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

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

An agitated child: Jeremiah

This is a little vignette provided by Helene Bonnaud in her book: 'L'inconscient de l'enfant.' 

The mother of Jeremiah had been very reluctant to consult a therapist or counselor for her child. When the psychoanalyst H. Bonnaud meets the mother and her child she meets a very anxious woman who is having great relational problems with her son. She had been struggling with him since the time that he became more indepedent: when he could walk on his own. Before that he was mostly in a body to body contact with his mother. When he was 3 years old the nursery school noticed Jeremiah's problems, and pointed it out to the mother. The mother refused the idea that her son had a problem. She thinks he is doing well, and is very similar to how she was at that age. She is worried being labeled a 'bad mother.' 

In the meetings with the therapist it becomes apparent that this term of 'bad mother' had used to predict what she would be like as a mother. 'My mother wanted to destroy me, ' she said. She also suffers from destructive thoughts regarding her own mother. In this context the problems of the child seem to be a response to the mother's experience of being hated by her mother. it is as if the mother is saying : 'I am a bad mother just as my mother has predicted, look at my child: he is the proof.' 

This way the mother is enclosing the child in her own problems, without leaving any place for mediation between herself and her son. The voice of her mother is confirmed in the reality: her child's behavior proofs she is a bad mother. So her mother's knowledge is absolute. Her son is also the one that potentially threatens her, as he is the one that makes her into the 'bad mother,' making the grandmother's predictions true.  That is why she experience her child as dangerous.

The child himself is also afraid of the mother. He fears being destroyed by her. His ceaseless agitation shows he cannot be at the place of a subject. During his therapy sessions he enters and leaves,  switches the ligh on and of in a repetitive manner. He seems little receptive when he is addressed. He seems invaded by a massive worry. 

The calming down of the child becomes possible at the moment when the mother finds a solution for the unbearableness of her mother's damaging words. Therapy was able to help the mother to operate a shift in the way she saw her child. She started to be able to see him for who he was, and not just as the proof of her belief in the all powerful thoughts of her mother. 

This vignette gives an idea of the kind of work therapy could help with - both the parent and the child. 

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

The importance of 'mentalizing' in parenting.

I recently attended a conference in Napa for therapists and early childhood workers of all ilks with the internationally known psychoanalyst and researcher Peter Fonagy. The topic of the conference was the concept of 'Mentalization,' or the abilty to 'keep the child's mind in mind.' This is the ability to take the child's thoughts, desires, intentions ... (his or her mental states) in mind, while engaging with the child. This abiltity allows for a 'reflective' stance, rather than a 'reactive' stance towards the child's behavior. The 'mentalizing' parent knows that underlying the behavior of the child are certain thoughts, motivations...

Especially the parents' ability to 'mentalize' with their young children between the ages of 6 to 18 months is crucial for helping the child develop a healthy and secure attachment, and to help prevent later psychological disorder. This is an important finding with a lot of practical implications for early childhood workers and parents alike, that was known for more than 75 years by psychoanalysts, but is currently robustly confirmed by contemporary research. It goes against the harmful assumption that 6 months to 18 months old children's thoughts, intentions... should not be taking into account as they are 'too young to understand,' or as they do not even have them. 

A parent who is able to keep the infant's mind in mind, and to see the child's mind as separate from his or her own will be in a better position to help regulate the child, and to help nurture the child into a secure relation towards the world and the broader social environment. 

Fonagy gave an example of the different reactions of two mothers to an 'unhappy' or 'fussy' child. One mother, who sees her unhappy child, still feels happy herself to see the child, and is able to sooth the child by mirroring to her child, talking to it. This mother experiences her child's mind as separate from hers, and she is able to help the child regulate. She does not feel threatened by her child negative feelings. The other mother, responds to her child's unhappiness with sadness. She might experience it as if the child does not like her, as if she is not a good mother, as a rejection. She gets 'caught up' in the child's emotions, and the child sees the sadness in the mother, and is not able to use the mother to regulate his own negative feelings, to 'make sense' of it. This can lead to a cycle or decreased mentalization, with as effect that the relationship between child and parent 'sours' and that the 'connection' is undermined.

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