NEW DIRECTIONS IN THE INPATIENT TREATMENT OF PSYCHOTIC CHILDREN IN A TRAINING CENTER

A review is presented of the treatment of 12 autistic and symbiotic psychotic children over a period of years at the Univesity of Michigan Children's Psychiatric Hospital. The paper focuses upon the effects of two contrasting treatment programs and their relation to problems specific to the treatment of these children in a training center. An initial group of 8 young psychotic children treated at the hospital showed relatively little improvement. Close scrutiny of the therapeutic program and course of their treatment revealed a number of potentially surmountable obstacles to these children's ego development. Subsequently, a group of 4 similar children were treated in a new, gradually evolved experimental program, with considerable improvement resulting. The new program included the use of multiple long-term therapists and group meeting for all personnel having close contact with these patients: it provided continuity of staff, coordination of treatment program, continual stimulation and reinforcement of the staff's therapeutic efforts, and generally diminished the likelihood of unchecked, malignant countertransference developments. Regularly scheduled group meetings for relevant personnel are in part educational but of greater significance is the group process which provides staff catharsis frequently and insight occasionally into their real feelings for these children. As a result the staff are less encumbered by negative countertransference. The staff members become mutually supportive when they share understanding of each others' efforts and sacrifices. Improvement in the autistic or symbiotic child is positively correlated with the total amount of the staff's sustained investment in his care, which can be enhanced by a staff "group."