The Bowl of Terror: A Case Study of an Adolescent Perpetrator of Sexual Abuse

This article describes a complex multimodal intervention with a family where inappropriate sexual contact had occurred between Taro and his younger sister Lara, when they were young children. The family presented to clinical services when Lara was brought to hospital with suicidal ideation, traumatic flashbacks and regressed behaviour at 13 years of age. Treatment involved multiple components: family work with all members of the family individual work with Lara, joint work with Lara and Taro, and finally, a brief intervention with Taro. This article focuses primarily on the therapist's work with Taro, the perpetrator of the inappropriate sexual contact. The Adult Attachment interview (AAI), a semi‐structured interview, was used by the therapist to assess Taro's developmental experiences and psychological functioning. Information from the AAI helped the therapist identify both the relationship factors that had contributed to the perpetration of sexual abuse and the self‐protective strategies Taro had come to use in order to elicit maximum comfort and protection from neglectful attachment figures. The therapist used the functional formulation derived from the AAI to structure a time‐limited intervention.     

Family‐of‐Origin Issues and the Generation of Childhood Illness

Unresolved family‐of‐origin issues can play a powerful but covert role in here‐and‐now family interactions, and can contribute to the generation and maintenance of childhood psychopathology and illness behaviour. This article describes an intervention with a family where the children frequently presented to local health services with a baffling array of psychological and somatic symptoms. The therapist was unable to pinpoint where the problem lay. In a final effort to understand family functioning she used the Adult Attachment Interview (AAI) in order to better understand parental state of mind and how parental anxieties and behaviours contributed to current family functioning. This information was used to plan a treatment intervention.     

Intergenerational Processes,Attachment and Unexplained Medical Symptoms

Children organise self‐protectively in response to anxiety‐provoking or dangerous parental behaviours. When children's self‐protective responses are extreme and persist over time, they may come to the attention of health professionals in the guise of emotional, behavioural or somatic symptoms. A parallel phenomenon is that harmful parental behaviours may be embedded in the emotional processes of the inter‐generational family unit, reflecting the parents' own experiences of comfort and danger, as well as the particular manner in which these experiences have been integrated into the parents' current functioning. Using a case study of a three‐year‐old girl with medically unexplained urinary retention, the article explores how information about attachment relationships and unresolved parental loss or trauma can inform our understanding of implicit, anxiety‐driven processes within the family, and to facilitate family interventions and symptom alleviation. The case shows that the Dynamic‐Maturational Model of attachment has significant applications in the areas of family therapy theory and practice, psychosomatic medicine and consult‐liaison psychiatry.