ADAPTING THE MODEL: THERAPEUTIC WORK WITH CHILDREN FROM ARMY FAMILIES

Abstract

The paper discusses the authors' joint‐disciplinary therapeutic work with young children and families referred to their under‐fives' service within CAMHS. Their familiarity with the Tavistock under‐fives model of early, brief, therapeutic intervention allowed them to adapt it for work with these complex referrals. Their model extended the number of sessions available allowing time to better grasp the complex dynamics within the family and the clinical work, whilst offering a service sensitive to the unpredictability of army life. The importance of both practitioners working each case together, or in parallel, is discussed in terms of its ability to meet unconscious material, largely the families' propensity for splitting practitioners. Working with such emotional deprivation brought powerful countertransference material. The model incorporates a weekly case meeting that enabled this material to be better understood. A discussion of work with one family serves to illustrate many of the points raised throughout the paper.

Keywords:

• army families
• brief therapeutic intervention
• CAMHS
• complexity
• containment
• emotional life
• deprivation
• dynamics
• joint‐disciplinary working

Notes

1. Early brief intervention for families where the referred patient is under five years of age. Based on the model developed in the Child and Family Department of the Tavistock Clinic, London.

2. To the authors' knowledge there is no literature established to discuss these issues for the British Army. Our searches revealed one recent example, although this was not focused on the emotional difficulties of families but addressed itself more to the ‘improvement’ of army morale (see Strachan, 2005). In the United States, interest in the emotional life of army children and families is apparently stronger. Baresch (1979) reports a project at Fort Riley, Kansas, combining military, community and private resources, and stresses parent education as a factor in problems of isolation and the individual's concept of self. Army chaplains ran an education programme for couples seeking to understand marriage. Its outcome was reported in Stanley et al. (2005). Pittman et al. (2004) studied the effect on family life of men returning from major war zones.

3. Nearly all the children we saw had married parents.

4. In our work we found it important to think about psychoanalytic concepts of maternal and paternal function. These do not indicate a socially defined gender bias or type, as both constructs can be found in the unconscious of both men and women. See Bion (1959, 1962a, 1962b, 1970) for a full discussion.

5. Reflecting on this after our work together ended we wondered whether we had missed an important opportunity to observe and offer help with what appeared to be a lack of what Britton (1998) refers to as a triangular space, that is fundamental to the capacity to think and have new thoughts. We wondered about the lack of a significant emotional paternal presence at one corner of the triangle. The importance of this has also been discussed by, amongst others, Daws (1989) and Wright (1991).

6. As with the absence of fathers in any CAMHS work with families, it was clear that some fathers had absented themselves, whilst for others their partners clearly were not interested in including them in our appointments.

7. For an introduction to this model see Miller (2000).

8. See Joseph (1985) on this development of Klein's (1952, p. 55) comment ‘in unravelling the details of the transference it is essential to think in terms of total situations transferred from past to present, as well as emotions, defences and object relations’.