Center for Reflective Communities.

I am often asked as a therapist working with children about parenting resources. I often  recommend as a good parenting resource the website of the Center for Reflective Communities (Formerly Centrum for Reflective Parenting.) You can find their website at www.reflectivecommunities.org. 

The center for reflective parenting develops parenting workshops that are based on cutting edge research in the field of mentalization, and reflective functioning. The relevance of their work is that they help parents approach their child from multiple perspectives. This ability to approach the child from a multitude of different vantage points will lead to a positive relationship, a secure attachment.

Sometimes the relationship between a parent and a child gets stuck when child and parent are stuck in one interpretation. For example, a parent comes in to talk about the child and says that the child is often 'lying,' A reflective approach can help the parent look at this 'lying' from different perspectives. This word 'lying' with its moral judgments ... might lead to interactions where the both parent and child feel misunderstood. Through reflective practice the parent might come to realize that there are many different varieties and reasons for lying, and might come to a hypothesis as to why the child might be doing this. Expressing these reflections might help the child move beyond this. It will typically lead to a different interactive pattern than the child 'lying', and the parent punishing the child for lying, and accomplishing nothing, as the child will typically continue with 'lying,' 

In difficult divorce cases it is often the case that parents lose their reflective capacity, Because they might feel so hurt they can only look at things from their perspective. This perspective seems to completely eclipse the perspective of the child. This is often so strong that although the parent notices this, he or she is not able to step out of it. It is often confounded by the fact that when the child is very young, the parents are unaware of their child's perspective at all. The parent might think that a 1 or 2 year old child might not be affected greatly by this. Unfortunately, this leaves the child in the lurch. 

For a parent to make a habit of not just reacting to the behavior, but of reflecting on what might be behind the behavior of your child is a crucial step in building that secure attachment with their child. Psychotherapeutic work with children and parents can be at least in part be understood as a breaking open of interpretations, 'meanings' that are too rigid and non productive; or only tend to produce quarrels and yelling, and not much fun.

To schedule an appointment call An Bulkens at (530) 321-2970

Child therapy and trauma II

For the child to master those invasive experiences, these excitements of his body which bombard him or her in the first years of  the child's life, he will need to turn to the Other to help him 'make sense' of them, to help him 'manage' this excess.  When this Other person is experienced by the child as absent, then the child is left to his or her own devices which might lead to anxiety - separation anxiety. It is this anxiety which lies at the base of fear of the dark, being alone, or finding a stranger instead of a familiar face. It is a reaction with respect to the absence of the person who helps manage this 'excess.' It is anxiety connected with an absence of a symbolic elaboration of this anxiety.

The child will typically attempt to master this anxiety by entering language, by starting to speak. Language will help the child to master the anxiety, to manage it. There is a double movement of the parents inviting the child into this world of language, while the child at the same time has to be willing to take the step into language. This is not always easy, as we see that a lot of children cannot make the choice to speak so easily. 

This anxiety has to do again with a 'structural' trauma and is not always easily perceived by parents and caregivers. But psychotherapeutic work can help a child that is stuck in anxiety move forward towards a growing ability to 'symbolize' this anxiety.

To schedule an appointment call An Bulkens at (530) 321-2970

Child therapy and trauma

As I mentioned in the last post, when concerned parents bring their child to me, they often have an idea of what might be the cause of their child’s problems. They think it is often connected to some traumatic event. A trauma is understood as an accident, something that could have been avoided. It is an overwhelming event that the child cannot handle, deal with, does not have the symbolic capacity to process.

The most common reason that parents bring in their children is because of a divorce, or separation. They recognize this as a traumatic event for the child. And often with good reason, as for the young child both father and mother in the house are the scaffolding of their world. Once this framework collapses it is as if their world collapses. The young child does not know about the intricacies of the adult world, and will often interpret this traumatic event with the tools that it has at its disposal. The mis-understanding that follows can be the seed for a lifelong feeling of inadequacy, low self esteem. ‘I was my dad’s princess. Now, he suddenly leaves me. There must be something wrong with me, I am not enough…’

However, trauma is not just accidental, it is ‘structural.’ In the early years of its life a child is bombarded with sensations, emotions that overwhelm, invade his body, and that the child does not know what to do with, what to make of it. For a very sensitive child these experiences can be truly ‘traumatic,’ and overwhelming. However, in those cases he parent who is not aware of an immediate trauma in the common sense of the word, can be at a loss at how to help the child. The parent might start to feel inadequate, guilty as he feels he cannot help the child. It is in those cases that therapy can often help the very young child and his parents. Unfortunately, they are the cases where parents often do not seek help because of the mistaken idea that since there is no clear ‘trauma.’ They think that in those cases therapy cannot help, that it must be ‘biological.’ However, in many cases the symptom of the child is connected to a ‘trauma’ that is not perceived as such by the parent as it does not conform to our common sense understanding of what trauma means.

