Showing posts with label children. Show all posts
Showing posts with label children. Show all posts

Sunday, June 16, 2013

The child’s grief process


In the DSM-5 it is proposed that the normal time frames for grief in an adult is 12 months and in a child is 6 months. Regardless of whether you agree with the time frames or not what they are saying is that the grief process for an adult and a child is significantly different and thus the child grieves for half the time that an adult does.  This is a interesting proposal that I have mused on since reading it, (I like using that word ‘muse’, it makes me sound intelligent).

In my musing it seems to me that the age of the child would be important. In the DSM-5 they do not make this distinction so maybe that is for the DSM-6 to take into consideration. As we know at age 8 the child suffers an existential crisis. It is at age 8 that a child first begins to understand that death is irreversible. Prior to that age it believes that death is reversible in some form.

Teen jumpers
What children do.

It seems reasonable to suggest that if you believed that the deceased person was somehow going to return one day then that would effect how you grieve and indeed the entire grief process. In essence you would not really be grieving because you believe the person has not really died in the first place. This could explain why the grief process for a child under 8 years old could be so much shorter.

Secondly in some ways a child is like a psychopath. As a child grows mummy falls in love with it and develops a strong and deep bond to the child. As I have said before all humans tend to automatically assume that others in the world think and feel the same way they do. So many mummys assume that the child will feel the same  way back to them as they feel for the child. Unfortunately this is not the case even though many mummys are convinced their child loves them like they do.

pumpkin
A child's reality is different to an adult's reality. Sometimes we forget that.



I read some where (I wish I had kept the reference) that it would be about the age of 10 years when a child would first be able to look after its own physical survival. Prior to that age the child is not able to get its act together enough to allow it to organize shelter, food and protection for long term survival. This means that children need mummy in order to physically survive. A fully grown mummy does not need a child for its physical survival and thus we have an important difference between what mummy feels for a child and what a child feels for mummy.

If a child is 6 years old and mummy gets run over by a bus then one of the highest, if not the highest priority for the child is to get a mummy replacement. If it does not then it will physically die, let alone psychologically survive. In a child’s mind mummys are replaceable. If mummy number 1 dies then it will get mummy number 2 to fill the role it requires. In this sense we see the psychopathic nature of the child’s psyche as that is how the psychopath thinks about human relationships. The psychopath sees people as replaceable items.

Of course to the mummy the child is irreplaceable. Yes they can have another child but that does not replace the first, instead it is another completely different child. And the mummy does not have the very dire need to have a quick replacement which the child does. This would explain how the feelings and bond between the mummy and the child are different to the feelings and bond between the child and the mummy and thus how the grief process for the mummy and the grief process for the child can be quite different. 

Me with santa
Santa claus is replaceable

Psychopaths do not suffer grief. They do not form the bond and attachment necessary to have a grief reaction when the person dies. They can just go and replace the deceased person with someone else. This also would perhaps explain why a child can grieve so much faster than an adult. The shorter time frame does suggest the attachment is less so in some way for the child. And I am sorry to all the mummys out there who like to believe that their child loves them deeply and that they are the one and only in their child’s mind.

Thus endeth this Sunday morning musing.

Graffiti

Thursday, March 28, 2013

Should children go to funerals?


Over the years I have been asked this from time to time and it has always struck me as an odd question. My answer has always been, “Why the heck not”. Of course the parents of such a child are fearful that being at a funeral might somehow psychologically damage the child. That wont happen given that other circumstances are OK.

Young girl and helicopters

Obviously a child can only go to a funeral if the cultural rituals allow for it. I would also recommend that a child not go if there was the potential for some major calamity or highly emotional event. If someone was going to angrily attack another person there or if someone was going to throw them self in the grave and start tearing at their skin whilst screaming. Baring such unusual events I would recommend that they do go as the child could psychologically benefit from it.

