Some Comments on the State of Clinical Casework Today*

The coming of age of the Association of Child Psychotherapists (Non-Medical) is an apppropriate occasion to pause and evaluate some aspects of clinical casework as it is conducted by a group of child psychotherapists within the Association. Since there are very great variations in the theory and technique as practised by our members, it seems to be most fruitful to confine this survey to my colleagues and my own experience at the Hampstead Child Therapy Clinic. Thus there will be emphasis on one clinical and theoretical viewpoint. It has to be remembered however that, as Freud stated, there is no monopoly any one of us possesses in the field of psychotherapy. He reminds us, “There are many ways and means of practising psychotherapy. All that lead to recovery are good … Because of the part I have played in founding this (psychoanalytic) therapy, I feel a personal obligation to devote myself to closer investigation of it and to the development of its technique”. (Freud, S., 1905.)

At the time we entered the field of psychoanalysis, certain shifts in emphasis had already taken place. Psychoanalysts were not so much concerned with infantile psychopathology as such, but rather with the need to regard child analysis as a source of information and confirmation of theories for the understanding and treatment of adult neurotics. The existence of infantile sexuality was accepted and indeed it was already beginning to influence methods of child rearing of our generation. The contribution of infantile sexuality to the establishment of an infantile neurosis which proved to be universally present in neurotic adult patients was also established fact.

A further shift from the focus of interest on content of the Id to the dynamics and operation of the ego had already taken place and was crystallised in Anna Freud's book The Ego and the Mechanisms of Defence. It established beyond doubt that childhood neurosis existed in its own right and showed a similar development to adu