Working with Anxiety in a Primary Residential Special School

Monica Lanyado Maladjustment and Therapeutic Education, Vol 6, No. 1 (1987)

The title of this paper is deliberately ambiguous. It leaves open the question of “whose anxiety” I am referring to. Working with deprived and emotionally disturbed children can be a painful as well as a rewarding experience. In order to understand the children, it is important to understand the many conflicting feelings they arouse in the adults who work with them and to accept that the communication of their unhappiness, anger, fear and despair to these adults is necessary if they are to recover. In this paper I wish to explore the many ways in which these feelings can be expressed and the manner in which professionals work with, and respond to, them.

I am in the fortunate position of having a dual role within Harmeny School. In addition to seeing children for individual psychotherapy sessions, I am also responsible for in-service training and providing opportunities for staff to reflect on their working practice. At present this involves regular study meetings, where we discuss previously read papers on a termly theme; open staff meetings to discuss current issues in the school; and mini case conferences on particular children. Some teachers also opt for an individual time in which they can discuss their class as a group or individually. There are 22 staff at the school, comprising care staff, teachers and family social workers and it is a measure of their enthusiasm for the work that the Headmaster has been able to establish a post such as mine! 

The Children and The Staff

For many of the 36 children who attend the school, this is the “end of the line” after many different kinds of intervention in their lives which have attempted to help them, but unfortunately have not been able to reach the heart of the problem. As a result, they often arrive at the school feeling total academic failures, or rejected and abandoned by parents, or indeed a powerful mixture of both. Their life experiences are often bizarre or tragic in terms of multiple losses of significant relationships. They may well have experienced traumatic events such as witnessing or being party to physical and sexual abuse. Frequently these painful experiences have started long before they were able to verbalise and as a result are deeply embedded in their unconscious life. They are children who are prone to “act out” rather than “think about” their feelings and as such may prove very frustrating to work with at times, although clearly in desperate need.

They are essentially children who: •

• consistently find it difficult to form and maintain healthy relationships •
• chronically fail to learn much that is growth orientated from their lives’ experiences (Bion, 1962)

In terms of the total Institutional Task as related to the children and their families we have the following situation: •

• The social workers are trying to relate to parents who, due to their own childhood deprivations, find it difficult to make healthy relationships as adults. It is just this kind of healthy therapeutic relationship that the social worker is struggling to form with them, in order to help them to help their child. In this respect they are trying to enable the parents to avoid perpetuating the cycle of deprivation that they are caught in. (Fraiberg, 1980) •
• The care workers are trying to relate to children who have either suffered so many losses and disruptions in their lives that they dare not form new relationships, or who relate indiscriminately to any available adult but are unable to form deep attachments. (Boston, M. & Daws, D. 1983) •
• The teachers are trying to teach children who tend to believe that they cannot learn, or whose emotional disturbance is such that, often due to uncontrolled feelings of envy, they stop other children in the class from learning. (Henry, G. 1983) •
• The child psychotherapist is trying to help children to find their way out of blind alleys in their development so that they can healthily utilise relationships and experiences at school and at home, in order to mature.

Seen in these terms, it is clear that the staff of a residential special school have a demanding task on hand, which can be anxiety provoking in two main ways. Firstly, there is the impact on the professionals of direct contact with the powerful feelings that are disturbing each child. Secondly, there are the anxieties relating to feelings of inadequacy, frustration and anger when all efforts to help may seem to fail.

All professionals working with disturbed children want to help them to lead happier lives – not only out of altruistic reasons, but also because of memories of their own childhood experiences. These leave a very personal sensitivity to the grief and distress disturbed children struggle to contain, which reminds the adult of the feelings they struggled to contain when they were young, even in fairly straightforward childhoods. Because of this, the work is very close to everyone’s heart and has a deeply personal aspect.

The degree to which professionals are conscious of using this side of themselves and are able to separate their own personal pasts from what they observe and feel with the children, is highly significant. It is very difficult to see clearly what a child’s real experience of life is, if this perception is constantly clouded by one’s own partially unresolved childhood experiences.

