Therapy with Children

An Existential Perspective

Chris Scalzo

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781855757301
• eBook ISBN: 9780429922923
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book explores the existential themes and challenges present in all therapeutic relationships when working with children. Existential ideas and concepts are a rapidly growing influence on the practice of psychotherapy and yet their application to work with children remains largely unexplored. This book begins to redress this imbalance in a practical and engaging way by presenting an existential perspective on some key themes in practicing psychotherapy with children, including: play, anxiety, guilt, choice, family relationships, language and process. Each chapter is punctuated with engaging vignettes of case material, blending theoretical insight with the realities of practice. Through these narratives readers are challenged to question their own assumptions and beliefs whether they are new to existential psychotherapy or already immersed in its rich philosophical traditions. Children are born into the world without choice and are drawn towards making connections with others, developing self-awareness and personal identity.

CHAPTER ONE
Questioning and assumptions

“The real is a closely woven fabric . .. Perception is not a science of the world, it is not even an act, a deliberate taking up of a position; it is the background from which all acts stand out, and is presupposed by them”

(Merleau-Ponty, 2002, p. xi)

“Science manipulates things and gives up living in them. It makes its own limited models of things; operating upon these indices or variables to effect whatever transformations are permitted by their definition, it comes face to face with the real world only at rare intervals”

(Merleau-Ponty, 1992, p. 159)

Much psychotherapy practised with children today seeks to objectify. Attempts to interpret what happens in a therapeutic relationship effectively close down possibilities and narrow the dialogue created towards a sense of “truth”. Existential psychotherapy does not do this. It aims to understand, not interpret. It does not seek an objective truth, or a quality of essential truth—a truth of essence. Instead, it uses the discourse of phenomenology to create awareness, and possibility. Analysis, as Heidegger tells us (in the “Zollikon Seminars”, Heidegger, 2001), is rooted in a definition of “breaking free”, not restricting, and it is the child who can be offered an opportunity to break free of, or transcend, their (family) history to become an individual. This is not an easy task, and not always immediately desirable by the family and professionals alike, but it is, I believe, the responsibility of the therapist to work towards this process.

The existential psychotherapist, Hans Cohn, wrote about the need for psychotherapy to break free and create possibilities when discussing the concept of hermeneutic understanding;

We can see that Schleiermacher’s view of interpretation as “understanding” gives the concept a range of meaning considerably wider than when used by most psychotherapists. Psychodynamic interpretation is, as a rule, the discovery of the “latent” meaning behind the “manifest” content of an utterance or symptoms, whereby what “appears” is considered only a disguise for what is “real”. [Cohn, 2005, p. 222]

The conventional psychodynamic therapy to which Cohn refers here has historically drawn psychotherapy towards a place alongside natural science. The predominating trend within the British National Health Service, and perhaps more widely in society, too, is for psychotherapy and, indeed, all “talking therapies” to become more quantifiable, moving towards an objectification and medicalization of psychotherapy. Natural science in itself carries out useful and helpful work. Recent developments have pushed not only modern medicine, but science in general, into new and exciting fields of neurology, and, by and large, a greater understanding of the world around us. Difficulties arise, however, when science tries to impinge on areas beyond objectification, such as what it means to be human—to be. Being is not a science.

Objectivity

Being, as Heidegger tells us, is a matter of coping with the world: being able to get around, and manage with day-to-day life. It is about how we understand the world, and we cannot step outside of our being in order to better understand it. We are simply unable, as living human beings, to step outside ourselves and observe what it means to be. In short, I cannot take leave of my consciousness in order to objectively reason what life actually is. I always have a certain perspective. Yet, through so much psychotherapy and psychological practice, people search for truths, for definitive systems, or ways to define what is “truly” happening for their client or patient. With children, this temptation seems to be even greater. Children, it seems, are categorized and objectified even further than adults. This is done by age, academic ability, medical diagnosis, behaviour, etc. Fundamentally, however, from an existential position, nothing changes. Children are still beings, actively coping with the world, trying to find their way about in the world, and with the same parameters and existential givens we must all live with.

Existential psychotherapy aims to create a discourse between child and therapist. It highlights how the existence of every one of us as living beings is defined by our choices and actions, our restrictions and our freedoms, and, at the same time, it is inescapably linked and co-defined by our relationship to the world. When a therapist arrives at a session to see and meet with a child, both parties are informed by their history and their context. The interaction is understood and interpreted by, and through, their own experiences. Certain core components of existential psychotherapy begin to emerge from this understanding of the dialogue between psychotherapist and child: experience, awareness, choice, and responsibility. When we are considering what it means to “Be”, the answer is somehow revealed in our everyday existence. An answer cannot be found by thinking deep philosophical thoughts about how people came to exist, or why we are here, but, instead, the answer is revealed in our daily life. This notion of living, or “doing”, is crucial in existential therapy. In the therapeutic context, this simply means that the therapist does not need to sit with a child or adult discussing their philosophical identity. Instead, an understanding of their world-view will be revealed through exploring their relationships with others and, in a broader sense, the world. This “dialogue” about how the child relates with others could be revealed through play, narrative, games, and so on, but, importantly, it is their creation of dialogue with the therapist that is most disclosive.

