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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.
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 recognise 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 internalised
and reappear as neurotic symptoms. They are then much less
accessible to external help and to changed 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 sympoms with persistent crying and many others.
In these children with largely internalised problems the Psychiatrist
or Child 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
treatment. The Therapist's aim in these interviews is to establish a
relationship with the child which will enable the child to work out
his own problems and thereby to cope more adequately with his other
relationships so that as an adult he may become a socially responsible
good citizen.
The child's parent, mother or father, is also seen by the Psychiatric
Social Worker for ¾ hour each week and, through the establishment of
an accepting relationship, helped to understand and modify her or his
attitudes towards herself or himself and the child.