ABSTRACT
Engagement is likely to become particularly important at sticking or turning points—rather as the grip between tyre and road becomes especially important during acceleration, turning, and braking. Arguably, engagement will start with the idea of coming to child and adolescent mental health services (CAMHS) but this would be engagement with a fantasy. The first concrete contact is likely to be the appointment letter. Certainly, letters play a part in engagement. The questionnaires that are often routinely sent out as a first response to referral in the public sector might be considered to have either positive or negative engagement effects. In engagement, the clinician's ability to accept two or more differing views without collapsing or exploding can offer hope to the child and her parents. Like risk, engagement is dynamic and is revisited regularly as it deepens and thins, dependant on stages of treatment, errors of judgement on the part of the clinician, side effects of treatment, and suchlike.
