Why does psychotherapy work with young children?

As a psychotherapist and analyst I can at times get a response of disbelief when I say that I work with children that are sometimes as young as 2 years old. Some of my colleagues work even with new borns, infants... The puzzlement seems to connect with a certain disbelief that 'talking' with such a young child could be helpful. And is there even need for help? Are children not resilient? Psychotherapy is  often, and rightfully understood as addressing some kind of 'trauma.' Are children that young already truly 'traumatized?' They can be, and even if there is no immediate trauma in the typical sense we are used to understand that word - a traumatic birth, a medical issue, there is the trauma that every human child is confronted with when he comes in the world: language. From the moment the child comes into the world he is immersed in a bath of language. The 'talking cure' can help even very young children for what can be truly traumatic for a child is exactly language. In spite of the best intentions of the people who speak them, words that surround the child can hurt and pain the child, can make it difficult for the child to speak, express himself.  It is this inability to put what hurts into words  that is the basis for appearing symptoms. Psychoanalysis and psychoanalytic therapy can  help deliver that what is said beyond the speakers intention, and what might be connected with the child's symptoms. Once this unspoken truth is delivered, the symptom can disappear. 

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

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 drama of Jealousy by C. Mathelin

Mathelin, a French child psychoanalyst and psychotherapist published the book 'Lacanian Psychotherapy with Children. The Broken Piano.'  It consists of short case studies which might give you an idea how psychoanalytic work can help children, and how it differs from different approaches.  Rather than helping your child adjust to a certain norm, its attention focuses on the uniqueness of each subject.  I want to pick one small case study, entitled Violette, or the Drama of Jealousy. I am closely following Mathelin's text here.

Violette was 6 when her parents came to see Mathelin. She was shy, withdrawn, sulky. The mother said that she was a loner, although the parents decided that they chose to have another child for her. Her little sister is 18 months old. The pediatrician had told them that jealousy is normal. They had read the work of Francoise Dolto. They had told her: 'We will always love you. you have the right not to love your little sister, but you must not hurt her.' It was no use: Violette hated her sister and the parents could not endure this. How was it possible, after all they'd read, and with all their knowledge (they were teachers of difficult children) that Violette could not bring herself to accept Marie's birth, and even wanted to choke her?

The previous week they had found little Marie suffocating as Violette said to her: 'I've had it. Now you will finally leave me alone!' The parents thought that she had gone mad and brought her to an analyst. Violette listened as the parents talked about the last 18 months. She sulked, no doubt thinking they were scolding her. Mathelin turned to her, asking: 'What is it, Violette? You look sad and angry? What do you think about what your parents are saying. What's going on between Marie and you? Do you want us to talk about it?'

Violette: 'I dunno. It's normal. Daddy says, it's normal if you don't love your sister. So I don't know why they pick on my. Ever since she was born they yell at me all the time. It's her fault. She gets on their nerves too much. When she was little, she never slept, so they were upset and took it out on me. We're at war.

C.M.: What was Marie's birth like?

Mother: Fine, no problems, but the pregnancy was much harder for me than when I was expecting Violette.

Violette had begun to draw a house with the shutters closed and the door barricaded, a house without flowers, without sun, a gray house. She stopped to listen to her mother speak of the time when she was pregnant with her. 

Mother: I was so happy when I was expecting Violette. I wanted a little girl so much. With Marie it wasn't the same.

Father: It's true. you did not want a second child.

Mother: No, I didn't. But I was persuaded by what I read (she laughed) about how it is not good for an only child.

C.M.: Why?

Mother: All the books say that. When a child is the only one, he gets bored, and hte world revolves around him. And that is true, because the world revolved around Violette before Marie was born. 

C.M.: Do you have a sister? 

Mother: No, I'm an only child. My mother 

The hyperactive, turbulent child

In an earlier post I talked about the child who is suffering quitely, and often 'invisibly' as this quite behavior is often not concerning to the parent, but understood as 'easy.' As a therapist I unfortunately often only get to see these children after the suffering has been going on for a while, and has reached a certain point where it has reached a magnitude that it has become visible - either through a suicide attempt, self harming behavior, or by concerns expressed by teachers or other people involved. 