Choice

Through their very existence, children, like adults, are defined by an active, deliberate process of activity: thinking, choosing, deliberating, acting, feeling, and even writing. When writing this book, I am making a series of choices all the time. I am making choices in an immediate sense every moment I live, and I am also making choices that provide the parameters and boundaries for the overall context in which the momentary decisions I face present themselves. For example, I have chosen to sit in my office and not play with my children or watch television: this is not, in itself, a decision about what I will be writing, but it creates a context for writing. Both context and choice are paramount for existential psychotherapy with children. Within existential thought, the importance of making (indeed, having to make) choices in our life is twofold. The first important aspect we must recognize is in defining who we are. To be human is not to be a defined, individual self, with a mysterious inner world and set characteristics. Instead, we are always an action, a choice if you will, relating to the world in which we live. The second notion, to which it is important to attend, is the experience of guilt that may arise from the choices we make. While we are always making certain choices in our daily lives, even if these are not acknowledged, there are always, by definition, options and choices that are not chosen. This guilt is, therefore, not the same sensation as feeling guilty about something (for example, I could have tried harder in that exam), but it is, instead, an existential guilt; rather, it defines our existence. Through psychotherapy, it is possible to understand our inherent inability in life to obtain completeness and acknowledge our inevitable shortcomings by not realizing every possibility we face. For children, this can come through exploration of the possibilities they face but often fail to reflect upon.

For change to occur through therapeutic exploration, there must still exist a motivation to make it happen. When working with a child, it is possible to encourage reflection and awareness of their circumstances, and, hence, the choices they are making. Subsequently, it is also possible to offer options, different ways of being, therefore presenting them with choices. The timid, withdrawn child, who struggles to socialize with his peers, may be able to develop enough trust in the therapeutic space or relationship to become more playful and less boundaried. In turn, this relaxation of guarded and defensive behaviour allows them to develop new experiences and confront possible fearful alternatives. Perhaps the greatest challenge, however, is not in grasping these optional choices wholeheartedly, but of encouraging the realization that choices exist. When, often, destructive behaviours appear as “compulsive” habits, they are simply reactionary choices upon which there has been little or no reflection. We could say they are pre-reflective behaviours. These may include aggressive behaviour, over-eating, excessive drinking or drug taking, and many more. It is also important to emphasize, however, that these behaviours could still be the repercussions of reflective choices (depending on circumstances). In order to address this behaviour, it is vital to focus on the here-and-now quality of the relationship in therapy with a child. This exploration presents experiences illustrative of the child’s experiences of the world, and will allow them to focus on reassuming responsibility, for, once they are responsible for what has gone wrong, then they can also assume responsibility for rectifying it (Yalom, 2008).

Choosing psychotherapy

The first step of any journey is making the decision to take the trip. In therapy, this decision comes, for client and therapist, right at the start of their journey together. Prior to the first session, there is a point at which a client decides to make a disruption to their world: a decision to change or shake up what has become familiar or accepted. To begin a therapeutic journey, a decision has to be made by the client to put themselves in a position for something new to happen. In basic terms, when something has become stuck or difficult to manage, whether this is brought to the fore by someone they know or someone they have never met, there is still always a decision for that person either to engage in a therapeutic process, their journey, or to choose not to. Even when the client is compelled to sit in front of a therapist by a person in authority, there is ultimately a choice as to how that person chooses to engage. Whether people are referred to me by their doctor, or whether their partner metaphorically drags them to a session, how they choose to engage with me is their choice, and, ultimately, theirs alone. They can really choose to explore their understanding of the world, to engage fully in a new relationship, or they may choose simply to attend.

For children, the choice to attend therapy is rarely their own. Even when a child may express a desire to attend sessions to see someone they understand to be a counsellor or psychotherapist, or the man who makes you “well in the head”, unless they are deemed mature enough to make an informed choice about their subsequent “treatment”, a responsible adult must consent on their behalf. How, then, can working with children ever be truly therapeutic? How can children ever take the first step on that journey themselves? Each time a child attends a session on a particular day, they are confronted with a choice: how much of their emotional world and experiences will they choose to reveal or expose, and how much will they buy in to this new and novel relationship? Regardless of age, these choices are always present.

What is this therapeutic relationship? How do we know if it is something to which both therapist and child are committed? What brings a child to a therapeutic relationship, and how can this be understood?

Daniel

Daniel was seven years old when first referred to me by a community paediatrician. He was wetting the bed and suffered what were described as “night terrors” by his parents. His behaviour at school was becoming hard for his teachers to manage; he was frequently violent towards his peers, and he had been excluded from school on several occasions. When I met his parents for the first time, Daniel had been asked to attend school only during the morning, and his parents felt that his actions were placing unmanageable levels of stress on all the family relationships. During this first meeting with Daniel’s parents, they described how his behaviour had always been difficult, and his father added that he would never have been able to behave as Daniel did during his own childhood.

