The Therapeutic Process with Children and Adolescents: Part Two

by Violet Oaklander PhD

Part Two

Aggressive Energy

The term ‘aggressive energy’ offends some people for it reminds them of hostile and destructive behaviour. One of the definitions given in my dictionary for the word ‘aggressive’ is ‘marked by driving forceful energy or initiative.’ It is this definition that I refer to when using this term. It is the energy one uses to bite an apple. It is the energy one needs to express a strong feeling. It is an energy that gives one a feeling of power. It is an energy that gives one the self-support needed to take action. Children are confused about this kind of energy, equating it with trouble for themselves. Children who are fearful, timid, withdrawn and appear to have a fragile self are obviously lacking aggressive energy. Children who hit, punch, have overt power struggles and generally act “aggressive” lack this kind of energy as well. They are acting beyond their boundaries and not from a solid place within themselves.

I provide many experiences for a child to experience aggressive energy and to feel comfortable with it. The self-support she gains from these activities are pre-requisites for expression of suppressed emotions. The child who has been traumatised needs help in expressing buried emotions in order to work through that trauma, be it illness, the death of a loved one, a loss of a pet, a divorce, abuse, a witness to violence, or molestation.   Since the child takes everything personally as part of her normal developmental process, when she undergoes trauma she feels responsible and blames herself for that trauma. This self-blame severely diminishes the self and makes it very difficult for the child to fully express the emotions that need to be expressed to promote healing. Further, the child developmentally take in many negative introjects, faulty beliefs about herself. These negative messages fragment the child, inhibit healthy growth and integration, and are the roots of her self-deprecating attitude, low self-esteem, and feelings of shame. A beginning in turning this disheartening process around is to help the child develop a strong sense of self, which in itself, gives one a sense of well-being and positive feeling of self.   Self-support activities are essential for this task.

The aggressive energy activities have several requirements to be effective. First, they must take place in contact with the therapist. Having the child engage in these experiences by herself at home, or as the therapist passively looks on, does not have the same impact as when the therapist is actively engaged with the child. This engagement is required in order for the child to feel comfortable with the internal force she may have feared. Second, these activities take place in a safe container. The child knows that the therapist is in charge and will not allow any harm to interfere with the experience. Third, there is a spirit of fun and playfulness in the interaction. Fourth, the play is exaggerated. Since the child has avoided this kind of energy (whether retroflecting or deflecting), she must go beyond the centre point before she can come back to balance.

Aggressive energy activities can involve smashing clay, shooting dart guns, pounding drums, smashing figures or cars together, having a Bataca fight, and so forth. There are some games that promote this kind of energy, though unfortunately there are not too many. Two games I have that are excellent aggressive energy games, but are no longer manufactured, are Hawaiian Punch™ and Whack Attack™.  A game called Splat where play-do bugs are smashed, come close. Don’t Break the Ice™ is a game suitable for children who are fearful of demonstrating this energy at first. Hitting the “ice” with a small mallet is quite mild. Let me emphasize again that to experience aggressive energy in a therapeutic context requires involvement of the therapist with the child.

Janine was a 10 year old girl who had suffered much trauma, including physical and sexual abuse and abandonment. She had been in several group and foster home placements and finally was adopted into a new family. Her process was to be as good as possible and smile at all times. Before I could begin to help Janine express outwardly her myriad of feelings , including anger and grief, I knew that she needed to gain a stronger sense of self and to feel her aggressive anger. The turning point came with the puppets. One day I asked her to pick any puppet, and uncharacteristically she picked an alligator with a big mouth – (her usual choice would be a cute kitten or bunny). I picked up another alligator and said, ‘Hello. You sure have a big mouth and lots of teeth. I bet you’re going to bite me.’  ‘Oh, no!’ Janine’s puppet answered. ‘I am your friend. We can play together.’  ‘Oh yeah?’ I said, as I inched my puppet closer to her mouth. ‘I know you’re going to bite me.’ Janine backed her puppet away as I came closer, but soon my puppet was directly in her puppet’s mouth.   Almost involuntarily, Janine’s alligator lightly closed on my puppet. ‘Ow! Ow! You bit me!!’ I yelled as my puppet dramatically dropped to the floor. ‘Do that again! Do that again!’ Janine shouted. And so we did, over and over, bringing in other ‘bad’ puppets as the shark and wolf for her to bite. Not quite midway into this play, Janine was biting my various puppets with great force and our puppets engaged in a great struggle before mine dropped to the floor. At the end of this session Janine was smiling broadly (not her usual forced smile), stood up straight and left with a flourish. In subsequent sessions we successfully began to deal with her suppressed emotions.

