Child and adult psychiatry: comparison and contrast.

Since its development from general psychiatry, child psychiatry has been influenced by its close involvements with the child guidance movement and pediatrics and by the age of its patient population. This has led it to evolve in ways quite distinct from adult psychiatry, so much so that at times the understanding and relationship between the two disciplines has been somewhat strained. This paper relates the development of child psychiatry to its history, its tasks and its patient population, highlighting some of the major differences between child and adult psychiatry. It then looks at why research in child psychiatry has lagged behind research in adult psychiatry. It concludes by discussing tensions between the two disciplines, and why it serves the interests of both professions as well as those of our patients, that a better understanding and collaboration between them be established.

Teaching child psychiatry to medical-undergraduates.

This article describes the findings of a survey of undergraduate curricula in the 16 Canadian medical schools in the areas of growth and development, behavioral sciences, and clinical child psychiatry. It identifies principles upon which such programs may be based and includes issues in integration of child and adult psychiatry.

The Foster Care Research Project: clinical impressions.

A two-year prospective study compared individual and group models of support for foster parents. Results showed greater foster parent satisfaction with the group model. An independent critique identified methodological flaws that would preclude further differentiation of the models and suggested that clinical impressions and trends in favor of the group model be given credibility. Operation of the group model is described, and reasons for the differences between clinical and experimental findings are discussed.

The Foster Care Research Project: summary and analysis.

This paper analyzes and summarizes five more detailed papers describing the Foster Care Research Project (F.C.R.P.). This compared two (individual and group) models of foster care as to their effects on foster parent satisfaction, placement breakdowns and several indices of children's adjustment in care. The group model is described and contrasted with other "extended family" models, and the results of the project, which were mixed, are summarized. A critique of the experimental design suggests why clinical gains noted in the children were not borne out experimentally. Following a clinician's analysis of the process by which the group model operated (illustrated by clinical vignettes), the paper ends by describing the content and process of two support groups for the natural children of the foster parents.

The preventive utilization of foster care.

There is a general, but unproven, belief that long-term foster care is inherently unstable and consistently damaging. This paper discusses eight biological, psychological and social factors that the literature considers responsible for the failures of long-term fostering. It then summarizes the clinical picture presented by such failures, pointing out how changes in the nature of children coming into care have necessitated shifts in the type of foster care required to meet their needs. The major part of the paper uses this knowledge to derive seven keys and associated practical strategies for preventing psychological and social deterioration for children in care.

Criteria and methodology for assessing credibility of sexual abuse allegation.

This paper will consider three types of interview that are held with sexually abused children. After discussing common problems in technique, it will suggest a methodology designed to help determine a child's credibility and assist in forming and demonstrating a reliable expert opinion for court purposes. Next, it will describe three types of data crucial in investigating allegations of sexual abuse, and will suggest clinical criteria useful in distinguishing true from false allegations. Finally, it will examine the validity of these criteria, comparing them to those of other workers in the field.

Beyond family therapy. Toward a systemic and integrated view.

We are entering an era in which the selective use and combination of a variety of complementary approaches to assessment and treatment of children and their families is becoming increasingly possible. This article surveys and summarizes the field, presenting the theoretical rationale and clinical vignettes to illustrate guidelines that invite a creative approach to choice of treatment based on the need of the patient rather than the bias of the therapist.

The management of children admitted to child welfare services in Ontario: a review and discussion of current problems and practices.

Children coming into the care of the Ontario Child Welfare System are generally older and more seriously disturbed. Foster parents and Children's Aid Societies have had to change in order to meet the needs of these troubled children. While the efficacy of foster care continues to be debated, there are ways to improve in-care management including: ways of preventing drift, appropriate assessment of parenting capacity, minimizing emergency placements, and more energetic and focused casework which deals appropriately both with the deficits and distortions internalized in the child as a result of previous damage and with the ongoing interactional stresses operative within the foster family system. The advantages of planned over emergency placements are discussed. The child separated from natural parents will mourn. Foster parents' and workers' roles in assisting the work of mourning in foster children are discussed. Soon after admission to care, the practicality of restoration to the natural family must be assessed, and management should then aim towards restoration or towards freeing the child for adoption or planned permanent foster care, should that represent the least detrimental available alternative. The family court system as presently constituted frequently and unnecessarily undermines rather than protects the adjustment and development of vulnerable children. Mechanisms by which this occurs and some proposed solutions are suggested. The paper concludes by suggesting that the traditional low priority given to child welfare services by governments is unlikely to be altered unless mental health professionals succeed in eliciting considerably more community support for adequate social services than is currently available.

