Stories from Child & Adolescent Psychotherapy

A Curious Space

Henry Kronengold

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317431008
• Edition: 1
• Topic: Psychologie
• Subtopic: Histoire et théorie en psychologie

In Stories from Child & Adolescent Psychotherapy author Henry Kronengold explores the unpredictable world of child and adolescent psychotherapy through a series of engaging and innovative clinical vignettes. The ups, downs, and dilemmas of therapeutic work are considered in each realistic narrative as readers are offered a unique view of what happens between the therapist and child, as well as the therapist's own process during the therapy. This captivating new resource is intended to spark a conversation within the reader, regardless of professional experience, regarding which therapeutic factors are ultimately most helpful to children and adolescents.

1 Introduction

A Curious Space

In the middle of a session, many years ago, a ten-year-old boy looked at me as we tossed a ball back and forth. He hesitated for a moment before asking me, “what are we doing?” as he wondered how therapy helped him. He surprised me that day with his question, but in truth, he was only echoing what I often ask myself. I see children and teenagers of various ages and challenges and I play and talk with them. I meet with parents, teachers, and anyone else who may prove helpful to a child’s development. I’m confident that I can help children and their families. At the same time, I often wonder about what helps in therapy. What actually happens between a therapist and children that allows for progress and healing?

“What are we doing?” This question is central to how I came to write this book. At some point I decided that while I’d continue searching for answers, I’d also embrace the question and its openness about child work. This is a book of case studies, or what I prefer to see as short stories, detailing my work and the therapeutic relationships I developed with six different children and adolescents.

These stories focus on the therapeutic process, and include many of the uncomfortable moments that occur in therapy. The therapy stories I chose to tell are not the ones with the best outcomes, nor are they in truth, the worst. Rather, they are therapies that have left me wondering about the critical factors that are helpful in working with children. Each of these children challenged me to think about crucial aspects of the therapeutic process. To what extent do we follow a child’s lead? To what extent do we encourage a child to handle a challenge when it provokes discomfort? At what point do we consider a child’s repetitive play or behavior a problem in therapy? Must the therapist have a clear idea of what is happening in a particular therapy in order to help a child? What about the role of banter and humor? Sports? Winning and losing? To what extent does the therapist’s own presence play a critical role in the work? How much is therapy co-created between therapist and child? How do we handle endings, being paid, or myriad personal questions headed in our direction?

These are some of the questions that I consider and which I think resonate for most child therapists. Each child is different and while there is a similar style underlying how I worked with these children, I also chose different paths in each of the cases. At times, my approaches may seem contradictory, which speaks to my own belief that rather than following one particular orientation, we need to consider the individual needs of each child and tailor our therapeutic approach appropriately. Of course I have my biases as to what is important in therapy, and I am quite sure they are reflected in these vignettes. Much of my work and training flows from psychoanalytic, humanistic, and developmental traditions, and their emphasis on the importance of play in child development and therapy. That said, I also utilize cognitive, behavioral, family systems, and sensorimotor approaches in my work. My hope is that these cases are sufficiently roomy so that any reader who is curious about therapeutic work with children will find these stories relatable and stimulating.

I freely admit to my focus on the importance of the therapeutic relationship, to the underlying meaning of what happens in a therapy session, and to the spirit of curiosity and adventure that I think are crucial to working with children. There is a sense of fun and playfulness in these sessions, even amidst the most poignant and difficult of moments. There is a wondering about the therapeutic process that stems from the experience and appreciation of the complicated lives and developmental paths of the young people who enter our offices or playrooms. The more I work, the more complexity I find as to what is and isn’t helpful to children. It is enticing to read a book or manual that seems to hold all the answers. If only it were that easy.

A quote from Antonino Ferro (1999) comes to mind when thinking about the individuality and complexity of children. He discusses a young girl, Francesca, who drew pictures in his office of a forest, called the wood. Ferro talks of looking at Francesca’s drawing and holding back from prematurely determining its meaning so that he can come closer to the child’s point of view.

Once I loosen the ties to my theoretical referents, I begin to sense the risk of getting lost. “Weak” models expose us to the fear of thinking and finding ourselves alone in the wood, whereas “strong” models would make us feel safe, but they would allow us to see in the wood only what the models themselves had already prefigured.

(p. 27)

I offer Ferro’s quote as an introduction to these stories and an invitation to take in and consider the different children whom I will discuss. I invite the reader with me into the therapeutic space. I invite the reader to wonder and to be curious with me. To get a little lost in considering what may happen in a particular therapy. Once we allow ourselves to get lost, we also allow ourselves to jump into a child’s world, a central attitude that underlies my attempts to help each of the children in this book. By necessity, we may not always know what we are doing, as jumping into someone else’s world necessitates a certain discomfort and suspension of knowledge. The feeling is uncomfortable, and the rush of trying to find one’s bearings can lead to much confusion or to a desire to quickly structure the therapy in a way that is predictable and comfortable.

