The beginning of the therapy

In time-limited psychotherapy it is particularly important to address these collusions and entanglements from the outset and in so doing we create further opportunities to broaden the field of our inquiry. For example, how the referral is made and by whom already gives us important information about the family dynamic. Women may make the initial contact to seek help for a child or young person whom they may refer to consistently as ‘my child’. This already gives us an impression of a father who is absent at least in the mind of the mother. An invitation to both parents to attend for an initial consultation may be met with disbelief that the father would be considered of any relevance, and so within minutes of a telephone call we already have an insight into aspects of how this parenting couple operate. This may in turn lead us to begin to make some hypotheses about the presenting problem, even before we have seen the child or young person.

When the parents arrive for the initial consultation, the mother may regale us with the list of the child’s misdemeanours or problems, fixing us with her gaze whilst totally excluding the father. He remains silent and from time to time surreptitiously looks at his watch. This scene perfectly encapsulates how the couple communicate and how this does not extend to any notion of shared parenting. The picture is complete when the therapist turns to the father and asks him for his opinion on the problem whereupon he says, ‘I don’t know because I’m not there’. This response is expected to be understood as referring to the fact that the father works all day and so is not present when the outbursts of the child for example are said to occur, and therefore he cannot be held responsible. Of course his comments tell us so much more, namely that he and his wife have in a sense ‘divided up’ the family and work tasks so rigidly that whoever is at work does not need to feel responsible for home and family life and vice versa. We are left with a sense that the children in this tightly stratified family have fallen out of the mind of one parent whilst being tightly interwoven in the mind of the other. For the couple this may represent a perfectly reasonable, even positive solution whilst it may in reality be devastating for the children.

This example demonstrates that through widening the field we recognise that everything that is presented is important and offers relevant data. We could therefore not make progress with solely focusing on the child or young person’s presenting problem, without first addressing the communication or lack of it on the part of the parents. Once it is made clear that the father is an essential part of the parenting team, and that therapeutic work can only be enhanced by his presence, we may be surprised at how quickly and how dynamically therapy may progress.

In situations where there is chronic conflict between a mother and her son, the absence of the father in an emotional sense, may go to the heart of the problem. This is another example of why rushing to pathologise the child’s behaviour may take us into completely the wrong territory. In one such example, an emotionally absent father who was very preoccupied with his work, was encouraged to ‘return’ to the family after the mother had been struggling with her young son for some time. The mother was heavily identified with her young son and was for much of the time the only parenting presence in the home. She had become concerned however, about her son’s attacking behaviour towards her. If we return to our psychodynamic framework, we can recognise the powerful Oedipal conflicts that were at work in this family and how this led the boy to struggle to create some safe space between himself and his mother. The involvement of the father immediately led to an almost total abatement of the problem. In their final session of mother, father and son, the therapist was left with a moving image of the father holding his son aloft as he walked out of the room; the evident joy in the boy’s expression was testament to what he had been craving from his father.

 
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