View report page

For most of the time the team has been without a Psychiatric Social Worker. In
the absence of this essential member, the psychiatrists have delved for themselves in
the social.field and drawn freely on the help of the Local Health Authority Psychiatric
Social Worker, Health Visitors, Officers of the Children's department. Probation Officers
and officials of the Education department. While such measures have not proved an
adequate substitute for the contribution of the Psychiatric Social Worker, they have had
at least two interesting side effects. Firstly, the Psychiatrists have been impressed by
the value of devoting more of their time to the needs of the parents and the whole family
rather than to the problem of the individual child. Secondly, co-ordination between the
work of the clinic and that of other agencies engaged in the welfare of children has
improved.
In general, the volume of work has been maintained throughout the year and inevitably
the bulk of clinical time and effort has been spent in maintaining the existing diagnostic
and treatment service. The contribution which the clinic should make to the promotion of
mental hygiene by regular conferences with teachers, parents and other adults in contact with
children has been meagre. This aspect of the work cannot be developed until the staff is at
full strength and reinforced by the services of a non-medical psychotherapist and additional
sessions from Educational Psychologist.
In comparison to the previous year's figures, the number of cases referred from the
usual sources show some appreciable variations. The School Medical Officers, the Head
Teachers and Maternity and Child Welfare Staff have referred fewer cases while Parents,
Probation Officers and Education department have sent more. The meaning of these changes is
difficult to assess, but the overall trend implied in them appears to be a desirable one.
Certainly the evidence that parents are taking more initiative in :getting advice on their
family problems is encouraging although it may represent an unsustained response to the
stimulation of relevant programmes at the cinema or on the radio and television. The
reduction in the number of referrals from the School Medical Officers seems to coincide with
a greater proportion of really difficult cases from this source and may mean more rigorous
'selection and screening. The spreading consciousness in Maternity and Child Welfare circles
of the importance of recognising and helping to resolve emotional difficulties arising in the
family setting during the child's earliest years means that problem situations are detected
earlier and often at a stage when they can be resolved without reference to the Psychiatrist.
Some 25# of cases seen during the year have been taken on for treatment and more
individual than group treatment has been given. As always a major stumbling block to the
establishment of successful treatment is the difficulty in bringing the relevant home and
school personalities effectively into the treatment situation. Even the least ambitious
therapeutic plan for an individual child is likely to prove worthless if it does not take
into account the child's total setting and be consistent with limiting factors inherent in
attitude of parents and teachers. Direct consultation with parents or teachers readily meets
resistance to psychotherapeutic advice which is often accepted on an intellectual level and
rejected on an emotional plane. However, the practice of taking groups of parents together for
mutual discussion of problems in the presence of the Psychiatrist who takes a non didactic
psychotherapeutic role is helping to overcome this difficulty. The parents enjoy these group
meetings. They gain confidence quickly and are soon whole-heartedly sharing in the treatment
situation in a constructive and knowledgeable manner. This use of group therapy methods might
well be extended to embrace teachers who could use the material of a case conference for
exploring and sharing divers attitudes to the common emotional and educational problems of
school children.
120