Clinical Child Psychology and Psychiatry

There are an increasing number of children who are being brought up in lesbian- led families. Research on non-clinical samples of children raised in lesbian-led families formed after parental divorce, together with studies of children raised in families planned by a single lesbian mother or lesbian couple, suggest that growing up in a lesbian-led family does not have negative effects on key developmental outcomes. In many ways family life for children growing up in lesbian-led families is similar to that experienced by children in heterosexual families. In other respects there are important distinctions, such as different types of family forms and the impact of social stigma on the family, that may influence how clinicians approach therapeutic work with children in lesbian mother families.

This paper focuses on non-directive play therapy with maltreated and neglected young children, and explores ways in which their symbolic play seems to be activated and accelerated during play therapy. The frameworks of attachment and cognitive development are utilized to examine therapeutic relationships. Examples from normal development and from therapeutic work are given in order to describe more precisely the seemingly essential features in the development of symbolic play in young children. The important features of a child’s social environment, physical environment and internal state which seem to contribute to the activation of symbolic play are then discussed in more detail. Finally, it is argued, studying a child’s transition from concrete to symbolic play during play therapy contributes to our understanding not only of damaged and delayed children’s development, but also provides additional information on normal children’s development of this capacity.

This article describes some of the principles informing a psychoanalytically orientated approach to brief therapy with parents and under-fives. A short account is given of the history of this approach, followed by an extended clinical illustration. The advantages and limitations of the approach are discussed and some of the features that are most typical of this kind of work are described.

Useful outcome research must use measures that are relevant to the clinical group in question. A literature review identified that little effort has been made to identify which areas of outcome are important for severely disturbed children with complex disorders, who are in day treatment. For a group of such children attending a psychiatric–educational day unit, this study set out to identify, at a qualitative level, which areas of change were valued by carers, teachers and clinicians. The results suggest that for children with severe psychiatric and educational problems a useful intervention need not involve large changes in the child. It was more important that the child’s informal and formal care network: carers, teachers, clinical staff and the professionals in other agencies, were able to reach a common understanding of the child’s difficulties, develop similar expectations of the child’s needs, and be able to agree on appropriate future plans for the child.

Sometimes our patients cause us to struggle with emotions and sensations that are invaders, they come from elsewhere and yet feel as if they are our sole possession. The same thing occurs in many different settings. This experience of projective identification can influence the recipient and he or she then becomes the changed person in the mind’s eye of the initiator. One of the reasons for psychotherapists to be in analysis during their training is that this gives them a better chance of being aware when such psychological parasites are present. And one of the reasons that theoretical models are important is that they can help us to decode what we feel at such times.

In this paper I describe an example of projective identification from work with a 6-year-old adopted boy, where I found myself almost completely unable to function for several sessions.

A traumatic past experience belonging to my patient, which he could have had no conscious knowledge of, had been pushed out of his unconscious to lodge in mine; and then, in turn, I acted out a version of that experience.

Many authors have written about the psychological consequences for the survivors when a family member commits suicide. Most clinicians use bereavement as a paradigm for planning therapeutic interventions. We have not been able to find any articles which recognize that the experience may be a form of child abuse. We believe that using the model of child abuse as well as traditionally used models of bereavement and trauma may be helpful when understanding the child’s predicament and planning therapeutic interventions. Two cases, involving four children, illustrate this perspective.

Children in care constitute a deprived and needy group of young people, who are at high risk of developing mental-health problems and disorders. This article describes the development of a direct access child and adolescent mental-health service for children living in residential units or with foster families, with data on the pattern and characteristics of referrals, and discussion on the arising difficulties. The main aims of this service are, to be responsive and flexible, to provide mental- health assessment and treatment, and to work with residential care staff, foster parents and field social workers. Young people referred to the mental-health service had high rates of abuse, history of offending behaviour, poor school attendance and frequent previous contacts with child mental-health services. There were also high rates of child mental-health disorders, particularly mixed conduct and depressive disorders, and history of self-harm. Anticipated benefits include a coordinated and cost-effective assessment, improved mental-health outcome, contribution to the care plan and prevention of further difficulties. Joint commissioning between health and local authorities should prioritize children in care. Different models of mental-health provision may be appropriate and require evaluation.

The case is presented of a 12-year-old boy who was diagnosed with Tourette syndrome (TS) when he was 8 years of age. The variability of symptoms manifested with the syndrome and the comorbidity of other related disorders were explored by developmental history, parent interviews, survey results, functional analysis and direct observations. The article considers the individual variability of symptoms and the ramifications of this variability in caring for a child with TS. It discusses the difficulties with intervention because of the inherent characteristics of the disorder. The case argues for more expansive attention to be given to a psycho- educational approach in meeting the needs of children with TS.

In the past few years, the business management literature has seen an exponential rise in articles on the concept of the Learning Organization. This organizational form is said to encourage innovation and creativity, improve adaptation and capacity for change, and enhance the commitment of staff. The model has been applied in a Child and Adolescent Mental-Health Service with some promising indications that it does indeed support experimentation, eclecticism and openness to change. This article provides an introduction to recent management literature on organizational design, and outlines some of the theory and practice of building structures and cultures which support ongoing evaluation and continuous quality improvement.