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

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

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. 

An important tool to help you connect with your child.

Here is an activity that I encourage parents to do on a regular basis, preferably every day. If you feel that life is moving from one thing to the next, with little time to sit back and just enjoy your child's presence this might just be the thing for you. 

Child Centered Activity (CCA)

Child-Centered Activity is a family activity that develop parents’ observational skills and ability to tolerate difficult feelings, in connection with their child’s play.  It was developed by Georgia de Gangi (2000) as an experiential, process-oriented model for improving the emotional and regulatory capacities of a child. 

The goals of CCA include:

-       Increasing the parents’ capacity to observe and reflect upon the meaning of the child’s communications;

-       Facilitating the child’s development of self-directed activity and problem solving and a joyful, secure attachment to the parent;

-       Increasing parents’ sensitive and attuned responses to their child’s needs, building a sense of competence and confidence in their experience as a facilitator, rather than director, of their child’s activity.

Child-Centered Activity Guidelines (adapted from deGangi, 2000)

1.    Set aside an uninterrupted 20 minutes a day to sit with your child in a non-prohibitive play area, with toys that allow your child to explore and which are open-ended in nature.

2.    The 20 minute time structure is important for both you and your child; it is manageable for parents, and helps the child feel more contained as parents practice effective boundary setting.

3.    The child is given the lead; as a parent you participate in play in a non-directive way, observing, listening and reflecting on what the child might be trying to show them. Feel free to respond to the play, but do not take over. This is not a teaching time.

4.    Avoid praising or setting limits during the play with the exception of hurting themselves or the parent, or destroying objects or toys. There are no right, wrong, or proper ways to play with toys.

5.    Notice and reflect on your own experience in parallel with your child’s. Being asked to sit and notice, rather than engage in an activity may stimulate feelings; furthermore, powerful feelings evoked by the child are important feelings for parents to take not of.

6.    Make simple, observational comments about what you are seeing which do not direct the play, for example ‘you lined all the cars up in a row and then raced them over to the wall.’ You can also ask simple questions about what is happening, and maybe bridge play if your child moves from one play topic to another without a sense of completion, eg. ‘what happened to the dinosaur? I thought he was hungry.’

7.    Pay attention to the feelings elicited in the child when the play time comes to an end. Simple narrative statements that let your child know that they can see how they are feeling (disappointed, upset), but that it is time to stop and do something else, can help the child feel understood. Narrate to your child what will happen next, e.g. ‘after we clean up, we will have a snack.’

therapist work with parents

As a child therapist one of the delights of my work is to be able to work with parents.  Sometimes, I work mostly with the child, and meet with the parents once every month or every other month. Sometimes, I work mostly with the parent, and meet the child only on occasion.  And sometimes I never even meet the child, I just meet with the parents.  

This all depends on the specifics of the situation, and of who wants help. Is the child suffering, and wants he or she help, or is it more the parents who need the help? To find the right modality or way to work might take a couple meetings.  But the multiplicity of also indicates that there are different ways of bringing change about.  Not all the players need to be necessarily involved.  However, the work will go much faster if there is a willingness of the parents to also be engaged when the child is brought to therapy.  It is not a prerequisite, but it is helpful, and allows for change in both parent and child, enhancing the therapeutic outcome. 

Sometimes there is an initial reluctance for parents to come talk, as they have the hope that the therapist will 'fix' their child.  Or they feel that by talking about themselves in connection to their child they implicitly acknowledge that they might somehow be implicated in their child's problems. 

One of the delights for me of working with the parents is to see how their  perception of the child's problems changes. Initially they come in focused on the problem behaviors, and on how to remove those behaviors.  However, as the work continues they start to see the behavior not just as a problem that needs to be suppressed but as a language of their child, as an attempt of their child to express something of their very being that they want to see recognized.

I think of the mother who was concerned about her son hitting and kicking her. She would consistently draw the line, and give him a consequence. However, the behavior did not subside, and the anger of the boy seemed to increase.  As I was listening to the mother I noticed that she was doubting the way that she was intervening with her son, she felt that the way she was drawing the line also implied her 'ignoring' him.  As we thought about it together it appeared that the mother was encouraging her son's behavior implicitly as she was not really listening to what was going on in the son, beyond his behavior.  She 'ignored' where his frustration was coming from. Not being listened to, being ignored made the son feel powerless, and encouraged his 'acting out' of hitting.  The mother came to the realization that there is a balance to be maintained between drawing the line, which she was naturally good at, and allowing room, recognizing where her son is coming from, creating a space for him.

My Child is lying!

As a child therapist I often have parents express their concern about their young child lying.  This 'lying' can take on many forms, and there is nothing that we can say 'in general' about lying, We have to look at very concrete examples to explore why the child might be lying.

However, when the child is still quite young, what parents perceive as lies are often just fantasies, myths, inventions. There is no point in treating these fantasies as lies and in reprimanding the child for them.  These are poetic inventions originating from the child's imaginary. Children, just like adults need this poetic dimension in life: As we have so little power, are so limited in our human lives, we like to imagine ourselves capable of realizing what we cannot do or have.  Those fantasies have the same status as an adult reading a novel, or watching a TV show: they are not true, but they are important in our lives. Reprimanding a child for these kinds of fantasies would be the same as reprimanding someone to read a novel, because why would you read something that is not 'real.' 

It could also be that the child tells a lie to contradict or get a rise out of the parent. Maybe the child has never had the ability to contradict the parent in play, in a 'pretend mode?' Better to treat these lies with a sense of humor. The child might be tricking the parent, enjoying the power of not complying with the parent, having his own little secret the parent does not know about...In any case, it is always important to explore why the child thinks lying is so fun.  It is crucial to try to understand where the child is coming from, rather than get upset and angry with her, as this is counterproductive. This is especially the case if the child tells a lie to get out of trouble.

Children often lie when they feel guilty.  Forcing the child to admit that he or she did the wrong thing, for example by saying: 'You won't get in trouble if you admit it,' misses the point.  If a child did something harmful or hurt another child the goal would be for him or her to be able to take responsibility for this act. Rather than forcing the child to admit the truth, you will move him more towards being able to take responsibility, according to Dolto, by talking to him like this: 'These are your hands, and your feet, but it was not you who wanted to hit the child; I know that sometimes the hands and the feet do things, that the head does not want them to do.' You are more likely to move the child towards taking responsibility like that. 

When a child is not able to take responsibility for his act that is fine. This cannot be forced, better to talk, and dialogue about it. In this case Dolto mentions the following possible interaction:

Parent: 'I see that you are too ashamed to admit. You are right, but please, don't do this again.'

Child: 'But I did not do it!'

Parent: 'I believe you. What is done is done. Let's not talk about it anymore, but know that even if you did it, I love you and I trust you: and if you did not do it, please excuse me for having suspected you.' 

I agree with Dolto that this is a better solution than creating a big drama.

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