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Is my child getting better in therapy

Writer's picture: marcuslewtonmarcuslewton

When a child is seeing a clinician for a long period of time—perhaps the weekly sessions have been going on for months—it’s natural for parents to look for signs of progress. Mostly, one can expect small changes, remembering that therapy is a process, not a “thing” that is simply done to a child. At times, however, it may seem that there is no forward movement or that the young person is not learning or is still having tough times.


Of course, sometimes the chemistry may just not be quite right between the clinician and the child, and another approach may prove more rewarding. Yet it may also be useful to recognise that even though the visible signs of change may not yet be apparent, the clinician may well be learning something very valuable about your child that will pave the way for deeper insight and more enduring change. The therapeutic process is to bring out and work through complex emotional dynamics, which takes time before significant behaviour change can emerge.


What follows below are some established clinical theories in contemporary psychology and psychotherapy that detail how a clinician can be working at a deeper level even when it appears outwardly that not much is happening:


Wilfred Bion wrote about how adolescents frequently convey their distress through the induction of feelings in others, even when the adolescents cannot put words to the feelings. In treatment, this means that a child might “pass on” anxiety or anger to the clinician without necessarily realising it. It is up to the clinician to notice these feelings and help the child make sense of them, slowly transforming overwhelming emotions into something they can put into words and understand.


Furthering this, Betty Joseph described how children unconsciously pull the therapist into certain roles or cause them to feel/act in specific ways that are reflections of themselves. For example, a child feeling powerless might easily induce feelings of helplessness in the clinician. These patterns serve to help the clinician understand what the child may be battling and how they perceive relationships, although these dynamics often take quite some time to clear.


Leon Grinberg made it a point to hold young people in their most difficult feelings and to remain clear of mind. In this manner, by keeping calm and reflective, the clinician better understood what the child was communicating and helped them work their feelings out. It is as if the clinician stood like an anchor on solid rock—not moving—in order that the child could find their way back to a calm sea when emotions seem overwhelming.


Similarly, Herbert Rosenfeld stressed how easily a powerful affect, such as rage or humiliation, could be projected into the clinician by the child through a kind of emotionally “toxic” communication. It is the clinician’s job to “detoxify” these feelings, insofar as they can be recognised and reflected back in a way that renders them less overwhelming, so that the child is in turn better able to work through what remains.


Another contribution by Joseph Sandler is that of “role responsiveness,” or describing how a therapist unconsciously responds to the different unreal roles the child projects onto them, such as playing the teacher or parent. The therapist becomes adept at recognising such roles over time, then makes use of such knowledge to delve into the child’s experience and relationship to show how they might be feeling with other important people in their life.


James Grotstein viewed these projections not as defences but rather as efforts on the part of the child to express inarticulated feelings. Consequently, the therapist’s role is one of “decoding” the hidden emotional message and reflecting it back to the child, hoping that they may gain an intellectual insight into their feelings. This gives a voice to the child’s emotional language, allowing them to master and talk about those inarticulated experiences, making them more accessible.


Thomas Ogden explained that therapy is the creation of an interpersonal space to which both the clinician and the child bring their feelings and experiences. By paying attention to what happens in this shared space, the therapist may pick up the feelings or fears the child externalises, of which they may have no awareness. This will help the therapist guide the child to a better understanding of themselves.


Sándor Ferenczi was one of the first to realise and understand that children have the capacity to make a therapist feel the way they do—and often without realising it. He felt that understanding the feelings induced by the child aids the clinician in connecting with the child on a deeper level, often illuminating what the child may be struggling with emotionally. By establishing these approaches, it is evident that even when the work of therapy appears to be slow, there is always deeper work at play. Consciously, the clinician attends to and responds to the child’s emotional world, which can be greatly enlightening and foster growth and healing in the young person.

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