Establishing a defined assessment process

The first session: Taking a therapeutic history of the child and the parents

The therapeutic frame involved in time-limited psychodynamic psychotherapy requires a defined assessment process which takes place over two sessions. The first session needs to be devoted solely to seeing the parents to ascertain how they describe the problem, how they have addressed it to date, and what sort of help they are looking for. The first session also offers the setting in which to take the therapeutic history both of the child and the parents, which will be described in more detail below.

The first session has three parts: the first being the identification of the problem; what brings the parents to seek help and how they have dealt with the problem so far if at all; the second is the taking of the therapeutic history of the child from birth and the third is taking a therapeutic history of the parents.

Identification of the problem

One of the many reasons it is important to see both parents together wherever possible, is that we may find that they have diametrically opposite views of the problem, or one parent may not believe that there is a problem at all and expects the therapist to convince them.

The assessment process is one of revelation. As explained earlier, once we view the symptom as the opportunity, it becomes the thread in a much larger story; once this thread is pulled, the larger story is unravelled and many more complex layers are revealed. The taking of a therapeutic history is a vital part of this process. This means that we first ask about the history of the child from conception through pregnancy and birth to the present time. Highly significant information is revealed in history taking, but we need to keep in mind that our task is not information gathering in a static factual sense. For this reason, note taking is ill advised and should not be taken during the session as it interferes with the careful observational and listening process. The therapeutic history requires our full attention as to tone and emphasis, and how it leads parents at times on a diversion in which they may reflect on other aspects of their child’s life and behaviour that have never been considered before. The taking of the history in the first instance, takes the heat out of the presenting problem and lessens the sense of urgency with respect to finding an immediate solution. In other words it literally gives us pause for thought.

Another issue of significance in taking a history from parents, is that with the ever increasing emphasis on a ‘managerial’ approach to parenting (Leach, 2004), there is a tendency for them to present themselves as empty of knowledge waiting for the professional to advise them. A focus on ‘wrong’ or ‘right’ ways to parent may lead us away from the therapeutic task which is to help parents ‘own what they know’ and to trust their judgement through tolerating trial and error. This therapeutic task has its parallel in how parents in turn can begin to understand their baby by recognising that rather than having to fill up the baby as an empty vessel, that they are able through a partnership with the infant to elicit what the baby already knows.

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