In this respect, there is a dilemma. It is essential to use the whole personality to relate to the children as they are quick to detect insincerity or lack of commitment in an adult, but the children also need people who are uncluttered by their personal present and past, and who for the duration of contact with the child, can put “themselves” aside and really pay attention to the child’s communication. So how is it possible to reach a response to the child which is both sensitive and yet retains sufficient professional detachment to receive all of the child’s communications in as open a way as possible, without preconceptions?

One of the answers surely lies in professional training, but the other lies in the organisational setting and the way in which staff anxieties and needs are allowed safe expression in the furtherance of the school’s main perceived task, of helping the children. This is one of the main functions of the staff groups. The threads of children’s, staff’s and institutional anxieties are closely intertwined. I would like to illustrate and comment on these by describing a particular incident at the school, how it related to a child’s therapy, and the work that the staff group had to do to help the child. 

Background Information

When I first arrived at the school, one of the major decisions to be made was how to select the children for individual therapy. In view of the school’s therapeutic milieu, many children could be helped through the discussions with the staff and the new insights that this provided. This could potentially lead to a fresh impetus in the work and greater tolerance of very difficult behaviour.

One of the factors which was crucial in selecting children for therapy was the feeling of the social workers that the parents were particularly anxious for their child to have individual psychotherapeutic help. Some had asked about this before there had been such a facility at the school. Others had been very interested as soon as they were told that there was a psychotherapist on the staff. Their perception of their child’s need for psychotherapeutic help seemed to be related to an awareness that their child was psychically damaged due to particular events or relationships in their past. They felt very guilty about what had happened to the child and their wish seemed to be that I should help to repair the damage done, as they felt unable to do so. This perception of a “damaged” child was shared by the school staff and there was often an anxiety in common with the parents that it may not be possible to help the child.

I would like to describe the work the School is doing with a boy I shall call Nicholas. In many respects he is like so many other very explosive children with whom we all work. However, for confidentiality, I shall only give such information about him as relates to the points I am trying to illustrate.

Nicholas was referred to the school, aged 9, because of his disobedient, disruptive and violent behaviour at home and at school. His mother had a very deprived childhood. She was the youngest of seven, her mother died when she was 6 years old and her father when she was 9 years old. She was briefly cared for by a relative but was then in a children’s home followed by Approved School. She had Nicholas when she was 16 but didn’t care for him during his first year, letting a relative look after him. She now has four other children and is a much more competent mother but feels guilty about the first year of Nicholas’ life and another period when her own problems were so overwhelming that she again let Nicholas be cared for by relatives. Her present marriage, which has lasted for five years, to a man who also had a very troubled adolescence requiring residential treatment, is a mutually supportive relationship. Two of the five children are of this marriage and Nicholas’ stepfather is responsible and caring towards him. In many ways both of Nicholas’ parents have come a long way in the face of very difficult childhoods.

Shortly before Nicholas’ admission to the school, he told his mother about an ongoing sexual relationship with his paternal aunt whom he saw when he visited his natural father for weekends and holidays. This had lasted for approximately two years and shed an entirely new light on Nicholas’ disturbance. He had also been sexually interfered with by an 11 year old girl, Ann, when he was 5, an incident that his mother had known about at the time. In addition to this, he had witnessed and been victim of violence from a man with whom his mother lived for a while, between her two marriages.

I decided that I would see Nicholas once weekly for individual therapy. As we were prepared for Nicholas possibly being upset at the end of sessions, we arranged a time which would mean that his key care worker would be available to him when he left me. There are several main themes in Nicholas’ therapy which lead up to the incident that I wish to describe, in terms of the whole school setting. 

The First Therapy Session

Nicholas’ first session with me was characterised by a manic denial of any anxiety about being with me. We got involved in a highly energetic ball game, rather like squash without rackets, which appeared to be serving the purpose of keeping me so busy that I wouldn’t have the chance to get anywhere near Nicholas physically, emotionally or in thought. Here is an excerpt from my notes. We were about half way through the session at this point.

ML “You seem to find this game very exciting.”

N “Yes, it’s great.”

ML “But I can’t help but feel that you’re also a bit scared of what I might say or do if we stopped playing ball.”

N “Maybe – but this is great. I like having someone to play with, I’m sometimes lonely.”

(We were playing ball mostly, and talking intermittently at this point in the session.)

ML “So there’s an excited Nicholas, a lonely Nicholas, a playful Nicholas, an angry Nicholas and also I think a frightened Nicholas who has to keep me well away from him.”