As they continued to describe their situation, they began to reveal certain inconsistencies in their approach to parenting: his father was very authoritative and emotionally “cut off” from his son, saying quite candidly that he found it hard to love him; and, as if to compensate for this, his mother was overwhelmingly affectionate towards him, and, through her guilt, found it hard to put in any appropriate boundaries or discipline. The more he misbehaved, the harder it became for his father to feel close to him, and their relationship was on an accelerating downward spiral.

Daniel also had a younger sister, four years of age, who appeared to be favoured in differing ways by both parents, although particularly by Daniel’s father. It was clearly noticeable that Daniel had been the less favoured child in the family for much of his life. The father would spend much more time playing with Daniel’s sister, and was always affectionate and tactile towards her, allowing her to sit upon his lap and cuddle up to him whenever she chose. At home, she shared the parent’s bedroom, while Daniel slept separately, in his own room. When I first saw Daniel and his father together, they shared absolutely no physical contact throughout the entire fifty-minute session, despite being given many opportunities to display affection.

At home, Daniel had begun to enact more and more resentment towards his sister, and had started to refuse to use the same cutlery and crockery as her to eat from. He still wanted to play with her, but had become outwardly possessive of his own toys and did not want her to touch them.

After agreeing to work with Daniel, I started seeing him alone for weekly sessions, but it soon became clear his father’s presence would also be beneficial. When I collected Daniel from the waiting area, he was always keen and enthusiastic about attending, and frequently ran the short distance to the room for our session. It was noticeable, however, that when his father also attended, he would still run to the room, but then stop before entering, choosing instead to hide under a table. Initially, I asked if he wished for me to invite him into the room, but he was quite clear that he wanted his father to do this. He said he would come straight into the room if his father invited him in, and, true to his word, when his father asked him to come in, he did. Each week, this scenario became an established ritual, and each week, his father would have to make the same request, for him to come into the room.

When we reflected on this situation, Daniel’s father said that he felt highly embarrassed by Daniel’s behaviour, clearly expecting me to be disappointed in some way by his actions. For his part, Daniel showed his appreciation of his father by increasingly encouraging him into his play. At first, Daniel chose not to speak to his father directly, but instead he acted out any responses to his questions through a silent mime. This, again, was a regular occurrence in each session, but later became increasingly playful. It was not long before both Daniel and his father smiled and laughed at each mime performed. Despite the challenges they both felt in allowing themselves to engage in a new and different way, it was not long before Daniel’s father was an integral part of all of their narrative and creative play.

The choices Daniel made in attending and engaging were vitally important to how he used the time. It seemed that he was very pleased to have the opportunity to come to our sessions himself, but that his father’s attendance (despite being something we had explored together) set a different context for his decision making. Their past and outside experiences together where somehow very present. The significance of wanting to be invited into the room by his father was revealing of their relationship beyond our sessions. I felt strongly that Daniel had a desire to be “invited into the family” in some way, and the opportunity to express that was valuable. This brief example illustrates how the choice to attend therapeutic sessions is present for even very young children, and shows how the challenges in truly deciding to engage in a relationship are equally strong for both adults and children. It was not necessary to look for a hidden meaning behind Daniel’s actions and behaviours. The opportunity was simply created for the disclosure of possibilities in the relationship to be revealed. It was important to view Daniel’s relationship with his father as setting part of the context for their possibilities, and, at the same time, to be circumspect as to how these choices became evident. Daniel created choices both for himself, through his own awareness, and for his father. If my focus was purely on interpretation of their actions, it would be drawing me away from what was being shown.

CHAPTER TWO
A theory of existential practice with children

“Theoretical behaviour is just looking, without circumspection”

(Heidegger, 2000, p. 99)

Before considering how a theory of existential psychotherapy with children would look, it is first necessary to consider how appropriate it would be to develop an all-encompassing theory of “existential child psychotherapy”.

Circumspection means to look around. This seems to be completely opposed to theory, which looks in one direction. In examining theory, the reader is looking for something, categorizing it, and jumping ahead of the text they are actually reading. A theory is formulated and examined in much the same way as a calculation. A calculation employs a process, which is already determined in some manner, since it must obey a pre-existing set of mathematical rules. We cannot, for example, decide to multiply in a new and original way. If a psychotherapist or counsellor aims to be truly open to the presentation of a child, then a theory must not be at the forefront of the engagement. If the therap...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• Dedication
• PREFACE
• CHAPTER ONE Questioning and assumptions
• CHAPTER TWO A theory of existential practice with children
• CHAPTER THREE The process of child therapy
• CHAPTER FOUR Play
• CHAPTER FIVE Family and method
• CHAPTER SIX Family and context
• CHAPTER SEVEN Existential psychotherapy and psychoanalysis
• CHAPTER EIGHT Existential phenomenology
• CHAPTER NINE Knowing and not knowing: existential perspectives on truth
• CHAPTER TEN Language
• CHAPTER ELEVEN Authenticity and anxiety
• Conclusion
• REFERENCES
• INDEX