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Chapter Two: Therapy with families and family therapy

Hilary A. Davies Karnac Books ePub

The East London Child Guidance Clinic was founded in London in 1927 by the Jewish Health Organisation. It was the first child guidance clinic in the UK and, reportedly, also in Europe. It was set up to meet the needs of the immigrant popu-lation who had settled in that part of London since the beginning of the century and whose children were perceived to have emotional, psychological, behavioural, and educational difficulties requiring this kind of service.

In 1929, the London Child Guidance Clinic was opened in Islington, North London. The Foreword to an early report of this clinic is quoted as saying that “in its efforts to adjust the groping child mind to life, to make useful citizens of difficult and abnormal boys and girls, [it] is doing the work of civilisation” (www.star-course.org/emd/posthuma.htm). The Clinic was able to offer a service to almost 1900 children and families from all over the UK in its first 4½ years of existence. The Clinic later moved and became the Tavistock.

In the early years of child guidance clinics, social work was a key clinical intervention, with the involvement of the children's families being regarded as most important. The founding honorary director of the East London Child Guidance Clinic was Emanuel Miller, who is quoted as writing in one of the Clinic's early reports,

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Chapter Six: Children who have experienced emotional harm

Hilary A. Davies Karnac Books ePub

Emotional harm caused to children by emotional abuse or neglect by a parent or main carer has been recognized more widely in the literature in the last couple of decades (Glaser, 2002; Iwaniec, 1995). Emotional abuse may, in some ways, appear to be a softer and less damaging form of abuse than the more widely recognized physical and sexual abuse and physical neglect. While emotional abuse and neglect may cause no physical evidence or scars, professionals are increasingly aware of their extremely harmful effects on children's healthy emotional and psychological development and functioning, their general well-being and happi-ness, and their social adjustment into adolescence and adult life.

Glaser (2002) categorized emotional abuse and neglect of chil-dren in five broad conceptual areas: emotional unavailability; nega-tive attributions; inappropriate developmental expectations; failure to recognize the child's separateness, individuality, and uniqueness; mis-socialization.

The number of children on Child Protection Registers (now Protection Plans) in England rose to 27,900 at 31st March 2007. Of these, 23% of registrations were for emotional abuse, a rise from 18% in 2002–2003 (Community Care online, 21st September 2007). For some children, emotional abuse is the sole form of abuse they experience, while for others it is an intrinsic and inevitable compo-nent part of other more visible and identifiable forms of abuse— physical or sexual abuse or neglect.

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Chapter One: Psychoanalysis

Hilary A. Davies Karnac Books ePub

A brief synthesis of psychoanalytic thinking that spans well over half a century is presented. The main focus on four figures is not intended to minimize the important contri-butions of others, but does aim to track the progression of psycho-analytic thought from the consulting room of Sigmund Freud out into clinics, hospitals, and community settings from the middle of the twentieth century and on into the twenty-first century.

The theory and practice of psychoanalysis were first introduced by Sigmund Freud at the end of the nineteenth and the beginning of the twentieth centuries as a method of treating mental illness. He constructed his original theory of psychoanalysis from studying the hidden psychological origins of various somatic symptoms in his patients that were neither explained by physical medicine nor responded to the conventional medical treatments of the time. He developed the practice of psychoanalysis with individual patients, usually adult, and frequently women.

At that time, Freud and his followers were writing for the medical profession and not for therapists. Through his work, he came to understand that beyond a person's observable behaviour, articulated thoughts, and expressed emotions lies something more complex and more profound. He sought to think about and to understand this internal self, and his work took him on from the study of the sick to an understanding of the wider meaning and implications of human behaviour, experience, and relationships. Specifically, he was interested in, and focused his thinking and writ-ings on, that level of a person and personality that was not easily available to scrutiny. Freud called “the unconscious” these layers of a personality structure that exist below what is immediately and consciously experienced by an individual and readily observable by others.

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Chapter Eight: Adolescents whose bodies bear the emotional hurt

Hilary A. Davies Karnac Books ePub

A person's emotional or psychological state may make a contribution to a number of physical illnesses and also, it seems, may affect progress in the case of some clearly physiological disorders, such as pneumonia and appendicitis (Barker, 1979).

There is also a group of disorders, known as psychosomatic or pseudosomatic or somatoform, where no organic cause can be found for some severe, physical symptoms which are not respon-sive to medical intervention or treatment.

Sigmund Freud, among others, studied what he called “hyster-ical” symptoms in his patients. He understood these to be physical symptoms that were not diagnosable and treatable following tradi-tional medical methods and procedures (Freud & Breuer, 1895d). The term “hysterical” has come to mean something quite different, and would no longer be used in this context.

A USA child psychiatric outpatient study reported “somatic” complaints in 11% of girls and 4% of boys, with rates between 1.3 and 5% for the occurrence of somatoform disorders (Oatis, 2002).

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Chapter Ten: Perspectives and practice

Hilary A. Davies Karnac Books ePub

Regardless of personal experience of psychoanalysis or psychoanalytic psychotherapy, therapists with fami-lies may wish in their practice to draw on concepts from psychoanalytic thinking, which can add to knowledge about the deepest sources of illness in the mental lives of children and families. Importantly, psychoanalytic theory can offer thera-pists with families some additional understanding of difficulty in changing, either by a family as a whole or by individual members. The central place in psychoanalytic theory of the concepts of defence against anxiety and of emotional conflict can give an important insight into reluctance or slow pace of change. The importance of containment is emphasized in more recent psycho-analytic thinking.

The pace of change will vary for different families. It may some-times take longer—not because the family is doing anything wrong or the therapist has forgotten a vital intervention, and not because the family is resistant to treatment and/or is too ill or stuck to be able to use available interventions. As psychoanalytic theory tells us, where an individual has built defences against anxiety or other unmanageable feelings, or is troubled by overwhelming conflict of emotions, it is predictable that it will take time to develop a therapeutic relationship in which the causes of anxiety, the defences against it, and unbearable conflict can be explored before it is safe to move towards change.

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