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The Analysis and Treatment of a Case of Neurotic Conduct Disorder in a Young Child Illustrating the Value and Use of Drawing in Child Guidance Technique

Published online by Cambridge University Press:  08 February 2018

H. Edelston*
Affiliation:
London Child Guidance Clinic

Extract

In spite of Freud's great discoveries tracing back the origins of adult psycho-neurosis to the mental conflicts of early childhood, until comparatively recently little was done by psychiatrists generally to investigate and treat directly the mental problems of difficult and neurotic children. Though a few clinics had been established for a considerable time in Vienna and elsewhere as a result of the work of Adler and his pupils, the “Child Guidance “movement obtained its greatest impetus from America. Here it arose, however, out of social problems rather than medical; more particularly from Healey's studies of delinquent children. Partly on account of its origin in this way, and partly no doubt influenced by the behaviourist psychology so much in evidence in U.S.A., the tendency there from the beginning was to stress the importance of the child's environment and the remedial effect of altering harmful influences found in it. The psycho-analytic schools, on the other hand, have emphasized the endogenous nature of neurotic conflict, i.e., localized the trouble wholly in the child's mind; which has led them to concentrate on treatment of the child itself to the exclusion of the material surroundings.

Type
Part I.—Original Articles
Copyright
Copyright © Royal College of Psychiatrists, 1939 

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References

* In this respect it is interesting to note that whereas the movement arose as “Child Guidance”, it is now developing into Child Psychiatry.Google Scholar

* I am here using the term “environment” to include the parents' handling of the child. Even so the point made is only partly true, as, owing to the maturing of the child's attitude under therapy, especially in older children, the parent figures come to have a different (and less important) meaning. None the less it is of importance in practice.Google Scholar

In addition visits are made where necessary to the school or to the home.Google Scholar

* Mental age 7 years. I.Q. 90. Performance tests on 8–9 years' level. Reading level 5'4 years.Google Scholar

* In the originals the sun is in red chalk, the sky blue, the grass green. Clothes and flowers are suitably coloured. All drawings reduced to ½ linear.Google Scholar

* To date the child had been seen about thirty times, the mother fifteen and the father four times.Google Scholar

* By this I mean directing the course of the play—without, of course, the child knowing it—in such a way as to obtain the situation one wants for more effective interpretation (cf. p. 534, et seq.).Google Scholar

The Child's Conception of the World, p. 25.Google Scholar

Ibid., p. 26.Google Scholar

§ In the subsequent description I have not adhered strictly to the order in which the material was obtained, as that would make it difficult to follow, but have rearranged it to make a coherent narrative. One must not forget also that the mother's story was sandwiched in between much discussion and interpretation.Google Scholar

* The stories were elaborated in conversation during and after the drawing, and the essential parts are reproduced in the titles to the pictures (q.v.).Google Scholar

* C.f. Shirley Temple in Fig. 3. The “Big Bad Wolf” is also a favourite figure in the phantasy of a patient (aged 6), to indicate her father when he is cross with her.Google Scholar

Referring to this drawing Jean told the social worker that “she had a frock like this when she was a bridesmaid”. (Have you a hat like this ?) “Yes.”Google Scholar

* In this question and answer type of description the brackets contain the psychiatrist's remarks and the inverted commas the child's reply.Google Scholar

This corresponds, I suppose, to the negative phases in the analysis of adults.Google Scholar

* The class teacher at school at the time.Google Scholar

* Nothing could be done about the school situation at this time. After much difficulty it was later arranged for her to transfer to another school; the result remains to be seen.Google Scholar

It was noticeable that during her absence Mrs. S— had lost a good deal of the insight into the problem that she had previously been gaining so well, with consequent deterioration of her handling of the children.Google Scholar

The previous week I had commented on how nice she looked in her new frock, so that unwittingly I had been partly responsible for what had happened. Jean greeted me with, “I didn't want my best dress on to-day”, but she accepted my interpretation “You wanted to put your best dress on to please me” with a relieved smile.Google Scholar

* With regard to the second half of the picture there was some considerable and complicated phantasy about the “new baby”, with which she seems partly to identify herself, but I could not get the details at all clearly.Google Scholar

* That her school failure was like so many another's, emotional and not intellectual in origin, is shown by the Educational Psychologist's report of “considerable improvement after only four lessons”. I am indebted to Mr. Highfield (Fellow in Psychology at the London Child Guidance Clinic) for the term “educational convalescence”, which can be aptly applied to the coaching in these cases.Google Scholar

See later for interpretation, p. 542.Google Scholar

* She had done the same trick with the psychologist previously, but I did not know of it at the time.Google Scholar

* Here I acted on a suggestion from Dr. Bowiby, Psychiatrist at the Clinic, whose advice and criticism throughout this case have been immensely helpful.Google Scholar

* The transfer to her new school had not yet taken place.Google Scholar

* The child Marion R—, aged 6, was attending for treatment on account of stubborn defiant misbehaviour. One day she went to school and asked the teacher for another seat. The teacher asked why. “My name isn't Marion any more, it's Happy”. (What has happened to Marion ?) “Marion's dead.” Another child (aged 8), sent for a similar kind of behaviour disorder, did a drawing of two girls and painted all round one of them in black. When asked about it she explained that this one was wicked and “ought to be dead”. She adniitted when directly questioned that the drawing referred to herself.Google Scholar

* For a brilliant exposition of this theme in some detail see Karen Homey's The Neurotic Personality of Our Time, Chap. 5.Google Scholar

The disguise is admittedly very thin as a rule, being so very near the event and so lightly repressed,but cf. Fig. 9.Google Scholar

* In view of the actual school situation her flight into phantasy is almost justified; at any rate it is her only escape from a very unsympathetic world.Google Scholar

This point is rather important. Parents can be brought to see the child's point of view in most matters, but often cannot appreciate the magnitude and nature of the emotional upheaval in the child on the arrival of a new baby in the house. And this is just one of those non-recurring events, whose damaging effects can be prevented with care. In such cases neurotic stealing in response to the temporary loss of the mother's affection is a well-recognized form of behaviour disorder.Google Scholar

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