It is critical to genuinely play, to join a child and sometimes get lost, as a co-player, with that child in his or her world. Entering a child’s world and seeking to understand a child means that the therapist walks with a sense of purpose and playfulness, but also humility that comes from trying to understand another person and realizing that there is much to learn in the process. This very experience is powerful and therapeutic, whether the therapist engages in the child’s world through play, art, talking, or whatever medium the child uses in his or her experience. If the child plays baseball, then the therapist can become a baseball player. If she or he draws, then the therapist may become an artist, and if the child enjoys puppets, then by all means, one can grab a puppet and create characters with the child, developing a shared and imaginative space that drives a treatment. It is also important to note that if a child approaches the world mostly by talking, then one can engage a child verbally in that same sense of discovery.

There are children whose play enters a fantastical world, and such play can be rich and great fun. But the wonder and discovery of play can just as easily be grounded in play that mimics reality, such as a board game, active physical play, or verbal back and forth. To the extent that each child creates his or her world in a different way, it is our job to enter into it, without preconceived notions of what or how that world should be. But, again, not to just follow along, but to jump in, so that like any good playmate or partner, we co-create narratives, develop an engaged relationship, and hold onto affective experiences that help a child move forward developmentally.

I can think of older children who rely on metaphor and younger children who work best with a verbal model of therapy. The difference is how each child experiences and approaches the world. To me, the question is how we consider our therapeutic work in light of a given child’s different tendencies, so that we make room for that child’s dynamically evolving approach to the world in the space of our therapy room. It is important to consider how this therapeutic space is co-created by two people, the child and the therapist, and that the therapist brings his or her own proclivities and tendencies to the relationship. I happen to enjoy sports, Lego, and in the form of back and forth banter, engage children with humor. Though I enjoy art, I happen to be a truly awful artist. Sadly, this lack of skill can impact my sessions as well. The idea is that each therapist I think needs to consider how she or he can best connect to a child, while being respectful of the child and honest about the therapist’s own preferred way of working. It is our connection with a child that underlies so much of what we do in therapy. There is an old tale that has stayed with me since I first heard it long before I started my training as a child therapist. The Hasidic story of the Rooster Prince has much to teach us about working with children who are vulnerable.

Once upon a time a prince lived with his parents in a city in Eastern Europe. Every day the king gave his son tasks and instructions for how to behave. “Be polite to all the elders. Behave in a princely fashion. Speak this way, walk that way.”

One day the prince woke at dawn, sat up, and began to crow like a rooster. At first no one paid much attention, but when he took off his clothes and waddled downstairs, still crowing at the top of his lungs, the servants began to laugh. The queen was in the kitchen eating breakfast, and when she saw her son, she gasped. “My dear, go put on some clothes! You’re not behaving like a prince!” But the prince ignored her and crouched under the table where he began to peck at the crumbs on the floor, just as a rooster might. The king scowled. “This is hardly princely behavior. We are not amused!”

But no matter what the king and queen said or did, the prince crowed and waddled and pecked and behaved in every way like a rooster, not like a prince. That evening, instead of going to his room, the prince padded out to the barn, and there he spent the night. At dawn he opened his eyes and began to crow, and soon he trundled back into the house to sit beneath the kitchen table and peck at the crumbs on the floor. This went on, day after day.

In despair, the king and queen called upon an assortment of royal doctors who offered pills, spells, rituals, and tried talking sense to him, but the prince crowed in their faces. “What can we do to make our son behave like a prince once again?” the king asked his wise men, but nobody had an answer, and soon word spread of the rooster prince.

One day an old sage came to the city. His face lined with age, his eyes nearly invisible, the sage limped along with the help of his cane. He made his way to the palace and announced, “I assure the king and queen I have the cure for their son.” The king pointed to the kitchen where the prince now spent his days under the table, and the sage limped there. The king followed and stood in startled silence as the old sage undressed, climbed under the table, and began to cluck and peck like a chicken. “How can you cure my son of his madness if you are mad as well?” the king cried. But the sage only clucked more loudly and scurried about, pecking for crumbs. The king and queen consulted with each other. “What shall we do?” the queen pleaded. “Now we have two madmen in our home.” “We must wait,” said the king, though his heart swelled with worry.

The next day the rooster and the chicken, the prince and the sage, pecked away under the table, clucking and crowing, and as they pecked, they began to talk to each other. “I’m a rooster,” said the prince. “So you are,” the sage said, “and how is your life here in the kitchen?” “Fine indeed,” the prince said. “Everyone leaves me alone to enjoy my time. It’s a fine life.” “I understand,” the sage said.

This went on until one day the sage called to the royal seamstress. “Bring me a pair of pants,” he said. When the seamstress brought them, the sage began to put them on. The rooster prince stared and cried, “What are you doing? Chickens don’t wear pants!” “Who says?” the sage asked. “Why shouldn’t I be warm? Why should humans have all the good things?” For the first time the rooster prince noticed the floor was cold and the barn too; the next day, when the sage asked for a shirt, the rooster prince stared and said, “Chickens don’t wear shirts.” “Why should I shiver just because I’m a chicken?” the sage answered. Once again the rooster prince thought about how cold he felt, and when the sage put on socks and shoes, the rooster prince saw how bruised and tired his own feet were. Shortly thereafter, the prince returned to his station, having given up the life of a rooster.

