GEORGE HALASZ, B. Med. Sc., M.B., B.S.*
A brief history of the development of children's rights provides a context to discuss four areas the child psychotherapist needs to safeguard regarding these rights: informed consent; distinguishing between the child's withdrawal of consent and resistance in therapy; the distinction between "difficult to treat" and "unsuitable for treatment" cases; and empathic listening. Family dysfunction and "managed care" pose further challenges to preserving children's rights in therapy. Principles related to the well-being of the child in psychotherapy are offered.
AN HISTORICAL PERSPECTIVE
Relationships between parents and children enshrined in Roman law provided the father, in patria potestas, with "supreme authority in the family . . even to the father having the power of life and death over his children and the right to sell them into slavery.' This absolute patriarchal power resulted in acceptance of systematic ill-treatment of children: abandonment, physical and sexual abuse, exploitation, neglect, and infanticide.
In the absence of any concept of children's rights, their status at the bottom of the social scale allowed for the continuation of infanticide until the 4th century.2 Only then did parents begin to see the child as having a soul, ushering in a less drastic but still inhumane era of "child abandonment."2 Socially sanctioned child abuse persisted for centuries. It was not until the eighteenth century that an empathic ethos began to pervade Western society, heralding a new attitude toward children. Interestingly, the function of empathy in psychological treatment has recently been highlighted as a potent therapeutic factor.3
Despite the Victorian motto "children should be seen but not heard," by the nineteenth century, the legal profession began to challenge the absolute rights of parents, (notwithstanding the recognition of the unique bonds between parents and children), and foreshadowed the modern concept of best-interest-of-the-child standards to determine care of children where parents violated or neglected their rights.
At the same time, the medical profession began to study the basis of childhood mental disorders. Research into their causes was actively pursued by the latter part of the nineteenth century.4 Freud's "analysis" of five-year-old Hans,5 published in 1909, gave birth to the specialty that was to become child psychoanalysis and child psychotherapy. Mental health professionals finally came to appreciate the importance of family attitudes and relationships for children's psychological development. Anna Freud and Melanie Klein contributed further insights by unravelling unconscious layers of the child's mental life.6 Those "revolutionary" ideas gained widespread acceptance within and beyond psychoanalysis.
Social reforms were given impetus with publication of Bowlby's influential WHO's commissioned report Maternal Care and Mental Health7 and Kempe's8 classic on child abuse. Increasing media attention paid to abuse and the "rights movements" of the sixties and seventies contributed further to the groundswell of public empathy for the plight of abused children and intensified social resolve to formalize better protection for children.
The next major development was Goldstein, Freud and Solnit's two publications, Beyond the Best Interest of the Child9 and Before the Best Interest of the Child, 10 to which we now turn. Goldstein et al. made the developmental foundations of children's rights accessible to the medical profession as well as to the lay public, claiming, "that a child's need for continuity of care by autonomous parents requires acknowledging that parents should generally be entitled to raise their children as they think best, free of state interference," [and,] "that the child's well-being-not the parents', the family's, or the child care agency's-must be determinative once justification for state intervention has been established"lo (pp. …