Clinical challenges. The potential of the time-limited model
The previous three chapters have described the essential method and technique of time-limited psychodynamic psychotherapy and how the child and young person can be placed within this therapeutic frame. This chapter will focus on how this model can be applied with respect to some of the clinical challenges that are presented to clinicians who work with children, young people and their parents. Clinicians who have worked for many years in the field may identify two particular areas that pose challenges in the therapeutic encounter. The first is that of emotional and psychological problems that present as embedded within the child and young person. These generally take the form of obsessive behaviours. They may also take the form of physical problems for which no organic cause can be found. The second area of concern for many clinicians is that of the often apparent confusion on the part of parents about their parenting task and responsibilities. These confusions in turn give rise to fraught child/adolescent/parent interaction in which the challenging behaviour of the child becomes the focus of attention. The fundamental assumption made here is that these problems in almost all cases will not be responsive to the taking of a solely individually focused therapeutic approach. They have to be interpreted more broadly to take into account the links between the intra-psychic, the interpersonal, the social and the systemic domains, and these need to be reflected in the therapeutic work. The following account of responding to these clinical challenges in the context of time-limited therapy is intended to offer an aide to practice through considering this more interactive approach.