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NOT EVERY CASE in child psychiatry is of direct concern to the social worker. I present the case of Kathleen because in spite of the fact that the case was managed by myself it was not primarily a treatment by psycho-therapy. The burden of the case rested on the mother and indeed on the whole family, and the successful outcome was very largely the result of the work done in the child's home over a period of a year. Management was required from me, and this meant that I had to see the mother and child for ten to twenty minutes each week for a period of months.
At the first interview I was able to come to a fairly definite conclusion as to the psychopathology of the condition and to form a tentative opinion as to the parents' ability to see the child through her illness.
The child was referred to me with a view to my arranging for her to go to a hostel, as it had not occurred to those who were initially in touch with the case that under certain conditions a spontaneous cure could take place in the course of time. The important point was that in a careful history-taking in the first interview I was able to make a graph of the symptomatology and from this it was clear that the climax of the illness had been reached and that there was already a tendency towards improvement by the time of the consultation. In the graph there was a peak of acute neurotic anxiety followed by increasing distress and eventually the illness altered in quality and the child became ill in a psychotic way. The neurotic acute phase followed a story told to her by her sister, during a period in which she was already beginning to be upset because she was due to be bridesmaid at the wedding of her favourite aunt. The period of acute psychotic disturbance corresponded roughly with the marriage.
I was interested to find that the child had started to improve, and going into