Danny, eight-years-old, had been witness to violence in his home until his mother fled, taking him with her and leaving behind all that he was familiar with, including his father.   Danny appeared to have difficulty adjusting to his new environment: he was disruptive at school, bullied other children, and physically and verbally abused his mother. In my office Danny was terrified of any aggressive energy activities. He refused to have a Bataca fight with me, and would command me to cease and desist if my puppet spoke aggressively to his. As Danny felt safer and more comfortable with me, he began tentatively to suggest some of the more energetic actions. Eventually he initiated games of attack with me involving He-Man figures, shooting at a target with a rubber dart gun, and other similar games. Simultaneously his behaviour at school and at home dramatically improved.

Many therapists have argued that children who have witnessed violence particularly in the home, should not be introduced to ‘violent’ play in the therapist’s office. These children are particularly restricted and cut off from themselves. They blame themselves for the chaos and family disruption. They feel guilty if they are angry at having to leave their homes, or feel sad to leave their fathers. At the same time, they want to protect their mothers. They are so confused, that the only recourse is to restrain themselves and push down their emotions. As with Danny, the organism, in its quest for health, broke through his boundaries in unacceptable aggressive behaviour. I believe that these children need opportunities to find the power within themselves in order that they may be freed from the constraints that inhibit their ability to accept and express their varied emotions, and to live freely and joyfully.

Emotional Expression

To help children unlock buried emotions and to learn healthy ways to express their emotions in daily life is not a similar matter. A variety of creative, expressive, projective techniques assist in this work. These techniques involve drawings, collage, clay, fantasy and imagery, creative dramatics, music, movement, storytelling, the sand tray, photography, the use of metaphors and a variety of games. Many of these techniques have been used for hundreds of years by people in all cultures to communicate and express themselves. You might say we are giving back to children modes of expression that are inherently theirs. These modalities lend themselves to powerful projections which can evoke strong feelings. Everything the child creates is a projection of something inside of her, or at the very least, something that interests her. So if a child tells a story you can be sure that there is material in that story that reflects the child’s life or who she is, and expresses some need, wish, want or feeling that the child has.

If a child creates a sand tray scene with the varied miniatures that are displayed on shelves, the very act of projecting this symbolic material is in of itself therapeutic. Something within the child has been expressed. If the child tells a story about his scene, even more of himself is expressed on perhaps another level. If the child can own various aspects of the scene, integration takes place at a much quicker pace.

For example, Jimmy who is seven, is very absorbed in making a sand scene. I can see as I watch him, that all of his energy is devoted to his task. He is fully present and contactful with his task. I do not interrupt or talk, unless he asks me to help him find a certain object. I watch the clock so that I can pace the session, in order to make sure he can make some kind of closure before the time is up. I may say, ‘You need to finish now’, (although most children announce ‘I’m done,’ with plenty of time to spare.) If we don’t have time to talk about his scene, that will be fine. I can see by his energy level that whatever he is doing is very important to him and needs to be done. Now Jimmy looks at me and tells me and tells me he is finished. There are ten minutes left to the session. He says,’This is the best I’ve ever done!’ Jimmy, who loves to do sand scenes, says this each time he does one, indicating to me his satisfaction and pleasure. Jimmy describes the scene to me. There are numerous monster-type figures in conflict encounters with each other. There is a cave with some crystals in it. There are many, many trees and hidden among the trees is a tiny green caterpillar. Jimmy looks at his scene with perspective and articulates what makes sense to him. Most children will look at their scenes and attempt to make sense out of them, an important part of the integrative process. Children always try to make sense of what goes on in their lives, and feel frustrated and confused most of the time. They need to experience the satisfaction and power of making sense of their own creations, at least.

