The journey from children to parents and back

This process paradoxically presents us with the opportunity to begin to work with the ‘right’ person. In one such example, parents brought their nearly four-year-old son to the therapist because of their concerns about his reluctance to toilet train. It emerged that the parents had a very busy work schedule and had set up routines in their home in almost militaristic style. This suggested an anxiety that chaos would reign if these schedules were not adhered to. The toileting problem ceased almost immediately once the parents relaxed their rigid stance and the child was happy to be included directly in discussions about his ‘ownership’ of his body. However, some other more minor symptoms persisted and the mother particularly reported similar concerns with her other children, and was critical of them when they were not as careful or tidy as she wanted them to be. It became clear to the therapist that the need for control resided principally in the mother, and it was suggested that they meet separately to discuss this further. Given that there had already been a positive outcome for her child, the mother was prepared to cooperate with this suggestion. Through these sessions, a picture emerged of the mother growing up as a child and adolescent, having to manage high levels of parental dysfunction. Her need for order and rigidity was an appropriate response to the disorder and chaos she had experienced in her earlier life. This important insight created a transformative experience for the mother with respect to lessening her demands on herself, and becoming more emotionally available to her children.

There are other examples where parents may present with high levels of conflict about how they parent together, and are critical of each other. On occasion, the conflict may be so high that the parents cannot agree to bring their child to therapy even though they acknowledge that there is a problem. One may hypothesise that they may be reluctant to find a solution to the child’s problem, since the child’s difficulties have an underlying function in maintaining their relationship. Making the suggestion to shift the focus entirely away from the child is then helpful. This may involve continued work with the parenting couple or with one of the parents. The important task is to gain clarity about where the problem actually lies.

In summary, therapeutic work with children, young people and their parents because it is intrinsically dynamic, and encompasses the four domains of the intra-psychic, the inter-personal, the systemic and the environmental, represents a journey in which there is rarely a path that leads directly from A to B. As psychotherapists therefore, we need to be prepared to be agile and open to the change of direction. In so doing, we promote the best interests of children and young people, as well as the capacity of their parents to care for them.

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