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This clinical extract raises many interesting and important issues. In this brief commentary, I will focus on three important themes, namely: the impact of the setting of this work, the case material itself and the importance of maintaining the therapeutic setting in our mind.
The school-based context for this work raises a number of immediate questions. What is it like for us to apply our thinking and work within a school setting? How do we need to adapt the way we work, think and take up our role? How do we experience and manage our relationships with teachers and parents? What is (or isn't) different about this from work within a more ‘ordinary’ outpatient CAMHS setting? Is ‘child psychotherapy’ really possible within a school?
In principle – most of us would agree that there is a need for child psychotherapy to extend itself into community-based settings such as schools to ensure that we reach those children and young people who would never otherwise make it to an outpatient setting. At the same time, this imperative can trouble us as we fear we will not be able to establish the kind of long-term psychotherapy work that sustains and
nourishes our thinking. We can also worry about how we will manage the boundaries of our role when we are working in relative isolation – wearing several hats at the same time within the school and usually having to act as our own case manager, which might involve being pro-active in liaising with teachers, parents and other professionals – all of which can make it harder for us to hold the therapeutic boundaries and frame with our patients.
There is no doubt in my mind about the importance, effectiveness and substantial opportunities inherent within school-based child psychotherapy projects – not only for the patients and staff with whom we work but for our own prof