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Dr. K. Graf reports as follows on the year's work at the Tetherdown Centre:-
"This is my seventh annual report since I was seconded by the North-West Metropolitan Regional
Hospital Board to serve in this area as Consultant Child Psychiatrist, and my fourth report as Medical
Director of the Tetherdown Child Guidance Centre, which was established in its present set-up at the
time of the reorganisation of the London Boroughs.
During the year there have been several fundamental changes in the staffing of the clinic. Miss
Gwen Kidgell, for many years Educational Psychologist at Tottenham, and lately also at this Clinic,
retired after holding the post of Senior Educational Psychologist of the Borough for four years, and
her special interest in the Tetherdown Clinic will be missed by us all. However, she has now been
ably replaced by Mr. B.J. Watkins, who has been an Educational Psychologist at Tetherdown for several
years.
Miss Beryl Raven, Senior Psychiatric Social Worker at Tetherdown over a very long period, retired
from full-time work at the end of August but, fortunately for us, she has agreed to continue her
valuable work with parents and children on a sessional basis for one day each week. Her post yet
remains to be filled.
Mrs. Elizabeth Hunter left in July and her place has been filled by Mrs. Sheila Lucas, who
transferred from the Tottenham Clinic.
Mrs. E.P. Maschik, the child psychotherapist, left in December, but was immediately replaced
by Dr. Roberto Azevedo. a most experienced medical psychotherapist.
The Child Psychiatrist, who attended for two weekly sessions, was mainly occupied with
diagnostic work, the medical direction of the clinical aspects of the work, communication with the
referring parties, and therapy of a limited number of cases which did not require very intensive
attention. During the year he saw 53 new cases for diagnostic assessment and individually
reviewed 51 old cases. The sources of referral remained the same as in former years, and the
majority of children reached us through the Medical Officers of the School Health Department. Only
slightly fewer children were sent for assessment with the parents' permission by Head Teachers of
local schools when they noticed educational difficulties or behaviour problems which seemed due to
emotional maladjustment. A fair number of cases came through the Probation Department (including
reports for the Juvenile Court), and the Children's Officer.
We particularly valued those cases which reached us from the family doctors or the parents
themselves, and there continued to be mutual referrals for opinion and treatment between the child
psychiatrist and his colleagues in the hospital service. We also appreciated very much the
considerable interest shown in specific aspects of our work by Dr. U.P. Seidel, and his department,
who has been associated with the Clinic for years.
As in past years, we felt that many of the problems of the referred children stemmed from social
difficulties within the home situation which were not amenable to treatment, but in some cases we
were nevertheless able to help the child to deal with the unchangeable situation in a more independent
and mature manner and not to rely any longer on neurotically maladaptive reactive behaviour which
was harmful to him and annoying to society. On the whole, however. Child Guidance is more
competent to deal with a child's emotional unsettledness or conduct disorder when these are due to
conflicts either within himself or in his relationships with his family. Problems obviously due to
environmental shortcomings or social factors are often better dealt with by other social agencies.
Head Teachers who are justifiably frustrated by the disruptive influence on the routine and the
discipline of the class through a perpetually aggressive child, may be disappointed when referral to
our clinic does not provide them with immediately applicable suggestions on how to cope with the
difficulties complained of, particularly if we report that there is no evidence of treatable emotional
disturbance to account for the behaviour. Equally, parents who have brought to us a child because
he has stolen or told lies, are bewildered when they gather that instead of emphasising to the child
the seriousness of his wayward behaviour, we treat him by permissive and, for him, quite enjoyable
playtherapy spread out over a lengthy period; but this has to be done to gain his confidence for the
exploration and treatment necessary to alleviate and cure the emotional maladjustment underlying
the behaviour disorder. It has to be appreciated that naughtiness and predelinquent behaviour of
varying degree of severity may present with symptoms and manifestations of conduct identical to
emotional disturbance in a child, and it requires the specialised skill and experience of the child
guidance team to make the differential diagnosis, because naughtiness and anti-social behaviour,
even if they are rooted in psychologically explainable causes, are best dealt with by training and
disciplinary measures applied best by the home, school or other appropriate agencies, while only,
behaviour problems due to emotional maladjustment or mental disturbance require the specialised
approach of the hard pressed and overloaded facilities of the Child Guidance Clinic.
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