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CHAPTER SIX Working in a Hospital

Mary Boston Karnac Books ePub

by Rolene Szur

This chapter describes further aspects of work in a hospital setting and returns to the subject of individual therapy with both out-patients and in-patients. The functions of a residen tial psychiatric unit for children are discussed. In hospital, the child psychotherapist may work in close liaison not only with the psychiatric team but also with the staff in other branches of the hospital. M.B., D.D.

A child psychiatric department in a hospital may offer certain facilities not always present in a child guidance clinic. The Day Centre described in the last chapter is an example. In some hospitals there may be a residential psychiatric unit for children or adolescents. The close links with other hospital services are important and interesting for the psychotherapist. Work with out-patients, however, follows very similar lines to that carried out in local clinics. Both see the same wide range of problems - including learning difficulties, school refusal, bed-wetting, conduct disorders and so on. Occasionally, a child is referred specifically to a hospital because the symptoms are very long standing, or are causing severe anxieties.

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7. Psychological Assessment

Mary Boston and Rolene Szur, Editors Karnac Books ePub

Eva Holmes

Psychologists do not often assess children in care unless a court report is needed or a child is admitted to an assessment centre, often after a family crisis or a foster breakdown. The observations in this chapter, however, are based on the unusual experience of being the educational psychologist attached to several children’s homes in a London borough. I was asked to see children in long-term residential care who presented chronic learning difficulties, and young children with serious behaviour difficulties for whom decisions about fostering or rehabilitation had to be made, as well as a number of older children whose problems appeared to increase at adolescence.

The low self-esteem of these children has been described already. What became evident was that teachers, care staff and social workers often shared these low expectations of the children and this seemed to account for their failure to refer them for any kind of special help. It was taken for granted that all children in care would have learning difficulties and poor school reports. The possibility of remedial help was rarely considered, sometimes because of a mistaken concern not to label a child still more, sometimes because of uncertainty about the future. Perhaps previous psychologists had stated the obvious: he is disturbed and under functioning because of his disturbed background. To avoid this trap I tried to ensure that my observations and the results of testing contributed in follow-up discussions with care staff to a more detailed understanding of how a child was feeling as well as why he might be failing. I also made every effort to ensure that the assessment resulted, where appropriate, in the implementation of remedial help, psychotherapy, special schooling or a reconsideration of long-term plans. At the very least, a meeting of teachers, care staff and social workers took place, often for the first time. In short, I saw the role of the educational psychologist as more interventionist than just offering advice in reports. In the case of the very young children I assessed, this led eventually to the setting up of a special education unit described more fully elsewhere (Holmes 1980).

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14. Fieldwork: First Visit to a Foster Family Brian

Mary Boston and Rolene Szur, Editors Karnac Books ePub

Brian Truckle

One important aspect of the complex roles of the social worker when working with children is the quality of relationship which he is able to offer a child client. How to get to know and understand the child is often a worrying preoccupation, especially as major decisions have often to be made on his behalf. Hoxter (1977) suggests that with any psychotherapeutic contact with a child the first step is for the worker to have a ‘space’ in his mind for this particular person, freed from the worker:s own preoccupations and prejudices, from the weighty luggage of worries about the last client or the next case conference.

Many professionals in contact with deprived or distressed children have frequent opportunities to offer a child this ‘mental space’ and the experience of being attended to, remembered and valued. At this point the child may feel safe enough to bring his own worries and concerns to the worker in both verbal and non-verbal ways.

An opportunity to do just this is illustrated by the following description of a visit arranged to introduce myself (then a social worker in an area team) to a foster-mother and two children. The previous social worker, Mrs Quest, who was moving, accompanied me on this first occasion to meet the family. Gary, one of the two fostered children, was home from boarding school. The other child, Lucy, who was out visiting a friend when I arrived, had made good progress with these foster-parents.

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6. Technical Problems in Therapy Mary

Mary Boston and Rolene Szur, Editors Karnac Books ePub

Mary Boston

Many of these severely disturbed children present particular problems of technique and management in the course of psychotherapy. Tom, Keith and Desmond showed aggression and cruelty which was difficult to control and to contain. All the children, at times, some in more subtle ways than others, made their therapists feel useless, helpless, rejected, abandoned, messed up or cruelly treated -precisely the experiences and feelings which the patients themselves found intolerable or hard to bear.

This reversal of the painful experience seems very important in trying to understand children who do not find it easy to communicate in words. Their behaviour itself is often the vital message. It is our task to receive and respond appropriately. We may have little to go on apart from the feelings we experience ourselves.

Susie, a little girl of 4, who had been taken into care by the police very abruptly, in the middle of the night, because of sexual abuse by her father, was cutting out a pattern in a piece of paper. Her therapist described the scene thus:

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CHAPTER FOUR Child Psychotherapy in a Day Unit

Mary Boston Karnac Books ePub

by Dilys Daws

Chapter 3 described how the child guidance clinic is organized and how the child psychotherapist functions in that setting. This chapter describes the practice of psychotherapy in a day unit, where children spend the whole day in the building in which they receive therapy. The effects of the setting on the children are discussed, and something of the meaning of the framework in which therapy takes place emerges. M.B., D.D.

I work as a child psychotherapist in a day unit connected with a child guidance clinic. As in the clinic itself, the therapeutic staff of the Unit is a team comprising a psychiatrist, a psychiatric social worker, an educational psychologist and a child psychotherapist. In my Unit they all work part-time, and the staff also consists of three teachers, employed by the I.L.E.A., together with three assistants who are employed by the Health Service. Finally, there is a full-time secretary, a caretaker and a cook, all of whom are also employees of the Health Service.

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