On the other end of the spectrum is the loud child. The charicature of this child is a 3 year old agitated, noisy, disorderly, sometimes violent child, who is also lively, restless and very difficult to live with. He is not going to be the teacher's favorite when he enters preschool! 

Do these children suffer? Or do they make their environment suffer? They do test their parents pushing against limits to explore their firmness, and consistency. They need to be firm so they can feel safe and protected. The limit helps them to structure themselves. So, sometimes it could be that it is the parents that need the support and help with this very challenging and not very easy task. 

But it could be that this turbulency masks an underlying anxiety as the child does not feel secured by a certain structure. It could be that the child is suffering from that, but not always. When parents consult me for such a child, it might take some time to explore whether the it is indicated to see the child in treatment. As each child and each family is unique this has to be addressed and decided on a case by case basis.

If you want to schedule an appointment with An Bulkens, call (530) 321-2970.

Ruptures and Repairs: Building a strong connection with your child

Children benefit when parents provide structure in their lives. Some parens might have a harder time providing a consistent structure, as they feel pressured to give in to the demands of the child. Or they do not like to see their child in distress. It is typical that when a child is provided with a limit she will express her dissatisfaction. When a child hears a 'no' she might sense that her desire or whatever she did was 'wrong.' A very sensitive child might even think that she is bad, or wrong herself. This might lead to a sense of being rejected. The child might withdraw or become oppositional. The key to staying in connection during such limit-setting interactions is to reflect back to your child what her desire was about, without actually fulfilling her wish. 'I hear you like to have a cookie, but it is too close to dinner. Maybe you can have one after dinner.' This is a very different experience for the child than  hearing: 'No, You can't have it!' 

These kinds of interventions can help a child move beyond his frustration. However, sometimes the child stays upset. Allowing the child to have this distress without trying to fix it, indulge in it, or punish him can allow him the opportunity to learn how to tolerate his distress. 

Parents can learn how to parent more effectively by reflecting on past unsatisfying experiences and trying to figure out what they could have done differently. And of course, there is not one way, there are many different ways 

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

I love you rituals

When parents come to consult a psychotherapist or counselor to help them handle their children they are often at a point where they feel that parenting has become a hassle where rewards are few and far in between. They experience their children as insisting with requests, that never seem to be satisfied, and which once satisfied, just seem to create more of them; and they resents themselves having to nag, repeat themselves without being listened to. 

It boils down to the following points: neither child nor parent feels 'listened' to by the other, the tendency to take a child's requests at face value, the tendency to focus on the behavior by reacting to it, vs responding what might be behind the behavior or the child's request. A child can ask for a cookie, but might just want to spend some time with you. Requests that insist might be just ways of the child to engage the parent.

It can be hard to tackle all these issues at the same time, but the Child Centered Activity which I mentioned in an earlier post is a great starting point. It will introduce some time to just be in eachother's company and where you can reflect on your child and on yourself just being in the presence of your child. It seems easy, but it can bring about some strong affects. As I mentioned before, just spending a little bit of time like this every day can bring about a major change in how your child will engage with you. The child is typically very appreciative of this kind of time spent together.

As a preschool teacher I have also experienced that introducing little pleasurable one on one interactions with your child can do wonders. They can also make transitions which can be sometimes hard for a child a lot easier. Nursery rhymes and songs are key here. I would refer you to a book by Becky Bailey, 'I love you rituals.' It has a lot of nursery rhymes and little fun games to play with your young child.  Sometimes she has cleaned up the original nursery rhyme which she felt was too violent or not as loving enough, with more loving words. Becky will not let the cradle fall down with baby and all. I disagree with her on this. Working as a therapist with young children, I know that the inner world of the young child is not as idyllic as we adults like to believe it. I think it is actually a nice message to have a nursery rhyme that might be somewhat violent in content, but where the violence is tempered by the rythmic, loving, playful tone of the parent.  It sends the message that we do not have to be afraid of those cruel, and aggressive ideas that might sometimes pop in our heads. It sends the message that we can handle them, we can play with them. In Becky Bailey's approach it seems that this darker side is unnecessarily locked out. 

