Children and adolescents who are seriously disturbed as a result of abuse, neglect or the experience of multiple family disruptions present major management problems for mental health and social services. Young children may challenge the skills of experienced foster carers, resulting in repeated placement breakdown. Adolescents may present with uncontainable aggression or life-threatening self-harm. They arouse serious anxiety in those caring for them and appropriate placements are hard to identify and sustain. Without intervention their disturbance escalates and with it the cost of skilled professional input for care, education and therapy in residential settings. These children and adolescents may pose a risk to others, but more often to themselves, e.g. mutilation from repeated self-harm, dependency on alcohol or drugs, sexual exploitation and early parenthood. Some end up in secure units, prisons or on the streets; others will not survive.

Recent improvement in services to children in local authority care and extension beyond the age of 18 have led to increasing expectations that mental health services will provide treatment or advice about placement in appropriate therapeutic residential units. This book describes psychodynamic work with damaged youngsters in residential settings and may be useful for professional staff of all disciplines involved in their care.

The author, a Kleinian analyst, has organised a collection of his papers that previously would have reached a child psychotherapeutic readership. They are grouped in three sections – the young child, the child in the family and the adolescent – introduced by a chapter discussing psychotherapeutic approaches in specialist settings and an explanation of psychoanalytical concepts. The author does not quite succeed in his attempt to bridge the gap between his expert therapeutic knowledge and the needs of professional staff struggling with the complex emotional demands of work in such settings. This is because of the preponderance of highly technical psychoanalytical language. However, the clinical material is stimulating and discusses issues such as the rehabilitation of abused children with their parents, adoption, and group work with physically disabled adolescents.

Psychotherapists, child and forensic psychiatrists and other professionals providing supervision or treatment in residential or in-patient settings will certainly appreciate this book.