Jimmy says that the monsters are fighting each other over the treasure in the cave, that he puts a lot of trees in because he likes trees so much, and that one can’t always see things that are under them like the hidden caterpillar. I ask why the monsters are fighting and he answers that he doesn’t know but maybe to get the treasure. ‘None of them will get the treasure because they are too busy fighting. But the caterpillar is safe because the monsters don’t see him.’ (He is now developing a story/metaphor.) I then ask which figure or object is him, and after careful consideration he says that he is the caterpillar. (If we had more time I might have had a dialogue with the caterpillar.) ‘What about the caterpillar makes you want to be it?’ I ask. Without hesitation he says ‘Because it is hidden and safe.’ I then ask in a very soft voice, ‘Jimmy, do you wish you had a place like that in your life?’ He lowers his head, looks at his feet, and says softly, ‘Yes, I need one.’ He then begins to chatter about my Polaroid camera and the picture I will take of his scene. I know that his resistance has surfaced, and that he has turned his attention elsewhere. Whatever has happened is just about enough for him.

There are many therapeutic levels in this piece of work. Jimmy has expressed his actual life metaphorically in this scene, something he would never be able to articulate at his age.   The conflict, the danger, the goodness and hope that is inaccessible, the feeling of being small and powerless, the need to be safe and hidden, his fears and his anger. Of course these are my interpretations, though probably fairly accurate since I know about Jimmy and his life. My interpretations are not therapeutic, however. What is healing is Jimmy’s expression of what he needed to express in his scene – understood by him, perhaps, on a very deep intuitive level, the feeling of safety in my office, the easy relationship that we have developed, the acceptance and respect he feels from me, the knowledge that there are limits and boundaries that I set and take responsibility for (as, for example,time), and his feeling of control and power within those  limits to do what he needed to do without interruption. What is also therapeutic is our interaction regarding his scene, my interest in it and my acceptance of it as a serious piece of work.

I ask questions, but I do not push for more than he will give me. For me the most therapeutic aspect of this session was Jimmy’s statement about needing a safe place of his own, his expression, which surfaced from deep within, is now fertile ground for us to explore at a later time, rather than a hidden feeling blocking healthy organismic functioning. The resistance that came up, evidenced by Jimmy changing the subject, told me that Jimmy reached his limit in this piece of work, and that he did not have enough support to go further. Time, too, may have added to this resistance, since he knew our time was just about up. In a sense he grounded himself. Often when the time is up I may need to help children ground themselves by asking superficial questions, such as, ‘What do you think you’re having for dinner tonight?’ It is particularly essential to help children come back to earth if they become excited and high in the course of our sessions.

Assisting children in emotional expression often has a sequence of its own. Sometimes children have pushed their feelings down so far that they are completely disconnected from the whole concept. So when this becomes evident, we begin talking ABOUT feelings.   What are feelings anyway? We explore, cognitively, all the aspects of anger, grief, fear and joy. One can feel mild annoyance, for example, or, at the other end of the continuum, blind rage. Then there are body states that are often labeled as feelings such as frustration, boredom, confusion, anxiety, impatience, loneliness. We examine these states as well. We look at pictures, play games, make faces, move our bodies to drum beats, act out various feelings, use puppets, draw pictures, use clay, make lists, tell stories, read stories, – all related to feelings and body states. Language plays an important role too. As children grow and develop mastery in language, they are much more able to be aware of, and express, the nuances of their feelings in a more satisfying way.

An eight year-old girl who had been severely physically abused by her father was unable to express any feelings at all. It was as if she had no understanding of what feelings were. A game we played called The Happy Face Game mystified her. It consists of cards with various faces and no matter which card she picked, she said the same thing. ‘I feel happy when it’s my birthday. I feel mad when it’s my birthday. I feel sad when it’s my birthday.’   Even though she listened with some interest to my statements when I picked a card, she continued her birthday statements. We played many games about feelings, as indicated above. One day we were playing school at her request, and as the teacher she told me to write something that made me sad, mad and happy. When I did this I noticed that she was busy writing her own sentences on the chalk board on the wall. She wrote, ‘I am sad because my cat ran away and I don’t know where she is. I am mad because my mother wouldn’t let me watch TV last night. I am happy because my father doesn’t hit me now.’

