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upon the children and much of the work with parents here is helping
them to understand and sort this out.
If the child is old enough and willing enough to separate from
his parents he is seen by the Educational Psychologist while the
mother is seeing the Psychiatric Social Worker, and is given a series
of tests, not only to assess his intellectual capacity but to gauge
his attitude to learning. Some children show particular types of learning
difficulties, e.g. in reading, which may indicate a need for special
help. The parents and child are then asked to attend for an interview
with the Psychiatrist who already has the reports of the first interviews.
The child is usually seen first in the playroom with toys where
the Psychiatrist attempts to form a friendly relationship and observes
the child's behaviour and reactions with play material and offer
to help him with his problems. Most children, even three-year-olds.
are quite willing to admit that they have worries and usually express
their willingness to come again for further help.
The Psychiatrist then sees the parent or parents and discusses the
child's problems and possible ways of dealing with them, though
final decision about this may need to be postponed till the case conference
has taken place.
A Case Conference between the Psychiatrist, Psychiatric Social
Workers and Educational Psychologists, and attended by the Child
Therapists, who may take the child on for treatment, is then held.
In some of the cases the problem is largely a social marital one;
in others an educational measure may be needed; in some the mother
needs help and counselling in her handling of the child; but in a
large proportion of cases, the child needs to attend for weekly treatment
while the mother sees the Psychiatric Social Worker.
These diagnostic interviews are very time consuming but are
nevertheless essential.
It was stated recently in a Medical Journal that under the
National Health Service, the doctor talks and the patient listens, while
in private practice the patient talks and the doctor listens. In this
respect, all our patients are largely private patient It is what they
say and how they say it that gives us the data on which we make our
diagnosis.
In a full diagnostic survey at least three people are involved. each
spending an hour and a half on every case and there are often additional
interviews as well as the Case Conference.
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