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REPORT ON THE WORK OF THE WEST HAM CHILD GUIDANCE CLINIC
by
T.P.Riordan, MD., B.Ch., D.P.M.
During the year 1955 the work of the Child Guidance Clinic for the most part
followed the pattern of previous years. The bulk of the staff time and effort was again
deployed on the provision of a diagnostic and treatment service, and no new ground was
broken in the field of prophylaxis. Special features of the years activities were, an
emphasis on individual therapy with children and sustained work with parents in cases
needing long term treatment, the extension of remedial coaching facilities on the clinic
premises, and a more effective link with the educational service.
The table of statistics does not vary significantly from that of the preceding year
and calls for little comment. The reduction in the number of children who attended for
psychiatric interviews reflects the increase in individual therapy at the expense of
group therapy. The current practice here is to use group therapy for most of the preschool
and infant school children and for some of the adolescents. Individual therapy
is reserved for the more difficult problems of maladjustment irrespective of age group.
One such problem that received considerable attention during the year was encopresis. A
small number of children with soiling as the presenting symptom was studied in some detail
in an endeavour to indentify causative factors. The problem was found to arise in a
different way in each case and no suggestion of a common causative factor emerged. The
mother-child relationship was always disturbed and often the symptom appeared to be a
vicarious means of satisfying an individual need denied a more direct and natural
expression. In one instance in which maternal inconsistency and partial rejection was
clearly a major stress, advice to the parents leading to a reduction in maternal anxiety
and to father taking a greater share in the management of the child was followed by steady
improvement. In another case in which maternal rejection appeared to be the important
factor, the girl's incontinence was clearly linked with frustrated aggression. She
described the feeling of a "quiet rage" as she soiled herself. The majority of the children
with encopresis were boys and in general the mothers were intelligent, anxious and not
consciously rejecting in their attitude. Usually, they were highly critical of themselves
and often unaware of the critically expectant and over-close relationship they had with their
sons„ Progress in the treatment of such situations was slow with periods of improvement and
relapse succeeding each other often to the great distress of the parents. As the treatment
relationship developed between child and therapist, visits to the clinic often evoked
recurrences of soiling. More than one boy asked whether clinic attendance would finish if
soiling ceased and more than one boy experienced satisfaction from his behaviour lapse. At
this stage in the treatment it was often very difficult to dissuade parents from assuming
that such attitudes on the part of the children called for immediate and severe corrective
measures. More often than not untimely correction was meted out. This usually induced an
immediate, but unsustained improvement in the child and brought about a setback in the
progress of treatment.
The decline in the figures for home visiting by the psychiatric social worker during
1955 caused concern, particularly to the psychiatrists who felt that the time and effort
involved in doing this work was amply repaid by the insight such visits gave into the
atmosphere of the home. However, as much home visiting could only be done in the evenings
and out of the usual office hours, it was found more convenient and time saving to arrange
for most of the social histories to be taken at the clinic by the psychiatric social worker.
She then, was able to plan her work with the confidence that she could^fulfill a planned
programme of interviews - psychotherapeutic,, social and educative - during her working
hours.
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