Parent-Child Art Psychotherapy

Dafna Regev, Sharon Snir

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351745055
• Edition: 1
• Topic: Psicologia
• Subtopic: Psicoterapia

Parent-Child Art Psychotherapy presents a working model of ways to incorporate parents into a child's art therapy sessions, drawing on the relational-psychoanalytic notion of mentalization in the treatment of difficulties within childhood relationships. The model is introduced by clearly explaining the theory, the setting, the role of the therapist, and the work with the parents. In addition, the book offers a full section dedicated to practical applications of the model, replete with illustrative case studies and detailed therapeutic art-based interventions covering leadership, movement, collaborative and solitary work, and parent-child exercises. Intended for art therapists, students, parent-child psychotherapists, and other therapists interested in expanding their knowledge in the field, Regevand Snir provide a definition and conceptualization of a short-term treatment model with the potential to have comprehensive effects leading to positive change.

p.1

Part I

Fundamental Elements and Principles

p.3

1 Introduction to Parent-Child Art Psychotherapy

History of the Parent-Child Psychotherapy Approach

In the parent-child psychotherapy approach, both parent and child are present in the therapy room together, and the therapeutic process centers on their relationship. Today, the presence of a parent in the therapy room tends to be taken for granted, but this is a relatively new therapeutic development that has made emotional therapy with very young children possible. This approach is particularly important for children and toddlers who go through enormous developmental changes while acquiring new essential skills. Therapeutic change is thought to be more feasible in early childhood precisely because this is a period of developmental change. Teachers and therapists as well as developmental and educational psychologists all concur that early intervention for young children who are experiencing emotional, social, and functioning difficulties is crucial, and that this type of psychotherapy can lead to change. This may explain why growing numbers of therapists are engaging in parent-child psychotherapy with older children as well, particularly when a specific client can benefit developmentally from this approach.

This chapter summarizes the major milestones in parent-child psychotherapy. For many years, it was believed that psychotherapy for children should be based on the same conventional therapeutic techniques used for adults. These techniques included awareness of object relations, identifications, transference, and interpersonal features. Melanie Klein (1932), who addressed the issue of psychotherapy with children, and Anna Freud (1928) both believed that children could not be given the same treatment as adults because the child’s ego is not sufficiently developed, objects have not yet been fully internalized, and their awareness and realistic view of the world are limited (Stern, 2005). Gradually, techniques have been developed that consider and relate to children’s processes of emotional development, while recognizing their abilities and play activities as crucial therapeutic factors for emotional health (Albon, 2001).

Over the years, the systemic approach has become increasingly recognized. The field of emotional therapy now relies less on intrapsychic psychology, and more on intersubjective psychology, while emphasizing the importance of interpersonal relationships as a key element in the development of emotional well-being (Aron, 2013). The prevailing therapeutic approaches for children were heavily criticized for their lack of attention to the concrete family in the therapy room. Their absence hindered the disclosure of important information about family relationships and communication and the possibility of creating change (e.g., Minuchin, 2007). Child psychotherapy gained ground when initial studies showed that the family unit is crucial to the child and must be addressed during the observation and therapeutic process (Bateson, Jackson, Haley, & Weakland, 1956; Bowen, 1959). The importance of the parent-child relationship to child development and well-being has been emphasized by various theorists (Bowlby, 1979; Klein, 1975; Mahler, Pine, & Bergman, 1975; Stern, 1995; Winnicott, 1971). Together, they all attribute considerable significance to the relationship between the child and the parents in general, and in particular the relationship with the mother. Object relations theory posits that the building blocks of an individual’s personality, development, and mental health are closely linked to the infant’s relationships with both the caregiving figure and parents (Klein, 1975; Mahler et al., 1975; Winnicott, 1971). It is argued that patterns of attachment with the mother figure influence the child’s self-perception and perception of others, and thus shape the child’s future relationships with others (Bowlby, 1979; Bretherton, 1990; Stern, 2004; Winnicott, 1971). In recent decades, a new school of research and clinical work has emerged that aims to develop innovative therapeutic models that incorporate the parent into the therapeutic process. These include family therapy and parent-child psychotherapy, which both relate to the needs of the parents as well.

