The Boundary between Psychotherapy and Therapeutic Teaching*

Education and psychotherapy make a complex, and in some ways contradictory, combination. The therapist who works in a special school has to adapt the technique that was developed, and is more usually applied, in outpatient settings; the educational goals of the school have to be respected, and there is the danger that these swamp those of the therapist. For the teacher there is correspondingly a necessity to include a therapeutic dimension to the work with the disturbed child; this can militate against the social expectations of education and get the teacher into difficulties with the child. Given also the frequently intractable nature of problems presented by these children in special schools, it should come as no surprise that teacher and therapist find themselves sometimes at odds with each other around the “emotionally and behaviourally disturbed” child. I shall attempt here to show how this conflict is not only a function of professional rivalry or territoriality, but also can be seen as an expression of the child's difficulty in integrating inner and outer realities. When, for example, the worker feels threatened in his or her professional identity, this may be a clue to feelings that the child himself is unable to deal with, such as terrors of castration or annihilation. The steps by which workers become frustrated, ineffective and divided can be retraced to the child's disturbance. If both the child and the adults are nearer to the source of their difficulty with each other then they may also be closer to the possibility of change for the child.

I was asked recently, as the child psychotherapist in a day special school, if I would see a boy about whom there was a great deal of concern expressed, particularly by his teacher. Ian, as I shall call him, was uncommunicative, isolated, resentful, and given to bouts of violent rage. The attempt to find a psychotherapeutic view of this child's difficulties illustrates some of the problems and opportu