Geri L Ness, LCSW - Psychotherapy for the Whole Family
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A sneak peek inside a child therapist's office

7/21/2014

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Your 4 year old just cannot master toilet training even though you have read the books and followed all the instructions. Your 5 year old has been very aggressive at pre-school and kindergarten, hitting other kids, and the teachers are complaining. Your 6 year old is struggling to keep up with the other students in learning the new skills taught and expected in first grade.

These are all issues that bring children into the offices of child therapists, sometimes at the urging of the teachers or the pediatricians and sometimes just from the parent's own frustrations.

Since visiting a therapist is a new experience for most people, it can be a bit scary to start this process without knowing much about how It all works. As a child therapist with 20 years in the field, it is one of my first tasks to help the parents feel comfortable with bringing their children to see me.

If you are finding yourself in any of these situations and are thinking about taking your child to a therapist, then perhaps a "sneak peek" inside a therapist's office would be helpful to you.

Along with the usual couch (and chairs) found in an adult therapist's office, a child therapist's office will also have a lot of toys, games dolls, and art supplies. This is because child therapists firmly believe that "play is the language of children." Children communicate differently from adults and use the play material to express what's on their minds. They use the play material in what we call "symbolic play," which is how feelings they might not even be aware of can be expressed. They play out themes that reflect what is going on in their lives and with the therapist's help mastery can be gained over difficult, painful, and sometimes even scary aspects of their lives.

The therapist directly observes and participates in the play with the child. Our job is to create a comfortable, non-judgmental environment so the child will feel safe enough to freely communicate his worries and concerns. And although limits are set so no one gets hurt, we want the child to play without having to worry about being messy or criticized.

An example of how this works includes a girl who was in foster care and who in the therapy room used the dolls to express some of her deepest feelings and worries. At the child's prompting, the therapist was instructed to "give birth" to many babies who after they were born, were usually treated harshly and thrown away by the child. This reflected her feelings that this is how she had been treated. Allowing the young patient to have a safe space to express these painful feelings was very healing and helped her to overcome the difficulties in her life.

Another example of child therapy involved a boy past the usual age for toilet training who very obstinately refused to use the toilet for bowel movements. In the therapy room this boy used the play to show me his inner world and created a character that we had run and hide from while it piled up lots of dirt around the room. After many months of playing this games and confronting this scary character, the boy eventually mastered the use of the toilet and became less afraid of many other activities he had avoided as well.

Some children use the play in other ways. Older children who feel like they never win in life or get to be successful frequently gravitate to the board games to show me what it feels like to always be on the losing side. It is not uncommon; that no one in their lives helps them to win or to feel like they are a winner . In the therapy room, I try to create the environment where both of these things are possible and work towards improving the child's skills and self-esteem.

In order to accomplish real change for the children, in addition to the play therapy, it is important that the parents are part of the treatment. The therapist meets separately, but regularly, with the parents so she can learn more about their child's history and current living situation. This helps the therapist to better understand what the child is trying to communicate in the play. Work is also done towards helping parents better understand and relate to their children. If parents are flexible and amenable to understanding their role in their children's difficulties, then the work can be even more productive and successful. This can be hard, but is an important aspect of the treatment.

Play therapy can produce long-term change. Children need a safe, comfortable, non-judgmental atmosphere if they are going to reveal their innermost selves. This is the most important part of the work and in this aspect is no different from what is needed for therapy patients of all ages.

I hope that this peek into a child therapist's office will make it easier for struggling parents to feel less trepidation in seeking out a child therapist if and when the need arises.




Originally published in Brooklyn Family/Special Child Nov 2013 edition















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Attachment research and how it has informed parenting and psychotherapy.

12/6/2012

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 In the last few decades there has been much intensive research on child development and attachment theory aided by the use of videotaping of the moment by moment interactions between mother and child. (see the work of Daniel Stern and Beatrice Beebe). Even at this very early stage in a child's life, the way a parent interacts and responds can have a profound effect on their child's development. Being very attuned to your child's emotional states and responding appropriately can help them to grow up with a feeling of security that their needs will be met and their feelings heeded.

 Ensuring this requires getting the balance right between being present and available to your child and knowing when to back off. Even infants need space to learn to self- regulate and manage their emotions. Too much stimulation causes their heart rate to increase and can result in their  turning away from you briefly to calm themselves down. The videotapes of the mothers and their infants show that this is not always easy for parents, who can feel dejected when their baby turns away from them. This is especially true for depressed mothers.

There is a burgeoning field of infant-mother therapy that has developed to work with new mothers who are struggling with depression and other difficulties.

 The research clearly shows, though, that learning to follow your child's cues is one of the most important things you can do for them starting when they are newborns.  You don't have to do it perfectly or all the time, but just enough for your baby to know and feel that you can read her. This results in the feeling of safety and security they need to grow.

To a large extent this is true of all the stages of your child's development. Being attuned to them, but not overbearing or intrusive is the stance that usually works best. This helps them learn to regulate and be in control of their feelings.

 More than teaching them facts and information, affect regulation is the most important skill they need. Sadly, the world is filled with people who do this poorly and who have learned to sooth themselves with food, drugs, alcohol and the myriad of things we know are available.

Knowing how to do this well can be hard for those whose own parents were unable to do it for them. This is one of the ways trauma is transmitted from generation to generation and gets passed down.  Parents who do not acknowledge to themselves how difficult their own childhoods were are especially prone to this. Therapy can be vital in these situations and can address  these issues. A helpful book to read on this topic is by Daniel Siegel,   Parenting From the Inside-Out.

Psychotherapy itself has been deeply influenced by this research. The relationship between the patient and the therapist is thought to be a mirror of the parent- child relationship with some of the same attachment issues involved. Therapists try to create an environment where the patient feels safe and secure in order to work through those issues that linger from childhood.

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    Psychotherapist with 20 years experience.

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