Practical Child Psychotherapy
84 MENTAL WELFARE :Author: Curt Boenheim. With a Foreword by Prof. Dr H. Kinkelstein. John Bale Medical Publications Ltd., 85 Great Titchfield Street, London, W.l. 1938. Price 10/6.
I am glad to review a book by an experienced German author, who, coming by way of somatic medicine, thence progressed to child education and psychotherapy. This is a way now chosen by many pediatricians (including the present reviewer) and therefore I may at once say that the perusal of the book has revealed on most points a wide agreement of experiences and conclusions drawn from them.
At the beginning the author states that psychology is often a playground for psychologists without adequate medical knowledge and later on he calls special attention to the fact that experienced physicians are all too familiar with the harm done by lay psychologists lacking the necessary knowledge of clinical teaching and practice.
The classification followed in this book is based only upon purely practical considerations. The ” minor psychotherapy ” ?a term used by the author as analogous to “minor surgery”?is its chief concern ” because it is the main activity of the general practitioner in so far as he practises psychotherapy In the ” General Considerations ” one finds a short exposition on the ” Present Position of Psychotherapyoutlining the development of this new branch from Freud via Adler and Jung to Stekel. Here the author states that one of the most important results of analysis is the insight into the development of instincts, into the dynamics of the conscious mind, of repression, and of dreams. The conflict of opinions of the modern schools direct him to the conclusion that Freud’s concept of “infantile sexuality” has by no means secured universal acceptance.
The accurate study of the child at play (Charlotte Buehler, Hildeg. Hetzer, Margaret Lowenfeld) is described as a very happy inspiration. Reviewing Adler’s individual psychology (characterizing him as a social psychologist) and quoting Jung’s attempts to examine drawings (“modes of expression other than the spoken word”) the author agrees with Hartmann that Psycho-analysis can only partially contribute to characterology and that it has to be supplemented by type-psychology and descriptive psychology.
He then deals with experimental psychology, the very important problems of constitution and environment and the difficulties relating to the question of what is “normal”? Pointing to the case of the only child, to the ” age of rebellion”, to ” failure of adaptationetc., the author considers that the general vagueness about so many of such conceptions is one of the main obstacles which debar us from an insight into the genesis of neurosis. He describes types of neuroses and their symptoms, refers to Pavlov’s theories of conditioned and unconditioned reflexes, to the inferiority feeling and Adler’s organ inferiority, and his summary about all these problems shows a very great reserve. Certainly he is fully right. He states that the events in the period of early childhood are of fundamental importance, since a disposition to disturbances is marked owing to the sharp conflict of the pleasureprinciple with the reality-principle. The disturbances take place in many cases in the somatic field, because in childhood, especially in the first period of development, the control of somatic functions assumes an important place. Discussing the general indications for, and methods of childpsychotherapy, he enumerates the indications, speaks about suggestion and training, development and environment, and the comparative value of symptoms, and ends by criticizing the methods, which must vary according to the age of the child. Here he calls special attention to the observation of younger children at play and also to play as a therapeutic agent; hypnosis, he considers, should not be looked upon as the most obvious therapeutic measure, but rather as ancillary to other therapy. Later on in the second part of the book (page 128) he states that he only uses deep hypnosis in complicated cases … always under the guiding principle of relaxation and calming, ” never of forbidding or commanding therapy(In the reviewer’s opinion one should generally avoid hypnosis with children under the age of adolescence because one can achieve relaxation and calming by methods involving less direct interference through a combination of physical, medical and psychological treatment. I have given my opinion in this connection in my book on Enuresis.) Important as therapeutic methods are, rest and relaxation, exercises, encouragement, activation and change of surroundings are equally important. In all cases an accurate individual treatment affords protection against mistakes, “which ought to be avoided at all costs, since every tactical error seriously undermines the physician’s influence.”
The second part of the book is concerned with special considerations. It is impossible ?owing to want of space?to give any detailed review of this part. I will therefore only note that it refers to alimentary and urinary disorders, disorders of sexual development, nervous habits, motor disorders and other syndromes influenced by psychotherapy. It relates 38 characteristic case histories as examples of particular disorders and a very wide experience is laid down in these pages.
(The reviewer points to the importance of the role of music in treatment by psychotherapy. One is able to arouse many reluctant children with music, singing or whistling, and many exercises are made less difficult by the help of simple music. Undesirable results of thumb-sucking are very often seen in a striking change of the position of teeth (prognathy, etc.). The psychotherapy of chorea plays a leading part, not?here I agree with the author?in the treatment of chorea as an infectious disease but in the cases of so-called relapse of this disease which can be cured only by psychotherapy. Migraine, also in children, is in many cases caused by allergy, and the patient should therefore?before the beginning of psychotherapy?be tested for this possibility.)
At the end of the book the author gives a very well-elaborated questionnaire. I believe that the excellent book will be very helpful for the understanding of psychotherapy, not only for physicians, but also for everyone interested in educational work for problem children if they are convinced that a knowledge of such work will no’t enable them?here I quote the author?” to set out on a dangerous voyage on the rough seas of psychotherapy.”
Albert Uffenheimer.
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