If you have ever wondered what psychotherapy looks like through the eyes of a child, we asked child psychotherapist Dr Margaret Lush for her view.
| “It makes you feel better inside” said John*, an 8 year old adopted boy, in response to his puzzled sister’s interest in what therapy actually is. At this time, I had been seeing him for about six months in once weekly child psychotherapy.|
The first time I met John with his adoptive parents, he sat silently and appeared frozen. As the discussion unfolded, parents started talking about being on holiday. They described, in an atmosphere of increasing tension, driving along a precarious road along a ravine, conveying a sense that they could hardly hold things steady and a great fear that they would all career over the edge. As they spoke I noticed that this had really captured John’s interest. The family were here because John’s behaviour at home had become intolerable, with violent and extended tantrums, and it seemed that they had brought this problem vividly into the room as a parallel to their story. The parents experienced John’s emotional distress as such a threat to the family’s capacity to manage and hold together that they were all living in a constant state of utter precariousness. His earliest experiences meant that he could only be in his adoptive family in this violently disruptive way but he also feared that he would push the family over the edge. How could any of them continue, let alone feel safe in that situation?
There are times when any one of us might need to feel ‘better inside’ and Rafan House also works with ordinary families with no trauma, who take the opportunity to get a bit of help untangling something they are struggling with in an ordinary way.
So what exactly is it that Rafan House can offer a family or a child? Anyone considering making a referral to Rafan House might ask the same question. All the child and adolescent psychotherapists at Rafan House are accredited by the Association of Child Psychotherapists, the professional body for psychoanalytically trained child psychotherapists. In contrast to some other psychological interventions, the work is not based around pre-determined structured tasks. Rather, the approach is to gather understanding over time of the unique dynamics and difficulties within this particular family and this individual child within the family. These can then be explored and worked with.
Initially, the director or clinical director may have a brief phone conversation with the parents who would then be invited to a first meeting. This will be an opportunity for the parents to explain the child or family’s difficulties as they experience them. What emerges from this discussion will give the clinician some sense of the quality of relationships within the family and perhaps the beginning of an understanding of what the family as a whole might be struggling with. In this meeting it often suggested that three assessments sessions are set up for the referred child, with a child psychotherapist.
Parents can often feel extremely isolated if they are struggling with a distressed child, all the more so as they can often feel blamed by others who they believe see them as bad parents. Judgement is not in the DNA at Rafan House – it is not about apportioning blame. Rather, we offer parent review sessions to understand the dynamic with us.
An experience of being understood is at the heart of child psychotherapists’ work with individual children. At different ages children communicate in different ways – young children express what’s going on inside their minds predominantly through play, behaviour and other non verbal communication. For them, playing is the equivalent of thinking. Young children in regular psychotherapy have their own box of small toys and drawing materials, through which they can let the child psychotherapist know about their preoccupations and feelings.
Older children and adolescents are more likely to be able to talk about what is on their minds and the child psychotherapist is interested in what lies behind the stories they tell. An initial experience of being understood eventually leads to an adolescent’s increased capacity to think about themselves. They come to a greater understanding of what drives particular behaviours and perhaps an increase in control over the choices they make.
Parents or referrers may worry that a child won’t be able to make use of psychotherapy because they can’t talk about their feelings. But how can they talk about their feelings if they don’t know what they feel? When John came into individual psychotherapy, his level of early trauma meant that for a long time he could only sit in the chair, rigid, for the whole of every 50 minute session. All he could feel was terror. Over time, he did explore his box and began to play but he was silent for a while. However, even in the silence he poignantly communicated painful states of mind and unbearable feelings and having someone who could begin to understand those brought him some relief and helped him feel ‘better inside’.
*Name and family details have been changed to maintain confidentiality