To schedule an appointment, contact An Bulkens at (530) 321-2970

Treating the child

A child cannot addres him or herself to a therapist on his own accord. He has to pass through the parents. Sometimes, it happens that the child asks the parents directly to go see a therapist, to 'talk to someone.'  Typically however it is the parents who worry about the child's nervousness, agitation, or apathie, about the symptoms he is presenting. 

The parents often have an idea of what is not going well for their child.  Often the parents think that the problems are related to events that they think might have been traumatic for the child.  This first dialogue with the parents is very important for me as a therapist and gives me a lot of information that will be helpful in starting to work with the child.  That initial dialogue will also help the child to determine whether it can trust the terapist.  As he feels the parents have trust, he might start feeling comfortable entrusting some of his thoughts and feelings to this person.  

In my work with the child it is important to not encapsulate the child in a pre-established schema. This might be a bit different from an approach which is very widespread where the child is compared to the yard stick of the ‘normal child.’ But where is this normal child? That child is nowhere to be found as the norm is just an average of a big group of individual kids, each with their own specificities and particularities. Instead of letting myself be guided by a norm, I take my starting point in what the child brings to the session, what he says, what bothers him. It is important for me to listen to the child’s own suffering, and to listen to his truth that emerges in there. It is important to see what reality is intolerable for the child, and to help him treat this in the treatment through conversations, play, and art: different means the child can use to ‘treat’ that what is problematic for him or her. 

Contact An Bulkens at (530) 321-2970

Counseling children caught in custody battles

Parents often consult a therapist for their children while they are involved in a custody battle. They are concerned about the effect the divorce has on their children, and wanting the best for them they want to offer them a place where they can be listened to.  In those situations it is important that I meet as the therapist with both parents.  This apparently simple situation becomes more complicated when the parents are not only considering the therapeutic space as a place for their child to speak freely, and to be listened to, but as a place where they can get to settle a score with the other parent of their child. They might for example think that the information the child divulges to the therapist might become useful to support their preferred visitation schedule. Parents might come in with the impression that the therapist is an ‘expert’ who is going to ‘make a recommendation’ to the mediator or court with regards to the safety of the child.

Of course, therapy is confidential and moreover this kind of expert, evaluator position would put the therapist in a dual relationship: the therapist of the child, and an expert evaluator of the safety, well being of the child. Those roles do not mix, and they will jeopardize any genuine therapeutic process. Of course, the therapist is a mandated reporter: whenever there is a reasonable suspicion of child abuse or neglect a report has to be made. In extreme cases, where the agenda of the parent is blinding the care for the child, the child might be encouraged to divulge certain negative things about the other parent to trigger a child abuse report. Of course, therapeutic work with the child becomes very difficult, and will become impossible when the child might believe that his or her words in the therapy session might be used by one of the parents against the other. When the therapeutic work gets complicated with considerations like these it might take a very long time to untangle. Most of the time the parents have only the best interest of the child in mind, and the parents are not always aware of how they unaware might intrude and thwart the child’s therapy. In those cases the therapeutic work can be difficult, but does not have to be impossible. It will be important to meet not only with the child, but also on a regular basis with the parents of the child to help the family move forwards. 

How to begin and end a child's therapy?

As a psychotherapist working with children I am confronted with the question by parents of how long therapy will take. I have come to realize that addressing this question from the beginning with parents is important. The response is that there is no clear cut answer to this. To each individual therapy there is a time and a logic that is unique, it is unique to the child. It might take some time for the child to engage in therapy, to want to come do therapeutic work, and once this work is started it will evolve following a rhythm and logic that ideally is not interrupted prematurely. For parents it might be frustrasting that this logic not necessarily corresponds with what they perceive as 'success.' Dramatic symptoms can disappear in quite a short time, but this does not mean that the child is done with the work.  There is a logic to the therapeutic work of the child that is ideally not interrupted in a random way, with disrespect or disregard to the work the child is doing. Just as we don't want to force a child into therapy, we don't want to force a child out of therapy. Forcing the child into therapy and removing the child prematurely imply a certain disregard for the psychic 'time' of the child. This is why I find it very important in my work with children to also meet with parents on a regular basis, to connect with them with regard to this work of their child. Although I will respect the confidentiality of the child, I find there are ways to have them appreciate the work their child is doing in his or her sessions. 

The child who is suffering quitely

As a therapist working with children I get often consulted by parents who are concerned about the big 'acting out' behaviors of their children like temper tantrums. Those behaviors 'disturb,' are in your face, and have the capacity to dysregulate the whole family.

