THE THERAPEUTIC OPTIONS IN CHILD PSYCHIATRY

Abstract

Discussing Professor James Anthony's paper entitled Developments in Child Psychiatry: Varieties and Vicissitudes of the Therapeutic Situation in the Treatment of Children, the writer agrees with his conclusions regarding the. child's psychological and emotional resources which “lead one to regard him as a highly treatable subject”, and the coming of age of child analysis “as a genuine psychoanalytic method and not merely as a parameter”. A psychotherapeutic approach consisting of two phases is suggested by Dr. Anthony and is welcomed by the writer as a unifying conceptual framework for the divergent trends in child psychiatry. The first phase, practised in child guidance clinics, is based on a symbiotic type of relationship and uses corrective experiences and catharsis. The second phase is psychoanalysis proper with the accompanying transference neurosis, and requires to develop a special therapeutic setting or ‘predisposing environment’. It is recommended mainly for “children with circumscribed neurosis in whom the conflicts are largely internalized and the environment not markedly abnormal.” The writer explores the historical development of child psychiatry, psychotherapy and psychoanalysis. In 1909, Sigmund Freud published the case history of Little Hans, the first analysis of an infantile neurosis. During the same year, William Healy founded in Chicago the Juvenile Court Clinic and utilized in the first ‘orthopsychiatric team’ pædiatricians, psychologists and psychiatrists, co-operating with social agency workers and probation officers. Psychoanalytic concepts were assimilated by education and social work quite early in North America. Applying ‘dynamic’ principles and sharing a common experience in their team approach, social workers, psychologists and psychiatrists were able to present their heterogeneous techniques as psychoanalytic therapies specifically adjusted to the child. A double standard has finally evolved in the practice of psychoanalysis or psychotherapy: a very exacting and orthodox attitude when adult patients are concerned, and a most flexible and benevolent acceptance of any ‘activity’ or ‘play’ as valid forms of psychotherapy and even psychoanalysis for children. In the writer's opinion, a transference neurosis cannot develop in a therapeutic setting which is not governed by the rule of abstinence. The therapist must eschew the acknowledged role of educator that the child ascribes to adults in his environment. Psychoanalytic treatment is possible if it is not actively hindered by conditions incompatible with the analytic technique. The use of play or drawing in individual or group sessions, does not alter the nature of the therapeutic process, which derives its originality from the analytic situation, transference and interpretation.