Clinical vicissitudes of adoption.

Many interacting forces shape the unique experience of adoption. The adoptive parents' fantasies, fears, and perceived lack of entitlement to the child can detrimentally influence their parenting abilities. The adopted child's often powerful need to master early abandonment may lead to maladaptive behaviors that feed the adoptive parents' fears and fantasies regarding the child's past and future. The therapist familiar with the challenges of adoption can take an empathic stance with the adoptive parents and the adoptive child that can contain their anxieties and conflicts and pave the way toward a better resolution of their individual and shared experience.

Forensic child and adolescent psychiatry: a review of the past 10 years.

OBJECTIVE: To review important developments in child and adolescent forensic psychiatry from 1987 through 1996. METHOD: Major changes in the law and developments in research and practice were surveyed in the areas of the legal regulation of psychiatry, family law (divorce and child abuse), consultation to juvenile and criminal courts, civil litigation, and the development of the subspecialty. RESULTS: There has been a large increase in research based on quantifiable descriptive data of forensic populations, although studies using comparison or control groups remain relatively rare. While managed care has heavily influenced treatment practice, legal liability remains largely with the clinician. Issues regarding techniques of evaluation for sexual abuse have been scrutinized by the courts and by researchers. Legislative responses to rising rates of juvenile violence have been in the direction of treating violent adolescent offenders as criminally responsible adults. There has been a major move toward setting standards for forensic evaluations, training, and credentials. CONCLUSIONS: Child and adolescent forensic psychiatry remains an area encompassing diverse clinical issues. It remains unclear the extent to which it will develop into a formal subspecialty.

Adequate evaluation of divorce-related child sexual abuse allegations.

The accepted child protective service model for evaluation of sexual abuse is inadequate for divorce-related cases involving young children. Three cases illustrate that lack of contact with the alleged offender and lack of pursuit of alternative explanations for phenomena presented as indicative of sexual abuse predispose to "finding" abuse. It is suggested that such agencies engage experienced child and family clinicians to help with these cases.

Use of a horror film in psychotherapy.

Modern improvements in the technology of cinematic special effects have ushered in a new genre of vivid and graphic horror film. The numerous sequels of these films attest to their popularity among adolescents and young adults. Considerable concern has arisen on the part of parents, professionals, and policymakers regarding adverse effects of these films upon children. The authors discuss the meaning of a horror film to a troubled 13-year-old boy and describe the use of the film in his psychotherapy. The modern horror film serves many of the same functions for the adolescent that the traditional fairy tale serves for the younger child.

Child custody consultation in abuse and neglect: a practical guide.

Mental health professionals are being asked with increasing frequency to consult to the courts regarding custody in cases of suspected abuse and neglect. This paper provides practical guidelines for evaluation of these families in order to maximize the effectiveness of consultation and minimize common pitfalls usually encountered with such evaluations. The authors offer suggestions for structuring the evaluation, dealing with family reisitances, writing the report and testifying in court. It is the hope that with such practical guidelines, other mental health professionals will be willing to attempt such consultations and will be able to structure them in such a way that they can be carried out efficiently and effectively, benefiting not only the courts, but the children and their families as well.

The physician's work and marriage.

Medicine and personality characteristics of its practitioners pose for physicians unique hazards to emotional health and marital satisfaction. The attempt to meet too many emotional needs in work may preclude adequate attention to personal and family problems. The physician should be more aware of his own and his family's emotional needs, and be less threatened by less-than-perfect adjustment in himself or other family members. Suggestions include: teaching psychiatry on a developmental and adaptational model; offering marital groups in medical school; and encouraging the process of marital contracting and the use of marital therapy when emotional problems arise in either spouse. The understanding and resolution of emotional distress of one marital partner often requires the involvement of both, as people intimately attached to each other tend to have neither problems nor solutions in isolation.

Child abuse and neglect: the rights of parents and the needs of their children.

The trends in treatment and in legal decisions with respect to custody of abused and neglected children are reviewed. Parental rights, including a familial right to treatment, are discussed in terms of the needs of children for their parents and for a safe home environment. It is argued that the critical point for the assertion of parents' rights is not the ultimate custody hearing but the initial decision to remove the child from its home.

Children in divorce: intervention in the phase of separation.

Divorce of their parents can create difficulties for the development of young children. The ability of children to integrate the various losses involved in the breaking up of a family is impeded by limitations of their cognitive understanding of events taking place during the separation phase. Because their thinking process is as yet immature, children often feel responsible for the divorce, and they otherwise distort the meaning of the events about them. The pediatrician can often guide and encourage parents to facilitate their children's understanding and acceptance of the changes in their lives.

Adoption in evolution: recent influences on adoption in Virginia.

Adoption is a relatively new and evolving institution. The characteristics of children available for adoption are changing. Some hard-to-place children will be helped by subsidized adoption. The concept of children as property of biologic parents continues to shadow efforts to terminate parental rights. Virginia law allows adoption against parental consent if such consent is withheld contrary to the child's welfare, but decisions continue to be based upon whether or not parental behavior has been sufficiently extreme to justify a finding of unfitness. New legislation is required to put the child's interests on a par with those of parents.

Child custody contests in historical perspective.

The author reviews the historical background of interparental child custody disputes. The father's superior right to custody in the nineteenth century continued the English common law tradition, but in the twentieth century the mother's claim became superior to the father's, reflecting women's generally increasing rights and the assumption that women are better suited to caring for children. Partly as a result of recent cultural changes leading to a beginning equalization of parental rights and partly because of greater concern for children, courts are starting to focus more on children's emotional needs. It is likely that courts will increasingly call on psychiatrists and other mental health professionals for help in making their decisions.