Gianna Polacco Williams
Gianna is a Consultant Child Psychotherapist and Psychoanalyst and is one of the most respected and incisive clinicians in child mental health today.
Her paper ‘Doubly Deprived’ (Henry, 1974), written as Gianna Henry, broke new ground. It became an instant classic and is still one of the most quoted papers in child psychotherapy. The significance of this paper cannot be underestimated. It sparked research into psychotherapy with traumatised children, pioneered at the Tavistock Clinic by Mary Boston and others (Boston and Szur, 1990). Before it was published there was a widely held belief that severely deprived children could not be helped with psychotherapy.
The concept of Double Deprivation suggests that the first deprivation is that which has been caused by a child’s external circumstances which cannot be changed. The second deprivation is due to a child’s internal defences which have developed in the avoidance of psychic pain and the nature of the child’s internal objects, which with treatment can be modified and so is changeable.
In this interview she talks about Martin, the 14 years old patient who was the source of her ideas, and why the concepts she wrote about then are as relevant today.
She also discusses in depth one of her other key theoretical ideas, the ‘No Entry’ defence, an illuminating concept in understanding the development of some eating disorders.
Gianna has worked all over the world, including the Tavistock Clinic for over 50 years (2020) where she led the child psychotherapy discipline in the Adolescent Department. She has been instrumental in establishing child psychotherapy trainings in her native country, Italy.
Gianna became a member of the Association of Child Psychotherapists in 1966, and worked at the Child Guidance Training Centre, Tavistock Centre from 1968-70. She has been working at the Tavistock Clinic from 1970 to the present day.
Outline of interview
1’00 Why did she write Doubly Deprived?
Wrote this paper without realising at the time that somehow it was breaking new ground. I was seeing this adolescent and finding the work initially v difficult. Asked for supervision on it and came to realise something important that has helped me at the time and in the future– this child was treating me like a wimp and nuisance, trying to get some of his attention. I was helped to understand that he was really doing was to turn me into an aspect of himself that he couldn’t tolerate.
3’10 Martin’s background
Martin had been deprived by his life. By the way he protected himself from psychic pain it meant he was inwardly deprived. He used defences that turned himself into an orphan inside as well outside himself. Foster parents gave him up because of continuous stealing and he tried to jump from second floor window. Started seeing him aged 14
4’53 ‘I’ve got no time for your rubbish!” The “Brick wall” of defences
His brick wall defences evident when he spoke to foster mother, he pretended nothing was happening whilst she was crying. The brick wall defences meant it took a long time for me to establish contact with him. I found it hard to know how to react when he said, “You’re talking to a brick wall”, “I’ve got no time for your rubbish, you’ve got to suffer”. Eventually with supervision was able to understand that he was not just attacking but a communication. The communication is what he was making me feel – which was a wimpy child who was trying to get attention from someone who had better things to do. This was a picture of the internal landscape of Martin; there was a parent who couldn’t give attention and the wimp who wanted it. The wimp was put into me, and it was my work to put him in touch with the vulnerable part – but only gradually, and not to take how he was treating me as an attack but as a communication.
7’25 The meaning of doubly deprived
The first deprivation is external and then the second deprivation is what happens with the internal defences which stop a child taking in what they need to receive from others. He said I don’t miss anybody, people miss me. He had created a ‘carapace’. Every rejection cemented the hardness of the internal object of the parent who has no time for him and the wimp ever more needy. Putting him in touch with this was very painful for him and he became very demanding- he said I should be like a 24 hour restaurant.
9’28 Martin said if it hurts how can you call it getting better?
One of his many incisive communications. He came more open to experiencing pain. When he was 16 he had to leave children’s home and was attached to the house parents and he said he would move only if he could take them with him. He was very damaged by his defences.
10’29 Links between trauma and learning difficulties.
He had a reading age of 6 when he was 14 yrs old. This made me think more about another area of my interests, which is how so many learning problems originate from emotional obstacles. This is about not being able to think about where it hurts and why it hurts. If you can’t make that link it can lead to reading and writing impediments. He did develop literacy capacity as a result of therapy.
11’25 Defences against making someone precious
If you depend on somebody, they become precious. This is the source of many pathologies: defences that prevent you from making another person precious. When Martin was more open to the loss of separation, it was as though I had stripped what he called the 7 layers of skin – when he was in pain I thought I was making him better but I was uncovering his ‘soft spot’ in my work.
13’05 The difficult work of putting children in touch with their pain
It’s so important to be careful in our work with defences, they should not be stripped in a brutal way. As a psychoanalyst I realise that defences should be respected. You can’t expect people to drop crutches before they walk. You have to focus on what makes them limp before lessening the defences.
14’35 A Golden Rule: Never interpret a defence if you don’t know what the anxiety is behind it
Martin said I am the only person who has no feelings. I was about to take a holiday. He kicked a radiator, saying, ‘Call this central heating? It’s cold water running through a mass of metal.’ It was obvious he was in pain because I was leaving him. I could talk about how him finding me a cold-hearted person, and that it was a way to protect himself. It was important I could hold the anxiety.
The threat of physical violence was always present with Martin.
