Child psychotherapy

Child psychotherapy combines many aspects of the integrative and transpersonal approaches I use - with three main adjustments.

First, the theories of child development I might consider when working with an adult are visible almost in real time with children.

Second, there is far less focus on talking with children, and more on play.

Third, we can usually include consideration from school and family life to support the process.

Whilst Freud’s psychosexual stages of development are somewhat outdated, the concept of a child needing to resolve various conflicts which can otherwise result in fixations still rings true today. Anecdotal comments such as ‘orally fixated’, ‘anal’ and ‘Oedipus complex’ build connections between a therapist’s possible clinical language and families’ understanding of their children’s behaviour. Theory makes reality and vice versa.

Winnicott also coined soundbites which encapsulate what therapists can evaluate through observations. The ‘good enough mother’ is actually the process of caregivers around the child recognising their changing needs, adapting to them, and managing a repair if there has been a rupture. Where this fails the child may develop a ‘false self’ which is unconsciously made to meet the caregiver’s needs, rather than the ‘true self’ of the child.

This touches on attunement, the prerequisite for attachment as described by Bowlby and Mahler. What we’re looking for here is a secure base. The child can go off and explore, or ‘practice’, and feel so seen, held and understood that their sense of safety becomes internal, not just reliant on the physical presence of the caregiver. This reinforces a positive sense of self that can emotionally regulate and build rewarding relationships.

This sense of adventure often plays out in myth as the hero’s journey. Hill describes the process of a child becoming an adult by inhabiting masculine and feminine polarities through fiery initiations. In layman’s terms this is a child growing up and leaving home, finding a career, starting a family and retiring gracefully. These developmental stages can be observed cyclically in the child’s behaviour but also played out by other family members. 

Other ways of observing a child’s developmental stages include play. Using sandtray therapy is excellent during as assessment with children, as well as helping them to integrate imbalances in their psyche during the therapeutic process. Symbols are used to show the themes coming up for children which can also be observed through their drawings or other artwork and interactions with board games, sports and musical instruments.

Use of the family can be really impactful, taking some of the focus away from the child and looking at the family as a complete unit. Minuchin introduced the practice of therapists becoming part of the family, effecting change from within. Seeing the family as a system, adjustments might include enacting stronger boundaries, better communication and reduced power hierarchies so that individuals function in harmony alone as well as together.

The last piece of the child psychotherapy puzzle includes input from their school. Children often behave differently away from the home environment, so it is really beneficial to speak with teachers at the school to hear any of their concerns and act as an advocate for the child, mediating between themselves, their home and school environments. Schools are also a very safe place to offer therapy sessions and enact systemic changes there as well.