Work with the Parents in an In-Patient Adolescent Unit

The Adolescent Unit at the Cassel Hospital has sixteen beds, two doctors, three nursing sisters, and a Psychiatric Social Worker half-time. The total hospital community usually consists of fifty to sixty patients, comprising about ten families, fifteen to twenty children, ten to twelve single adults, and fourteen to sixteen adolescents. The Unit is separate only in terms of staff organisation; there is no physical separation, and the whole hospital is run along therapeutic community lines. The structure is in general permissive, but the culture is one of high expectation of social participation and of co-operative endeavour by way of a variety of committees, work groups and so on, which are built around significant areas of communal life, e.g., reception of new patients, housing, cooking, cleaning, problems of limits, etc.

One doctor treats adolescents in a group which meets daily. I treat patients in individual psychotherapy. The orientation is psycho-analytic, modified to conform to a treatment period which averages six to eight months. The age range is fifteen to eighteen years, and the selection of patients is governed by two main considerations, (1) whether there is a reasonable prospect that a permissive setting—but with considerable exercise of social controls —is appropriate, and (2) whether the patient recognises that he is emotionally disturbed and is likely to make use of a psycho-therapeutic approach. In practice, this means that we do not admit those showing psychotic disorders, organic states, nor severe delinquency. Types of adolescent disorders treated include exacerbations of neuroses of longstanding, uncontrolled violent outbursts, anorexia or compulsive eating, promiscuity, running away from home, larceny, truancy, school phobias, psychosomatic disorders and depression. Patients are encouraged to take part-time jobs or to continue their studies while in hospital. A feature of the psychopathology in virtually all our patients is a problem in the rel