Monica Lanyado

Risk factors for development of sexually abusive behaviour in sexually victimised adolescent boys: cross sectional study

Abstract Objective: To identify factors that may increase the risk of a sexually victimised adolescent boy developing sexually abusive behaviour. Design: Sexually victimised boys who had sexually abused other children were compared with sexually victimised boys who had not done so. Setting: Social services departments in south east England were invited to refer sexually abused and sexually abusing boys to a London postgraduate teaching hospital. Subjects: 25 adolescent boys aged between 11 years and 15 years and 11 months. Main outcome measures: Adjusted odds ratios estimated from unconditional logistic regression. Results: Unadjusted odds rations for witnessing (8.1) as well as experiencing (18.0) intrafamilial violence and discontinuity of care (7.2) discriminated boys who had sexually abused from others who were solely victims of sexual abuse. Only the adjusted odds ratios for witnessing intrafamilial violence (39.7)discriminated the two groups. Conclusions: The risk of adolescent boys who have been victims of sexual abuse engaging in sexually abusive behaviour towards other children is increased by life circumstances which may be unrelated directly to the original abusive experience, in particular exposure to a climate of intrafamilial violence. Our findings have implications for the management of boys found to have been sexually abused and raise important questions about the possibility of secondary prevention of subsequent abusive behaviour in those at greatest risk.

Holding and letting go: Some thoughts about the process of ending therapy

Abstract In this paper, the process of ending therapy is likened to the ordinary developmental task of ‘letting go’ that parents have to undertake, to help their child to grow up. ‘Letting go’ is contrasted with the process of ‘holding’ the child in mind that is so central to the therapeutic and parental task Following thoughts about some of the external issues that play a part in the decision to end a childs treatment, this developmental perspective of psychoanalytic psychotherapy is discussed through a clinical illustration of the ending of a 5-year-old boys treatment. Different strands of the therapeutic relationship as highlighted during the ending phase of therapy are distinguished and attention is drawn to the role of the ‘new relationship’ between therapist and child and how this differs from the transference relationship. Countertransference issues in their broadest form are also considered.

Understanding boys who sexually abuse other children: A clinical illustration

SUMMARY The therapeutic assessment of a 12-year-old boy who sexually abused, is described. He was one of forty-eight boys who took part in the psychotherapeutic assessment stage of a large multi-disciplinary research project, funded by the Department of Health. For a period of some years, at a young age, ‘Frank’ was brutally sexually abused by his father. Having been severely traumatised, he became traumatising for others when he started at puberty to sexually abuse. The twelve-session assessment consisted of semi-structured interviews and standardised questionnaires within the framework of more open-ended psychotherapeutic consultations. The authors discuss the clinical and theoretical implications of this work.

Winnicott's children: The holding environment and therapeutic communication in brief and non-intensive work

Abstract This paper discusses brief and non-intensive work using a Winnicottian framework for understanding the processes involved. The importance of play, communication and interpretation are considered within the careful establishment of a unique holding environment for each patient. Parallels are drawn with ordinary development and care of the infant and young child. Two clinical examples are given to illustrate these concepts. The first describes the treatment of parents and children following the accidental death of the youngest child, and the second describes time-limited work with a sexually abused and abusing teenage boy. The value of providing a range of psychoanalytic treatments to meet the range of needs of patients is discussed. The importance of conceptualizing such treatments in ways that do not imply that they are ‘diluted’ psychoanalysis is also stressed, particularly with a view to the increasing pressure on therapists to offer help to as many children as possible within limited treatment...

Asymbolic and symbolic play: Developmental perspectives in the treatment of disturbed children

Abstract “Put a lot of store on a childs ability to play. If a child is playing, there is room for a symptom or two, and if a child is able to enjoy playing, both alone and with other children, there is no very serious trouble afoot.”

Putting down roots: the significance of technical adaptations in the therapeutic process with fostered and adopted children‡

Severely neglected and traumatised children have also suffered from a lack of the parental nurturing which is needed for ordinary emotional development to take place. Often their past experiences make them unable to utilise the nurturing that foster and adoptive families try to give them and they are delayed or stuck in their development. In therapy, when the early small signs of new emotional development start to emerge, they may be heralded by technical challenges to the therapist. Two examples are given in this paper, which are discussed in the context of Stern et al.’s ideas about moments of meeting, Winnicott’s concepts about transitional phenomena and playing, and Hurry and her colleagues’ thoughts about the therapist as a developmental object. It is argued that it is important for the therapist to be alert to the possible significance of these technical adaptations in terms of the child’s capacity for new emotional development. These often indicate that a watershed in the treatment has been reached and if positively responded to, that the patient is in the process of ‘putting down roots’ in the ground of the therapeutic relationship and starting to grow across a spectrum of developmental pathways.

Transforming despair to hope in the treatment of extreme trauma: a view from the supervisor’s chair

The author considers how, when working with severely traumatised patients, times of despair can be transformed into moments of hope within the therapeutic process. She considers these moments from the perspective of ‘the supervisor’s chair’ and what emerges within the supervisory relationship when difficult and distressing sessions are openly and honestly bought to supervision. Drawing on Thomas Ogden’s ideas about ‘dreaming up the patient’ in supervision, and Michael Parsons’ thoughts about the supervisory relationship, she gives two examples of this process in action, the first about the transformation of despair to hope in the consulting room, and the second about the transformation of despair to hope in the professional network. She argues that these transformational moments of hope correspond to what Daniel Stern and his colleagues have described as ‘moments-of-meeting’ and are indicative of a potential turning point in the therapy. These fleeting moments need to be attended to and nurtured so that their potential for change and emotional growth and recovery can be harnessed.