The Process Model of Family Functioning.

The Process Model of Family Functioning differs from the McMaster Model of Family Functioning and their common source, the Family Categories Schema, by its increased emphasis on the dynamic interaction between the major dimensions of family functioning, and by its stress on the interface between intrapsychic subsystems and the interpersonal dimensions of the family system. A model of family process rather than family structure, it defines six universal criteria of family functioning. It describes the processes involved in each along with the content components and the critical aspects of each. A self-report test developed from the model (FAM-III) is being widely used both as a research tool and as a clinical adjunct. Tests to define its validity and reliability continue.

The integrated use of individual and family psychotherapy.

For almost thirty years after the development of family therapy, the concurrent use of family and individual psychotherapy was seen as incompatible by leading proponents of each modality. Although recently the literature has revealed an increased willingness to utilize family and individual therapies concurrently, the decision for or against any such combination has been left largely to the intuition or bias of the individual clinician. This paper suggests the concurrent use of family and individual psychotherapies when disturbances of family structure and interaction co-exist with, reinforce, and are maintained by largely ego- syntonic internalized psychopathology (that is, the character defences of individual family members). It provides a rationale for integrating the concurrent therapies, and uses clinical examples to illustrate how each can potentiate the other. There is a discussion of indications and contraindications for the integrated use of concurrent family and individual therapy. From their attempts to apply these principles, the authors conclude that the experience for the family, the individual and the therapists is that the selective and integrated use of concurrent family and individual therapies can achieve more than can either therapy alone--the whole is greater than the sum of the parts.

Clinical applications of the Process Model of Family Functioning.

This paper discusses clinical applications of the Process Model of Family Functioning. It provides a framework for conducting and systematically recording a family assessment, and can help clinicians achieve and use improved control of clinical sessions to increase their diagnostic and therapeutic effectiveness. Ways of using FAM-III, a self-report test derived from the model, to confirm or amplify a clinical assessment and to assist or monitor therapeutic interventions are discussed. Viewing psychological and family systems theories as complementary, the model provides a rationale for integrating both sets of theories to achieve a more pluralistic view of pathogenesis and a more selective choice of therapies. An extended example illustrates the concurrent use of individual and family therapies. Other topics discussed include the role of family strengths, the derivation of therapeutic goals, moving from content to perceive underlying structure and process, making the conceptual shift from group-of-two to conceptualizing the family as a group (system) in equilibrium.

The psychiatric training of medical students.

Undergraduate psychiatric education should be concerned mostly with those aspects of psychiatry required for the proper practice of medicine. Psychiatric concepts and techniques are applicable to all medical practice and relevant to the daily work of every physician or surgeon. Therefore, in the psychiatric training of medical students the focus should be primarily on teaching "psychiatry of medical practice" and much less on teaching "specialty psychiatry." The teaching of psychiatry for medical practice will be best accomplished by selecting patients who are more like those the student will see later on as a practising physician. A systematic effort should be made to develop joint teaching with other departments, if we are to hope that students will carry over the approach we teach them to other subjects of medicine. Counselling and psychotherapy are essential skills for every physician or surgeon; medical students should be taught these skills by psychiatrists who are not just skilled psychotherapists but are also comfortable in their role as physicians in view of the importance of this role for the development of the identity of the medical student as a physician. The quality of the psychiatric training of medical students is dependent to a large extent on the priority accorded to undergraduate teaching by the department of psychiatry; competing activities, however, can result in undergraduate teaching being given less than top priority. Long-standing difficulties which psychiatry and psychiatrists experience in the medical school may impede undergraduate psychiatric education; these difficulties can be lessened by the closer involvement of psychiatrists with other physicians in the clinical and educational programs.