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necessarily the most damaged or in the most need of help. A
neurotic fear which causes little overt alteration in normal behaviour,
and is not a nuisance to others, may need prolonged treatment if
the child is to adjust and develop normally. But a child who has
been mismanaged, and in consequence is out of control, may with
some advice and understanding of his particular difficulty settle
quickly and easily and cease to be a problem.
The parents willingness to co-operate in further work for the
child is very important, and the extent to which they are capable of
this is not always apparent at the first interview. Sometimes parents
superficially very anxious to have help in understanding and dealing
with the child, prove later to be unable to modify their attitude
or opinion, or to accept that their own difficulties are closely bound
up with the child's. On the other hand, parents who have appeared
relucant to see the trouble as it affects the child, and may be actively
hostile towards it, do after a time prove really willing and able to
co-operate in helping him.
The child's accessibility and desire to overcome his difficulty
or understand his problem is also significant when assessing the
value of treatment. Here it may be some time before a definite
decision can be reached.
Social and economic factors may be of prime importance in
causing disturbances in a child and here the Clinic service can be
of little direct help. The family may be put in touch with a social
agency which can assist them, but in such cases the root of the
trouble is outside the scope of the Child Guidance Clinic.
Occasionally a child is so unstable that he is virtually not able
to benefit from any form of treatment however intensive or
prolonged. These children are generally found to be psychotic or
near psychotic in their make-up, and little at present can be done
for them except to give such advice on management as will minimise
the difficulties of handling and relieve those caring for the child
from the anxiety resulting from their very natural wish that " something
should be done."
Lastly, but no means least, there is the question of human
need. Although we may be unable to see ourselves any way of
relieving the mental distress of parents or child, or of solving the
problem presented to us, we do at times see parents or children
whose urgent need is to have someone willing to listen to their
troubles, or to befriend and support them. For this we make no
apology, believing that there is still much to learn about the
therapeutic situation, and finding that an attempt to meet this
human need, even in comparative ignorance of the factors involved,
may produce results we have not forseen or hoped for.