Supporting psychological mindedness in parents

Creating a setting for psychological mindedness is described in the following example, which also demonstrates how parents can be drawn into psychodynamic understanding that befits the presenting problem. A caring couple contacted the therapist requesting help for their seven-year-old son whose behaviour they found both challenging and defiant. He was described as being different from their other children, who they felt were more reasonable and compliant. They had previously seen a psychologist whose attempts to take a purely management approach to the problems had not been successful. The child’s behaviour improved briefly but then reverted back to the old problems. The parents also described hypersensitivity on the part of their little boy with respect to clothing and his appearance. The therapist noted that the parents whilst caring, spoke about their life at home in very pragmatic terms, and commented that all their children had to fit into a busy family schedule. This busyness seemed to be echoed in the way the mother spoke, which had an almost rapid fire quality to it, as though she believed she was perpetually short of time. Father’s reaction to the stress was to use reassurance for his son, assuring him that he was fine and much loved.

In the course of taking a history of the child, it emerged that he had suffered from a significant hearing loss which unfortunately had not been diagnosed until he was over two and a half years old. The parents reported their puzzlement that they could not understand why their son, when he was a baby, would keep his back to them when they spoke to him. They had interpreted this as the beginning of his challenging behaviour towards them. Surprisingly, the hearing loss had not been picked up by the previous psychologist and was not mentioned by the referring doctor. On seeing the child, the therapist noted an attractive little boy who was clearly using lip reading as well as listening. He tried hard to ingratiate himself with her, asking her about her children and what they were like, and focused on her clothes and jewellery. The intensity of his questioning appeared to be a way of distracting from any discussion of the problem and his fear of criticism. It became evident that the child’s hearing problem had played a significant part in compromising both his capacity for attachment as well as his mother’s ability to bond with him, as she had found him so difficult from the start. The therapist drew attention to the hearing problem, and made this, and the likelihood of how the hearing loss had affected the child’s attachment and the mother’s bonding, the central focus of the therapeutic encounter.

Helping the parents to shift from a behavioural problem focus to one in which they could begin to understand the role of attachment and bonding, and how this had been compromised by their child’s hearing problem, meant that they could access not only underlying meaning, but also important knowledge of which they had been previously unaware. Once this understanding and context was established it became more appropriate to explore how they could manage the child’s anxieties and some of his outbursts differently. By demonstrating child-parent interconnectedness, it helped the parents additionally to see how their child’s hearing loss was also their loss. Whilst this aroused sadness in them, it also set the scene for the beginning of a more appropriate reflective process on their part, which would serve them well in the future.

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