You didn’t seem to be overly alarmed even seeing him get a knife out and you said therapists should be able to tolerate what his internal and external objects could not? He was bringing his violence to a place where it could be thought about instead of terrifying Pakistani children. That’s not to say I suffer knives gladly!
The significance of boxes in Child Psychotherapy
He did enough damage to the box to say we need to get a new Gianna Henry!
19’12 Why has Doubly Deprived been so enduring as a publication?
It is a rather hopeful paper. Not all deprived children can respond to treatment, and I was perhaps lucky with Martin. After the publication, there was major research at Tavistock about deprived children with different defences. (note: Book re this is called, ‘Psychotherapy with Severely Deprived Children,’ by Mary Boston and Rolene Szur) Shows that with many deprived children, work is possible. Marked the beginning of commitment to work with very deprived children who had previously been thought to be untreatable. This should be central reading to Child Psychotherapists. Gives hope that in many cases there isn’t damage which is beyond at least some repair.
21’00 Louise Emanuel’s concept of ‘Triple Deprivation’
The professional services failure of deprived children as an extension of ‘Double Deprivation’.
21’37 Eating disorders as a ‘No Entry’ defence
Gianna’s interest in early defences and how that has influenced her treatment of difficult to reach children, eg those with eating disorders.
In late 90’s I wrote a book (Williams GP. Internal Landscapes and Foreign Bodies: Eating Disorders and Other Pathologies. London: Routledge; 2002.)
Underlying issue of avoiding establishing dependence on an object that could become important and precious and therefore painfully precious.
No entry defences linked to children who might have been defending themselves from something toxic. They might have received projections [from a parent] they cannot metabolise. Children are receptacles rather than containers. What gets into the child isn’t contained in Bion terms, it is like a foreign body and the child tries to protect themselves from foreign bodies. No entry defences are initially healthy, so they aren’t too porous to toxicity from the parent.
24’30 The Case of Sally with Anorexia and No Entry Defences
Sally had a very disturbed mother who had been almost drowned in the bath by Sally’s father. Sally was asked to hold her mother’s hand when only three years old when her mother had a bath. Sally couldn’t contain this psychotic anxiety at such a young age. Sally developed a No Entry defence which had a healthy beginning but extended as she grew up to not even being able to hear sounds.
Intergenerational pouring out of projections going down the generations. The opposite of a Russian Doll. No Entry defence extended to anorexia: Sally would not take in food, had dread of penetration [she was an adolescent], couldn’t even allow loud sounds to enter ears.
A child who is contained by someone who makes sense of their experience, internalises something that organises her/him. A child who is not contained or projected into, might internalise something opposite to alpha function = omega function. This would be a disorganising function in the child’s internal world. (See Bion, 1962 and Williams G. Reflections On Some Dynamics Of Eating Disorders: ‘No Entry’ Defences And Foreign Bodies. International Journal of Psycho-Analysis. 1997;78:927-941)
28’10 Tiptoeing up to Defences: Pastel rather than Primary Colours
If a child is so fragile, [your therapeutic] language has to be as light as a feather. For example – say ‘maybe’ rather than ‘perhaps’. It’s a softer word. Frequency of Work- sometimes just weekly is enough. Offering a coffee spoon, not a plate of food [more than once a week] that a patient is able to take.
31’15 Rosenfeld’s concept of the Internal Gang
I worked for a long time with adolescents. External gang is a reality for many of them. One patient had to report back everything in his therapy to the gang. Internal gang also present for many. It is related to drug addictions. Internal gang saying, ‘I can make you better’.
A small child had conversation in a session with an imaginary friend saying, ‘Why are you listening to that crap that woman is talking about’.
There are internal gangs who do not allow you to give up membership and become ferocious when you try. Process of internalising a good object [in therapy] is painful but ultimately worthwhile.
36’30 Poor feeders: The case of baby Patrick
Patrick had 3 older siblings who had died. Mother projected her fear of baby’s death instead of being to contain it. She could not attach.
Patrick spat the food out and threw it out all over the kitchen. Symbolised something very disorganised in relationship.
Bion says the most important fear the mother should hold is the fear the baby might die. However, this mother projected her fear of his death into Patrick.
Unwillingness of Patrick to depend on his mother. Father mostly looking after him because she was so frightened.
We are drawing a link in this case between the external circumstances and what happened to Patrick. It looks linear but this isn’t always the case.
40’50 Sometimes its Nature not Nurture
I am concerned that parents feel blamed when things go wrong with their children. There are different reactions in different children to the same circumstances. Eg exhibition of children’s drawings about a flood in village showed a range of emotional responses to same event. In some cases the parents are clearly responsible and have an impact but we should not generalise.
43’58 Psychotherapy in non-clinical contexts: Mexican Street Children
Extension of interest in Double Deprivation in this context. Visited NGO, Together with the Children. They needed more understanding of emotional issues of children as well as their practical needs such as education and food.
