The role of the body as the medium in child psychotherapy: snapshots of therapy with an 11-year-old,severely abused,multiply placed girl

In Victoria, Australia, children with a history of abuse and severe attachment difficulties, and who have experienced multiple carers and placements, have been traditionally viewed by mental health services as unsuitable for psychoanalytic psychotherapy. A number of factors, including the lack of integrated, long-term case planning; unstable residential placement; and the belief that psychotherapeutic treatment will be of an extended duration, have influenced the decision not to provide individual psychotherapy for these children. Currently, the movement within mental health services is towards responsive and briefer treatment models. The child psychotherapist is challenged to re-think theory, technique and practice. This paper identifies contextual constraints that have led to these children being precluded from accessing psychotherapy. An alternative model of intervention is discussed and illustrated with clinical material. The contributions of Alvarez, Trevarthen, Schore and other writers are drawn on to underpin the clinical work. This model involves a change in technique and role and the use of a time-limited intervention. Intrinsic to the model is the understanding of the child's psycho-biological experience of trauma and disrupted attachment. The child's experiences are conveyed in the pre-verbal, gestural domain to enable history to be given voice.