N Almost in confirmation of this he accelerated the ball game and asked anxiously, “How much longer is it now before we stop?”.

Many thoughts and feelings were going on in me at this point in the session. I was highly aware of a sexual quality to his excitement over the ball game. I was also conscious that for him to be alone with a playful woman was potentially a sexual experience, which was also extremely frightening. He was strongly attracted to me in an alarming confusion of a normal childish wish to play and an abnormal sexualised child-adult excitement. With hindsight, there was already an air of sexual seduction about this first session. Nicholas was showing me that he was a lonely little boy who loved playing but due to past experience had found a significant part of this playfulness in a sexual relationship with an adult.

At the same time as exhibiting these very manic defences, I was highly conscious of gaping emotional wounds in Nicholas, which left him feeling utterly vulnerable, defenceless and open to abuse. This was the underlying anxiety and I knew that he was talking to many people in the school indiscriminately and inappropriately about his sexual relationship with his aunt and Ann. It was as if after the years of secrecy he had been blasted wide open and gone to the opposite extreme, where nothing was private. He needed help towards reestablishing emotional containment where some things were personal but not secret. I did not share all of this with Nicholas as I felt it would not be helpful at all at this point, in view of his great need to defend himself from what he would only experience as further invasion or even a form of mind reading. In addition to this he had a realistic need to know that he could defend himself from anticipated further “abuse” from adults.

Let us go back to what was actually happening in this session.

ML “It is nearly time to go back to class.”

N “Oh – but I want to play with the toys still.”

(Actually he continued a bit longer with the ball game.)

ML (I wanted to establish some boundaries to the session.) “You know Nicholas, what happens when you come to see me is private and I won’t be telling the other children about it at all. You may want to talk to other children about it, but you don’t have to.

N “But I do have to tell everyone here about Auntie Val and Ann, Mum said so.”

ML “No, not everyone. You also don’t have to talk to me about what happened with your aunt and Ann. You can use this time in the way that you want to, whatever that may be.

Nicholas got out the dolls house and furniture and started arranging toy people around home.

ML “I’m afraid we have to stop now.”

N “Can I take some toys with me?”

ML “I’m sorry, no, they belong here.”

N “Okay. Where do you keep my toys?”

I showed him his chest of drawers.

N “Can I put my drawing up on the wall?”

I showed him his envelope for his drawings and where it would be kept in his drawer of toys.

Nicholas left the session reluctantly having to accept my boundaries. His toys and drawings stay in the room; I retain what he has communicated within me and don’t blurt it out around the school; and when I say we must stop, we must stop as otherwise other children’s time is invaded. He did, however, manage to sneak a toy car out of the session which he immediately told his teacher, in front of the class, I’d allowed him to take. He asked her to look after it for him till he next came to see me.

As is so often the case, the key therapeutic issues are all embryonically present in the first session. Nicholas arrived at the next session literally armed with a wooden weapon with which he threatened me, and openly admitted to bringing in case he needed to defend himself. He has since brought many other such weapons to the room and at times has really made me quite alarmed about my safety with him, if I do not behave and speak extremely cautiously. He has, however, also left weapons with me in safe keeping and brought other small treasures for me to care for.

The car that he took was the beginning of his expressed wish to be “special” to me, over and above the other children that I saw in the school, particularly those in his class. By requesting that his teacher look after a toy which he claimed I had given to him, he was trying to make the other children believe that he could bend my rules, because he was “special”.

As Nicholas’ therapy has progressed to the present time, his distress at not being able to get the kind of “special” relationship with me that he craves and thinks he needs, has led to increasing sensitivity to rejection by me. In particular, the end of a session is experienced as me throwing him out and not caring about him, preferring to see other children, whose therapy he is intensely curious about. More often than not he becomes very abusive and threatening towards the end of the session, often leaving me relieved if he goes early, as I am myself wondering whether for my own safety and his we should stop the session. 

A Critical Incident

Two days before his eighth session, I heard about a disturbing incident in which Nicholas had been involved. His care staff, in our regular meeting, reported that Nicholas, together with another boy, had held down a girl at the school and forcibly interfered with her. It was clear that Nicholas was the main instigator and that the other boy, although he held the girl down and was curious, would not have thought of attacking her in this way. The girl was terrified that Nicholas would “batter” her for telling anyone about what had happened as he’d threatened to do so, but she was so upset that she couldn’t hide her distress from the staff.

