The dynamic nature of the ‘here and now’

A particular feature of time-limited psychodynamic psychotherapy is how, because of the time limitation, as well as the opportunity for individual and conjoint work, it introduces a level of intensity into the clinical interchange which brings to the fore many of Luborsky’s ‘core conflictual’ elements of the child and family dynamic. These elements would in traditional child psychotherapy tend to take a considerable time to emerge, or may never come to the fore. In time-limited therapy, particularly in conjoint sessions with the child and parents, it is remarkable to observe how in the ‘here and now’ of the sessions, children demonstrate through their actions, the need to draw the parents’ as well as therapist’s attention to the dilemmas with which they are faced. Often it is these wordless experiences in the ‘here and now’ that more than any discussion can illuminate the core unconscious dilemma. It is these ‘here and now’ experiences coming explicitly to the fore in time-limited psychotherapy, that help move the therapeutic process forward by leaps and bounds.

In one such example, a mother complained about the challenging behaviour of her young child which had arisen mainly because of earlier turmoil in their lives. Her behaviour towards him tended to be inconsistent and when things were at their worst between them she expressed the belief that he hated her. The therapist observed that in fact the child was closely attached to his mother, but was at times uncertain about how to approach her. His struggle with his loving and hateful feelings were dramatically revealed when in one joint session in which his father was also present, the little boy went over to his mother to plant a kiss on her cheek. However, as he did so, he also bared his teeth.

It was an action that perfectly encapsulated Shedler’s description of how the psychodynamic approach can illuminate ‘inner contradictions’.

The therapist, who saw what had taken place, whilst the mother was not entirely aware of it, was able through gentle humour to explore with both the parents and the child what was being communicated. This in turn opened up a discussion about having mixed feelings both as parents and as children, and how this need not be a frightening or destructive emotional state of mind.

There are many other examples of children who enact the drama of their conflicts in the session for the benefit of their parents, in the hope that the therapist will be able to understand what is being ‘said’ and to act as facilitator and translator. One example refers to a confusion about hierarchy between parents and children, particularly when parents feel overwhelmed with the task of being in charge and try to flatten out the hierarchy by being the child’s ‘friend’. How this is manifested in the clinical sessions may vary, and may tend to take the form of the child monopolising the parent, and not allowing them to speak, or denigrating them, or talking to them as though they are a version of themselves. The therapist may also be drawn into this enactment, but by being active and communicative in the ‘here and now’ can help both the parents and the child to undo some of these entanglements.

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