There probably is one other thing to keep in mind. When a child and a parent are placed into a sudden unpredictable high stress event such as a car accident or a bomb goes off near by the first thing a child will do is to look at the parent and try to read them. As the event is unusual the child will not know how to react so they will look to the parent for ‘guidance’ in this way. Does mother get angry, collapse in shock, get calm and problem solve and so forth? The child will take the cues from how mother reacts and then react in its own way which most often (but not always) will be similar to mother’s reaction or some derivative of it depending on its own natural temperament. Either way it will be heavily influenced by mother’s emotional reaction to this unpredictable event.

Injection


If at a funeral mother is really, really going to loose it emotionally then it might be a good idea to have someone else look after the child whilst there. There is nothing wrong, in fact it is psychologically good for a child to see mother cry at a funeral and even sob at a funeral if someone is nearby reassuring the child that mummy is OK. Which of course mummy is. Mummy will start sobbing and then mummy will stop sobbing and then life goes on. A child will not be psychologically damaged by viewing such an event.

When my two sons were about 4 and 6 years old their grandfather (my father) died from an illness. At the chapel we had a viewing of him in his coffin and I took my children up to him and we said a few words and each touched him in turn. I never have understood what’s the big deal. People live and people die. When people die you say your goodbyes, you take time to grieve and life goes on.

As this diagram shows there are two different ways of knowing things, in your Adult and Child ego states. When a loved one dies we will know in our Adult ego state that the person is dead. We have an intellectual understanding of it.

A thinks, C blieves

This is quite different from the Child ego state feeling, knowing and believing the person is deceased. We all have a 4 year old inside us who will be there until the day we die. So we all have the ability to think and feel quite irrational things like a 4 year old can. Accepting that a loved one is deceased can be one of those occasions where the Child in us will think in a prelogical way and not accept the death in some way.

clowns carry coffin

Funerals in this way can be very helpful. If the cultural rituals allow it I always suggest that there be a viewing of the body where the bereaved go and stand close to the body and touch it. The touching part in particular will let the 4 year old inside of us get some comprehension that the person is dead and gone. Often this can be quite powerful psychologically. And of course there is no reason why children cannot do the same.

Graffiti



Wednesday, March 20, 2013

Games children play - Happy to help


This game is about survival

The good child. This child does what it is told, follows the rules, can be overly
helpful, can be quite shy, is reluctant to express what it wants or needs, will put
others before itself. If they are not so much the shy one they can become high
achievers if they have natural talent in some area. They learn that to be good you do
well at school, or in sport or in civic work and so they achieve in that way, by doing
’stuff’, rather than hiding away.

Why would such a youngster exhibit excessive Conforming Child ego state and
give up their Rebellious Child and Free Child ego states?

Ego states - good child

There can be a number of reasons for this
* There can be an excessive pressure for the child to conform by the parents
who may be quite conforming themselves. “What will the neighbors think” is often
the motto of such a family. The parents are reluctant to be non-conforming
themselves and perhaps are merely parenting the way they were parented.

The pressure can also be applied because the parents use the child as a status
symbol. Often this is the eldest child in the family or the one the parents believe
have some natural talents. I recall one instance of an individual who was
relentlessly pressured by mother to go to university and become a doctor. When
ever there was a family get together it was repeatedly announced particularly by
mother that he was a doctor. She was using her sons achievement to compete or gain
credence in the wider family. You see clients like this in counselling room in their
30s or 40s and they say things like, “I never wanted to be an economist, I just
wanted to be an opera singer”.

Gymnastics

* This can be the oldest child in the family which the parents use as a live
in baby-sitter for the younger siblings which frees up the parents. If the eldest
child accepts this role this fosters the child to put its needs behind
those of its younger siblings. Alternatively it can be a child who has a sibling who is
disabled, or sick, or has extra needs of some sort. The parents simply do not have
the time and energy to deal with the non-sick youngster so they force it to be good
so it requires less attention. In large families as well you can get the ‘forgotten
child’. In today’s culture any family that has over three children is quite possibly
emotionally damaging to the children for the reason just cited.