Needless to say, the girl’s own history predisposed her to this kind of attack. Her mother and her maternal aunts had all been taken into care due to incestuous relationships with their father. The maternal grandfather cast a malevolent shadow over this child’s family life, because her mother’s way of coping with her own distress was to over-emphasise sexuality generally in a sinister, but unwittingly tantalising way. The girl’s mother had created such a taboo about sexuality, although clearly still obsessively preoccupied with its “evil” effects, that the girl was intensely curious about sex and very flirtatious towards boys. It seemed that what had started as an innocent enough flirtatious game had suddenly turned into a violent nightmare for the girl.

Naturally all the staff were also upset and concerned about what had happened as so many difficult issues were raised, not the least our feelings of guilt and responsibility in relation to the children involved. What can be learnt from crises such as these which, in one form or other, pepper the life of any institution attempting to help emotionally disturbed children? The crises may come in many shapes, for example uncontrollable violence, absconding or selfdestructive behaviour. We have to learn from them, whatever form they take.

There are practical ways in which it is possible after such an event to keep a particularly watchful eye on the children and become alert to dangers which were previously not seen as being such. The immediate situation required that the girl be comforted and Nicholas’ behaviour talked about with him in a constructive way. The care staff felt that Nicholas probably would “batter” the girl if they immediately tackled him and actually waited a couple of days to do so, during which time Nicholas smouldered with his guilt and anxiety about what he’d done. Significantly, this also gave the staff breathing space in which to think about how best to tackle him. Meanwhile, Nicholas was hypersensitive, threatening to abscond, running out of school and ready to “batter” anyone who came anywhere near him. He was extremely upset and relieved to come clean after a great deal of initial denial. He was terrified of punishment for his behaviour – his aunt was facing prosecution – and surprised when this did not occur.

When I saw Nicholas for his next regular session I was aware of seeing him in an entirely new light which, despite my theoretical knowledge of these matters, I had been blind to before. Many authors (Boston and Daws, 1983, Kempe and Kempe, 1984, Mrazek and Kempe, 1981) have pointed out the tendency of sexually abused children to become sexually abusing adults. Nicholas had also experienced physical abuse which added to the likelihood of him turning his passive experience into an active one, where violence and sexuality become fused.

What I had not expected was to see this reversal so vividly demonstrated by a sexually abused child, whilst still a child. For all his violence Nicholas is a very appealing, humorous and honest child, whom all the staff genuinely call “delightful” and whom until that point we’d all seen as a “victim”. How could one reconcile this with the violent rapist mentality that lay behind his sudden attack on the girl?

Nicholas arrived for his session with a vicious looking imitation dagger and launched straight into the ball game, which by now had a murderous quality about it, when he smashed the ball against the wall of the therapy room. I rapidly felt intimidated by the violence of his “play” with the ball which excluded me, but seemed to suggest what would happen to me if I stepped out of line. Considering that Nicholas is small for his age, and indeed only 9 years old, he was succeeding in frightening me and I could appreciate what the girl must have felt.

I was very quiet and serious, not really knowing how to respond to him and what to do with the information I had about him from the care staff. The atmosphere that my stance created in the room seemed to sober him and disarm him to some extent. He stopped the ball game and diverted to the sand. We barely talked – even less than was usual for this active boy. We stood on opposite sides of the sand tray. He made a wall between us out of sand so that on my side of the sand tray I only had a small space in which to build a sand castle as he had instructed me. He also built a sand castle in his much larger area of the sand tray. When his sand castle wasn’t as good as mine, he wanted to swap sides – and changed the position of the wall as well, so that I still only had a small section of the sand tray. The effect was to keep me well away from him.

ML “You still seem to be very scared of me and won’t let me close to you – look how you’ve moved the wall to keep me away. You’ve even brought a knife with you today, because you daren’t trust me.”

N “Yeah – and if you start to talk about my auntie or Ann, or say things to upset me, I’ll stick it in you, and then I’ll batter you (all with demonstration) and then I’ll climb out of the window on to the roof and you won’t be able to stop me.”

(This was all said in a strange mixture of violence and bravado.)

