Working with children

To appreciate the complexity of a child’s world and its influences, an understanding of the normal milestones of development and the child’s family system is required. It is not our intention to explore in any depth the psychological, physical or social background of any particular child problem, but rather to give some guidance as to how general principles of care must be applied in a special way to children because of the nature of the child’s state of development. Whether a child is seen at home, attends a mental health unit or is admitted, each is frequently perceived as a symptom of failed care approaches in the family system. It is often a last resort to admit a child, and in our opinion this should remain so, as prolonged absence from a normal family unit can produce more maladjustment than it is designed to relieve. However, there are times when it becomes clear that the child and the family, no matter what intervention takes place, are in such turmoil with each other that some space between them is necessary. The particular challenges involved in work with children on a day or residential basis have led us to concentrate on these particular means of intervention. For example:

David’s behaviour had become increasingly demanding. He would change from a state of withdrawal to a state of hyperactivity, with frequent temper tantrums. He suffered from encopresis and had a fear of men. The decision to bring him into the unit was due to the fact that his presence at home was causing a strain on his mother, who directed her frustration at her boyfriend, who in turn regularly hit David in the face, on one occasion causing severe bruising and bleeding. David’s father, who has since left the household, also had a history of violence, mainly directed toward David’s mother. Admission was brought about shortly after David had caused severe bruising to his 2-year-old stepsister. David was 6 years old. In this case, it seems that both David’s and his family’s safety was in jeopardy, and the space provided by admitting him gave a chance for the multidisciplinary team to assess the situation without the fear of further risk to David or his sister. During the first 48 hours David was totally withdrawn, refusing to speak and cowering or moving away from any approach made towards him by any male member of staff. It took a long time before he could appreciate and enjoy the security of a loving and trusting relationship.