ABSTRACT
This chapter addresses some specific aspects of diagnosis, therapy and prevention as well as the question of transmission. It discusses clinical aspects concerning the work with adult replacement children: role of the therapist, alliance and transference, questions to ask and techniques. The diagnosis is easily overlooked as adult replacement children may ignore the circumstances of their conception, birth or role in the family. Loyalties, defence mechanisms and a taboo surrounding the topic of death further hinder the diagnosis. Replacement children can evoke the uncanny, having “one foot in this world and one the other.” During the anamnesis, questions help assess whether symptoms are due to this condition, and dream images, expressive arts and fantasies give further insight. Drawing up a family tree may reveal whether children were lost in previous generations, and help assess whether elements of the condition may have been transmitted transgenerationally. Analysis of unconscious material and creative expression can lessen the risk of further transmission. Concerning prevention: informed parents who are conscious of the risk of replacing, and who strive to reflect their child’s true self and remain alert with regard to their projections, fantasies and relational modes, can help their child. Adult replacement children can discover the self-healing quality of psyche and reconnect with their original self in their individuation process. Analysts and supervisors need to assess whether they have elements of the condition to avoid collusion. Training programmes for medical and counselling professions as well as parental preparation and support group staff would benefit from a module for diagnosis, treatment and prevention of the replacement child condition.
