In Part 6 of a Parents’ Guide I commented on what to expect from a psychological evaluation of your child and how to consider the recommendations that follow from it. In this seventh post I am giving you a closer view of what actually happens in child therapy sessions.
I first review the guiding principles of the work, ones that I touched on in my fifth post about getting off to a good start with a child. Second, I share three vignettes intended to bring you into the playroom and reveal the therapeutic process at work.
Brief Review of the Guiding Principles
Children don’t talk about their troubling experiences, relationships and feelings like adults do. Play is their language, and children “talk” about themselves in their play. A child chooses and directs the play, and I follow his lead, playing my part as directed. I am at once an actor and an observer.
Wearing my observer’s hat, I have in mind the following questions. Of all the activities he can choose, why these? Why does he involve me in this particular way? What is he telling me about himself and his relationships? What is he feeling inside?
Play metaphors encrypt a child’s emotional and psychological concerns. My job is to “break” the code, figuring out what the play both expresses and hides.
At the beginning I most often don’t know what a child is “telling” me in the play. It takes time to figure it out. Most often a child settles on a play theme that is repeated over sessions and becomes further differentiated and elaborated. In the process I deepen my understandings of a child’s troubles as these are expressed in the play.
Adults talk. Children play. Therapy with adults requires discussion, self-reflection, recognizing and gaining insights regarding the sources of the underlying issues. But does this requirement hold for a child? How important is it for a child to become consciously aware of the conflicts and issues encrypted in his play?
Child therapists heatedly debate this question. One camp asserts that a therapist must offer interpretations that reveal the child’s underlying conflicts and struggles. In this view a child cannot develop self-reflective insights and understandings without the therapist, when the time is ripe, interpreting the play to the child. The other camp counters that interpretations, intended to bring out-of-awareness issues into the child’s conscious awareness, are not essential. From this perspective the conflicts can be worked through in the play without requiring the child’s becoming consciously aware of them.
Based my 35 years of practice, neither view can claim a monopoly on truth. Neither excludes the other and both have their place. It all depends on the child, the family and the circumstances.
David, a six year old boy, has great difficulty modulating his feelings. His anger boils into defiance and physical aggression towards family members, including his mother. Home is a war zone. I make a home visit. David crashes his toy trains into trucks and lego “people” lying on the tracks. At my office, we repeatedly hurl Match Box cars across the floor that crash violently into one another. At his request we watch YouTube videos of car, train and plane crashes. He is fascinated in rapt attention. Seemingly he can’t get enough: crashes pervade our sessions.
Several weeks into this drama, I comment that while the crashes are fascinating to watch, I have the idea that he is telling me about something more personal, closer to home – “people crashes.” David immediately and contemptuously dismisses my interpretation as “stupid” and ignores me as if I am a fool. I don’t force it. However, a month later he spontaneously describes conflicts at home labelling them “people crashes.” It appears that my interpretive remark implicitly resonates and takes up residence in his mental life, even though he emphatically denies knowing the source of the term he is using.
Bridgette, a seven year old girl is bossy, imperious and non-cooperative at home. She is intensely anxious, especially at school where she excitedly and rhythmically self-soothes flexing her legs together, becoming red-faced, oblivious that such a public display could embarrass her and result in peer exclusion.
In our first meeting she rummages through a bag of play clothes and puts on a blond wig and a cape, dramatically asserting that she is the Wicked Witch of the West. She then casts a spell on me, turning me into a port o’potty. Her mother agrees to be a vending machine. Me on the floor and mother on the couch, Bridgette races back and forth excitedly between the port o’potty and vending machine, imaginatively peeing and pooping repeatedly in the port o’ potty as she squats over me and moments later grabs candy from the vending machine.
Wow! What does this mean? Two ideas or conceptual lenses i.e., representations that focus and make meaning of the play themes, come to mind. First, with the port o’ potty I speculate that she is “telling me” that she can no longer hold back the pressures of feelings that have built up inside her. She must expel and express that gross and smelly stuff, hoping that the receptacle, i.e. me, will be accepting and safe. Second, I think of grabbing the candy from the vending machine as a representation of an equally urgent need to fill an emotional hunger for attention and succorance.
In many subsequent sessions she engages in imperious play demanding that I, her “servant”, cater to her power, whims and appetites. With a stop watch she times her servant as he frantically runs downstairs to fetch her ice water. He is always too slow, always falls short. I repeatedly disappoint her demands and urgencies, and in this game we have fun together.
Over the course of our work together her anxiety abates as do her imperious demands both in the my office and at home. I do not make interpretations. The play is the engine of her therapy, creating space for her to work through her conflicts, those burrs under the saddle of her young life.
Christopher, a remarkably considerate, engaging and friendly seven year old boy, is a natural and talented athlete. His parents enthusiastically enroll him in youth basketball and baseball. Although loving sports, he is gripped with anxiety, to the point of resisting attending practice and even games. For Christopher competing is aversive and unsettling. He can’t explain it and minimizes and avoids discussing his worries.
In our meetings Christopher creates elaborate and fun competitions. For example, he distributes objects on the floor from gable to gable of my attic playroom. We compete jumping from object to object without touching the floor. Whoever does it the fastest without falling off an object wins. Needless to say I almost always lose.
One competition in particular captures my attention. We stage a war between two armies with toy plastic soldiers, tanks, artillery pieces and bombs (foam balls). Unlike anything I have seen before with any child, he insists that each army must have a hospital equipped with beds for wounded soldiers. As the bombs explode, we carry our wounded to their respective hospitals for care. Plastic soldiers lies on beds(small wooden blocks) and are given time to recover as the war rages on.
Another Wow! What is this all about? I speculate that the play expresses Christopher’s anxieties about competition. By competing, he puts himself in harm’s way, just like the plastic soldiers. His fears of injury profoundly inhibit his participation in sports, and all of this is quite outside of his awareness.
In our two years together Christopher stages endless varieties of competitions as he works through his anxieties. He doesn’t injure me, and I don’t injure him. We are both safe and having fun. His worries dramatically lessen. One day his mother emails that Christopher believes he no longer needs to see me. We met one last time and together celebrate his liberation from those constraining worries.
I hope the seven posts of a Parents’s Guide have offered you a sense of my understandings of the psychotherapy of children. Please don’t hesitate to offer your views and ask me any questions that you may have about child psychotherapy.