Dimensions of Dreams

Abstract

There are inevitably some omissions, inconsistencies, or points of disagreement in a compilation and summary of papers and workshops. The most prominent omission is a conceptual framework of family functioning as related to the development of children. There is a specification of qualities, behaviors, and circumstances, but little discussion of the processes with which these elements of a family system interact. Also lacking is a theory of psychopathology to explain observations and to serve as the basis for a strategy of intervention. The developmental model which defines all psychiatric disorders as disturbances in the course of the child's development obscures more than it enlightens. Familiar categories such as psychosis, emotional disturbance, behavior disorder, or brain dysfunction could be more dearly linked to therapeutic approach. The section on child abuse fails to mention the role of impulsive parents or of protective services and does not convey the sense of urgency appropriate to this situation. The busy physician will be discouraged from attempting to do a family inventory by the comment that this skill can be acquired only through direct observation and supervision with an experienced practitioner. Furthermore, generalizations about current trends in family life have a tone critical of parents even while emphasizing the absolute necessity of establishing a therapeutic alliance with them. This monograph touches on virtually all issues relevant to the evaluation and treatment of children with psychiatric problems. It will be useful to nonpsychiatric physicians by calling attention to matters they must consider in the management of these problems. It should also be useful as a training aid to the child psychiatrist involved with primary-care physicians.

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