People who are this type of good child often will tend towards the helping
professions in adulthood. They can quite easily become transactional analysts
because in such a role you focus on the needs and wants of others and do not discuss
your own such wants. Your needs are secondary at least while you are working.

* Sometimes it is the only position left in the family. As a new child enters the
family and grows into it he has to find where he fits. The parents have the Parent
and Adult ego states covered and a sibling may have the outspoken, demanding
position taken so the ‘happy to help’ good child position is the only one left. If the
child’s natural temperament is of that kind than it can very easily fall into the good
child position in the family.

* The good child can be anxiety driven. If a child develops significant anxiety for
some reason (abuse, abandonment, threats, etc), it can make the early decision, “To
make myself safe I need to sit quietly and watch what is happening” or, “I must not
rock the boat or bad things happen”. This is an unfortunate child as it can suffer quite bad anxiety or depression but it never gets identified or diagnosed. As it does not cause problems at school or at home the adults around it will focus on other problem children and it is left unattended.

Smoking girl

The ‘Happy to help’ game in essence involves a contraction of the Free
Child(FC) ego state. As mentioned before such game players often present for
counselling in their 30s or 40s and ask the question, “Who am I?” in some form.
Without good access to the Free Child one cannot answer that question. If you are
high Conforming Child (CC) the answer to that question is - “I am who you want me
to be”. If the person if high Rebellious Child (RC) they answer - “I am the
opposite of who you want me to be”. Both the RC and CC are adaptations to the
parents. If they are left to do what they want then they are lost, they do not have
a sense of who they are and thus will not have a direction in life and will never find
their true passion in life. The person with good access to their FC will be able to
answer the question, “Who am I?”. They can answer that with the practicalities of
life, but they will also have a sense of who they are. They will feel it inside. The RC
and CC do not feel it. The good child will struggle with this problem.

Graffiti

Sunday, March 10, 2013

International women's day


I am not sure if this will get me into trouble or not.

The other day was women's day and the local newspaper here did a big spread on a local woman called Fiona Wood. She has been Australian of the year and is a high profile woman. She runs a successful medical practice and business that develops new products like spray on skin for burns victims. She specializes in burns and was at the forefront when all the burns victims from the Bali bombing arrived in Australia. She is also the mother of five children.

Family on bike
With a young family it is often like this. 

The newspaper had a photograph of her hard at work and another photograph where she was surrounded by her five smiling children. The article was how she claimed she had been able to maintain a busy high powered work life and have five children where she could also meet their psychological needs over the years. She was putting herself out there as a woman who did this and being a model for all other women who wanted to do the same. 

In my view she does not help women in general and indeed perpetuates the problem. Most days I work I counsel women and their children. A common theme of what these mother’s present is guilt about what they have and have not done with their children along with their desire to fulfill their own work life aspirations. This can cause a great deal of angst for some women.

Fiona Wood claims she has been able to do both successfully and puts here self out there in public for other women to see. That is a big claim to make, that may or may not be true. I have had two children of my own and I know how much time it takes. I can recall making the decision when they were both very young that I would put the development of my career on hold as it would simply take me away from the children too much. I did not see how it was possible to have a very active career and be around the children enough to meet their psychological needs in relationship to a father. And I only had two children and I was the guy (not the mother)!

Knocked up nun

So the claims Fiona Wood makes are either not true or if they are true then she has very exceptional abilities at organization and being able to meet children’s psychological needs in a way which the vast majority of other people can not do, including me. Which ever one it is I do know that many of the mother’s I counsel are going to read the newspaper article and realize they cannot do what Fiona Wood claims she can. They are then going to feel guilt, bad about themselves, they can not do what others can do, they must not be trying hard enough, and so forth. Basically it is going to make them psychologically worse off.

It is well known the damage supermodels can do to the psyche of women. They are put out there in magazines with bodies that the vast majority of women can never have because they are not built that way.

