Psychiatric Bulletin (2005) 29: 279. doi: 10.1192/pb.29.7.279
© 2005 The Royal College of Psychiatrists
Psychiatric Bulletin (2005) 29: 279
© 2005 The Royal College of Psychiatrists
Severe Emotional Disturbance in Children and Adolescents: Psychotherapy in Applied Contexts
Denis Flynn
Alyson Hall, Consultant Child and Adolescent Psychiatrist
Emanuel Miller Centre for Families and Children, East London and City
Mental Health NHS Trust
Hove and New York: Brunner-Routledge, 2004, £50 hb, 258 pp., ISBN: 1
583912 11 8
Children and adolescents who are seriously disturbed as a result of abuse,
neglect or the experience of multiple family disruptions present major
management problems for mental health and social services. Young children may
challenge the skills of experienced foster carers, resulting in repeated
placement breakdown. Adolescents may present with uncontainable aggression or
life-threatening self-harm. They arouse serious anxiety in those caring for
them and appropriate placements are hard to identify and sustain. Without
intervention their disturbance escalates and with it the cost of skilled
professional input for care, education and therapy in residential settings.
These children and adolescents may pose a risk to others, but more often to
themselves, e.g. mutilation from repeated self-harm, dependency on alcohol or
drugs, sexual exploitation and early parenthood. Some end up in secure units,
prisons or on the streets; others will not survive.
Recent improvement in services to children in local authority care and
extension beyond the age of 18 have led to increasing expectations that mental
health services will provide treatment or advice about placement in
appropriate therapeutic residential units. This book describes psychodynamic
work with damaged youngsters in residential settings and may be useful for
professional staff of all disciplines involved in their care.
The author, a Kleinian analyst, has organised a collection of his papers
that previously would have reached a child psychotherapeutic readership. They
are grouped in three sections – the young child, the child in the family
and the adolescent – introduced by a chapter discussing
psychotherapeutic approaches in specialist settings and an explanation of
psychoanalytical concepts. The author does not quite succeed in his attempt to
bridge the gap between his expert therapeutic knowledge and the needs of
professional staff struggling with the complex emotional demands of work in
such settings. This is because of the preponderance of highly technical
psychoanalytical language. However, the clinical material is stimulating and
discusses issues such as the rehabilitation of abused children with their
parents, adoption, and group work with physically disabled adolescents.
Psychotherapists, child and forensic psychiatrists and other professionals
providing supervision or treatment in residential or in-patient settings will
certainly appreciate this book.
