therapeutic thoughts about children
parent-infant and child parent mental health
play's the thing!
children’s play is under threat from increased urbanization, perceptions of risk and educational pressures. Here, the first research centre of its kind aims to understand the role of play in how a child develops.
Cambridge University Research Center
Put your little one to sleep with stretches,
Good Night Yoga: A Pose-by-Pose Bedtime Story (VIDEO)
holding in mind . . . internalizing them
we hold children in our minds,
we think of children-in-relationship -
we think of them in terms of where they are located --
children in time, and place.
and emotional space.
our clinical thinking about children in families is greatly enriched by transactional contextual conceptualization (Sameroff)
acknowledging that not only are all individuals in a family reciprocally influencing each other --
they are also all being changed as they move through time together.
with wounded children, teens, adults,
and hurting families, we work in relationship,
we work together to co-create healing
and hope-filled, new stories, new narratives to replace their trauma-shaped life narratives.
as clinicians, we have taught,
clinically researched, supervised,
trained and practiced for decades
emphasizing the importance of early intervention for traumatized children, and describing
the nature, assessment, and effectiveness of relationship-based treatments
for preventing and healing the adverse effects of their exposure to high conflict and violence.
in our clinical work at abbey, we continue addressing severe stress and trauma through psychological assessment and assessment-based treatment within relationships, --
at times, helping to preserve and enhance relationships,
facilitating healing and healthy reconnection within families,
other times, sustaining children who will not be able to be reconnected by offering stable,
longterm, healthy, and enduring supports
so they may grow into new, hope-filled lives.
more thoughts about our clinical approach with children . .
we are listening precisely to, and working compassionately with, them.
working authentically and effectively with people -- especially children -- requires exquisite attention and presence, humility - and energy, imagination; humor;
willingness to listen deeply to intuit as accurately as possible their actual, lived experience
monitoring carefully what that brings up within ourselves as we plan interventions.
we seek to understand children's inner experiences by observing and listening to the many ways in which they symbolize their thoughts and perceptions, fears, imaginings, hopes, their dreams and daydreams --
we encourage those in relationship with them to recognize and respect a child's unique, symbolic ways of communication -- in their artwork, words, stories and play, and sometimes, yes, in what they say - each and all of those a door to a rich, inner world, containing representations they've created of their experiences, all that they form and carry forward, mentally, of themselves, others, relationships, the wide world, and the future.
what's in their "backpacks"?
An interesting question to ask ourselves, as parents and psychologists, is this, --
let us imagine children's inner mental "representations" and schemas as items in "backpacks" -- normal and helpful carryalls, but, which can be hindrances at times, crowding out normal, developmentally appropriate types and amounts of thinking, disrupting a child's reasoning and functioning --
how do we alleviate, lighten, the heavy, sometimes distorted, emotional load that children may be carrying?
How do we lift the load of negative, distorted perceptions they may have formed about themselves, others, the world, relationships; presuppositions such as
"men always leave you", or, of their future, "I'll probably die before I'm eighteen" - one commonly voiced by marginalized kids living on the streets, -- "a sense of a foreshortened future" is also a hallmark of kids who've experienced severe trauma . . . easily discerned by asking about their future plans, ambitions, wishes, hopes.
How do we convince young people that we therapists, parents, adults, are strong enough, adult enough, predictable enough, trustworthy enough, to carry that backpack of concerns for them? because those worries and concerns are rightly based on the behaviors and actions of adults (not just based on our saying, "don't worry, everything will be all all right") . . What would convince children that it is no longer necessary for them to be burdened down with adult worries and concerns . . . that the adults around them are dependable and mature -- and protective? and functional?
Another aspect of thinking clinically when working therapeutically, with teens, in particular, is
"How do we nurture their strengths and the hope within them"?
How do we best help them locate the sparks of possibility and hope that may appear to have been pulverized by chronic stress, chronic exposure to community or interpersonal, intraparental violence, by tragedy or by repeated victimization, -- hopes and dreams dashed, and the resulting cognitive distortion that accompanies internalizing disorders (depressive disorders; high anxiety)?
Better worded, how best do we address the mental health issues which have become chronic within systems of impoverishment, stigma, marginalization? . . . how can we reach children and teens sooner and better? How can we bring treatment to them, as in innovative school-based treatments, etc.
are there ways we are able to lend them our strengths?
somewhere, some way, chlldren we treat are often burdened with caregiving adults, parentified, . . . role-reversed, anxious, unpredictable. Child patients/clients will quickly reveal that in their relationships with us, by attempting to take care of us emotionally or literally.. How do we best "lend them our ego" (our maturity, our strength) in areas where they are not strong enough to cope in an age-appropriate manner without their needing to take care of us in some way? (non-traditional forms and locations of "treatments"?)
do we communicate that we really see them? do we hear them? can we show them how we imagine them to be in the future?
How do we best share with them the vision we have of how great they are, how we see them, just as they are, worthy, and wonderful, no need to prove their inherent worth by their achievements, status, the neighborhood they live in? (And, how we imagine them to be some day?)
