Brandon Medical (United Kingdom)

In this paper, the author describes the pressure put on the analysis of a 5-year-old boy by his parents, who repeatedly tried to terminate the analysis soon after it had started. Detailed clinical material illustrates the impact this pressure had on the analyst and the boy, including a considerable conflict of loyalty between his parents and the analyst and being overwhelmed by intolerable feelings of violence and persecution. The clinical account also shows how this boy struggled to cope with feelings of destructiveness, badness and being unwanted and with intense pressures and demands placed on him by his parents to grow up, to abandon his infantile self and to control his impulses, particularly his anger. Despite the turbulence of the analysis, he was able to make some moves in the direction of tolerating his feelings of guilt and containing his destructiveness. The discussion focuses on the role of parents in child analysis: their concerns and anxieties, the impact they can have on treatment and the interventions available to help them to allow their child's analysis to proceed.

The author presents clinical material from the analysis of a patient who made sense of his chaotic life by creating seamless narratives in the analytic situation. Initially, his experience of meaning was derived from the form of his narrative. He repeatedly constructed the 'perfect' narrative, which he related to as a real object and as an object of reparation. There was a significant change in his narrative style and his experience of meaningfulness when he was able to struggle with the contradictions, ambiguities and inconsistencies in his life. The author argues that the patient's earlier narrative style, which he calls the manic narrative, is an aspect of the manic defence, whereas his later approach, when he relinquished the manic narrative in favour of a genuine experience of meaningfulness, was a move towards accepting depressive anxiety and acknowledging the state of his objects.

SUMMARY The paper describes a clinical audit of a community-based psychoanalytic psychotherapy service for young people between 12 and 25 years old. The process of managing the incorporation of the audit into the clinical sphere at the Brandon Centre is discussed. The author then focuses on the evaluation of the outcome of the psychotherapy service. The measures used are presented; the results of the data collected twenty months after the start of the project are reported, including a follow-up analysis of new patients three months after intake, based on self-report forms filled out by the young people. The tentative implications of the audit for the pattern of service delivery at the Brandon Centre, and its impact on the Centre's work, are discussed. The work presented in this paper shows that the methodologies of audit can be successfully integrated with clinical work without harming psychotherapeutic practice, and can make an important contribution to planning the direction of the clinical service.