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Treatment.
Our decision about the type of treatment and its probable
duration rests largely on whether the problem when referred to us
is still an external one or whether it has become internalised within
the child's own personality.
in the small child of pre-school age most problems are external
and present a conflict between him and his mother, or father, or
brother or sister. Often help for the mother, with or without the
child, may clear up the problem in a small number of interviews.
Another type of external problem for which we can give considerable
assistance is in helping the child to adjust psychologically
to some traumatic but unavoidable happenings:—a severe physical
handicap, an injury such as the loss of a leg, the death, or mental
or physical illness, of a parent.
We can also help to prepare a child for the birth of a brother
or sister, for going to school or going to hospital in cases where
the parents ecognise that the child will have considerable difficulty.
In older children, too, problems are usually external at first,
but are too often left untreated until they have become interna'ised
and reappear as neurotic symptoms. They are then much less
accessible to external help and to change attitudes in the family
and need prolonged psychotherapy to cure them.
To give an example, all children feel jealousy of younger
brothers and sisters though they may not show it openly, and have
some difficulty in coming to terms with it and developing a satisfactory
fraternal relationship where a competitive spirit is mutually
helpful. Some children fail in this task, especially if they are made
to feel too guilty over their jealousy and may repress the whole
struggle only to show it later in an internalised form when they fail
in all competitive situations. If their conscience forbids them to
have any feelings of rivalry they may fail at school and elsewhere
whenever such feelings tend to be aroused.
The neurotic symptoms which we see are these inhibitions of
learning or making friends, fears of all types, anxiety states, chronic
depressive symptoms with persistent crying and many others.
In these children with largely internalised problems the Psychiatrist
or Therapist takes them on for weekly treatment of ¾ hour for
an average period of eighteen months, though difficult cases may take
longer. Those with externalised problems need a shorter period of
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