Fiona Wood is the same. She is a kind of supermodel working mother that other women can aspire to. In my view the average woman can not ever achieve what Fiona Wood claims she and thus we have the same damage caused to the women’s psyche as the bodies of supermodels do. They are left feeling not as good as, or yet again a failure.

Graffiti

Saturday, June 16, 2012

The psychology of the beautiful woman - Part 2


Some time ago I wrote an article on life positions and concluded that there were 7 life positions instead of the customary 4. However in that article I asserted that human do not naturally see OKness in others. They have to be forced to see others as OK as it is not a natural thing for them to do. Whilst this may seem a somewhat machiavellian view of human nature it is one that I hold to and I may add could be argued to be consistent with Freud’s view of the natural state of human psychology.
This view follows the idea of primary narcissism as was presented by Freud. Every child is born a narcissist or as Freud would put it, with a form of self love that he called primary narcissism. On a side note this makes the narcissistic personality type unique amongst all the other personality types such as the paranoid, schizoid, OC, hysteric and so forth. People as they develop will grow into these personality types. They develop over time as a result of the person’s natural temperament and the early life script decisions they make. With the narcissistic personality it is not a matter of growing into it but growing out of it. The narcissist never resolves or develops out of his state of primary narcissism as all the other personality types do.

Sit woman


One resolves their primary narcissism by having the value of others forced upon them. Parents show to the child that the value and rights of their siblings are just as important as their own. Parents force the child to see the value of their siblings. They can’t eat all the cake alone but are forced to share it with their brothers and sisters because they are just as important. When this happens the child develops out of its state of primary narcissism and begins to conclude that others are OK. 
The machiavellian part is that if left alone a child will not naturally share the cake. Instead it will eat it all and leave none for the siblings if it can get away with it. So what has this got to do with the psychology of the beautiful woman you may ask. In my original article I state that people who are exceptionally good looking, very rich, famous or very powerful are not required to see others as OK like the average person is. Because of their special attribute they will always have a queue of people who are willing to be friends or at least associates of theirs. They do not have to treat others with as much respect that the average looking woman does, at least with males. Now I am sure many very good looking women have the view that others are OK, but the point here is that it is harder for them to maintain that position than it is with the average looking woman. That average female does not have a queue and hence she is constantly reminded of the necessity to treat others as OK such that they will still want to be her friend. The very beautiful woman has to spend extra effort to avoid the ever present slide back into her state of primary narcissism.

Blizanci
Siblings are crucial for our development out of primary narcissism.



I have mentioned before how the beautiful looking woman is in danger of being seduced by her own seductiveness. From early adolescence onwards she discovers that her beauty will get some (many) men to give her extra special treatment when she wants it. The problem with this is that she will start to rely on it. The more she relies on it the less she has to develop other skills to get what is wanted. She does not have to develop other skills that the average looking woman does and indeed the male does, to get on in life and get where one is wanting to go.
A woman, particularly a good looking woman can use her physical attractiveness to climb up the ladder of what ever profession she is in. I am not talking about sleeping with various people to get to the top but as I mentioned in part one, the unconscious level of communication that is ever present in human communication. In this case between the woman and the man that will have some level of sexualness involved in it, especially for the very good looking female. Indeed I suggest that this will happen in many males minds whether she likes it or not.
This provides an interesting view on what is known as the glass ceiling effect for women. The idea, at least in westernized democracies, that there is a trend for women to make it only so far up the corporate ladder and then they seem to stop. There are very few women who actually get right to the top of what ever profession they may be in such as in politics or the commercial world. There are probably multiple reasons for this but for the beautiful woman she is especially disadvantaged in this way. 

