Psychotherapy in Child Guidance
- Author:
Gordon Hamilton. Columbia University Press. 1947.
pp.340. $3.50 (22s.).
Sometimes one wishes that the paper shortage would reach America. Here is a book which sets out to be an authoritative book on the social worker’s role in psychotherapy. The field studied is the network of clinics and social organizations for the welfare of children provided by the Jewish Board of Guardians. In a foreword, Dr Nathan Ackermann claims here “that positive commitments are made in both the theory and practice of child psychotherapybut there is a good deal of repetition and the material is not presented in a very orderly fashion. Professor Gordon Hamilton describes for example the methods used by psychiatric social workers who are undertaking very much more than family casework, and are in fact carrying the main burden of psychotherapy. But it is not until page 214 that it becomes absolutely clear that in many cases the same social worker treats both parent and child. Not only in the U.S.A., but here in England all practising psychiatrists know that they are faced with what is virtually a breakdown in the provision of therapy, owing to the large number of cases requiring treatment. The solution is usually to put patients’ names on the waiting list. It must be a common experience at many clinics that some situations improve during this period of waiting, so that one is led to wonder whether something was wrong with the diagnostic procedure: and some situations become very much worse, so that children have to be handed over to Juvenile Courts. Their problem might never have reached such dimensions had treatment been given at the appropriate moment.
Thus an authoritative word on the selection of patients for treatment and the points which guide the psychiatrist in deciding whether this case must be carried jointly by psychiatrist and social worker, or whether it could be carried wholly by one or the other, would have made a very interesting chapter in this book. But nowhere, except in the most general terms, are we given a picture of what principles guide the plan for treatment.
In a general way, it appears that the most severely disturbed cases are treated by a psychiatrist working jointly with a social worker, but many of the cases cited, and recorded material is given very fully, are by no means only lightly disturbed. After a broad description of the development of psychotherapy in relation to children, beginning with the early treatment by Healy and others of delinquents, following on to the rise of psychoanalysis in the thirties, and from there to an understanding of the relationship and development of the modern psychotherapeutic situation, the author makes it clear that for the last 20 years workers in the field of social psychiatry, particularly with children, have had to deal with not only disorders of personality, but with disordered situations associated with difficult or defective personality in the child’s immediate environment. On page 20 the author remarks, ” especially with the shifting picture of the growing child and immediacy of his home and family problems was it impossible to distinguish one as wholly the province of the psychiatrist, and the other of the social worker With this view there could be little disagreement, the point being only to decide whether the work should be divided between the psychiatrist and social worker on the basis of conference and exchange of material, or whether with the extreme shortage of personnel, one would not have to find techniques in which one worker could carry both parent and child. Professor Hamilton is at pains to explain that psychotherapy and analysis are not the same thing, although most psychotherapists will have had a close acquaintance with the practice of psychoanalysis in their training, and many will have had a training analysis, whether they are medically trained or not.
The book then deals in considerable detail with individual case histories, illustrating the impulsive child, the neurotic child, the primarily anxious child, and the severely disturbed child, some of the latter with definite psychosis.
The remainder of the book is given over to a discussion of treatment, divided up into treatment of younger children, treatment of the older child, treatment of adolescents, and treatment for the family. Here one feels that the significance of the parent-child relationship is not always brought out clearly enough, and it is particularly in this section that one would have liked a more succinct analysis of what Allen calls the ” movement ” in the progress of the case. The chance remark on page 219, ” after only six months of treatment leads one to suppose that treatment is universally regarded as needing to be thorough, deep and involved, which is all the more reason for making the exposition of it less involved by careful selection and careful analysis of the different stages of treatment.
A rather clearer picture is given later, of the requisite training for a social worker undertaking psychotherapy. Whether this be psychotherapy in the strict sense, working directly with the child, or whether it be what is often equally difficult handling of a not very co-operative or understanding parent, it is good to see that the social worker of the future is to be a recognized factor in dealing with these two aspects of psychotherapy. E.M.C.
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