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Many children present quite severe problems in their homes, yet
may function quite normally at school. Others may be outwardly conforming
at school but release the pent-up feelings relating to school
with increased intensity when they return home. Most teachers now
recognise the over-good child as a disturbed child who is afraid to be
natural.
Diagnostic Survey.
When children are brought to us, we need to know as much as
possible about them and the family set-up and background. We make
use of whatever records are available from the School Medical Officer,
Family Doctor, Health Visitor, and the schools he has attended.
The parents first come (fathers as well if they can) and are seen by
the Psychiatric Social Worker who takes a full social history. This
includes the problem for which they attend, its onset, duration, and also
a full life history of the child's development, his personality and his
interests; his relationships to his parents and brothers and sisters and
theirs to him; the family background, housing and material conditions
and the varied anxieties and stresses through which the family has
passed. The parents' own history of their childhood is important. The
way they handle their children will depend very largely on how they
were treated themselves and what their relationships were with their
families. It is their own past sufferings and problems, rather than " the
sins of the parents" which are visited 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 offers 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 or 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 patients. It is what they say and how they
say it that gives us the data on which we make our diagnosis.