Kissing girl

I would suggest that right at the very top of any profession her physical attractiveness counts for very little. She needs the other skills required, such that the men at the top have, whether they be political skills, commercial skills or some other kind of skill. At the very high levels the beauty stops working, or is much less influential in the males mind at least. She becomes more of a direct competitor to the male. If she has relied on her beauty then she has not had to develop (so much) the other skills over the years and hence she is disadvantaged. She has been seduced by her own seductiveness. Physical attractiveness for the male has never helped him climb the corporate ladder and thus he has had to develop the other skills required over many years.
One other thing not uncommonly seen in counselling with the female who is entering mid to late adulthood involves at times a significant level of psychological adjustment to be made. It can be quite a difficult time for her indeed. The looks start to disappear. What a western society has determined as physical attractiveness tends to go for the female when she reaches this stage of life. She discovers she is noticed less by males and indeed they start to notice the younger looking female instead. The more physical attractiveness she had the more she is going to notice this. For some women this period can be a time of quite difficult psychological adjustment.
Graffiti




Tuesday, November 22, 2011

Games children play

For the love or money


This is an associated game of Stupid and is sometimes called the game of Spoilt Child. Here love and money get mixed up. The parents believe they can express their love to a child by giving it things. They may even end up saying to the child, “Of course I love you look at all the things I have given (done) for you”.

The parent is for what ever reason unable to express feelings of love or affection to the child. (Their parents may have done the same to them, they have a “Don’t show your feelings” injunction, they may have their own closeness issues, they may equate affection feelings with sexual feelings and that scares them, they may just be self centred and have little interest in giving affection to the child because they want it themselves, and so on).

Hair women

So the parents give things instead showing love or affection. A prime example can be boarding school in some instances. “I have sent my daughter to a very expensive boarding school so she gets the best education”, (and by the way it also gets her out of the way so I can go and do all my things).

In this game, over time the child’s bedroom begins to start looking like a shop of “Toys-r-us”. The child gets a never ending series of toys and things with which it can play or be entertained by. Computers, computer games, bikes, flat screen TV, pets, DVD player, CD player, overseas holidays, swimming pool, and so on endlessly. (This is of course encouraged along the way by all the marketing which often portrays the line that if you buy this gift for your child then he/she will feel loved by you.)

Smoking girl


The problem with this game is that it half ‘hits the spot’. And that can trick both parties’ Child ego states. They think they are being shown love when in fact they are not. All humans have a need for love. That need can only be fully met when:

It is shown to the person first hand (so not mother telling the child that father loves her)
Is face to face (so not via email or even the phone to some extent)
Has emotion involved
Has some form of physical contact.

If these conditions happen then the Free Child need of the person for love is met and satisfied. Indeed the child will feel loved by its mother or father if the love is expressed to the child in ways like this.

Love transaction

False love

I sometimes hear clients say; “I know my father loved me, even though he never told me that”, or “I used to over hear my father tell others how much he loved me but he never actually told me”. Unfortunately these only half meet that Free Child need for love.

Societies will even formalise times when the Free Child need for love is meant to be met. In our country it is often birthdays, and the birthday gift is meant to be an expression of love for the other person. But the physical gift is only a symbol of that love and to the Free Child that does not mean much.

This is summed up well by Coleman & White (1988), “To clarify this point, consider the example of a parent and child playing a game of cards. We would invite such a parent to consider the following question : Are you playing cards with your child, or are you playing with your child and that just happens to be cards at the moment? Toys, games and play activities can provide an effective way of avoiding contact with a child. They can allow the parent and child to become side-tracked into the activity and avoid closeness, contact or openness with each other. Parents who provide children with expensive toys particularly need to consider how they play with their children.”(P13).


Trivia wall

In the wall of trivia ‘things’ get in the way of the two parties actually getting close and having intimacy. The Free Child to Free Child transactions get blocked. Indeed in some marital counselling, the counselling can become a thing that gets in the way as well. It gives both parties a ‘thing’ to talk about other than themselves and their feelings for the other party.

