Delmas C, Gachnochi G
Secteur I 01 de Psychiatrie infanto-juvénile de l'Essonne, C.H.S. Barthélémy-Durand, Etampes.
Ann Med Psychol (Paris). 1992;150(1):51-4.
Many children placed in foster families chosen by the local administrative authorities need an intensive and complex treatment, which would well justify their case being handled by the Specialized Psychiatric Unit responsible for a number of selected foster families. The foster family, which is often chosen hurriedly, is generally unprepared to deal with the child's psychological problems. Moreover, the child's links with his own family have not always been maintained. Soon social workers and the foster mother will be expecting the local Child Psychiatry Outpatient Unit to provide them with massive aid, which this unit is not properly equipped to give. It happens frequently that members of this team will have to face particular counter-transfer difficulties. However certain aspects of this medical structure are helpful for the treatment of these children: the Child Psychiatry Unit offer specific facilities, like therapeutic groups, and as the members of its team have no part in the factual decisions concerning the fate of the child, they feel more neutral and can be considered so by the different actors involved, including the child him- or herself. We discuss two clinical cases, and then touch upon the fundamental issue involved, that of the organizing power of psychiatry in a given environment.
许多被安置在当地行政部门选定的寄养家庭中的儿童需要深入且复杂的治疗，这充分说明应由负责若干选定寄养家庭的专门精神科单位来处理他们的情况。寄养家庭通常是匆忙选定的，普遍没有准备好应对孩子的心理问题。此外，孩子与自己家庭的联系也并非总能维持。很快，社会工作者和寄养母亲就会期望当地儿童精神科门诊单位为他们提供大量帮助，而该单位并没有妥善配备来提供这种帮助。这个团队的成员经常不得不面对特殊的反移情困难。然而，这种医疗结构的某些方面对治疗这些儿童是有帮助的：儿童精神科单位提供特定的设施，如治疗小组，而且由于其团队成员不参与有关孩子命运的实际决策，他们感觉更中立，并且包括孩子本人在内的不同相关方也可将他们视为中立。我们讨论两个临床案例，然后触及所涉及的根本问题，即在特定环境中精神科的组织力量问题。
