Incontinence and ritualistic behaviour

Helping the parents to help the child is part of the process, particularly where as the embedded problem continues over time, it becomes associated with ritualistic behaviour. For some children incontinence takes the form of trying to resist their faeces coming out and holding on. At these times they become angry if their parents encourage them to go to the toilet. Parents may describe huge scenes in which at these times the child becomes rigid and controlling, demanding that the parents leave them or they may demand excessive reassurance about being loved.

Seeing both parents and taking a history of themselves and the child invariably reveals many complex issues. We may find that a child’s incontinence is closely connected with the parents’ highly acrimonious separation and their contradictory views of handling the situation. In the course of creating a formulation in these circumstances we may hypothesise that the child’s incontinence may represent the only control they feel they have when everything else in their lives has become out of control. Maintaining a problem that is so resistant to help also functions to bring their parents together, and makes the child the central focus. It may also serve to distract the parents from fighting with each other. In these situations it is not uncommon for warring parents to become highly competitive with each other in their attempts to help the child. Their mutually contradictory views create further anxiety in the child and make the child less invested in giving up the problem behaviour.

It is not unusual as mentioned earlier for zonal confusions such as toileting problems to exist alongside geographical confusions such as sleeping problems, where the child is too frightened to sleep in their own bed and sleeps primarily with one or both parents. The overly involved parents may see this as further evidence of the child’s need for them, and are happy to consider it as separation anxiety. However, it is more likely a further manifestation of the child’s inability to develop a sense of their own identity through an appropriate separation from their parents.

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