What constitutes a positive outcome?
A positive outcome in time-limited psychodynamic psychotherapy would lead to the following changes:
- • Reframing the symptom or presenting problem of the child and young person as having meaning, and thereby opening up communication between them and their parents or caregivers;
- • Creating a reflective communication process that promotes resilience for the future;
- • Supporting the child and young person to ‘find their real voice’ and supporting parents to ‘find their own voice’;
- • Supporting parents’ own knowledge to ‘own what they know’ and assume appropriate authority.
Reframing the meaning of the symptom
As discussed throughout the book, the aim of the therapeutic work with children and young people is to give their presenting problems its rightful place and legitimacy. Our understanding is predicated on the assumption that in the vast majority of cases, the child or young person has to resort to annoying, worrying or challenging behaviour because no other avenue of communication is open to them at that particular moment in time. This is powerfully described in Bowlby’s classic 1979 paper, ‘On knowing what you are not supposed to know and feeling what you are not supposed to feel’. Once we understand that difficult behaviour may be a code for what cannot be expressed in another way, we can begin to address why this may be so, and facilitate the process of opening up the ‘real’ communication that needs to take place between the child, young person and their parents. A relationship and meaning making therapeutic process in which children and young people are perceived as reliable witnesses to their own experience, minimises the need for acting out and dysfunctional behaviour. It has the further advantage of enabling children and young people to ‘find their own voice’ and to ‘give voice’ to their own experience, which in turn promotes their capacity for self-regulation.