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Emanuel, L. (1997). Facing the Damage Together: Some Reflections Arising from the Treatment in Psychotherapy of a Severely Mentally Handicapped Child. J. Child Psychother., 23(2):279-302.

(1997). Journal of Child Psychotherapy, 23(2):279-302

Facing the Damage Together: Some Reflections Arising from the Treatment in Psychotherapy of a Severely Mentally Handicapped Child

Louise Emanuel

This paper attempts to explore ideas about the nature of the attachment between a mother and her handicapped or damaged baby. I suggest that when a baby is found to be damaged, at or soon after birth, the parents’ phantasy of a normal ‘beautiful’ baby dies and the mourning process is seldom adequately completed. Unbearable feelings of ‘primary disappointment’ (Emanuel, 1984) experienced by the mother cannot be fully processed, which limits her capacity to provide containment for the infant. The infant may introject a disappointed, hostile or even horrified internal object and may feel herself to be monstrous and worthy only of rejection. The infant's ‘primary handicap’ may be compounded by the development of a ‘secondary handicap’ (Sinason, 1992) — emotional damage — through projective identification with a disappointed, rejecting internal object. I relate these ideas to Donald Meltzer's theory of ‘aesthetic reciprocity’ (1988): his description of the powerful aesthetic impact of the mother and newborn on each other and the effect of noticeable damage in the baby on this aesthetic encounter. These thoughts are illustrated by detailed case material of a 6-year-old severely mentally handicapped girl (brain damaged at birth), who had developed severe ‘secondary handicaps’ — autistic features and eating problems — and who was seen for once weekly psychotherapy. The patient's progress in therapy, as she emerged from a state of autistic withdrawal and autoerotic sexual arousal, is described, and technical and ethical issues arising from the treatment of such a severely damaged child, are discussed.

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