Confusion about developmental milestones

It is important for therapists not to idealise the process of psychotherapy and not to perceive it as a golden space. In therapeutic work with children, young people and their parents, we need to take a robust and practical perspective not unlike the nature of development itself which is a work in progress. We may be confronted at times by the apparent lack of understanding on the part of parents about their child’s development. Earlier the problem of pathologising the child was discussed, but we need to be equally cautious of not pathologising the parent when the real issue may be a genuine ignorance on their part.

There are a number of confusions that parents present about the developmental milestones of their children, starting virtually from birth when they expect the newborn infant to have an established sleep pattern. The problem of not recognising that children’s behaviour has a meaning is almost universal right across the socio-economic stratum. In this regard children are generally perceived as having a kind of innate resilience that allows them to ‘bounce back’ from challenges as though they are rubber balls. The inclination towards encouraging premature independence is another confounding issue, particularly for the parents of adolescents. Most significantly, parents regularly undervalue their importance to their children and how their presence and communication is essential to their child’s health and growth.

In time-limited psychodynamic therapy it is considered legitimate to address these confusions directly. When they are disregarded they invariably become an impediment to development and also lead to conflict and misunderstanding between parents and their children. The opening assessment process in which we explore the history of the child and young person and that of their parents, will already have given us an inkling of the nature of these dilemmas and what we may need to address.

Creating the therapeutic scaffold in this context means that we help parents to recognise the implications of their actions, and in some cases we have to challenge their assumptions about their children. For example, a family that had experienced a number of moves were considering a further change when their daughter had already demonstrated how difficult these transitions were for her. Her father insisted that she would never know the difference if they relocated, as children were not aware of their surroundings, and these things did not matter to young children. His statement created an opportunity to open up a conversation about change and transition and what this means for children in general and his daughter in particular. It also enabled us to be able to make connections between the changes that had already occurred in the family and the emotional problems his daughter presented.

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