A Study of Anxieties and Dilemmas Relating to Breaks in the Therapeutic Relationship with Children Whose Relationships in Early Infancy were Reported to have been Emotionally Unstable and Traumatised: A systematic Study of a Young Child who had suffered early abuse and neglect

ABSTRACT
The present study is a psychoanalytic single case study; the intended aims of which were: a) to perform a systematic exploration of core features of the thera-peutic relationship with children who have suffered early abuse and neglect; b) to investigate possible links between such core features and breaks; and c) to con-tribute to the development of a transparent and systematic methodology for the psychoanalytic case study by application of rigorous qualitative research method-ology.
The clinical research data was case-file material from a concluded child psychotherapy case as well as transcripts from interviews with the six years old child’s birth and foster parents, conducted 2 ¾ years after the end of therapy. The case material was analyzed in three different steps; at each step principles for transparent data selection and analytic strategies developed:
1) Inductive analysis highlighting four relational themes as central in the first 24 therapy sessions.
2) Deduction of empirical consequences from the central themes as distilled by the inductive analysis; the resulting predefined themes subsequently studied in notes from 4 consecutive Christmas break-sets, each consisting of 2 be-fore-break sessions, 2 after-break sessions, and 2 no-break sessions. Christ-mas breaks chosen as the potentially most agonizing break of the year, espe-cially for children in care.
3) Finally, the same predefined themes were studied with regard to how they appeared in reports from the child’s various caregivers from infancy through her day-to-day life during and after therapy.
The inductive part of the study identified four relational themes characteriz-ing the interaction and dialogue between therapist and child. A subsequent deduc-tive analysis convincingly showed breaks a convenient way to highlight core fea-tures of the therapeutic process; suggesting the child’s reactions to breaks to be a good indicator of change. Conspicuous links between breaks and the eruption of hostile parental and sibling figures in the mind seemed especially pertinent as well as characteristic difficulties of symbol formation in before-break sessions.
The completed data analysis strongly corroborated Hinshelwood’s assump-tion that the relational themes found to be central in the therapeutic relationship would also permeate the child’s past and current relationships (1991a).
With regard to the research method, the detailed results concerning breaks and the similarity of relational themes inside and outside therapy seem to confirm the value of systematic integration into the psychoanalytic single case study of inductive-deductive analytic principles from the qualitative research methodology of Interpretative Phenomenological Analysis. This combination of methods led to unexpectedly rich insights; it may be of special importance in the development of psychoanalytic and psychotherapeutic theory through single case studies.