ML “It seems then that if someone is to be scared in this room, you want to make sure that it is going to be me, not you.”

N “Yeah” (and he proceeded to repeat similar threats to those already mentioned).

ML “When you’re playing ball, as you did just now, it looks from your face as if you could murder someone – batter them as you do the ball.”

N “Yeah” – but he followed this with many cheeky anxious pseudo grins which seemed to be desperately seeking reassurance that I still like him, despite knowing how real and dangerous this side of him is.

This was in fact exactly where I was in my thinking – as I believe were other adults working with Nicholas at this point. Could I face this side of his nature and still accept and try to help him? I certainly couldn’t like what I saw, but needed to keep facing it in order that his destructiveness be brought into the open in the therapy. 

Anxieties Raised in the Staff by the Incident

The sexuality of this whole episode was, I believe, deeply disturbing for all the staff. After all, we are working with primary school age children, not adolescents. To discover this degree of sexual behaviour, which certainly exceeds what is felt to be acceptable childhood curiosity, makes us question what is acceptable. This in turn throws us back on whatever childhood sexual curiosity we remember displaying – and was that “perverse” or “normal”? Freud discovered what a Hornets’ nest this was, and, indeed, it is only now, 80 years later, that his observations about childhood sexuality and sexual seduction by adults are gaining more general acceptance. Until maybe even 5 years ago, these ideas were generally believed to be in the main infantile fantasies in neurotic and psychotic patients.

I would like to suggest that a number of anxieties were raised within the staff by this incident which needed to be faced in the school as a whole. There seemed to be a feeling that this sort of thing really shouldn’t happen and as a result there was either a wish to angrily allocate blame to others for not doing their job properly, or an anxiety that personally, one was not helping the child.

Certainly I worried about whether I was not containing Nicholas’ anxieties properly in the sessions and that this may have led to his “acting out” with the girl. This was quite irrational in view of the fact that I’d seen the boy only seven times. This same irrationality seemed to be present in the attempts to blame others and the guilt felt by different staff members. Questions such as “can we really help these children?” seemed to be rife. “Maybe they just are too damaged.” “How could the parents have behaved as they did?” – were other thoughts that were expressed. As you can see, the normal sanity of a school such as ours, could quite readily be rocked by the anxieties that surfaced.

Another major preoccupation was the staff concern about what in their behaviour could be misconstrued by a child to be sexual. We are in the business of providing a nurturing facilitating environment (Dockar-Drysdale, 1968) for these children – yet for some children it is almost inevitable that their past experience will lead them to expect that this can only be offered with sexual connotations. When is affection experienced by the child as seduction?

There was conflict over the female staff’s identification with the girl in the incident. It was very hard to remember that Nicholas’ past experience predisposed him to reversing the situation, so that he was in control and someone else was the humiliated and helpless victim. There was a split view of Nicholas as a victim and a “delightful child”, and Nicholas as an attacker, who was feared.

The school as an institution had to struggle to contain sensibly the anxieties that had burst out of an individual child. All of the feelings and thoughts that I have just described were shared in the various staff meetings we held, so that the incident gradually became digested by the school culture and used as a means of increasing understanding of Nicholas’ disturbance. However I think it remains difficult at times for the school to be “in touch” with both sides of Nicholas’ nature, and there is a tendency to relate to him as if the whole event didn’t happen. In this respect I feel I need to occasionally remind the staff of the other side of this “delightful child”, and in this way embody a kind of institutional memory of the event.

Nicholas completed his first term at the school in a very satisfactory way. The issue of how close he dare come to a caring adult continued to be worked on in the therapy, with the emphasis on his need to defend himself from the seductive and violent attacks he constantly expects from female grown-ups. This expectation became focused in his relationship to one of the care staff whom he harassed with the mixture of accusations and threats that I also received in therapy. Eventually after a violent scene, he completely opened up with her and told her in detail, without any prompting or suggestions, about his relationship with his aunt and Ann and how this still affects him. This was a great achievement for him, because of the healthy way in which he eventually used the care worker – as an adult he could safely trust with these distressing feelings and experiences.