Therapeutic work modelled on Martha Harris’s ideas she developed at the Tavistock. Special Time Technique: Sitting with child for 45 minutes with a box with child’s name on it. Giving full attention to child, not asking too many questions, trying to make a link with the child’s play and what might be happening in their life. Important to prepare for ending of it. Example of child who had been left in same room as his dead father for 24 hours. Gianna would sit in Bus Station at night to befriend the children who were very wary. People interested in this technique of ‘special time’ in non-therapeutic environments can look at Gianna’s papers in the book ‘Work Discussion: Learning from Reflective Practice in Work with Children and Families’, by Margaret Rustin & Jonathan Bradley (eds)
50’12 What drew Gianna to Child Psychotherapy?
Initially studied philosophy and had theoretical interests (which might have been a defence!). Feel lucky to have had psychoanalysis herself.
50’54 What difference does Gianna feel she has made?
After Doubly Deprived, there was research that shows children who are deprived can be helped, as Martin was.
I started courses in child psychotherapy in Italy and there are now 400 trained there. There are also many in Turkey and Latin America where I also started off the training. Martha Harris had the most influence on me. She said, ‘Psychoanalytic ideas should travel and find fertile lands to flourish.’ I’ve been lucky to find fertile lands.
My heart is in psychoanalytic work. It helps children find a meaning of their suffering. I realised it helped me find meaning.
A child psychotherapist is internalised as a good presence which joins with other good characters inside the child to sustain to bear conflicts and difficulties so they can open up to the riches of life, including relationships.
Reading / Bibliography
1983: WILLIAMS, Gianna (with SALZBERGER-WITTENBERG, Isca and OSBORNE, Elsie) The emotional experience of learning and teaching. London, Routledge & Kegan Paul. Translated in Catalan, German, Greek, Italian and Norwegian.
1990: WILLIAMS, Gianna et al. Eds. Interazioni terapeutiche in contesti diversi. Esperienze e ricerche in psicoterapia infantile. Napoli, Istituto Italiano per gli Studi Filosofici.
1991: WILLIAMS, Gianna (with ADAMO S.M.G. eds.) Working with Disruptive Adolescents. Napoli, Istituto Italiano per gli Studi Filosofici.
1992: WILLIAMS, Gianna (with DARTINGTON, Tim and MENZIES LYTH, Isabel) Bambini in Ospedale, una Ricerca della Tavistock Clinic. Napoli, Liguori. Italian translation of The psychological welfare of young children making longs stays in hospital. Final Report. Tavistock Institute of Human Relations, Doc. No. CASR 1200.
1995: WILLIAMS POLACCO, Gianna (with COSENZA, Angela et al. Eds.) La Riparazione. Storie di Bambini alla Ricerca di una ‘Officina di Pensieri’ Pisa, Edizioni del Cerro.
1995: WILLIAMS, Gianna (with COPLEY, Beta) The Teenage Years. Understanding 18-20 year olds. London, Rosendale Press. Translated in French, German, Italian, Polish and Spanish.
1997: WILLIAMS, Gianna Internal Landscapes and Foreign Bodies. London, Duckworth. Translated in Chinese, French, German and Italian.
1998: WILLIAMS POLACCO, Gianna (with ADAMO S.M.G. eds.) Il lavoro con adolescenti difficili. Nuovi approcci della Tavistock. Napoli, Idelson-Gnocchi Editori.
2004: WILLIAMS, Gianna (with WILLIAMS Paul, DES MARAIS, Jane and RAVENSCROFT Kent Eds.) Exploring Feeding Difficulties in Children. The Generosity of Acceptance. Vol. I, London, Karnac. Translated in Italian.
2004: WILLIAMS, Gianna (with WILLIAMS Paul, DES MARAIS, Jane and RAVENSCROFT, Kent Eds.) Exploring Eating Disorders in Adolescents. The Generosity of Acceptance. Vol. II, London, Karnac. Translated in Italian.
2012: Williams Gianna. Mattie at work. In: Williams MH, Rhode M, Rustin M, Williams GP, eds. Enabling and Inspiring: A Tribute to Martha Harris. Karnac Books; 2012:1-10
Papers and Chapters
Henry G. Doubly Deprived. Journal of Child Psychotherapy. 1974;3D(4):15-28
Henry G. Reflections on Infant Observation and Its Applications. Journal of Analytical Psychology. 1984;29(2):155-169.
Williams GP. States of Body and States of Mind. Tavistock Clinic; 1995.
Williams G, Miller L. A Short History of the Tavistock Model Courses in Italy. Journal of Child Psychotherapy. 1999;25(3):405-410.
Williams G. On Different Introjective Processes and the Hypothesis of an “Omega Function.” Psychoanalytic Inquiry. 1999;19(2):243-253.
Williams G. Reflections On Some Dynamics Of Eating Disorders: ‘No Entry’ Defences And Foreign Bodies. International Journal of Psycho-Analysis. 1997;78:927-941
Williams GP. Mattie at work. In: Williams MH, Rhode M, Rustin M, Williams GP, eds. Enabling and Inspiring: A Tribute to Martha Harris. Karnac Books; 2012:1-10
Williams GP. At times when I see your face thinking, I am thinking as well. In: Garvey P, Long K. The Klein Tradition : Lines of Development-Evolution of Theory and Practice over the Decades. First edition. Taylor and Francis; 2018