Attending to the developmental scaffold and the core developmental task

Helping parents to become developmentally aware is another aspect of helping them to become psychologically minded. Identifying and promoting the developmental task for children and young people is central to the therapeutic enterprise, and it is here that time-limited psychotherapy can truly come into its own. As Rawson (2002) puts it, the primary objective of time-limited psychodynamic psychotherapy is to ‘facilitate change by dealing satisfactorily with the strategic focal issue that is holding up development’. Thus, when working with children and young people, the presenting problem is always understood in the context of the developmental task. In other words, how does the child present in terms of their age and stage, related to expected social and emotional milestones? The great benefit of working with children and young people is that we are fortunate in having growth on our side. Development as Winnicott has indicated in all of his writings contains within itself the power for growth and change. This is a formidable ally in the therapeutic task. This means that the therapeutic process does not have to involve the therapist in doing all the work, but rather on helping to elicit and promote the inherent capacities within the child as well as the young person.

It may be suggested therefore that less in therapeutic practice terms becomes more. This resonates with Winnicott’s contention that in work with children and young people we may want to consider how little needs to be done, before rushing into action. This process has its parallel in infant-parent relationships, as in when parents’ anxiety is contained, they are able to elicit from the infant what already exists in potential and what Daniel Stern has called the infant’s ‘formidable capacity’ (Stern, 1977).

There are many instances across the age range from early childhood through to late adolescence, in which a variety of often complex factors interrupt developmental milestones, or where they may fail to develop altogether. In one such case, a little girl of three and a half was referred because of her challenging and omnipotent behaviour within the home. There had been some physical problems at birth and postnatally and these had been resolved, but a high level of parental anxiety remained about the fragile nature of the child. The parents believed that their little girl was unusually gifted intellectually and they poured a lot of attention into stimulating learning experiences for her. However, when the therapist saw the child she felt that she was in fact surprisingly immature in terms of the abilities one might reasonably expect of her age. She was more interested in ‘dazzling’ the therapist with her charm and verbal ability than doing a drawing, or showing any interest in the toys. Her capacity for concentration was also limited and she had a low boredom threshold. In this case the parents had wondered if their child might be showing early signs of a disorder, but it was the therapist’s belief that the rarified atmosphere surrounding the little girl and her parents’ over-investment in her, were what in Rawson’s terms was ‘holding up development’. We may hypothesise that the child was also confused about her position in the family hierarchy; as the much admired and highly invested child, was she in fact one of the adults or one of the children? Certainly her omnipotent and highly controlling manner suggested that she believed the former might be the case. The central focus in this therapy therefore was on helping her parents create appropriate opportunities for maturation that would be child-centred and not adult-centric. Helping the parents to set firmer boundaries and be clearer about their own relationship as a couple, and as a parenting team, would also set the scene for more positive change. In this situation a visit to the childcare centre or kindergarten, was also indicated, as the little girl ostensibly had no interest in other children, but spent most of her time relating to the adults. Here we see another example of widening the field in order to get the best outcome, and ensure that all the people surrounding the child have a shared commitment to positive change.

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