THE INNER, EMOTIONAL WORLD OF THE CHILD WITH CHD
AUSTIN E. WILMOT, M.S.W., L.C.S.W.
Articles about looking for a therapist have typically focused on making you therapy-savvy during the search process. For instance, what questions to ask during that first phone call with the therapist to determine whether they might be a good fit for you and your child. While a helpful and important resource, this article is different in that it is geared toward evoking a different side of reflection—introspection regarding the feelings, motivations and expectations for starting therapy with a child therapist. This article provides a therapist-side view of how the therapy situation can stir emotions for all involved and the ways in which the cartoon above may actually depict the conflicts endemic to the enterprise of child therapy more generally.
When parents reach out for help from a child therapist, there is an implicit acknowledgment that they have found themselves unable to help their child in some way. Even in this day and age, there remains resistance to therapy with the feeling that one has “failed” in some way by needing to talk with a therapist. Of course, it is a sign of strength to be reaching out instead of remaining stuck, but that is not always the loudest message in our culture. In the non-judgmental and safe space of therapy, a well-trained therapist can help a parent navigate their own feelings about having sought help alongside walking through their concerns about their child. Guilt, however that shows up, can be transformed into usable concern for one’s child that can be harnessed for good purposes by joining forces with the therapist—it can be a team effort and parents always remain the most important people in that child’s world. Even so, parental guilt about having sought out a therapist can contribute to difficulty in the therapy if not addressed early. For instance, a parent might find themselves becoming jealous of their child’s growing attachment to the therapist and act in ways that sabotage the therapeutic relationship. At the extreme, a parent can effect a unilateral, premature termination, yanking the child from the middle of a therapy process without consideration of their child’s feelings, perhaps without a chance for a “good goodbye” or termination process to occur. How traumatic for the child this can be! In pulling the child from treatment, the parent acts to shift the family system back to its original state with the child back in the position of being the one with the “problem”—the “identified patient”—a stabilizing and familiar state for that family. Again, a well-trained therapist would be alert for this and work with the parents to uncover what it is that is going on in their own feelings and make space for their anxieties, instead of the parents remaining alone with their own uncomfortable feelings and taking matters into their own hands. Might the child’s problems be related to their being left alone with their own feelings? It is true that a therapist making space for parent feelings can help grow the parental capacity for making space for their child’s feelings. And this is also what can inevitably lead to the emotional rollercoaster of child therapy.
It is the catch-22 of child therapists that as the child “gets better”, the parents, in a manner of speaking, “get worse”—the underlying family dynamics and conflicts for which the child was serving as a scapegoat, come more to the surface leading to increased anxiety and regression in other members of the family system. Parent sessions get more conflictual. New details emerge about the family dysfunction that had never been shared before. More “acting out” occurs and perhaps a new crisis is birthed to attempt a new distraction. During this time, should the therapist say the “wrong” thing, he/she might well have put a target on their head. The next thing you know, one of the parents is setting the scene for a dispute about an issue regarding policies (for which they had already agreed at the beginning), which they set in motion by pushing the limit of the cancellation policy, seeking to decrease the frequency of their child’s sessions (or their own parent sessions) or all of a sudden proclaiming an inability to afford therapy and asking to decrease the fee (attempting to effect a devaluation of the therapist and the work with their child). Of course, the hope is that, by this time, the alliance with the therapist is sufficiently strong (having been supported by ongoing parent work and practice at reflection on myriad feelings and issues) as to help the parents weather and work through even further the issues and conflicts that they themselves may be experiencing and contributing to. This might also mean helping a parent or both parents to see the need for and benefit in their seeking out their own individual therapy, in order to help them address issues rooted in their own individual history that get in the way of being the best parent they can be. While these issues as written are not destined to happen in every situation, I share them as a synthesis of real clinical experiences to foster an awareness for how powerful the therapy process can be in stirring thought, feeling and action as deep, enduring change is sought.
Therapy fails to get off the ground (or is “set-up” for failure) when parents cannot make the requisite commitment of time, money and of themselves-as-participants (in the parent work). Can therapy be prioritized is the overriding question. Therapy also fails when unrealistic expectations for the therapy process are held. Does one parent come in with an expectation about the duration of therapy? The frequency of therapy sessions? The nature of the parental involvement (or not)? The concerns revolving around commitment and expectations are important topics for early discussion and exploration. Like sitting at a red light before accelerating ahead, the questions below are meant to support a reflective pause—a moment to be thoughtful on a number of levels that may lead to some helpful insights no matter where you accelerate next.
Questions to ask of yourself when looking for a therapist for your child:
· Why, at this particular time versus another, am I seeking help for my child?
· What would be the difference between seeking a therapist for my child at this particular time versus a therapist for myself (and/or couples therapy)?
· What do I feel is “wrong” and when did it start? What was happening then in my child’s life, my life and our family’s life?
· How do I currently understand my child’s feelings, thoughts and behaviors, and do I notice any patterns?
· How have I been available, curious and interested in the inner world and feelings of my child?
· How have I played with my child as a means of learning more about his/her mind and nurturing a relationship?
· What history of experiences with therapy do I bring with me and how might those experiences shape my engaging and working with a therapist for my child?
· How much of a commitment and priority am I willing to make therapy?
· What expectations do I have of my child’s future therapist and the therapy?
· What expectations do I have for myself in this process? My partner? My child?
· Would I be open to parent work with my child’s therapist and understanding and working on my own parenting skills, including how past experiences with my parents and family might contribute to how I parent?
· What do I imagine happening between the therapist and my child that will be helpful?
· What change do I want to see happen in this process?