It is not uncommon to hear upon further inquiry that a hyperactive child, very early on was very easy going. An initial 'passivity' can turn later on in hyperactive behavior, and psychomotoric agitation, with the child ignoring limits, putting him or herself in danger. This hyperactive child can not 'stop' to take a breath, observe the other, imitate to learn, construct. He is just a twirling, swirling body, acting out, often refusing to enter language. 

It is often at this moment that parents consult while there might have been concerns much earlier on. It is indeed the children that initially disturb the least, the children that make no or few demands that are often the most in need of help and care. 

Warning signs:

-a baby who does not express much.

-who expresses little pleasure or little dissatisfaction

-a little child that does not cry much

- a child that has only very little changes in mood

- a child that has little capacity to self regulate

- a child who does not show many transitional states (for example: a child that moves from anger to hypersomnia)

A lot of these warning signs could not be noticed as they might be interpreted as a sign of an 'easy' child, they are not 'loud.'

There might be also psychosomatic signs that might go unnoticed, as they tend to be frequent and common:

-unexplained fevers.

-infections and respiratory problems

-frequent hospitalizations.

It is often only by careful observation of the baby that certain problems can be noted:

-problems in tonus

-motoric problems: movements that are just centered on the self, balancing

In my experience it makes sense to consult as soon as the parent notices something of concern. The earlier concerns are explored and if necessary addressed, the easier it is on the parent and the child as well. With really young children intervention can be quite easy, and addressing it early can prevent a lot of worries and concerns down the road.

To schedule an appointment, contact An Bulkens at (530) 321-2970

For Therapy to succeed...

For therapy with a child to succeed it is important that certain parameters are in place. The child needs to understand that the counseling session is confidential, that the therapy room is a place where her feels safe.  The child has to come out of his or her own desire to the counseling session, and not to please the parent or the therapist.  In case the parents are the ones that are suffering from the child, but the child is not suffereing from his symptoms, it would be more indicated to work with the parents.  It can take several sessions to establish this, and for the child to get a full understanding about the working of the therapy. 

But there are certain issues that if not put in place right from the beginning can already immediately predict the failing of therapy.  One common case is when a parent asks for therapy for a child, without telling the other parent with whom they share legal custod  about it. This becomes a very difficult circumstance to work under. The other parent will find out eventually, might become upset, and when the child feels that one of its parents are not in favor of it, the therapist's office stops being a safe place, and the work is jeopardized. As a therapist, for the sake of the child, I typically only work with the child when both parents are consenting to it.  Excluding one parent, would make it impossible for me to talk to this parent, who is equally important to the child as the other parent. Parents often do not fully realize this, as they are hurt by the other parent, and might not consider them a good husband or wife. This might be the case, but still each of the parents, no matter what their human flaws and limitations are need to be genuinely recognized and respected if the work with the child will be successful. 

This became again very clear to me through my work with a foster child. Unable to work with the parents, due to the state funding, as they were considered the 'perpetrators,' I was unable to build an alliance with the parents of the child, to connect with them. The inability to gain the trust of the parents of this child made it very difficult for this child to come to his counseling sessions. He did not experience it as a safe place, as he felt that his father was not in favor of it. 

Another typical situation that undermines the therapy work that can be done with the child is when the parents are engaged in a legal battle.  When the child feels that saying certain things might jeopardize the position of one of the parents, as there is no trust in confidentiality, the child then is torn between parents and therapy is not a safe place for her anymore. 

To schedule an appointment with An call (530) 321-2970

How long will my child need therapy?

In my practice I often get the question how much therapy it will take for a child to get better. The unsatisfying answer to it is that 'it depends.' 

A very young child that is brought in when he or she has not been struggling for a long time can improve quite quickly within a time span of 6 to 8 sessions.  A child that is in the later years of elementary school, junior high or high school and has been struggling for quite a while might take a longer time. In those cases it might be unrealistic to expect that a couple sessions of 'talking' will bring about the hoped for change.

Sometimes, there are dramatic improvements after the first couple sessions. This might cause optimism in parents and they might feel like they can end the treatment right there and then. However, too much, too soon, might be something to be suspicious of. It is likely that the child is feeling somewhat anxious about the treatment and is trying his best to be 'good.' It is important to have the time to explore this, and to not cut the treatment short too soon.

Children (and adults) can start to change quite quickly and typically after about 6 months of consistent therapy you will see some substantial change. Unfortunately, a lot of parents want to stop the treatment as soon as the symptoms that bother them disappear.  However, to the work of therapy there is an internal logic, and it is important to complete this work. Rather than having the parents decide when to stop the work, it is important to take the child's wish into account.  If the child is not ready, the work should ideally be continued.  

Just as the child should be the one ending the treatment, he should also be the one that wants to enter it. It might take several sessions to explore whether the child wants to come talk for him or herself. If not, it could be helpful for the parent to talk in the presence of the child or even without the child being present. Therapy cannot be forced.  

To schedule an appointment you can reach me at (530) 321-2970