Nr 6. 2002 sid. 9–32

The Aims Of Child Psychotherapy:
A Kleinian Perspective.

 Paul Barrows


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    Paul Barrows är utbildad barn- och vuxenpsykoterapeut vid Tavistock Clinic i London. Han arbetar nu vid United Bristol Healthcare Trust (NHS). Han är speciellt intresserad av små barns mentala hälsa. År 2000 vann han den 4:e annual Frances Tustin memorial prize in lectureship. Han är också joint editor av tidskriften Journal of Child Psychotherapy. I artikeln beskriver han målsättningar för barnpsykoterapi utifrån ett kleinianskt perspektiv där han fokuserar på hur man kan hjälpa barn att återintegrera avsplittade delar av personligheten. Artikeln har tidigare publicerats i Clinical Child Psychology and Psychiatry 6 (3) July 2001.


    Child psychotherapists are still sometimes seen as being rather evasive about the nature of their work, concealing their arcane practice behind a guise of confidentiality and having difficulty explaining and justifying themselves to their colleagues. For example, Lask has written:

    There remains a hard core of psychotherapists who do not believe in multidisciplinary team work, and who are happy to practice their undoubted skills in isolation … without communicating with either the parents or any professionals. These omissions cannot be justified under the guise of confidentiality … (Lask, 1997: 342)

    They are also frequently taxed about the lengthy treatments they indulge in. Why should this be necessary? What is it that they are trying to do and how do they aim to achieve their goals?

    In these times when there is growing pressure on all professionals to justify their practice, and to work within an evidence-based context, it becomes increasingly imperative that child psychotherapists endeavour to give a good account of themselves. They need to find ways of conveying the nature of their therapeutic endeavour. Similarly they also need to engage with hard-headed research to try to evaluate the efficacy of their work, albeit this task faces all the methodological problems that beset any of our colleagues when it comes to attempting to measure psychic change. A start has, however, been made in this area (see Hodges, 1999; Target & Fonagy, 1994a, 1994b, 1996; Lush, Boston, Morgan & Kolvin, 1998; Chiesa & Fonagy, 1999).

    In this paper I hope to contribute to the discussion by describing the aims which, to my mind, inform the approach taken by a Kleinian trained child psychotherapist. I shall concentrate on describing those aims in the context of work with more ordinary, 'neurotic' children (albeit these increasingly represent a small proportion of the child psychotherapist's case load). The aims and technique are somewhat different with psychotic and autistic children, at least initially, and incorporate a more developmental approach. These have been described elsewhere by Alvarez (1996) and Hurry (1998).





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