Book review: Child psychotherapy

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Publication Title:  Key Papers from the Journal of Child Psychotherapy
Publication Author:  Paul S Barrows (Editor)
Publisher, year of publication: Brunner-Routledge, 2004.

For a therapist working with children with varying degrees of disorder, it is sometimes difficult to engage children in cognitive work, even with the use of cognitive play techniques. In addition, some of the children we work with are emotionally damaged to the point that it is extremely difficult to draw out their emotional experience from their deeply protected selves. Therefore, I decided to explore some of the traditional child psychotherapy literature to see what I could find that might broaden my repertoire of therapeutic skills with children. I was delighted to receive this book to review, as it gave me the opportunity to do that work.
The Journal of Child Psychotherapy began in 1963 and is the world leader in its field, and the papers chosen for inclusion in this book are intended to provide access to “some of the key child psychotherapy texts” (preface). The book is divided into three parts: Mainly Theory, Mainly Clinical and Mainly Applied. I found the first and the last parts most useful, as the case material in the Mainly Clinical section sometimes contained interpretations that I found difficult to relate to.
My overall experience was one of finding very valuable ideas mixed with very strange ideas, although I have no doubt that the strangeness was associated with my theoretical training not being psychoanalytic. For example, in the first chapter, The Absent Object, by Edna O’Shaughnessy, there was great material about the child’s developmental need to tolerate frustration at not getting immediate gratification; the experience of coming to terms with the alternate presence and absence of the therapist; and the ultimate ability to feel comfortable with separation from the mother. However, this is interspersed with case material that I found difficult to integrate into my therapeutic framework. In an analysis with a 12-year old boy, the therapist said to him in response to a drawing, “Your drawing pictures your inside. You feel you’ve got me inside as a breast with your volcano in it – this is now burning you up in the middle. You feel you mustn’t let these burning gases get out your other side – but all the same, you feel they are leaking out in the smells from your anus” (p 17). This interpretation was made in spite of the fact that the boy had not mentioned the words “inside”, “breast”, “smells”, or “anus”. 
I found the chapters on transference, counter-transference, and projection and externalisation clarified these sometimes complex concepts very well, and gave me insights into my work with children and adults alike. For example, generalisation refers to a mode of functioning that involves the child attributing his own beliefs, intentions and emotions to others. This mode of functioning is similar to a child who hasn’t developed a theory of mind yet, but may also be characteristic of personality disorder. Externalisation involves any process that involves the child allocating inner phenomena to the outer world in order to cope with unpleasant emotions. For example, the child who fails at some task feels humiliation, and so externalises that humiliating aspect of himself by insisting that a toy, or a younger sibling, is the one who is failing. This certainly makes sense of the teasing or blame that goes on between siblings, and the destructive behaviour of children who are struggling to accomplish their developmental tasks. Similarly, I can see this happening when the mother accuses the ex-partner of being a bad father to get rid of the suspicion that she may be a bad mother. Projection, on the other hand, is a defence against a destructive impulse that allows the allocation of the child’s intention to another person to reduce his anxiety about having such a bad impulse. For example, the adolescent who is angry and frustrated at her parent may say, “My mum hates me” when, in fact, she is feeling terribly guilty about feeling hate for her mother. In the clinical setting, the child’s emotional reaction to each of these is different, with anxiety following projection (given that there is the possibility that the projection could be accurate, e.g., “my mum hates me”), and a reduction in anxiety following externalisation (given that there may be little fit between the externalised aspect and reality, e.g., saying “my baby brother can’t read so he’s stupid” to the therapist).
The chapter by Isca Salzberger-Wittenberg provided great insights into the nature of the ‘helping relationship’ in any setting – therapy, supervision or training – and the relationship dynamics in mental health teams. In particular, there is a need for the helper to demonstrate over and over that she is strong enough to contain the helpee’s most powerful emotions so that the helpee can safely experience those emotions without fear of harming the helper. In contrast, the chapter on adolescent development seemed to concentrate particularly on grief and mourning for the lost “internalised objects of fantasy and childhood” (p 122) rather than the progressive developmental tasks of differentiation and identity formation. In this it seemed a little unbalanced. I could say more about other chapters, but space restrictions demand that I stop here.
Overall, I was left with regret that, in the current therapeutic climate, we do not have the opportunity to explore the wonderfully intricate workings of the developing human psyche to anything other than a superficial extent. I enjoyed many parts of this book and recommend it to all, irrespective of whether they are working with children or adults.

Reviewer: Fran Vertue
Review date: 2007




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