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(2004). Psychoanalytic Psychotherapy, 18:238-240

Book Reviews

The Internal and External Worlds of Children and Adolescents: Collaborative Therapeutic Care edited by Lesley Day and Denis Flynn (Karnac, London, 2003). 188 pp. £15.99.

Rosemary Loshak

As one whose task it is to bring thinking about the needs of children and of whole families into an adult mental health service which is organizationally split off from child and family services in its district, I read this volume of essays from the Cassel Hospital with interest and excitement at what can be achieved when the meaning of such splitting can be thought about, and with gratitude for the ‘sense of hope (which) is held onto for the children and adolescents who are worked with at the Cassel’ (p. 12). The Cassel provides a unique service where adults, adolescents and whole families are admitted for psychoanalytic and psychosocial treatment and live as part of an in-patient therapeutic community in which patients share responsibility for their own treatment, for their children and for the daily management of the units. This is what Denis Flynn refers to as

the sustained involvement of patients and staff together in a ‘culture of enquiry’ within the therapeutic community.

(p. 59)

The youngest patient worked with in this book is around one year old when she and her mother come into the Families Unit, while the Adolescent Unit works with young people who typically fall in the gap between adult and child mental health services, that is, aged from 16-21 years. Thus the book provides a developmental view with an emphasis on growth and transition, from child to adult, from the safe world of the hospital back to the community.

The book shows what can be done therapeutically in family situations where previously therapeutic work might have been unthinkable. The early part of the book describes first, adult psychotherapy with a mother who presented with Munchausen's syndrome by proxy, having poisoned her two eldest children; then, mother-infant psychotherapy with the same mother and her youngest, 2-year-old child; and finally individual child psychotherapy with two young children, one of whom has witnessed the killing of her baby sister, and one of whom was poisoned by her mother when she was younger. Although these chapters all describe individual psychotherapies and are concerned primarily with the internal worlds of the patients, both adult and child, the emphasis is

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