Child therapy and trauma III. The boy who thought he was a fish.

When parents consult a therapist for their child, they might at times have an idea of what 'caused' the problem: a divorce, sexual abuse.  In our culture these seem to be 'legitimate' reasons to reach out to a therapist when there are issues with a child.  The problem seems to be able to be related to an understandable 'trauma' for the child. 

However, when there is no clear 'traumatic' cause, and the child is having problems it might sometimes be harder for the parent to bring in especially a young child. The parent might feel that the suffering of the child must be somehow related to him or her not doing something 'right.' The parents are often saddened that they are not able to help the child. In a couple recent posts I have been trying to open this notion of 'trauma.'

Trauma is not accidental, it is structural. There are different components to this: The young child in his very first weeks, months, years is bombarded with experiences that affect him or her. The child has limited tools to make sense of these experiences. But he will make sense of it with whatever tools at its disposal. A very sensitive child can have a harder time and might need extra support.  As mentioned before a child will try to master these experiences by entering into language, trying to make sense of it. His 'interpretations' can be in the eyes of the adult utterly illogical, irrational. But it is a sign of the child's intelligence that it is trying to put a world together that 'makes sense' with whatever elements are at its disposal. 

So, entering language is a way for the child to make sense of 'traumatic experiences,' but language in itself can is traumatic as also addressed in an earlier post. In this context I want to refer to a vignette H. Deltombe. 

A little boy of 4, Dylan, does not talk. In school he is isolated and sad. He does not sleep or eat well. At the first encounter with the therapist, however he seems eager to engage but does not have the means. He does not play, does not draw... However, at one point he started tapping the table in a certain rhythm. The therapist responds.  He is delighted with the effect he has on her. A game starts where the rhythms are differentiated, modified.  

As the treatment progresses he engages in a game of peek-a-boo. A game that would be typically liked by younger children, but in which he delights. Each child asks himself the question: 'Can I be missed, can they do without me?' When the therapist goes looking for him she indicates that she wants to find him. This game develops over a long time. Although he is still not speaking, there is communication using rhythms, and sounds. Eventually he starts making animal sounds from his hiding place. The therapist guesses the different animals. Sometimes he tries to make her afraid, and she guesses: a lion, a tigre. Then, at one point she hears a small sound, that she is not able to name. He appears from under the table and mimicks a fish. 'It's a fish.' He looks at her pensively and quitely, nods, and continues to make the same movement with his mouth. At that moment the therapist remembers what the mother had told her during the initial interview. She had joked with the father as they were going to have a child: 'As we have already Bob, the fish, we can now have Dylan,' in honor of their favorite singer. 

The therapist immediately tells him: 'You are not a fish, that is just a joke, you are a little boy and you can speak.' After what appears as a moment of shock, he suddenly seems 'at ease.' The following weeks he changes, eats, starts speaking. 

This boy was petrified under a 'traumatic word.' The treatment was able to separate him from this place of the 'fish of his parents' to which he had been reduced. By himself, by his parents? It is not that simple. But through the treatment he has been able to free himself of that position of 'object.' He can now truly become a boy. 

This is an example how something what is 'traumatic' can be very subtle and how it differs from the regular understanding of an 'accidental' trauma.

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

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

Language as traumatic for the child.

In the earlier blog I talked about trauma and psychotherapy with the child. When parents bring their child in they often think that their child’s suffering must be connected to a trauma, which is typically understood as ‘accidental.’ If trauma is  ‘accidental,’ it would imply that it can be avoided, and that there are some children who can escape it.  However, trauma is 'structural.' This means that also children who have not suffered an ‘accidental’ trauma can sometimes get stuck, and might at times benefit from psychotherapeutic work.

Indeed, one can say that entering into language for a child is puzzling, even traumatic. Language is at first completely incomprehensible to the child and full of equivocations. The words of adults are for the child full of impasses and ambiguities that cannot be resolved, and the affectif charge often adds anoteher puzzling dimension. The child's attempt to make sense of this, or to question the adult can be complex, puzzling, and lead to a cascade of mutual misunderstandings between parent and child.  Parents often think that communication is straightforward: a word is a word and means a thing, and they might gloss over the fundamental dimension of misunderstanding that is structural to human interaction. Often the implicit question goes unnoticed. In my work with children and parents it is crucial for me to explore what parts of language might be puzzling the child to the extent that it gets in the way of his or her development. And what might be the implicit questions that are connected with this piece of language which are not being heard. 

A little girl yells in a bout of frustration, angry at her mom: this is my house, leave my house, leave me alone.  These words shock and hurt the mother: They are the exact repetition of the words her father had used when the couple was going through a divorce but still living together in difficult circumstances. The mother’s affective response to these words was one of pain, sadness, feeling rejected by her daughter. She took the words literally as a real desire of the little girl really for her mother to leave her.  This lead to a response of the mother moving away from the child, leaving the child feeling abandoned, in despair, clinging to the leg of her mother, who became increasingly frustrated with the apparently illogical behavior of the child.

It is clear that those strong words the girl heard spoken by her father at age 2, 5 had a big impact. The threat of her mother being sent out of the house must have been a scary, but maybe even fascinating thought –leaving her alone with her daddy. In her anger with her mother, she expressed the same movement of rejection, she had seen her dad express to her mom. However, although she spoke those words, she was clinging to her mother’s leg, clearly not wanting her mother to go.  One could think that maybe the example of her dad being angry with her mom was the only model she had, and that was how she expressed her anger.  But there might be more at stake. We might see that expressing them in a moment of anger to her mother also implies an expression of puzzlement with those words. It might be a question regarding their parents’ relationship ending, and wondering about their fights, and about her place in this story.  Are the fights between her and the mother also going to end in her mother leaving her? Would her dad ever say such a thing to her, if he would get mad at her? When she yells this at her mom, could it mean: Dad was right to send you out of the house. I wish I could just be with him, and not have to bother with you. At dad’s house batteries never die…’

In my work with parents I hope that they can start to see that what their child says can have many layers to it, it is not one dimensional. When a relationship is stuck or a child is stuck, and the parent does not understand the child, or might be stuck in a limited understanding of the child, psychotherapeutic work can help start exploring a different approach that might open up the relationship between the parent and the child, or might help the child get unstuck.

In my work with the young child I help the child in the process of making sense of the enigmatic language of the adults that surround him or her, and I offer him a place where he can start to find his own place in the for him possibly confusing world of language. 

To schedule an appointment, call An 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

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.