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Home arrow Psychology arrow Time-limited Psychodynamic Psychotherapy with Children and Adolescents: An interactive approach

The interactive connection: Work with the child

We may find in consultation with children who have experienced a lengthy period of incontinence that they present as being totally disengaged from their soiling problem, as though it exists completely out of their control and out of the control of their bodies as well as their minds. They may be pleasant and polite with the therapist but quite evasive. It may come as a surprise that they appear to be not very concerned or even embarrassed by the soiling problem which is a clear indication that its function is too important for them to readily give it up. From a developmental and meaning making perspective, the constant attention to their bodies combined in some cases with co-sleeping, recreates a revived infancy. This gives the child some temporary respite from their anxieties. This revived infancy may represent a time when things were happier for the child whether before parents divorced, or other difficulties occurred within the family.

Carrying the burden of family difficulties

When the move towards regressive behaviour is central to the problem, this often manifests itself in other aspects of the child’s interaction. Having become separated from peers as well as the experience of learning if they are not attending school, children in the therapeutic setting may show a reluctance to engage with toys, drawing or fantasy play. They present as though the very core of their developmental process has been interrupted or arrested. In one case an intelligent seven-year-old girl with an entrenched soiling problem which had baffled the various professionals involved, drew pictures that evoked the kind of formless images of a much younger pre-school child. When asked to draw her family, these were represented as three heads with no bodies and these disembodied images in a blank white space seemed to capture the essence of her dilemma. The formlessness and emptiness of the drawing also suggests reluctance on the part of the child to reveal too much information.

A child whose separated parents were in permanent conflict eventually revealed that she was worried about having to take sides and seemed to have to put all her energies into maintaining a good relationship with each parent. However, she was aware that this was hard to do as she was always the person inbetween who also tried to stop the conflict between her parents.

We may also find where boys as well as girls carry a burden about parental and family difficulties that cannot be articulated, they also convey at times a world weary sense of wanting to bypass childhood altogether and arrive in adulthood as soon as possible. This may be demonstrated through the use of words and phrases that may have been picked up from the tense, angry and unhappy adults around them which they then repeat to the therapist in parrot fashion. These words and phrases referring to the breakdown of a parental relationship for example, such as ‘these things happen’ seem intended to provide the therapist with a kind of statement of fact that closes down communication. The child’s world weary presentation is also conveyed in their reluctance to play with the toys, as though they have given up childish things a long time ago and are now more interested in the games and activities of adolescents or even adults.

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