'His troubles are not over, but he is much calmer'

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As a pre-school child, Jack's tantrums were generally put down to a particularly bad case of the "terrible twos". But when he was seven, Jack (not his real name) still seemed unable to cope with not getting what he wanted.

He was teased at school because other children found that he was easily wound up. He was disruptive in the classroom, and fell behind with his work because, although bright, he could not concentrate. At home he would fly into a rage over the slightest thing. He was very jealous of his brothers, who were two years and three years younger, and would hit them ferociously. Jack's school referred him to the local child guidance clinic. There, a social worker advised Jack's parents on how to handle him, emphasising that he needed firm boundaries.

But this did not help. His parents asked if he could be seen by the clinic's psychiatrist or therapist, but there was a long waiting list and the social worker insisted better parenting would solve Jack's problems. So they found a child psychotherapist in private practice. She saw the parents together, then asked for separate sessions with Jack's father and mother and asked questions about their childhoods. The answers, she hoped, might throw light on how they handled Jack. She saw Jack twice, and referred him to an educational psychologist.

She told Jack's parents his problems were the result of a deep-seated disturbance related to his very early life. To find the cause and cure it, she would need five therapy sessions a week in school term time for a minimum of one year and a maximum of three years. She also advised the parents to have separate sessions with another therapist. This is often advised if the therapist thinks the way the parents handle their feelings is part of the child's problem.

Jack's parents hesitated. Five sessions a week seemed heavy for a child. The cost, at pounds 30 a time, was also a factor. But, at nine, he was on the brink of being excluded from school. They decided against therapy for themselves.

Jack has been having therapy for a year. His troubles are not over, but he is much calmer. The therapist does not think she has yet reached the seat of the problem, and believes the treatment should continue. Jack's parents would like to see it come to an end before he starts secondary school in September.