A derivative of the game, “for the love or money” is the game of “Childhood obesity”. In this game love does not get mixed up with an expensive gift but instead love gets mixed up with food. The parent has the mistaken belief that it can express its love to a child by providing it with food and the child begins to take this on and when it feels full it feels loved. So it is provided with lots of food and it eats the food in its desire to feel loved. Again this only half “hits the spot”. For a brief while the Free Child need for love is met when it eats but it does not last because the need is not really getting met in the way I described above. (Note there are many other reasons as well for the over weight child).

Woman & dog.

The other derivative of the game, “for the love or money” is the game of “Higher, faster, longer”. In this instance love gets mixed up with achievement in the child’s mind. “If I can jump higher, swim faster or run longer then mum will love me”. “If I can win the gold medal then dad will finally notice me” The child believes that if it can achieve success in sport, business, education and so on then the parental love that it craves will finally be given. I would suggest that many high achievers are of this ilk. Again, it works for a little while, and the parents may in fact provide the contact with the child when it does achieve. The problem is there is always another race, there is always more that could be achieved. So the child never gets to the end and often high achievers are left with a hollow feeling as they look at their trophy cabinet, investment portfolio or degrees hanging on the wall.

Graffiti

Monday, September 28, 2009

Should children go to funerals?

Over the years I have been asked this from time to time and it has always struck me as an odd question. My answer has always been, “Why the heck not”. Of course the parents of such a child are fearful that being at a funeral might somehow psychologically damage the child. That wont happen given that other circumstances are OK.



Obviously a child can only go to a funeral if the cultural rituals allow for it. I would also recommend that a child not go if there was the potential for some major calamity or highly emotional event. If someone was going to angrily attack another person there or if someone was going to throw them self in the grave and start tearing at their skin whilst screaming. Baring such unusual events I would recommend that they do go as the child could psychologically benefit from it.


There probably is one other thing to keep in mind. When a child and a parent are placed into a sudden unpredictable high stress event such as a car accident or a bomb goes off near by the first thing a child will do is to look at the parent and try and read them. As the event is highly unusual the child will not know how to react so they will look to the parent for ‘guidance’ in this way. Does mother get angry, collapse in shock, get calm and problem solving and so forth? The child will take the cues from how mother reacts and then react in its own way which most often (but not always) will be similar to mother’s reaction or some derivative of it depending on its own natural temperament. Either way it will be heavily influenced by mother’s emotional reaction to this unpredictable event.



If at a funeral mother is really, really going to loose it emotionally then it might be a good idea to have someone else looking after the child whilst there. There is nothing wrong, in fact it is psychologically good for a child to see mother cry at a funeral and even sob at a funeral if someone is nearby reassuring the child that mummy is OK. Which of course mummy is. Mummy will start sobbing and then mummy will stop sobbing and then life goes on. There is no way a child will be psychologically damaged by viewing such an event.


When my two sons were about 4 and 6 years old their grandfather (my father) died from an illness. At the chapel we had a viewing of him in his coffin and I took my children up to him and we said a few words and each touched him in turn. I never have understood what’s the big deal. People live and people die. When people die you say your goodbyes, you take time to grieve and life goes on.


In the previous post on preverbal thinking about death I talked with Kahless about different ways of knowing things in your Adult and Child ego states. This diagram sums it up. When a loved one dies we will know in our Adult ego state that the person is dead. We have an intellectual understanding of it.


This is quite different from the Child ego state feeling, knowing and believing the person is deceased. We all have a 4 year old inside us who will be there until the day we die. So we all have the ability to think and feel quite irrational things like a 4 year old can. Accepting that a loved is deceased can be one of those occasions where the Child in us will think in a prelogical way and not accept the death in some way.



Funerals in this way can be very helpful. If the cultural rituals allow it I always suggest that there be a viewing of the body where the bereaved go and stand close to the body and touch it. The touching part in particular will let the 4 year old inside of us get some comprehension that the person is dead and gone. Often this can be quite powerful psychologically. And of course there is no reason why children cannot do the same.