p.4

Parent-child psychotherapy is a psychodynamic approach derived from the intersubjective school that views the individual as developing and growing within and through relationships with others. This approach is based on object relations theory, which deals with the early growth of the self in relationships with others (Segal, 1977; Winnicott, 1971), as well as Bowlby’s attachment theory (Bretherton, 1992). It focuses on sub-family relationships to treat disorders in relationships in the pre-latency period (Stern, 2005). Whereas individual therapy often makes an analogy between the parent-child and the therapist-client relationship (Fonagy & Target, 1998), in parent-child psychotherapy, the focus shifts from transferred relationships from the past to processing the object relations in the present (Kaplan, Harel, & Avimeir-Patt, 2010). There are many parent-child psychotherapy approaches, each with a slightly different emphasis on the role of the therapist. However, all their therapeutic goals have to do with the relationship between parent and child (Harel, Kaplan, Avimeir-Patt, & Ben-Aaron, 2006; Kaplan et al., 2010; Lieberman, 2004; McDonough, 2000; Muir, 1992). All forms of parent-child psychotherapy require at least one parent, and from time to time both parents, in the therapy room.

p.5

The Haifa Parent-Child Psychotherapy Model

Most therapists in Israel who work according to the parent-child approach have adopted the Haifa model, which was developed by the late Miriam Ben-Aaron and colleagues (Ben-Aaron, Harel, Kaplan, & Patt, 2001; Harel et al., 2006; Kaplan et al., 2010). The Haifa model is based on the concept of mentalization, as defined by the psychoanalytic-relational school (Fonagy, Steele, Moran, Steele, & Higgit, 1991; Fonagy & Target, 1997; Fonagy, Gergely, & Target, 2007) to treat difficulties in childhood relationships. The key concepts of the Haifa model are explained in detail below.

Internal Representations

Object relations theory posits that the numerous interactions that individuals experience during their lifetime with significant others are stored as abstract representations in memory (Stern, 1985). These representations, which are a composite of countless interactions, contain information about who the person is in the relationship (self-representation). For example, am I of value? Am I worthy of love? Am I competent? They contain general information about other people and what characterizes them (representation of other). For example, can I rely on others? Do they have the strength to change things? Are they empathetic toward me? Internal representations are used as a script or scenario on which to base expectations of relationships with others, and also include information about relationships, and the routes and strategies to achieve intimacy and love, as well as independence and autonomy (Bretherton, 2005; Bretherton & Munholland, 2008). People differ in their representations of their relationships because they have different relational histories. Some have learned that the best way to get close to their mothers is to call out and express a need for her presence. Other individuals have learned that their mother will only respond after they have cried for a long period of time. Yet others know that their mother will only let them stay close if they are quiet and do not bother her with their problems, distress, or wishes. All this information is stored in what is referred to as the “internal representations” by object relations theory.

Throughout our lives and as a function of our experiences, we develop a hierarchy of representations that distinguish between types of relationships. During a new interaction, we elicit the appropriate representation to know what we can expect from ourselves, from others and from the relationship with others, and also to identify the best course of action to take in order to achieve our objectives. One of the representations that we develop during our lives is the parental representation. Parental representations are representations in memory of conscious and unconscious content that include perceptions, fantasies, hopes, fears, and expectations (Araneda, Santelices, & Farkas, 2010; Ilicali & Fisek, 2004) regarding parental roles. These include information about the relationship of the parent with the child, the way parents perceive themselves in their parental role, and the way they perceive their child (Slade & Cohen, 1996). Parental representations are created through early memories of the experiences of the relationship that parents had with their primary caregivers, and are the result of the parents’ internalization, organizing, and acceptance of the relationship with and treatment by their parents or alternative primary caregivers (Dayton, Levendosky, Davidson, & Bogat, 2010).