We are not speaking specifically of diagnostics or psychopathology, but of whole individuals, shifting, changing, impacted by and impacting their environment as they move through time - a vibrant, risk and vulnerability model that is flexible, self-explanatory, perhaps embedded, culturally, non stigmatizing, not reductionistic.
effects of childhood adversity -- and "resilience"
Some thoughts about the longterm effects of childhood adversity - -
because Americans, in particular, love the concept of "resilience". and love applying it to their weakest members of society - infants and young children: "kids are resilient!", a common saying.
Yes, there are some amazing children who survive, and sometimes even appear to thrive, despite growing up in unimaginably adverse contexts of absent or confusing, inept caregiving, multiple risk intertwined with massive, and cumulative, terrifying assaults to their daily lives and development. They are the ones we hear about.
There are probably more who survive but may never fully recover from the damage they've sustained.
adversity and resilience - what it looks like worldwide
For the millions of children in contexts of war and terror, chronic impoverishment, famine, unaccompaniment/missing parents, and the many other stressors that attend poverty and post conflict settings, some children may not survive long at all.
Most forcibly migrated children around the world never escape their countries: most wander within those borders,
exploited, harmed, become ill or depleted, and die without a chance of reaching safety, or even temporary refuge.
Of the migrating people by raft and boat who continue to attempt reaching the shores of Europe, many of whom lose their lives, half are young children.
"being held in another's mind . . . "
refers to, in Attachment Theory,
the process of internalization - the concept of communicating to a child that (s)he (the child) does not cease to exist (and,as well) cease to be loved and remembered) when absent from the caregiver (or the therapist) because he/she comes to understand that the caregiver or therapist always holds him in his/her mind (thinks of him, remembers and loves him- and remind him/her of that in some way session to session).
(Attachment Theory, J.H. Pawl)
When serving children in any capacity, it is important to remember that -
1. vulnerability is inherent in being a human infant or a child.
2. vulnerable children are to be found everywhere
3. vulnerability exists on a continuum
And so, we seek to work with precision, accuracy, ever-evolving competency, great compassion and tenderness, from the conceptual view of virtually "holding in mind" all children -- even when we are teaching or treating
just one child.
We bear in mind that children exist in time and place, both of which may be harrowing for some children, somewhere, now, (since perhaps this may be so for our child patient, someday, so we work protectively) -- and so we hold them - and all children - in our minds, and communicate that to them -
the hope is that our small patients will internalize our caregiving relationship.
As children also exist in the momentary, shifting, emotional space so characteristic of childhood development and
day to day living . . .
every clinical session with a child should rightly be conceptualized by the clinician as a potential termination session.
As children have absolutely no power over their lives -- what we do and say, and how we are present, matters in each and every moment.
Children disappear without explanation --
from treatment, from school, from apartments, from countries, overnight, sometimes, at the discretion of caregivers, parents who move suddenly, foster parents who give them up, CPS or social services personnel who make abrupt changes, couples who break up suddenly. Someone goes to jail, a parent dies. A child is abducted, abandoned, moved, removed, siblings are separated, at times, sent somewhere for no reason that we may ever know. . .
Teachers know this, Sunday School Teachers know this. Band Directors, Youth Pastors know this. Social Workers know this. Nurses and other Health Workers experience this all the time. It is not the way "Transitions" are ideally to be handled for children.
Practicum Students and Interns are understandably devastated when they experience this.
If you are part of a child's team - a parent, relative, support person, part of a treatment team, it is clinically and personally important to make some kind of meaning of this kind of painful situation in order to work the attachment piece through yourself with self-compassion when it occurs, and also in order to have something meaningful to convey to those others affected (for example, supervisees) as a Program Director or treatment provider:
The positive connection that began in the playroom with the therapist (or at home with the parent, foster parent, or with the nurse in the hospital, the Youth Pastor, etc., goes on internally in a child's life because of strong processes of attachment which have been begun, attachment processes children are so good at forming) --- this occurs to the degree that the child has internalized the therapist's presence and their relationship of intentional, unconditional care and regard.
So, we plan, on one level, for "unexpected termination" in each session. With that in mind, there are things, then, that a therapist might especially highlight, might review, or might intentionally initiate, in each session (each therapist, each child and their issues would necessitate this being quite individualized - and this may or may not be made explicit, depending on the circumstances)(reminding a child of their strengths, encouraging the child to think through solutions, helping a child to identify how to choose a potentially safe adult to confide in, go to, for assistance when in trouble, etc.).
One might give more attention to helping an at-risk child strengthen relationships with an older cousin, proxy parents, caregivers, etc., with the potential mobility of the child client in mind, give more attention to shoring up the child's reserves and potential resources - family members or siblings who may be likely to remain in touch should a child be moved, remain proactive and protective, for example. With all children, one might work to find several ways they can learn to approach their teachers comfortably and advocate a bit for themselves.
An attachment-informed intervention which is especially potent is to note, during a session,
" . . as I was thinking about you this week . . ." (i.e., "I held you in my mind!").
That is an experience many children may have only had with you,
and they will remember that you remembered them, they will remember, "being held" . . . "in the mind of another" -- who cared for them very much, so much so that they thought about them when they were not present, and told them so.
(There is therapeutic work to be done here with parents who may have never had, themselves, the experience of being held in the mind of a mother or father, and therapy trainees for whom this experience may be foreign . . . .)