Psychotherapy in a Hospital Clinic

The purpose of this paper is a practical one, namely, to give a picture of the work of a child psychotherapist in a hospital clinic and to suggest some possible directions in which this work might be developed. The use made of the therapist will, of course, depend on the department's policy and on its relationships and facilities within the whole hospital. It will also depend on the attitude and interests of the individual therapist.

Although the work will, therefore, vary according to the needs and resources of the department, there is a marked difference between the children referred to the Department of Psychological Medicine in a teaching hospital and those generally seen in Child Guidance Clinics. The difference is mainly due to the sources of referral. In the hospital clinic the greater portion is referred by the medical profession as cases come from general practitioners as well as from outside paediatric consultants wanting a second opinion. Some children are sent because it is known that a particular paediatrician is interested in certain investigations. These may include infants who are not thriving in the usual way, and those whose development and behaviour show some specific abnormality. Children may be admitted because of a physical complaint when insufficient grounds have been found to account for the condition; these children may or may not be showing obvious behaviour difficulties. In addition, the psychiatrist may find it useful to work in the general outpatient's department for brief consultations and refer some children for full investigation by the psychiatric team.

The obvious consequences of these sources of referral are the following:

1. The hospital clinic sees children within a lower age range than that in the usual Child Guidance Clinic: more pre-school children are seen in hospital, and fewer adolescents.

2. In children referred to a hospital clinic the condition is often complicated by organic factors which, in some cases, cannot be precisely diagn