Compassion, sadism, words and song: development and breakdown in the intensive psychotherapy of an adopted boy

ABSTRACT

This paper describes the intensive psychotherapy of a late-adopted boy who had been severely traumatised in his first five years of life. In describing the progress and then deterioration of his mental state and his psychotherapy, I examine the development of his compassion for the vulnerable side of himself, as part of a battle between identification with the vulnerable and sadistic aspects of his internal world. I trace how this compassion was reflected in his concern for others in his external world and fantasised others in his play. I also describe the use of sound and rhythm in enabling him to experience sufficient containment in his psychotherapy for his deepest preoccupations to begin to emerge. In so doing, I examine literature on music and musicality, and seek to demonstrate the relevance of Suzanne Maiello’s advocacy of listening with a ‘musical ear’ to psychotherapy with looked-after and traumatised children, whose life ‘rhythms’ have been so catastrophically disrupted.

KEYWORDS:

• Adoption
• abuse
• relational trauma
• intensive psychoanalytic psychotherapy
• music and child development

Acknowledgments

This paper is dedicated to the memory of Maggie Fagan, for whose wisdom I shall always be grateful. I am also indebted to Gillian Ingall for her supervision and advice. An earlier version of this paper won the Tavistock Society of Psychotherapists’ Hamish Canham prize for a psychoanalytic clinical paper in 2014, and I am grateful to the audience there for many insightful and compassionate responses. In revising the paper subsequently, I have been grateful to Margot Waddell and Jenifer Wakelyn for their constructive feedback and support. The revision process has been enabled by the project Waiting Times, supported by The Wellcome Trust [205400/A/16/Z], (see waitingtimes.exeter.ac.uk).

Disclosure statement

No potential conflict of interest was reported by the author.

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Jocelyn Catty

Jocelyn Catty is Senior Child and Adolescent Psychotherapist in the Bexley CAMHS Adolescent Team, and Research Lead for the Child and Adolescent Psychoanalytic Psychotherapy Doctoral Training at the Tavistock Centre. She is also a psychodynamic psychotherapist and member of the Foundation for Psychotherapy and Counselling. She was previously Senior Research Fellow in Mental Health at St George’s, University of London. She currently co-edits the Tavistock Clinic Series, published by Routledge.