The Child Patient and the Therapeutic Process

This book examines the treatment of young children from the perspective of the therapist's clinical decisions. How does the therapist know what to do at any given moment in a session? What processes of synthesis and integration allow the therapist to choose interventions that transform the relationship between adult and child into a treatment relationship? How does the child therapist balance working with the child and working with the child's parents?
This book is the narrative of a case as presented in supervision. Every week the therapist recounts her sessions with her young patient, a girl of six named Cleo, who is suffering from intense fear. The fear is invasive and unrelenting and the little girl is engaged in a desperate struggle to master it, but she fails over and over again. She cannot repress her terrifying fantasies. As Cleo plays during her sessions, we are witness to the derivatives of the fearsome fantasies and to her depleting and often futile struggle to find some measure of comfort. What is the therapist's role in this situation? How does the therapist enter this chaotic and emotionally draining zone and begin the work of treatment? The reader joins the supervisory sessions and follows the unfolding story of the treatment process. Each session is discussed in detail as therapist and supervisor work together to make the elusive and fragmented nature of the sessions technically usable. Much thought is given to trying to understand the possible origin and nature of the developmental forces that caused Cleo's emotional distress. The recurring themes of her sessions are extracted from the often confusing material and discussed with the goal of arriving at treatment principles - principles that could help Cleo deflect the force of her frightening fantasies. The supervisory process guides the treatment process by providing an affective and organizing anchoring. Everything is examined. What toys and why? Food in sessions? Frequency of sessions? Can the child's drawings be taken home? Presents? Confidentiality with children? Work with parents? Vacations? All that is particular to Cleo and all that can be generalized has the common foundation of classical psychoanalytic theory, enriched and expanded by developmental and object relations theory.
Throughout these chapters, the theoretical framework remains the fundamental gauge and guide - the compass of the treatment. The therapist's growing ability to harness the richness and organization it provides is shared with the reader.