ABSTRACT
This final chapter is an attempt to integrate ideas outlined in the book with some of my more recent thoughts. I have hoped to contribute to the literature on child and adolescent psychotherapy relevant to the cases we are seeing in this new millennium. Many of these patients are extremely dangerous to others as well as to themselves. Without treatment, or with treatment that ends prematurely, some are at grave risk of serious mental illness. One adolescent who was beginning to emerge from a breakdown and an over-intense relationship with a psychotic mother had to terminate her therapy when social services cut the funding. She was 15 and, after a year’s treatment, had matured somewhat – perhaps to something like age three or four – in her emotional development. Her despair was acute and, for her, termination might have been terminal. Children in treatment now are not only more disturbed and damaged than those referred half a century ago; they are often more emotionally and cognitively delayed as a result of both abuse and neglect. This book has attempted to systematize some clinical reflections after listening to generations of therapists’ struggles to reach them and help them, occasionally using methods that are too traditional to do so. Although many of the cases were helped by the more traditional approach described at the explanatory level, some were not. So, to my mind, it is time to begin a closer study of how we – both patients and therapists – manage to come to think new thoughts. I think in psychoanalysis we still have much to learn about the nature of introjections, internalization and identification.