I will leave the reader to consider the meanings of the Rooster Prince story, just as I trust the reader to consider the meanings of my own stories in this book. For me, this tale speaks to the power of what can happen when one individual allows him or herself to enter into the world of another, and in the process, to both connect to that person and to help that person move to a different place. But there are many ways to look at the story, just as there are many ways to consider our work with children. This book is called a curious space. There is the therapist’s curiosity in trying to understand and help a child and in trying to think about what approaches may help a child in a given moment. There is the curiosity of the child, frequently absent early in therapy, which is hopefully sparked in the therapeutic space and whose momentum can be so powerful as a child grows. Then there is the other sense of curiosity, the sense of puzzlement and wonder about what happens in therapy as we try to understand the moments in which a therapist and a particular child meet. It is that sense of curiosity that inspires my work with children and which I hope emerges and is stimulated by the therapy stories in this book. The idea of this book is not so much to answer the question of what we are doing, as much as it is to allow this question to simmer, and stimulate ideas about working with children and adolescents. I hope the reader will accept my invitation and join me in pondering the therapeutic process, at least as it unfolds with six very different young people and one particular therapist.

2 Hey Toy Man

I first meet children when I walk out of my office and greet them in the waiting area. They are usually tentative, wondering who they’re about to meet and what they’re about to do. Abby was not one of those children.

I walked out of my office and said hello to a tall and lanky six-year-old girl with long brown hair. Ensconced in pink, Abby smiled quickly, gave a brusque hello, and as I looked at the contents of her knapsack spread out on a waiting room chair, seemed to have made herself right at home. I invited Abby into my office and she followed easily. Actually, I followed, as Abby bounced in to begin our first session and immediately starting looking around and exploring. She first looked at a toy castle, then a basket filled with nerf balls, before she noticed the door to my toy closet slightly ajar. Opening it, her eyes widened as she looked through the closet trying to decide what to do first. She searched quickly but methodically through the closet before settling on the contents of a play kitchen, including pots, plates, and all manner of pretend food.

Abby was one of those children who gets tagged as energetic or spirited. As in her recent Kindergarten teacher’s report – “Abby is an energetic and spirited child who loves to be creative and is learning how to follow classroom rules and play with other children,” which was a nice way of saying that Abby wasn’t listening to her teachers or making any friends. Abby liked to do what she wanted and was otherwise uncooperative. Abby’s mother echoed these concerns, telling me how Abby became easily frustrated at small disappointments and was having frequent temper tantrums at home. Adopted as a month-old infant from a small village in Romania, with little known about her biological parents, Abby was now living a comfortable life in Manhattan with her adoptive mother and a ten-year-old sister, who was also adopted. Abby’s mother, a successful attorney, was very patient, and as is often the case for a parent, was quite exhausted and just not sure what to do next.

In the early days of our two-year therapy, I felt as if our sessions began before Abby entered my office. I would hear Abby as she sat in the waiting room, talking animatedly to her mother or her babysitter. As soon as I would open the door, she would bounce up, and dive quickly into play, greatly enjoying the different games and materials. In our early sessions, Abby liked to experiment with different items, playing with pretend food, building with blocks, and taking out paper and markers to draw. But most of all, more than any of the toys and games, Abby loved to boss me around, her voice sharpening as she told me what and what not to do.

Stand over here! Get that box! No! Not the red one! The green one! You set it up the wrong way! How many times do I have to tell you that I don’t like that one! Over there already!

While this may sound grating, and at times it was, there was something endearing about the way Abby ordered me around. It helped that Abby seemed to enjoy and invest herself in the sessions, which told me that her controlling behavior was probably going to be important in some way in the stories and characters we would ultimately create. Often, controlling behavior serves to stop a line of questioning or an avenue of play. But in Abby’s case, it seemed to be a main character in the play. It also helped that as Abby bossed me around, she did so with a twinkle in her eye, hinting at an underlying motivation that I suspected would prove meaningful. So, I played along, working as a cross between hired help and indentured servant.

(Abby, sitting on the carpet building a house, looks up at me as I approach)

ABBY: You can’t sit here. This is my place.

ME: Abby, can I sit over here? (pointing to a spot to her left)

ABBY: No!

ME: How about here? (I point to a spot a little further to the left)

ABBY: That’s a little better, but not quite. Move that way! (Abby points imperiously to a spot on the right)

ME: Ok, Ok. Gee, a little touchy. Yes ma’am.

ABBY: Don’t call me ma’am (her voice turning chilly at this point)

ME: What should I call you?

ABBY: By my name. (She looks at me as if I couldn’t be a bigger fool)

ME: Ok. I think I’...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• A Note on Confidentiality
• 1 Introduction: A Curious Space
• 2 Hey Toy Man
• 3 The Adventures of Captain Pineapple
• 4 Picturing a Frame
• 5 Real Madrid 18 – Tottenham Hotspur
• 6 The Princess and Dal Bhat Tarkari
• 7 Upside Down
• References
• Index