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

Lucie: a tiny vignette

This is a small clinical vignette by Philippe Lacadee, originally published in French.

Lucie is a 9 year old child, who enters the therapist's office one day very excited with the complaint that her mother does not want to 'abondon' her to a magazine. In french the words for 'abandon' (abandonner)  and 'getting a subscription' (abonner) are very close. When the therapist gives her back her own words, 'She does not want to abandon you?' Lucy is irritated and replies that the therapist never understands anything. 'I am talking about the magazine. Mom does not want me to subscribe to it.' 

Lucie knows the word for subscription in her mother tongue, but somehow she can only understand her being as 'abandonned' by the Other, incarnated by the mother. To receive from the mother the magazine, instead of her presence that would be the sign of abandonment by the Other who leaves her alone. So, she fears that if the mother would say yes to her demand, that she would not be 'subscribed' to her mother anymore. 

This resonates with the importance to not always say no to a child's request. This is something I have been emphasizing in earlier posts. For Lucie a yes, can mean an abandonment by the Other. At this point in the treatment Lucy is not ready to give up her attachment to the position of being abandonned. We hear that it is she who does not want to be abandonned by the mother. 

How to help your child become more responsible?

As a child therapist who also works with parents I often hear exasperated parents complain about their child not taking any responsibility to do regular daily tasks, like homework, brushing teeth. They complain that they have to keep their child on track, keep reminding them tens of times, and it is as if the child could not care less. Their words do not make an impact. 

Especially when the child is 6 or older, there is no point in keep reminding them of all those tasks. But the parents can say that from now on the child will be able to do thing on his or her own, because he or she can. And if the child has a hard time with something, then the child can ask for help. However, there is no point in controlling the child, watching its every move.  

It could be that the parent has been very focused on helping the child, and doing things for the child, rather than encouraging the child to become independent. 

So, when a child comes to the table with dirty hand, instead of getting upset you can simply point out that it is not the best idea, as the hands touch a lot of things. The parent can point out that he or she washes her hands first. Then the child can go wash them or not. But, it is best not to make a big deal of it. 

In my practice I see a lot of children conflicted between wanting to get help, and wanting to do things on their own. What they really seem to want is to be supported in being able to do things on their own.

So, as a parent it is important to send the message that they do not have to brush their teeth, wash their hands to please the parent. They will do it when they see it as it is something that they will do for themselves as boys or girls who identify with their parents as role models, because they want to grow up to become adults like them. Just like in the last post: the child has to sense that he gets to do the things because he or she wants to, not because he has to please mom or dad. 

The terrible two's: How to handle your child's loud and clear 'NO!'

It can be a shock for a parent, when their sweet and loving baby suddenly turns against them with this loud and clear no. Sometimes parents experience it as a rejection, a withdrawing of the child's love. And understanding it this way can lead to a cascade of misunderstandings between parent and child, and to a souring of the relationship.

However, this NO is indicative of a very important shift in the child's position: from being a baby who could not conceive of anything other than doing what the parent wants, towards becoming his or her own person! This is a moment to be celebrated. As Dolto points out: The child says 'no,' to be able to do 'yes.'   What does this mean?  That the child says no, 'because you ask me, and I do not want to do whatever you ask me, as I am my own person'.  However, the child immediately follows up with a yes, 'but I want to do it for me, because I am a becoming a big boy, or a big girl, and I want to do things on my own, for me.' 

If the parent understands this, these ‘two's’ do not have to be so terrible. Typically, when the parent does not insist, or refers to another adult of importance for the child as making the same request, the child will eventually do it. The child will do it not to please the mother or father, but to become his own person, and not just a 'child' that is commanded like a pet, or a little kid. 

