A conceptual and practice framework for time-limited psychodynamic psychotherapy with children, young people and parents

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Reconfiguring a psychodynamic approach for current times. Refreshing and redefining the psychodynamic enterprise

The four domains as cornerstones in time-limited psychotherapy with children, young people and their parents

It is proposed that we need to refresh and redefine the psychodynamic enterprise for our current times, particularly with respect to how we configure time-limited psychotherapy with children, young people and their parents. This necessarily involves reconfiguring some of the foundations of our clinical intervention moving away from an exclusively individual and linear approach, to one that is integrative and interactive. In order to do so, we need to attend simultaneously to four different but interconnected domains within the therapeutic encounter. These domains are identified as follows:

  • • The intra-psychic: The internal experience of the child, young person and their parents. What the presenting behaviour ‘means’.
  • • The inter-personal: What takes place between the child, the young person and their parents.
  • • The systemic: What takes place within the family system. How the child and young person ‘speak’ the family.
  • • The environmental: The impact of the living arrangements that surround the child and young person, such as school, childcare and broader social and cultural factors.

These four interconnected domains represent the real space, time and experience that children, young people and their parents actually inhabit and that cannot be kept artificially separate from each other within the therapeutic encounter. For this reason alone, a psychodynamic perspective encompassing as it does these four domains is perceived as providing a particularly apposite conceptual and clinical framework. In much of clinical practice however, these domains are kept separate from each other, often resulting in varying degrees of fragmentation. In other words, an integrated position that acknowledges the interconnectedness of the four domains, is the opposite of a position in which practitioners avoid contact with parents, or with significant others connected with the child, because they believe that they must preserve the ‘purity’ of approach in individual therapy with a child or young person.

A further problem that emerges in this connection is the tendency to refer to everything as ‘psychoanalytic’ that pertains to a non-behavioural deeper, meaning-making approach, whether this refers to therapy with individuals, families or groups. This generic usage inevitably raises confusion with respect to treatment versus method and also denies the contribution of systems thinking and understanding of group dynamics, which while it is a part of a psychodynamic way of thinking, is not psychoanalysis. If we are to be able to provide clarity on these matters, then we must ensure that the order of words does not become the order of things (Good and Kleinman, 1985). For this reason, the acknowledgment of the four domains needs to become integrated within the mind of the therapist as well as within their clinical practice.

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