Psychiatry. XI, 1948: The Rôle of the Parent in Psychotherapy with Children. Hilde Bruch. Pp. 169–175.

Hilde Bruch, in her private practice, has reversed the prevalent tendency in child psychiatry to delegate the management of the parent to another therapist, by undertaking herself to deal with the faulty and detrimental attitudes of the parents of her young patients. This paper is a discussion of some of the difficulties encountered in the use of this approach. It concerns itself in the main with the problems presented by parental attitudes, although mention is made of countertransference dangers, e.g., reactivation of anxiety in the therapist by the very fact of dealing with parents, excessive identification with the child, and competition with the parent for the child's affection.

The early assessment of the parent's attitude to psychiatric treatment and the proper handling of it are important for the success of therapy. There is the parent who is frankly antagonistic, having come to the psychiatrist as a result of outside pressure or from a conscientiousness which would overlook no resource, improbable of success as it might seem. Direct analysis of this attitude may effect a constructive coöperation between parent and therapist; if neglected or side-stepped, it will wreck the treatment. A case illustration of how such a negative attitude was successfully managed is presented.

The more typical attitude of parents nowadays is to expect psychiatric miracles. These modern parents are often burdened by a fundamental doubt of their adequacy and by a feeling of guilt at having failed in their rôle. Without further undermining their confidence in their ability to be good parents, the therapy aims to make them aware of their true attitudes toward their children. 'The therapeutic task is to help such parents discover their capacities for love and a genuine relationship with their child.' The treatment of the parents is limited to the areas which significantly enter into the relationship between parent and child.