Maintaining the momentum for change

We recognise that time is of the essence in helping the child move to health and growth and prevent the problem from becoming chronic with its attendant physical and psychological difficulties. By conveying directly to the child that we understand that they may not be able to speak in the usual way about things that are bothering them and that therefore their bottom has to do the talking, we let them know that there is a real meaning to what is happening that can be understood. It is also important to convey with the help of the parents that there is nothing physically wrong with the child’s body, particularly when they have been involved in extensive medical investigations. These communications about the health of the child and the health and appropriate functioning of their body can be most helpfully carried out in a joint meeting with the parents and the therapist. This conveys that the parents are stepping out of a medical illness framework and can reassure the child that they can allow their body to do the work.

A successful outcome in helping the child is not only evident when the incontinence ceases, but can also become manifest in how they perceive their body. By helping the child understand that their body belongs to them, and to no one else, even their parents, helps them perhaps for the first time, to have a sense of ownership of and responsibility for their bodies. This has implications for their future personal and sexual interactions as they get older. The fact that they begin to have an awareness of ownership of their bodies also helps to create more age appropriate separation from their parents.

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