Those seeking expert psychological help with sexual difficulties should, as a general rule, go first to the general practitioner, who may be prepared to undertake counselling and treatment himself, or who can refer to specialists nearby.
A. Children: Parents and those who have charge of children can receive advice freely at child guidance clinics or the outpatient departments of children’s hospitals. Both the child and the mother and often also the father are interviewed, and in most clinics the work is carried out by a team consisting of the psychiatrist, the psychiatric social worker (who takes the history from the parent and continues to see the parent should treatment be advised) and the psychologist who assesses the child’s intelligence and deals with any matter concerning his school education.
Sometimes it is sufficient to give advice on one or two occasions only. In other instances treatment is recommended which varies according to the clinic’s resources and the child’s needs. In very young children, parent and child are seen together. The child expresses his feeling mostly through play or through painting and modelling and these activities are the main implements of treatment. Often a child’s sexual problem seems to be caused mainly through the parents’ inability to solve their own problems, and in these cases the parents require treatment too. Usually it is found advisable to treat each member of the family by one member of the team; so that the child may have treatment with a play therapist while the mother is interviewed by the psychiatric social worker and the father, if more seriously disturbed, is treated by the psychiatrist. Frequent conferences permit the team to work in accord, but the separation of their roles in relation to the family prevents their being dragged into the conflict that has caused the disturbance.
B. Adolescents: These are seen at child guidance clinics or at psychiatric outpatient clinics for adults. Unforunately the latter seldom have enough time for the intensive treatment that is required in sexual disturbances of adolescence, and a few special teenage Clinics have been started. The first interview differs little from that with children, but subsequent treatment usually requires more intensive work with the adolescent and often less with the parent, for at that age the pattern of behaviour has already formed and cannot so easily be changed by the parents’ influence. The method of treatment resembles more that of adults, although activities, such as painting, modelling, drama or music are sometimes used; and there is more conversation than in the treatment of most younger children. Experiencing insecurity when he tries to live without the parents’ support, the adolescent may become dependent on the psychiatrist. Such treatment, even if it is not following the tenets of one of the