South Africa is in the grip of an HIV crisis that is leaving many children orphaned at a very young age. A project was initiated in response to a growing awareness of the impact that these losses were having on a group of children attending a child psychiatry community clinic. The aim was to provide therapeutic groups for both the children and their caregivers. In this chapter, I explore these groups and consider a relational psychoanalytic understanding of how some of the central processes unfolded. It is hoped that the lessons learned and failures encountered in these groups could be useful to similar ventures. It is written from my clinical experience as a psychologist in both a state hospital and a community mental health clinic.

THE CONTEXT AND SETTING

During the time of these groups (2002–2007), South Africa was in a difficult stage of its health policy relating to HIV. It was the Mbeki era (1999–2008), marked by AIDS denialism and ambivalent messages regarding the link between HIV and AIDS. Antiretrovirals were not readily available or part of the government healthcare programme, as they are today. For many people concerned about their HIV status, there did not seem to be a point to testing as the disease was considered untreatable. The common choice seemed to be to sit with not knowing rather than face the implications of being HIV+. In this context, being HIV+ was not simply about having contracted a terminal illness but was linked to shame, fear of exposure and vulnerability. The burden of these emotional states appears to have resulted in the emergence of manic defences, not just at an individual level but also at a broader societal level (Altman, 2005). In this chapter, I explore ways in which defences against unmanageable feelings emerged in both the project staff and the group members.

The setting was a children's community psychiatry clinic that operates as a satellite of a state psychiatric hospital. The community clinic was based in a neighbouring township where many families live in informal housing or shacks made of cardboard or corrugated iron. There are few resources available to this population. Levels of unemployment, poor education levels, deprivation, aggression and hopelessness are high among this strained community.