p.6

Internal representations are typically hidden and concealed (Fonagy, 2001), and we often activate them without realizing it. During an interaction between a child and parent in parent-child psychotherapy, these representations are activated and become rekindled in a way that allows for observation and mental processing. The child activates the developing representation of the relationship with his or her parents and with others, and the parent activates the parental representations that emerge during interactions with their child. These representations are heavily influenced by the parents’ past experiences, and they affect the way the parent responds to the child. Thus, in the clinic, parents are often affected by their parental representations to such an extent that it makes it difficult for them to see their actual child, and hinders their ability to adequately tend to their child’s unique need for support (Kaplan et al., 2010). For example, a mother who had a very symbiotic relationship with her mother for many years may have problems acknowledging that she is recreating a similar relationship with her daughter. The parent-child psychotherapist plays an important role when working with these representations. For this reason, Kaplan et al. (2010) defined the goal of parent-child psychotherapy as follows:

The goal is to encourage changes in the experiences of the parent and the child, as well as in their characteristic patterns of interaction that are based on the existing representations. The changes in these interactions lead to changes in representations, and therefore the goal is twofold, changing both the actual behavior, as well as the representation of the self, the other and the relationship. (p. 34)

Mentalization

Another key concept underlying parent-child psychotherapy is “mentalization.” Fonagy and colleagues (Fonagy et al., 1991) defined mentalization, or the reflective function, as the ability to understand the behavior of the self and others in terms of mental states (thoughts, feelings, beliefs, desires, and strategies). In practice, mentalization connects cognitive and emotional components to know the self and others. The reflective function develops within a secure relationship, when the parents help their children think about experiences, and this teaches the children to understand their individual emotions. For example, many parents are familiar with the situation in which a child does not go to bed on time (let’s assume due to a family event). The child becomes irritable, angry, and whiny in an atypical manner. The reflective ability of the parent to understand the child’s experience and predicament, and in view of the undesirable behavior, helps the parent direct the child in a way that can resolve the problem (e.g., speeding up the ritual, and by starting the process earlier in the future). This helps the child understand his or her inner feelings: “I am not a bad child, or a problematic child. I am a tired child.” As part of development, children acquire an understanding about mentalization processes from their parents. However, occasionally the child experiences a difficulty, or the parent responds to the child via parental representations, or there are communication problems. In these circumstances, the parent may not be able to activate reflective thinking to understand the reason for the child’s behavior (the parent may feel overwhelmed or identify with the behavior). In such cases, this ability is blocked. For example, a parent who suffered extreme social rejection during childhood and could have a self-representation of an individual of no value as a result, may lack the ability to make connections, and hence view the outside world as isolated. This parent will find it hard to help his or her child to understand experiences and cope with them, particularly when the child experiences rejection. In such a case, the child may have trouble understanding how to cope with a situation and struggle to mentalize and think of the self and others in different contexts.

p.7

In parent-child psychotherapy, mentalization serves as both the goal and the method behind the therapeutic process. The aim is to reach a state in which both the parent and the child (depending on the age and stage of development) are capable of being involved in the process of mentalization, and understand the actions and motivations of the parent-child relationship. The therapist helps the parent and the child through this learning curve by engaging in and practicing reflective abilities during therapy sessions (Kaplan et al., 2010). For instance, in the example above, once the parent is able to engage in a mentalization process of the rejection experienced during childhood while participating in parental training, he or she may gradually become more attentive and available to the child and think reflectively together about social events that the child has experienced.

The Haifa Parent-Child Psychotherapy Model in Clinical Practice

Self-representation and mentalization are crucial features of the Haifa parent-child psychotherapy model. This model acknowledges the complexity of parenting and the processes of change that parents often experience (Cohen, 2007). It helps gain a deeper understanding of the dynamics of intergenerational transference of psycho-pathological parental representations and ways to prevent such processes. The intergenerational transference of patterns of behavior, including neglect and abuse and the prevention of such behaviors, are built into the model through the concepts of attachment, maternal sensitivity, mentalization, and the ability to self-regulate (Fonagy, Gergely, Jurist, & Target, 2002). The model assumes that children develop a unique relationship with each parent, and that they need the active participation of both parents in their lives (Kaplan et al., 2010). When working within this model, the therapeutic setting includes weekly meetings with the same therapist and alternating mother-child and father-child sessions. Every two or three weeks, the therapist meets with both parents without the child for parent training purposes. During the sessions when the child is present, the therapist can observe how the main themes that characterize the parent-child relationship are recreated in the therapy room. Through play and dialogue, children often show parents how they need their support. The parents and child work to build new patterns in the...