Therapy with Children

Therapy with Children is a misleading title for this book since it is actually more about the topic of the subtitle, concerning the legal and ethical issues that arise in psychiatric treatment of children.  The authors are based in the UK and so the legal details they provide apply only to the UK.  The book is short, and it has two main parts, starting with a discussion of theoretical frameworks and moving on to case examples.  A final short chapter discusses general issues about how to empower children.

The introductory chapter on children's rights explains some of the legal and governmental issues as they arise in the UK.  It provides a brief history of the concept of childhood and the development of children's rights, and some landmark decisions.  In 1987, in the town of Cleveland, 121 children were taken into care because there was suspicion of physical and sexual abuse, and an official inquiry after this, titled the Cleveland Report, recommended that children should be made part of the decision-making process in such cases.  This influenced the Children Act of 1989, which was a very important reform of child care law for the UK, introducing a concept of partnership between families and caregivers.  This move away from the priority of parents' rights was also apparent in the well-publicized Gillick case.  Victoria Gillick wanted assurance that none of her five daughters would be able to get medical treatment or contraceptive advice from doctors without her consent, but the courts decided that she did not have the absolute right to this and there could be occasions when her children might receive treatment without her knowledge.  The decision would depend partly on the psychological maturity of the child.  This decision has potentially important consequences for treating the psychological problems of children and adolescents. 

After a second chapter that provides an overview of psychoanalytic approaches to therapy with children, the third chapter addresses the excellent question of who is the primary client in child therapy.  Some readers may feel that there is too much mention of psychoanalytic theory here, specifically the ideas of Melanie Klein and other controversial theorists, but such discussions are brief, and are supplemented by more empirically grounded observations.  The authors' conclusion is very plausible: maintaining confidentiality is at the heart of the therapeutic process. 

Nevertheless, it is likely that the fourth chapter on the law relating to therapy with children will be more useful.  They discuss confidentiality in school and therapeutic settings and cover more of the important legal cases in which this issue has arisen.  These become even more relevant in the second part of the book where each of the four chapters is devoted to a particular case example.  These make fascinating reading, and could be excellent examples for further discussion even outside of the UK. 

So Therapy with Children will be particularly helpful for clinicians in the UK who work with young people, but it could be a valuable resource for others too.  I have used the cases when teaching ethical issues in clinical psychology, and they have provoked some valuable discussions. 

© 2004 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.