The process of engaging young people with severe developmental disturbance in psychoanalytic psychotherapy: patterns of practice.

The author discusses some of the problems faced by psychoanalytic psychotherapists at a community-based center in engaging in psychotherapy hard-to-reach young people who present with severe developmental disturbance. The difficulties are suggested to arise from a poorly developed capacity, in these young people, to reflect on their own and others' mental states. The technical implications for the therapeutic approach are discussed. Case material is presented that illustrates this approach.