If the parent reads this no as a rejection, but as a positive intention of the child moving towards developing his own personality, separated from the parent, the child might feel that the parent is needing him or her to stay this parental extension. The child might get the message that he is there only for the sake of pleasing the mother, satisfying her needs, but is not respected in his or her own desires. If a third element or person does not intervene to bring about this separation between the parent and the child, it might be the beginning of difficulties for the child, and for the parent – child relationship.  The child might move back and forth between compliance and revolt and opposition. But stuck in this dynamic the child stays stuck to the parent in what can sometimes become an infernal dynamic for all parties involved. In that case therapy might help both parent and child to help bring about the separation that has not had a chance to occur. It is precisely this separation, (which indeed will imply  a certain loss), that will make a connection possible between parent and child.  A connection that will be much more pleasurable than the infernal dynamic of opposition and reconciliation.

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

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.’

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

The adult in every adolescent

Several years ago psychologist Ronald Epstein argued in his book 'The case against adolescence' that teens are much more competent than adults think, and that their problems stem for the most part from the restrictions placed on them by parents, and society. It is their infantilization along with the fact that we gather them in places where they spend most of their time with peers, while having minimal interaction with adults that leaves their capacities unexploited, underused.

The prolonged childhood that can last until  the 'child' reaches the age of 26, makes the transition to adulthood for a lot of teens problematic. There is a hesitation to start, to make the leap, a postponement that seems to coincide with the vast world of possibilities that are open today, and that the adolescents will put to the test. Adolescences seems to be a procrastination. It seems that the vast world of possibilities can be translated as an endless postponement. 

Miller in a recent text (En direction de l'adolescence) refers to a point that resonates with Epstein's observation of teenage children spending most of their time with peers and not with adults: Where in earlier times the child, to acquire knowledge had to pass through the Other (the parents, teachers, adults)at this point they have the knowledge in the palm of their hand. They only have to click and ask, and the device will answer, circumventing the necessity to address the Other.  

However, things might be changing.  The talk is that the newest generation of teenagers, generation Z is much more independent than the Millenials, and are intending on cutting lose from their parents at a younger age.  The digital age in which they grow up seems to provide them also with a platform that transcends just easy access to information, without having to address the Other. It opens a way of connecting to the wide world, and it opens possibilities of enterpreneurship and inspires initiatives by these young people who are eager to bring their abilities to the world. 

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

Therapists and doctors: they can collaborate.

Working with children who have also physical disabilities, it can be very important for the therapist to work closely with the doctor. Catherine Mathelin gives in her book The Broken Piano some interesting case studies relating to successful and not so successful collaborations between therapists and doctors.

She relates the story of Alexandre, a ten year old boy, physically disabled due to brain damage caused by brief respiratory failure during birth. Although he was a brillant student, his body could not follow suit. Mathelin describes her as a virtuoso whose only available instrument was a broken piano.

After his annual appointment with the chief neurologist the previous year, Alexandre had shut himself in his room, and had become quite oppositional. He did not want to go to school, and just wanted to be left alone. When Mathelin saw him he was oppositional and depressed, complaining about the injustice done to him. He felt caught between revolt and despair.

Talking about the consult with the neurologist he said that he was 'fed up with doctors.' He said that he 'tried to see the doctor's eyes, but it was hard, because he was not looking at me.' His eyes were on the 'chart.'

Every year Alexandre was brought before a specialist who did not look at him. Mathelin suggested to his parents to bring him to a pediatrician whom she respected, in addition to the visits with the neurologists. This pediatrician saw him alone, graphed his progress in a large notebook, explained all his interventions, and encouraged him to keep track of his development and growth. Alexandre was supposed to take care of the notebook and to bring it to every appointment. Unlike the chart, this notebook belonged to him. 

'For Alexandre, going to the pediatrician meant that his body now belonged to himself, just like the precious notebook.' He would speak to the pediatrician about the sessions with Mathelin and with Mathelin about the physician. 'For certain children with physical ailments, collaboration between their doctor and therapist is essential,provided that the roles are clearly defined and not interchangeable, and that the confidentiality of thesessions and respoect for the child are always in the foreground.'

Who is a 'real' mother or father?

