On Therapeutic Intervention in the Child Guidance Setting: A Case of Refusal to Stay in School

“As long as our assumptions are not challenged when we act on them, we shall keep them fixed.”

In this paper it is suggested (a) that the dissatisfaction with the services generally provided to paediatricians and others by Local Authority based Child Guidance Clinics is due primarily to long waiting lists for diagnosis and treatment, (b) that the waiting lists are largely the result of a failure to clarify the issues involved in providing a service, and (c) that it is possible to provide a better service, and reduce or abolish waiting lists, by a different kind of deployment of present resources, along lines already described in the literature.

This deployment entails making the psychiatrist readily available for the kind of consultation with staffs of relevant institutions which is described by Caplan (1959). In this work, educational and public health officials, teachers and so on are helped to deal with problems as they arise, often without the child patient being seen by the consultant. In order to prevent the accumulation of new cases and the consequent “suffocation” or demoralisation of clinic staff, there is at the same time an emphasis on the type of therapeutic consultation practised and advocated by Winnicott for many years (1942, 1963). Regular treatment is undertaken only when there is time available for a given type of case. (Weinreb, 1960). The psychiatrist practises a variety of holding techniques, keeping many cases under review, and dealing with crises as they arise, by telephone, by counselling other agents, or by further consultations. Psychiatric social workers and non-medical child psychotherapists (whose role is particularly vital here) are allowed to concentrate on the more time-consuming regular or intensive case-work and psychotherapy, which is needed in a minority of cases.

A clear distinction is therefore drawn, and maintained, between a consultative service, in which the educational p