factors likely to intrude into a treatment setting which makes use of the total environment. This is a difficult and painful realisation, because of the amount of love and care which the therapist has given to the child.
The ‘catalyst’ supporter plays an important role in helping the therapist to tolerate these painful insights, even being prepared when necessary to impinge into the involvement, when separating out is unduly prolonged, and there is a danger of involvement turning into collusion; just as the father in a family would impinge into the mother-baby unity if he felt that it was becoming too much of a good thing. On the other hand the ‘catalyst’ will be in a position to support the therapist; for example, in assuring him that the current failure in adaptation is not in fact a final catastrophe for the child, that failing is not ‘letting down’.
Usually it is a sound plan for the parents to take over the child at the stage where integration having been established, secondary experience comes into the picture. Often parents who have been unable to make adequate primary provision can successfully meet these later needs; the child may well transfer the image of the ‘good therapist’ on to the parents. We hear of this from parents and children subsequently, which is of course interesting information to receive; we also have the opportunity in some cases of watching a similar development at the Mulberry Bush, especially in deprived children whom we dare not risk sending into a new environment, however favourable, during such a critical period. The usual practice is for the deprived child to move gradually into another group. The relationship established with the new therapist will be secondary experience, a transference largely based on the primary experience with the first therapist; just as in analysis the transference to the analyst will be fundamentally based on the original experience with the actual parents. This move presents emotional problems for the first therapist; it is no easy task to hand over, however gradually, the child with whom there has been a deep involvement, but final separating out is essential for recovery.
Through my weekly individual and group discussions with the team, I have found that certain insights which we have gained together have been of value at these difficult moments.
A devoted mother, I have said, gives her baby a splendid start in life, but there are likely to be areas in which she may be inadequate because of her own personal difficulties; we are likely to fail for the same reasons. She must comfort herself with the thought that her husband, members of her family, friends, teachers and others will make up for her inadequacies. We, as providers, must console ourselves with the same reflection, and be able to let the child make good use of our failures.
A fear which has often surfaced in discussion is that the primary experience provided by the first therapist will be given away by the child to someone else. This fear is not well-founded, because it will not be the good complete illusionary experiences which will be transformed; these will be incorporated, they will really be part of the child by this time. Understanding of this makes the transfer of the child to another group more tolerable for the first therapist.
We should be glad, I suggest, if the child can find what we have not been able to give him with someone else at the Mulberry Bush, at home, or in a clinic later on; it is because of our emotional inadequacies that the child is needing compensating experience, just as the little child starting school (for example) may often find with his first teacher experiences which will compensate him for shortcomings at home.
Finally, it would seem to me that in any unit containing pre-neurotic children with a treatment team there will be providers, consumers (the children) and supporters (a provider in one situation at one moment may be a consumer or a supporter in another context). The balance struck at any time between provision, consumption and support will determine psychic equilibrium within the unit, and consequently the extent to which primary experience will be available to the children in treatment.
The need for the provision of primary experience in the course of residential treatment of certain deeply deprived children has been considered in the context of therapeutic work in a boarding school for maladjusted children. The nature of primary experience and means of providing this have been discussed. A distinction has been made between the needs of such children before and after integration as individuals. Some of the special problems faced by the therapeutic providers of primary experience have been noted.
1. This quotation also appears at the beginning of ‘The residential treatment of “frozen” children’. It seemed more useful to repeat it in full, rather than to refer to the earlier paper.