One of the advantages of working within a total therapeutic setting is that when a child is ready to make such a move it is much more likely to be sympathetically met by caring adults who have done some work on their own feelings so that they can truly hear what the child is trying to communicate. Therapy can loosen up the defences and try to contain deep anxieties, so that healthy relationships have a chance of establishing themselves both inside and outside the therapy room. I believe that the incident I described also aided this therapeutic process as the staff necessarily had to deal with the anxieties within Nicholas, in a manner which was ultimately supportive to each other and, thus, eventually to the child.

Theoretical Considerations

In an outpatient clinic setting, the boundaries of confidentiality of the therapy sessions can be demonstrated to the child by minimising direct obvious contact between family and therapist, school and therapist. In many respects this frees the therapist to concentrate purely on the child’s experience without the diversion of the other protagonists’ views of particular events and relationships. It is much more difficult – indeed some may even say impossible – to do this in a residential setting. It soon becomes evident to children in therapy that their therapist also has a relationship with their school mates, care workers, teacher and Headmaster and this inevitably blurs boundaries. Short of behaving in a cloak and dagger, elusive manner in the school, which I felt would only arouse paranoia, I have chosen to take a low key “one of the grown-ups” type role. In this way I can attempt to make therapy a part of their life which is felt to integrated within their total experience at the school.

By looking at my role as a part of the whole school system, the problems of confidentiality become different to those in a clinic setting. It is rather like a large extended family which works together to care for the children. Difficulties are more likely to arise when information about children has not been shared with colleagues than when it has. Indeed the children seem to assume that all the adults at the school know about their individual pains and crises, and behave towards them on the basis of these assumptions. Nevertheless within the therapy sessions it is necessary to be particularly vigilant in staying “where the child is” whilst keeping fully abreast of outside information.

There is a transference relationship to the institution as a whole, which needs to be understood and responded to coherently, by the staff. One aspect of seeing a child for therapy is to explore the nature of this transference with the child, through the therapist’s experience of counter-transference. It is essential that this insight be shared with the staff who are in daily contact with the child. (Hartnup, 1986)

Many children, such as Nicholas, deal with their anxieties by powerfully projecting them onto other people, so that they themselves do not have to bear them but someone else does. Just as in therapy, it is essential for the therapist to distinguish between their own personal response to a patient and what is counter-transference, so must the institution as a whole share observations about a child in order to clarify what belongs to the individual worker’s personal past and what belongs to a child’s communications. A sensible number of staff meetings to think about the children and the issues they raise in the staff group are important, if we are not to end up perceived by the child as a very disharmonious, extended family. Bion’s concept of the Work Group which requires a clearly defined task, and Basic Assumption Groups which are more primitively vulnerable to destructive group dynamics are relevant here (Bion, 1961). The group task is clearly related to the school’s work with the children. That is our baseline, and it is only when it is clear that Basic Assumptions are blocking the work that I see it as my role to comment on these dynamics. (Lanyado, 1986)

Nicholas is a child who craves affection, but has unfortunately come to believe that sexual love is the only kind of special relationship between adult and child that exists. The school needs to show him that there is a form of intense adultchild relationship which is not sexual and which is responsive to his need for love, and recognises that he is a vulnerable child without abusing this vulnerability.

This leads me to considering the ways in which the work of a residential special school parallels normal child development within the family. There are two particular relevant themes to explore. The first relates to the earliest days of life, and the two-person relationship of mother and baby. Bion’s concept of the mother intuitively receiving, containing and modifying the infant’s anxieties and perceptions is central to my understanding of how the infant gradually becomes able to tolerate frustrating and painful experiences (Bion, 1962). In the main, children requiring residential help have had incomplete experiences of having their anxieties contained by such a relationship. They make this very clear in the way that they appear to project wantonly their distressed feelings in the hope that someone will receive them and contain them. Bion is very specific that containment requires “feeling” and “thinking” work on the part of the “container”, plus the capacity to tolerate the projected powerful feelings and hold them until such a time as the infant/patient is ready to receive them in a more tolerable and potentially hopeful way.

There is a danger when working with disturbed children to fail to hold on to the “thinking” part of containing anxieties. Thoughtful communication between the staff supports them in their emotional experience of a child and enables them to think about this in a way which moderates the anxieties raised. The staff are doing work on themselves in order to feed back a more coherent and digestible response to the children. Similarly, a mother trying to understand her infant’s cries, has to open herself intuitively to the baby and then do some internal work on these feelings in order to respond appropriately to the baby and ease its distress. Without this internal work, the baby cannot experience a world which is potentially understandable and tolerable and which will try to help and protect them in their vulnerability.

