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Given a real family, even institutionalised children can develop their potential, says Robin Balbernie.

I have to change my mind about play or about orphanages, I am not sure which.

I recently observed a couple of three-year-olds, institutionalised since birth, playing co-operatively with a fold-out doll's house and all its miniature accoutrements. They looked more busy than cheerful. I was struck by how intent they were, engrossed in their game as they moved toys around, not squabbling, but not talking either. The little girl just about spared me a glance. The boy did not look round at all. I found these reactions odd. They seemed incurious about a stranger who must have sounded peculiar.

This suggested they were in a state of anxiety, and yet their play seemed busy and imaginative; although it was possible that this was all they ever did and it was a repetitive and self-soothing activity.

It is generally accepted that if a child is able to play freely and imaginatively then he or she is probably doing all right. The seriously emotionally disturbed child often cannot play creatively, or enjoyably. Yet here were two tiny children who had spent all their life in an orphanage. However kindly the staff, they changed around at regular intervals and life had always been governed by an unshakeable routine. For instance, the babies were put down for their eight hours sleep always at the same time, missing out here (as in all parts of their short lives) on the stimulating hurly-burly of normal family life.

It would be organisationally impossible for either of these children to have formed and kept a secure attachment to an adult, as this would have been the third age-grouping and staff group they would have encountered; although (I asked) it was common for the children to form strong friendship bonds, probably functioning as pseudo-attachments, between themselves.

It would seem then that play always needs a context, it is not diagnostic on its own and we cannot use what we observe to generalise about the child's emotional well-being without this. What I saw may have been less a matter of creative play and more a well-rehearsed defensive activity designed to anaesthetise despair. I was only observing for about 20 minutes. On the other hand, from a more positive perspective, these two were showing that they still had something going for them and, given a real family, it might not be too late to build on the strength of some sort of playfulness.

Robin Balbernie is a consultant child psychotherapist in Gloucestershire.

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