Walk-In Work with Adolescents

It is generally recognised that our mental health services cannot adequately meet the needs of adolescents, many of whom are unwilling to attend child guidance or family clinics, or are inappropriately placed in adult psychiatric units. A variety of special clinics and advice centres have been set up in an attempt to meet this need, but very little has been published about work in such clinics from a psychoanalytic viewpoint. I am aware of only one article, Jack Novick's “Walk in Clinics for Adolescents”, published in this Journal in 1977.

Novick describes the work of the Brent Consultation Centre* and gives an illuminating account of some counter-transference reactions to adolescents. He notes that most of the adolescents who “walk in” are severely disturbed, for “those adolescents who need only advice and support are perfectly capable of obtaining it from contemporaries or significant adults immediately available to them”. Novick holds that many adolescents come for help when there has been a failure in their long-standing pathological defences, and I believe that this is indeed so. He also holds that the point at which adolescents walk in is the time they are most likely to accept help, and he draws the conclusion that the person the adolescent first sees at the walk-in centre should also be the person who treats the disturbance. At the time his article was published I was in agreement with this last view. Gradually, however, I have come to think that a change of worker from interviewer to therapist is beneficial and preferable. The adolescent's knowledge that psychotherapeutic treatment — should he opt for it — would be with a worker other than the interviewer, can have most positive effects upon what may be accomplished during interviews and upon the crucial initial stages of therapy itself.

In this paper I hope to give you some impression of our work at Brent, although I would refer you to Dr. Novick's article for a more detailed picture of the Centre. I shall r