What is the impact of intermittent strabismus upon the therapeutic relationship

Abstract

This study asks: ‘How does intermittent strabismus impact upon the therapeutic relationship?’ A template organising style has been used to analyse child psychotherapy process records of children who suffer from intermittent strabismus during assessments for child psychotherapy. The research utilises ideas from the field of ophthalmology in order to assist in the development of a psychotherapeutic understanding of this condition. The themes that emerge from the analysis of the clinical data, together with an exploration of the relevant ophthalmic, psychoanalytic, and child development literature, have elaborated how intermittent strabismus might influence the transference and counter-transference, in a way that potentially promotes a fragmentary quality of emotional relatedness. It is suggested that this may challenge the child’s ability to maintain their relationship with the external world. It also illustrates, thematically, how child psychotherapists might respond to this negative influence by emphasising their own visual reciprocity, thereby aiding the child’s visual and emotional coherence. Also, when they do this, it might appear to correspond with the child’s ability to explore both their inner and outer environment reflectively. It is suggested that the findings might beneficially influence practice within the consulting room.