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This paper is concerned with the psychotherapy of children in a hospital in-patient setting, one aspect of the work of the Family Unit of The Cassel Hospital. The nature of this setting gives rise to special technical problems not found in the ordinary Child Guidance Clinic, both in the treatment of the child and in the therapist's contact with the mothers of child patients. Before discussing these problems, it is necessary first to describe some aspects of life in the Hospital Community and their effects on the children.
The Cassel Hospital combines in the framework which it offers to its patients the principles of a therapeutic community with analytically orientated individual or group psychotherapy. This means that the patients have considerable responsibility for arranging their daily life and that social pressure as well as group support constitute important forces in regulating the life of the Community. Meetings, therefore, are an essential part of hospital life.
This Hospital has, for many years, been associated with the treatment of disturbed mothers and their children. From the disturbed mother interest came to be focussed on the special disturbances of mothering, e.g. puerperal breakdowns and neurotic disorders associated with the development problems of her child, such as sleeping difficulties, eating problems, temper tantrums, etc. The recognition that these could most usefully and profitably be treated when the mother was currently confronted with the precipitating cause of her disturbance, that is her infant or child, led to the establishment of a Mothers and Babies Unit. Though the improvement in the mother was often reflected in corresponding improvement in the child, this did not always follow, and, in turn, drew attention to disturbances which had become intrinsic to the child. The outcome was the setting up of the Children's Unit, and this in its turn resulted in referrals where problems in the mother/child relationship