Paediatric Psychotherapy: The Development of a Technique for a Service in a General Paediatric Outpatient Clinic

Donald Winnicott (1958), Anna Freud (1961, 1975), Bergmann and Anna Freud (1965), Isabel Menzies Lyth (1985), the Robertson (1953a, 1953b, 1955, 1958, 1973) and Dora Black (1989) were all pioneers in establishing the importance of the need for communication between paediatricians and child therapists and psychiatrists in the care of paediatric patients. The impact of separation from parents, intrusive medical procedures, chronic illness and bereavement upon the developing child and his or her family have been well documented (Black 1978, Robertson 1953b, 1973, Kashani 1981, Furman 1984, Taylor 1987). For the most part this has been taken into consideration in modern paediatric practice. No ward nowadays forbids access by parents, most nursing care plans try to cater for the emotional well-being of the child, and many consultants attempt to educate their junior medical staff in the importance of appropriate bereavement work.

Historically, medical and nursing training has emphasised interview techniques for how to talk to patients rather than how to listen to the ways in which children and their families communicate their concerns. However, as paediatricians and clinical nurse managers become increasingly aware that a large proportion of their work demands psychological and therapeutic knowledge and skills for which their training does not equip them, child therapists and psychiatrists are called upon to provide appropriate education (Mrazek, 1987, Josse and Challoner, 1987). Predominantly this is done by liaison, consultative work, i.e. attendance at ward rounds and meetings, running staff support groups, and the supervision and formal teaching of medical and nursing staff.

In addition, a crucial factor in the educative process is the treatment of children and their families on an inpatient basis and the communication of aspects of that treatment to relevant medical and nursing staff. This combination of consultative, teaching, and clinical work can lead to the establi