Nicholas needed a normal one-to-one relationship at a time when his mother was unable to provide it. He was the first child of a very immature mother, who is nevertheless now able to respond much more appropriately to him, although he finds it difficult he recognises this potential in her. It is very possible that the incestuous relationship with his aunt grew from the fact that she did respond to him as if he was very special, and did receive his projected anxieties (Kempe & Kempe, 1984). This was the attraction of the relationship for Nicholas. His mother now recalls how he would often claim that “only Auntie Val loves me”. Unfortunately Nicholas’ aunt was not able to digest and transform Nicholas’ projections of anxiety and appeals for love in a manner which was understanding of him as an immature child. Her emotional problems overwhelmed her capacity to stay in touch with Nicholas’ needs and she imposed her own totally inappropriate needs on him. Kempe & Kempe (1984) and Mrazek & Kempe (1981) have described this situation as being the central psychic experience for the sexually abuse child.

As the infant emerges from the intense mother-baby relationship into the world of family life where loved ones must be shared with others, the classical Oedipal situation develops. The vast majority of children at a residential primary school are likely to have experienced the break-up of their parents’ relationship by the time they reach the school. Often this has happened before the age of two. The consequence of this is that they have not had the experience of two adults within a steady relationship, working together to care for the children. It is more likely that they have felt their relationship with the parent with whom they lived was less important to that parent than finding another sexual partner. The expectation of adult relationships is therefore either one of conflict, or a sexuality that excludes attending adequately to the children’s needs. Freud and Klein each in their own terms have emphasised the central importance of the healthy resolution of the Oedipus Complex. It seems to me that in Kleinian understanding, these children need the opportunity not only of reaching some maturity in terms of tolerating depressive anxieties, but also from the viewpoint of internalising the combined object of the good parental couple.

The way in which the staff involved with a child at the school genuinely work together to further these developmental functions for the children is of central importance in terms of their actual experience that such relationships can exist. Menzies-Lyth (1970, 1983) has lucidly described the defences that become established within an institution if attention is not paid to the particular anxieties to which that institution is prone.

A healthy residential school environment needs to be sensitively aware of distressed children’s feelings. Whilst it is not appropriate to delve into the personal past of each professional in that setting, it is essential to remain aware of how our own past childhood pains resonate with our sensitivities in the present. Not only is this good for the children in our care, it is also, as I have argued in this paper, good for us.

REFERENCES

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BION, W. R. (1962). Learning form Experience. Maresfield. Reprints: London.

BION, W. R. (1961). “A theory of Thinking” Int. J. Psych. Anal., Vol 43.

BOSTON, M. & DAWS, D. (Eds.) (1983). “Psychotherapy with Severely Disturbed Children”. R. K. P.: London.

BOWLBY, J. (1970). “The Making & Breaking of Affectional Bonds”. Tavistock: London.

DOCKAR-DRYSDALE, B. (1968). Therapy in Child Care. Longman: London.

FRAIBERG, S. (1980). Clinical Studies in Infant Mental Health. The First Year of Life. London: Tavistock.

HARTNUP, T. (1986). Children & Institutions (II): The Professional & the Institution. Journal of Child Psychotherapy, 12, 2.

HENRY, G. (1983). “Difficulties about thinking and learning,” in “Psychotherapy with Severely Disturbed Children” by Boston & Daws (Eds.). R. K. P.: London.

KEMPE, R. S. & KEMPE, C. H. (1984) The Common Secret. Sexual Abuse of Children & Adolescents. Freeman: New York.

LANYADO, M. (1988): “United we stand…?” Paper given at AWMC, Scottish Division, Annual Study Course. (February 1988) on the theme of Staff Support and Development.

MENZIES-LYTH, I. (1970). The Functioning of Social Systems as a Defence against Anxiety. Tavistock: London.

MENZIES-LYTH, I. (1983). Psychological Welfare of Children Making Long Stays in Hospital. Tavistock: London.

This paper is based on a lecture given to the Scottish Section of the Association of Workers with Maladjusted Children , in January 1987. It draws on the work of Harmeny School, Balerno, Midlothian.