Graffiti

Sunday, September 27, 2009

Prelogical thinking about death

I had a client say something today that was just very clear. You don’t tend to get such clear statements of this. She was reciting a situation when she was seven years old. She lived in a house with her parents and siblings and her aunt also lived there. Her aunt had an accident and died suddenly. She stated (This is pretty much as she said it):


“My aunt died and my parents did not want to tell me. I over heard them talking and they said that they were going to tell me that she had gone away to the country. But this was not a shock to me because I thought that dead people could come back”.


Not only did the parents little scam of not telling the child the truth not work as they were overheard, but the child would not have been distressed anyway because of her undeveloped understanding of the concept of death due to her age.


The truth?


It is sometimes noted that about the age of 8 years a child can get what is sometimes called “8-year anxiety” where they develop a pronounced fear of death. As Piaget has shown prior to age 8 the child is egocentric with magical thinking that involves prelogical thought. As a result of this children under 8 often think that death is reversible or that the dead can still see, hear and feel. At about age 8 the child’s thinking matures enough to allow it to understand that death is not reversible and thus it can hit that stage of “8-year anxiety” when it realises what is going to happen one day when it dies and when mummy and daddy die. In essence the child has an ‘existential crisis’ and has to come to terms with its own mortality for the first time at the tender age of 8 years which must be fairly hard for the little ones to do.


This woman’s statement was just so clear of this psychological phenomena that I noted it down and it does highlight one of the possible causes of childhood and adolescent suicide. The person at the point of making the suicidal act does not truly comprehend the consequences of what they are doing. In fact what they believe is going to happen maybe quite a distortion of the truth, such that death is reversible.


This is one of the four particular suicidal groups and I have called it the naive suicide group. Of course all adults also have a Child ego state. That is there is a four or five year old in all of us that remains until the day we die. For some people it can be quite pronounced and thus as an adult they can actually feel, behave and think in quite a child like manner. Thus part of them can believe at the age of 30 that death is reversible because they have a strong immature part where the Child ego state is quite influential. Such a person’s Adult ego state would know the facts about death but they also have a child feeling or understanding about it as well that is contradictory to the Adult facts.


Teenagers are in that twilight zone between

strong adult thinking and child like prelogical thinking.

At times they will oscillate between the two.


This phenomena is also particularly evident for some suicidal teenagers which makes suicide risk prediction particularly difficult for this group. The teenager may not show many of the usual indicators of suicide risk, especially the presence of the suicidal decision, the “Don’t exist” injunction, but still be at quite a high risk because of the reason I am just discussing as was highlighted by the woman’s comment. In suicide risk assessment I always feel much less sure when working with a teenager than working with an adult.


Graffiti

Sunday, September 13, 2009

Group therapy with children

In the previous post I mentioned how I originally trained in group therapy with children. Historically play therapy rooms have been set up with a whole array of apparatus that allows a child to express itself. For instance there can be drawing equipment, a sand tray, clay, paint, water play area and so forth.


The theory behind this is that the child through the use of such expressive opportunities will begin to display their internal conflicts or emotional distress. For instance with drawing the child can draw conflicts in the family or between its own internal ego states. This allows for the therapist to begin to understand what the child’s internal conflict and emotional state is like.


Some then hypothesise that as the child displays its angst through play that will allow it to express them and thus they will reduce. This is typical of the theory behind art therapy and some psychoanalytic perspectives. Alternatively those who follow more of the Carl Rogers approach see play as a means by which the child can express itself in the presence of a therapist. That therapist provides an environment that is safe, empathetic and unconditionally accepting of the child. It is the theorised that the child in such an environment will naturally begin to grow and develop towards health.


The woman whom I did my first two years of play therapy group training with was quite psychoanalytic in her perspective. The psychoanalytic, art therapy and Rogerian perspectives described above to me certainly hold merit. When running play therapy groups I use those approaches.


