ABSTRACT
The author describes how the initial work of two child psychiatrists at a school for children with physical disabilities evolved into an organisational consultancy that provided opportunities for the staff to think beyond individual children to how they were managing the pain and stress of the work institutionally. The chapter discusses anxieties inherent in the task of working with severe disability and children’s futures, and the impact of denial and other defences used by parents and staff to ‘cut themselves off’ from the painful realities of the children’s situation. The interplay of personal and institutional defences is illustrated through examples of individual cases. As staff communication became more open, the splitting that had been happening among staff, between staff and outside professionals, and between staff and parents, gave way to a more integrated way of working. The chapter illustrates how a shift from a fragmented, paranoid/schizoid position towards a, more contained, depressive position can free staff to ‘think their own thoughts’ and fully contribute to the tasks at hand.
