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Parker, N. (1999). Margaret Rustin Maria Rhode Alex Dubinsky Hélène Dubinsky (eds) Psychotic States in Children, Tavistock Clinic Series, London: Duckworth, 1997. 291 pp., £12.95.. J. Child Psychother., 25(3):486-489.

(1999). Journal of Child Psychotherapy, 25(3):486-489

Margaret Rustin Maria Rhode Alex Dubinsky Hélène Dubinsky (eds) Psychotic States in Children, Tavistock Clinic Series, London: Duckworth, 1997. 291 pp., £12.95.

Reviewed by
Niki Parker

On the cover, this book states itself to be the first of a series which seeks to make the work of the Tavistock available to a wide audience in a clear readable style. It comes at a rime when child and adolescent psychotherapists in the community are struggling to deliver a service to children and young people who have suffered trauma and abuse and the kind of mental pain that is described here, within the financial constraints and long waiting lists of the modern National Health Service, with its current stress on evidence-based practice and throughput. The prejudice might be that a book describing clinical work in a prestigious institution would not reflect current experience in the community. That this book gives a vivid picture of how it is to approach this work, and the complexities and difficulties that get in the way, is a great achievement.

It is less successful in the explanations of theory and technique which are of interest to the student of psychotherapy, but, because of their complexity, are less accessible to the general reader. The theory is proudly in the Kleinian tradition. I think that at this time when there is still such suspicion of psychoanalysis and when child psychotherapists are being replaced by other professions, it would add richness as well as being politic to include other theoretical traditions and their current development.

The deepest impression on the reader is that of the pain of the children whose stories we hear and that of their parents and families, glimpsed in the background. The psychotic states of the tide are understood as a communication by their therapists. Emotional understanding is explained as the way the children are helped to emerge from long-established retreats into bizarre behaviour patterns, to resume their development and place in school or college and attempt to establish normal relationships. The understanding of how early environmental failure has contributed to the confused inner world of these children is conveyed not as something blameworthy, but in a spirit of concern at what is a transgenerational issue, as so often with abuse.

The book is divided into theoretical overview, and then the first papers illustrate the huge impact and intrusion of sexual abuse on emotional development.

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