Resistance and Co-Operation: The Need for Both. A Further Study of Psychotherapy in a Day Unit

I work in a psychiatric Day Unit attached to a Child Guidance Clinic, officially a hospital school. I have described elsewhere (1977) the particular issues involved in working in individual psychotherapy with children in the place where the child spends his schooldays. In this paper my interest is in looking at how psychotherapy fits into the institution. I give a clinical example of a case where I felt I could attempt psychotherapy with a disturbed little girl with the backing and support of the Day Unit. Although I give much specific detail of how the professions relate in one particular institution, I hope that anyone involved in the setting up of therapy for children will be reminded of their own relevant network, be it families, G.P.s, teachers at ordinary schools.

The Day Unit differs essentially from, for example, a school for maladjusted children in that it is an N.H.S. facility with a Consultant Psychiatrist as head of the Unit. There is a part-time psychiatric staff of four, the psychiatrist, a social worker, educational psychologist and child psychotherapist. However, the Unit is run as a school by a teacher-in-charge who is one of three full-time I.L.E.A. teachers with one part-time I.L.E.A. remedial teacher, and three full-time nursery assistants employed by the N.H.S. The other staff are a full-time secretary/administrator, a caretaker and a cook, all N.H.S. employees.

The Unit was founded some 15 years ago by staff of the parent clinic, and seen then, among its other uses, as a Unit where children in therapy could be placed. Over the years it has been seen by referrers in the community, psychiatrists in other Child Guidance Clinics, teachers, educational psychologists, E.W.O s etc. as a place to refer children who for many disparate reasons have broken down in their normal schools. These are children who may or may not benefit from psychotherapy. The Unit offers a relatively short-term placement averaging two years, and during these years it is hoped th