Both, the children and the adults that I work with in my practice often tend to use the expression of 'my real father,' 'my real mother.' I might have addressed this before but the implicit resonances of this phrase are often quite detrimental for the child. For example, I had a young child become very upset about the fact that his grandma told him that his father was not his 'real father.' However, this father had been there since he was born, had given him his name and was actively involved in the child's life. For the child of a certain age, there is 'real' and there is 'fake' or 'pretend.' His grandma's phrase suddenly diminished the value of his father to the realm of the fake and pretend. This is not something he will easily accept, and this had quite a detrimental effect on the relationship between the child and his grandmother.  I explained to the child that each child has only one biological dad, but can have more than one dad.  The dad that raises the child is as 'real' as the dad who made the child in an act of love, but is not present anymore.  This explanation was quite a relief to the child, and did calm him down. 

It is more precise to speak about birth mother and father, or biological father, than to use terms as 'real,' which then reduces a person that can be extremely important and 'real' in the child's life to someone who is 'fake,' not real.  

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

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.

Parental Guilt

Child therapists often deal in their work with parents with the parents' feeling of guilt. Parents might feel that they have made mistakes in the early years of child rearing. They feel that the opportunities are missed and that it is now 'too late.'  It is true that a child's character is formed by the age of 6, and that this character is shaped by the type of relationships this child has had.  But this does not mean, if these early relationships were difficult that the child will necessarily suffer or be 'damaged.' 

The important thing is not to try to compensate for what did not happen in the past now.  What has happened, has happened. It would be much more important for the parent to talk to the child about it. The parent could tell the child that she realizes that she might have maybe done too much for the child, and not have left enough room for the child to make her own mistakes.  She can say to the child that she wanted to give the child everything she did not have as a child, and was maybe too 'giving,' and maybe smothering.  That she realizes that her child will have to find her own way, separate from her, that she cannot keep holding her hand. That part of her wished maybe that she could keep holding her hand, but that she also feels how important it is that her child can go her own way, and how proud she is of that as a mom, and that she can trust that the child can go her own way.

Or in the other direction: it would not make sense to starting to feed a 9 year old the bottle because the parent realizes that he was maybe not feeding the baby enough bottles when he was a baby. Although there are certain kinds of therapy that focus on compensating for what is missed, on closer investigation it is much more the symbolic dimension, the ability to symbolically work through the early trauma which is the healing factor.

In this context I also think of the young mother of a 15 month old child, who is prone to arguments with her spouse.  Although she tries to change this, the urge to argue is sometimes so big that she cannot resist.  After she got in a big argument in the presence of her son with her spouse she apologized to her son, and talked to him on how she was working on this issue.  She was surprised how attentively her son was listening to her as she was talking to him 'heart to heart.' Admitting our mistakes to our children in a genuine way, talking to them truthfully, in an open way, is a powerful tool that can mitigate possibly traumatizing experiences.

If you want to talk to a therapist,  call An at (530) 321-2970

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

How to handle your child's aggression?

In therapy with children, or in consulting work with parents the topic of a child's aggression often comes up. This is often quite troublesome for parents. 

Young children in their play like to pretend that one of the parents is dead, or little boys (and girls) sometimes like to 'shoot' everyone who is around. Parents are often scared and troubled by this 'aggressive' behavior, and might have the tendency to 'suppress' it, to 'forbid' it. However, the child is playing in the realm of the 'imaginary,' 'pretend.' Like I mentioned before, by forbidding this play, we miss the point, and we deprive the child of work that is crucial in helping him or her deal with the demands or his reality. Children need these phantasies, this imaginary world in an attempt to leave their crushing dependence on their parents in reality. They imagine being in a different world where they can be adults. It is important that the parents are not upset or bothered when the child plays this way. On the contrary, it would help the child a great deal that if the child 'shoots' them, they accept verbally to be dead.

Thanks to this play, to the pretend play in this imaginary world, the child can tolerates the reality, the limits to his freedom. Without this play the child would be without any defense against the cruelties in the world. The imaginary helps the child protect himself from the difficulties in the world.  Children are in need of this kind of play. 

Rather than 'forbidding' it, it would be better to offer a frame for it, to allow it within certain limits. For boys, this aggressive behavior can also be just a way to show that he is a boy. He can be congratulated on his strength, his power, and if the play becomes unsafe, he can be guided to a more constructive way of showing his strength. 

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