After I finished my training in play therapy I went out on my own and ran groups. Over time I noticed that they changed from the style of my original training. As I worked with children I found myself moving onto other techniques that seemed to have a result. This was not a cognitive process on my behalf but more of an intuitive process that just evolved over time


Three techniques that developed over time.

1. The approaches described above one could call quite passive approaches. The child is simply left to its own devices and would proceed and progress at its own pace with little direction from the therapist. That is indeed why Rogerian therapy is sometimes called non-directive therapy. Over time I found myself becoming more action oriented with the children which more suited my personality as a therapist. Instead of just letting a child express itself through drawing or clay I would be much more interactive in my questioning and comments with the child as he played. Asking what this and that was, requesting that they draw word bubbles for the people they were drawing, asking them to write what the various parts or people were thinking and feeling. Getting them to include pets and various other people and objects in the drawings or plasticine.


This allowed for more diagnosis and also I was getting the child to identify its internal conflicts and to basically do two chair. Offering them the opportunity to expressed the unexpressed feeling or thought or need.


2. Whilst the techniques being employed tended to be more action oriented so was the relational. The therapeutic relationship between the child and myself moved away from the passive “blank screen” therapist that one would find in the psychoanalytic and Rogerian approaches. When a child made some kind response to me directly I would seize upon it and use it to some therapeutic advantage.


For instance if an anxious child with a high Conforming Child ego state said or did something a bit rebellious to me I might highlight it and request that she do it again or some other derivative of it to me directly. Alternatively if there was another child in the group who expressed some defiance of me I might ask the conforming child to see if she could say the same thing to me. Once done she gets to experience the new behaviour and sees that my response back to her is not catastrophic or demeaning and so forth.


The relational contact between the child and the therapist became very interactive and goal oriented with myself manipulating it in various ways for various means. Over time this became a point of significant departure from how I was originally trained.


Again this was not a conscious goal of mine but it just evolved over time. As I became more adept and confident in working with children in the group therapy setting I think I just allowed my own natural personality to come out in that forum. This is certainly what I say to trainee therapists. Initially you begin as a technique based therapist. What you do with the client is based on what techniques you have learnt in your training. As one gets more confident then you the therapist as a person enters into your therapeutic style. One transforms from being a therapist named ‘Tony’ to being “Tony’ who happens to be a therapist. Hence the client will experience you as a person who also happens to be a therapist rather than the other way around.


3. Finally there was the development of romp play. By far the most common approach in play therapy with children is as I described before. A low key, meditative, self explorative type of approach. Over time I developed this thing called romp play which is a far more cathartic approach. It is high energy, boisterous, jumping, rough and tumble, very interactional type of play. From what I have seen of the literature this is quite unusual. Whilst some other approaches do have some cathartic methods they are nothing like the romp play described here.


Originally it evolved as a method for children to develop their own internal Parent ego state controls. It is structured such that the group proceeds with - romp play on, romp play off, romp play on, romp play off and so forth.


Romp play is high energy Free Child behaviour. Whilst that is all good and well the problem with high Free Child is people can end up getting hurt physically and emotionally. Unrestrained Free Child can be dangerous. One needs to develop a Parent ego state that can control it when necessary. In the group any child could put a stop to the romp play at any time by using a prearranged word and all the romp play would stop. Those children who found it hard to stop would be stopped by the therapist. This allowed the children to begin incorporating this into their own Parent ego state. They learnt how to be Free Child and how to contain it when necessary. They were learning the internal controls to do that by their own Parent ego state.


However I think there is more to romp play than just this, although it is hard for me to articulate what that actually is. I could just recite the theory and say that the Free Child is that natural part in all of us and thus when expressed we are being our natural selves in this way. One can assume that when such expression is achieved this will be therapeutic in itself. This is probably all true but there is something that nags in the back of my mind about this. There is something more to this romp type of play for children that I feel the theory is yet to enunciate. When children have an opportunity to do a very free type of play and relating there is some kind of therapeutic effect on them that I cannot yet describe.


Graffiti