My area of child psychiatry specialization has evolved since 1983 when I completed my training. Though trained as a psychoanalyst, my clinical interests tended towards those 'difficult' cases where treatments required flexibility and creativity. Because of this, I came to have the opportunity to treat quite a number of patients who had extremely traumatic histories of abuse, or who were, even at the time of treatment, involved in very difficult circumstances, such as being caught as a parent or child in endless divorce litigation. Quite by chance I had the opportunity to join a group of mental health professionals and lawyers who work in family law. Through private supervision, I learned how to do custody evaluations - the most challenging and difficult assessments I have ever done. I also learned how to interface with the various people in the legal profession who rely on our knowledge about development in making crucial decisions about a child's future. Over time this kind of forensic and consultative work became important to me as a professional in ways that private practice with individual patients cannot provide. Being able to divide my time between solo office work and something more collegial and oriented towards preventing pathology has been very rewarding for me. I have enjoyed the clinical puzzles involved in assessing the effects that go beyond the biological, psychological and family forces on a child. These cases also require understanding the impact and limitations of a sometimes very dysfunctional and poorly resourced legal system. It becomes an interdisciplinary task to devise recommendations for these families that have some chance of protecting a child's development. It can be a gratifying teaching experience to write reports and testify for judges who frequently have little or no background in child development. They benefit from thoughtful assessments from experienced clinicians.
I would encourage any child psychiatrist with an interest in this kind of work to obtain specialized training and supervision with experienced clinicians. Although child (and forensic) training is essential, even now there remains a tremendous lack of formal education in this particular area of child psychiatry. Because these legal issues impact such a high percentage of our 'ordinary' cases, I believe that some experience with the legal community should be a regular component of our training. I think of this area in the same way that we do when we provide consultation and liaison service to other specialties and to schools. Knowledge of how other disciplines or specialties function that impact heavily on children's lives can only enhance our work.
Stephanie Brandt, M.D.