On Asking What You Are Not Supposed to Ask: The Use of Transference in the Integration of Individual and Family Therapy

A recent declaration that the “undeclared war between child and family therapy may be winding down” (p. 1) (McDermott, 1979) has set me thinking. As a child therapist working in a child and family psychiatric unit which has for many years now integrated family systems and individual psychodynamic approaches, I realise that I have been fortunate to train and work in an integrated system. There have been times, especially during my training in child psychotherapy, when the integrative approach created some cognitive dissonance. There are still times now when I am faced with ethical, conceptual and clinical dilemmas.

The ethical issues in therapeutic choices is discussed by Sider and Clements (1982). They addressed the complexity of the problem, in particular with respect to the individual adult and the family or marital couple. They neglected to differentiate the special situation of a child referral. In child psychiatry the presenting patient, the individual child, is brought to the clinic by his or her family; they are both affected by and are affecting the problem. The child is being raised within the family system and he or she is clearly dependent on it for physical and emotional survival. Thus a basic understanding in child psychiatry has to extend to the family group as well as the child's budding individuality within that group. Both are essential for the good of the child. However, if we acknowledge that the individual child is a sub-system in a family system, we contradict ourselves if we then “narrowly define a problem primarily in terms of a family system perspective” (p. 1456), and likewise a solely intrapsychic system definition fails to contemplate other levels of the general system. In each case we are simply addressing one level of a multi level general system (Sider and Clements, 1982).

In child psychiatry it is not only a matter of being concerned whether “individual good is to be valued over marital or family good or the reverse” (p. 1458), and justi