The clinical method in time-limited psychodynamic psychotherapy with children, young people and parents

In this chapter, three core elements of the approach to time-limited psychodynamic therapy with children, parents and young people are described. These are:

  • 1 Asserting the legitimacy of the psychodynamic method and the making of meaning.
  • 2 Attending to the developmental scaffold and the core developmental task.
  • 3 Involving parents and caregivers in the therapeutic process.

Asserting the legitimacy of the psychodynamic method and the making of meaning

Shedler (2006) describes the great insight that the psychodynamic approach offers practitioners and patients alike, in that it ‘has contributed a vocabulary with which to talk about inner contradictions and techniques for working with contradictions in ways that can alleviate suffering’ (Shedler, 2006, p.14). In this regard, discovering an emotional vocabulary and finding one’s own voice are the essential components both of the therapeutic process and outcome. As described in this and the following chapters, the vocabulary that is discovered is necessarily that of a shared vocabulary about behaviour, that involves children, young people and their parents and caregivers together, as far as this is possible. It is striking in the child and adolescent mental health field, how often practitioners rush straight into a proposal of psychotherapy of whatever school, before they have had a chance to ascertain the child and parents’ readiness for such an intervention.

It is suggested that practitioners from the outset, are open and clarifying with patients about a psychodynamic way of working and its benefits. In a world where many parents understandably look for relief of symptoms, by being told what to do, or getting advice a mouse click away, it is easy for practitioners to get drawn into a symptom disposal mindset, rather than one in which the symptom becomes the opportunity for exploration and meaningful understanding. Creating a more transparent attitude requires that some of the ‘working machinery’ of the psychodynamic process, and how the practitioner arrives at a particular observation, is shared with parents. This is the opposite of maintaining a mystifying or aloof presence with respect to the therapist’s professional background and way of working. A more open approach may take the form of explaining to parents that giving advice and strategies has its limitations. Strategies do not help us to understand the meaning of behaviour, because the parent will not be speaking with their own ‘voice’ but with the instructional voice of the therapist. Given that behaviour constantly changes, and is dynamic, we may also advise that a strategy will have a ‘use by date’ as it leaves our lips.

Another way of describing this open approach is to perceive it as creating the capacity for psychological mindedness in both the parents and the child and young person.

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