One of the hardest things about working with children is determining how much of the problem lies in what particular arena. So many of the children have very real and multiple difficulties. So the child whose father left when he was a toddler, might also be struggling to deal with his ADHD or epilepsy, a difficulty with reading and his grandmother’s death. A teenager who is worried about his looks and future, has doubts about his sexuality and is really anxious about the direction his life should take. What is/should be the priority? Where should we start? Is the Mother’s worry more appropriate or valid than the child’s? Justin has mild acne, diabetes, has been bullied and has just lost his Uncle in a car accident. The bullying was dealt with by a change of school but this has not been totally successful. He gets called ‘Gay’ by boys and girls he meets on the buses and has started, not unreasonably, to avoid public transport. His acne is not visible to me, but his mother tells us that he spends a lot of his time looking in a mirror and trying different sorts of concealer. He was close to his Uncle and tears well up when he tries to talk about him and although he has been diabetic for some years, he is fed up of having ‘a problem’ and wants to be like everyone else. Certainly this was a reasonable referral. Parents hate to see their children unhappy but sometimes it feels as if this is more of the state of adolescence than any one problem in particular. Justin has a girlfriend and theirs is a close, sexual relationship of some months standing. So why is he upset when he is called ‘gay’ by boys he knows only slightly? The diabetes is under control and he manages his diet well; but after several years of needing to ‘control’ what he eats, he’s had enough and wants to go and eat what other people eat without having to think about it. I feel, half way through this first assessment interview, that, actually, Justin was coping well with all of these things until his Uncle died. His mother’s brother was not much older than Justin. They had spent a lot of time together, he had been a role model and a support. His Uncle was young, the accident was awful, and the newspaper reports meant that the situation was prolonged while all sorts of people commiserated and said how dreadful it all was. And of course, it took a little while for the inquest to happen so that there was a delay before the funeral. Everything made things worse. When you are young, you believe yourself to be invincible. Bad things don’t happen to you , and even if people in the family die, they are old, and it’s their time. His Uncle had been young. Justin knew that one day he had been there, playing football with him in the garden, and the next, he was dead. So Justin learned about death in a very harsh manner, and this sudden knowledge, changed his perception of everything else. Nothing could be easy or frivolous now, people can die. Bereavement responses are difficult. It can take a year to come to terms with the loss of someone you love. And while you are coping with this, everything else can seem much more complicated. We shall start with bereavement counselling and hope that in this way, I can contain some of his depression about other aspects of his life. Teenagers are often in a state of flux: anxious about who they are and where they are going. They can seem horribly sad and enormously elated. I think this is a lot more, triggered by the loss of his Uncle.