Important Note: The image in this post and in all the previous ones are not images of the children discussed in the posting. They are simply children whose photos I have collected throughout my travels.
The second option is consultation to the parents, for example, video feedback. This can be a very effective way of showing parents in visual form the nonverbal communication they might be unconsciously giving their child. The therapy takes the form of the therapist’s analyzing videotapes taken in the therapist’s office, or sometimes in the family’s home, and then looking at them together with the parents. For example, in one family video of mine, the father was stretched out across the floor in a supplicating position, trying to get his son to comply with my request that they play together. (Remember that effective limit setting contributes in important ways to the child’s sense of security.)
Feedback like this is usually followed by an invitation for parents to talk about what they might have been feeling that motivated the behavior they saw on videotape. Often, the self-reflection initiated by the video images helps the parents identify inner conflicts that interfere with their conscious intention of setting limits on their child’s behavior. For example, in this case, the father might recall the way he felt controlled by his mother when he was a small boy. This unconscious identification with his son might be influencing his difficulty collaborating with his wife in setting limits on the boy’s behavior. The main drawback in using this excellent technique is expertise. It is very difficult to analyze videotape and relatively few clinicians are trained in it.
The third option is dyadic or family therapy. This option is a good choice in that it can help both parent and child (or the whole family) become more aware of the way they actually behave in relation to one another in contrast with the way they imagine they behave. With reference to Attachment Theory, the therapist might be seen as a new source of security, creating a sense of safety experienced by both parent and child, and allowing both to take risks at trying new approaches that might have seemed too difficult at home.
There are many schools of family therapy. For example, there is “structural family therapy” in which the therapist focuses on identifying dysfunctional patterns of relationships within the family and disrupting them in the service of creating more adaptive ones. By contrast, a psychodynamic family therapy might focus primarily on the symbolic themes presented by the family in a play session. For example, in one family meeting, the “problem child” instructed his parents to “help (him) herd the animals into the barn because a big storm is coming!” Despite the parents’ conscious intention to support their son’s agenda, the play ended without getting the animals into the barn. The therapist thought that the family was showing her their problem – they were showing her how helpless they all felt to contain the impulsive aggressive outbursts of this little boy (“the storm”).
The final option is individual psychotherapy – play therapy – for the child, plus parent meetings. Play therapy requires a therapist who is trained in psychodynamic psychotherapy. That means that the therapist has learned to make sense of the symbolic representation in play of the child’s inner world. For example, if the child anxiously fingers a broken toy and then moves to play with something else, the therapist might imagine that he is afraid of his own or someone else’s aggression and its destructive potential, and the therapist will attempt to explore the child’s more elaborated fantasies. In this case, the fantasies might be about the child’s fear that his aggressive behavior towards his mother will hurt her and destroy their relationship, making him a bad boy and causing him to be abandoned. The therapist might then slowly support the child’s capacity to reflect on these fantasies, gaining insight into what thoughts and feelings motivate the aggression – for example, that the mother loves his sister better than him – and helping him discover a more complex landscape of meanings than the polarized all bad and all good ones the child started with. The work with the parents will focus at least in part on helping the parents understand their child better, gain empathy for him, and learn new approaches to setting limits. For example, in this case, the mother might find ways to help her son make a repair after hurting her, instead of punishing him with a lengthy time out.
It is hard to describe these complicated processes in such an abbreviated way, but I have tried to offer you some ideas about what to do to try to make the “Little Girl with a Curl” problem better. Returning to Attachment, you can see that problems with roots in infancy can be approached in various ways later on; there are many ports of entry. Each individual is unique and will make different meanings of themselves and their family relationships. I will talk more about this uniqueness and its relationship to Attachment Theory in my posting on interventions in infancy.