Auswirkungen von Zwangsbehandlungen und -massnahmen auf die klinische und Beziehungsarbeit in der stationären Kinder- und Jugendpsychiatrie

Abstract

The voluntariness to agree with a psychiatric treatment is not an all-or-nothing phenomenon. Numerous factors as developmental maturity, psychological mechanisms, cultural values, legal regulations, various dependenciesof the protagonists, available treatment strategies and resources interact and are part of a dynamical process. Children and adolescents usually do not go to psychiatric hospital of their own accord. If they endanger themselves or others by any kind of psychic disturbance, the use of power and coercion by parents, guardians, community or legal authorities is sometimes inevitable to take them into the care of mental health professionals. Therapeutical motivated measures which will be taken against disturbing behaviour of children and adolescents often consist not only of therapy but also of control. Coercion can be a legitimate dimension of treatment, but it demands careful examination by the clinician. Regarding treatment options and goals the way of negotiation is preferable whenever possible to develop and strengthen the own treatment motivation in children and adolescents. Even subtle endeavours to enforce therapeutical activities affect the therapeutical atmosphere on the ward and lead to emotional stress in both the patients with their families on the one side and the psychiatric staff on the other. The decisions in context of coercive measures are always influenced by subjective factors as personalities of the protagonists, quality of the relationships between them, sympathy, empathy and professional capabilities offered by each member of the staff. Scrupulous reflexion of psychopathological, psychodynamical and institutional issues is required, especially if coercive measures as seclusion, restraint or medication against the will were employed. As far as the sparse empirical literature on the subject allows and comprising clinical experiences the effects of coercion on the therapeutical relationships will be reported in this article. Recommendations on how to manage aggression and the consequences of coercion in therapeutical settings will be given. The importance of clarity of roles and cooperation between the institutions responsible for the use of coercive treatments and measures will be stressed in every individual case. All has to be done to prevent an abuse of power which can occur in context of the asymmetrical relationship between psychiatric institutions and psychically disturbed children and adolescents treated in them. Experiences with coercive measures of any kind usually produce long-lasting after-effects and endanger the motivation of the patients afflicted to accept treatment at all, namely in the current treatment episode or in the future when treatment may be needed again.