Forced into treatment. The role of coercion in clinical practice. Formulated by the Committee on Government Policy. Group for the Advancement of Psychiatry. Report no. 137.

Abstract

It is clear to students of child development that setting limits and using parental power are necessary in promoting the maturational process. In fact, family systems theory addresses the issues of power and power coalitions as paramount. Forcing a child into treatment initially is a legitimate role for parents or guardians and is validated by mental health professionals, who feel that this must be accepted as part of their regular clinical work--especially in the case of school-age children, who only rarely can initiate requests for help. Further, the clinical use of power and persuasion has been addressed by a number of authors at both theoretical and pragmatic levels. Child psychiatrists deal with issues of coercion systematically and successfully in clinical practice. Although children often come into treatment against their will--sometimes because of physical pressures or threats and sometimes because of economic or emotional threats--they often can make use of a therapeutic relationship that is negotiated over time and gives careful attention to the child's identified needs and wishes. This experience leads one to recognize that many seemingly overtly coercive treatment contexts may be turned into effective treatment interventions. Exploration of the use of power and coercion as they relate to children--whether in normal development or in treatment--is helpful in the study of the psychopathology of adults who require limit setting, persuasion, or coercion in their treatment, often quite possibly because their childhood developmental experience regarding issues of power was dysfunctional.