Children don’t always move from talking about feelings to expressing their own feelings.   We may use projections as a forum for expressions. The drawings, the stories, the sand tray scenes will be replete with material to draw from in helping the child own her own feelings. For example, Terri, a 13 year-old girl drew a snake in a desert after a fantasy exercise. I asked her to be the snake and describe her existence in that snake. Naturally, there was some resistance to this request. I said,’I know it’s crazy but just say ‘I’m a snake’. Imagine the snake is a puppet and you have to speak for it, give it a voice.’ So she said, ‘I’m a snake”, (rolling her eyes). I immediately engaged the snake in a dialogue, asking it questions as ‘Where do you live? What do you do all day?’ And so on. Finally I said, ‘What’s it like being out there in the desert all by yourself, snake?.’ After some pause, she answered in a very low voice, head down, ‘Lonely.’ The change in the energy, body posture and voice quality told me that something was going on inside of her, that perhaps she was connecting in some way to the snake. So I said very softly, ‘Do you, as a girl, ever feel that way?’ She looked up at me and I held her gaze, she burst into tears. She continued at that point to describe her feelings of isolation and desperation.

I’d like to emphasize a few points here. First, it is very important for me to ask important questions in a very soft, almost casual manner. Second, I have learned that when children cry it is mortifying for them (especially for a 13-year old). If I focus on the tears, as I might with an adult, I will probably facilitate the closing down process. So I keep talking. ‘Tell me about your loneliness, Terri,’ and she did. When the session was over, Terri drew a quick figure next to the snake. ‘That snake is really me, isn’t it?’ she said. Not all children will identify so readily with their projections. Often I need to say,’Is there anything about your story that fits for you?’ or ‘Do you ever feel like you want to attack someone like the lion in your scene?’

Since emotions often have a body counterpart, we spend some time helping children become more aware of their own body reactions. As children become attuned to their bodies, they can often use these responses as clues. For example, 16 year old Susan, stated that she never felt angry. We did a fantasy experience where I asked her to imagine something that could make her or someone angry and to notice what she felt in her body.   She then drew a picture of a cloud over a head. She labeled this, ‘the cloud of confusion’. I suggested that she use this as a clue – that whenever she felt confused to check to see if something was happening that she didn’t like. (‘Don’t like’ is a watered down, less threatening expression for some children). If she could know she was angry, she could choose an appropriate way of expressing it.

The child and I discuss at length various ways she might express angry feelings privately, without bringing further trouble to herself. By this time I have hopefully convinced them of the organism’s need to rid itself of this negative energy, rather than push it down. We make a list of these activities and practice them in the office. Some of the more popular methods include tearing magazines, drawing a face and jumping on it, hitting a designated pillow, screaming into a pillow, running or some other physical activity while focusing on the angry feeling, or writing an unmailed letter to the object of the anger. It is necessary for children to have outlets such as these. Direct expression is certainly ideal, but difficult for all of us and especially for children. When they attempt to directly tell a teacher or a parent what is making them angry, they are accused of having a bad attitude and often punished. Children do tend to speak in a louder voice when angry; they have not yet learned the art of diplomacy.

The child generally will go to great lengths to avoid dealing with deep feelings – feelings that are kept hidden, and interfere with healthy development. He very rarely says,’Today I’d like to work on my father.’ The child has so little support to deal with the intensity and weight of these feelings, that he will suppress them to the extent that he actually has little awareness of them. However, his behaviour and life process are greatly affected by these feelings, and helping children to uncover them and express them is essential in therapeutic work. Eleven year old John exhibited behaviours and symptoms that were interfering with his life. His grades were falling, he became forgetful, often had headaches and stomach aches. When I asked his mother when he began to have these symptoms, she vaguely stated that it had been going on for a couple of years, but had actually worsened lately. When I asked if anything had happened two years before, she said his brother had died, but she felt that they had all handled their grief quite well. I know that children need a lot of assistance to go through grief, and they are so good at pushing feelings down that they are often seen as doing well. Further, I know that changes in behaviour and new symptoms appear gradually, and become accelerated as time goes by. A child does not say, ’This is not working for me. I’ll try something else.’ The behaviours and symptoms intensify and increase. At one of our sessions, I asked John to make a clay figure of his brother and talk to him. He became quite agitated and refused. I asked gently,’What are you thinking about, John?’ (I rarely ask children what they are feeling, since they usually say ‘fine’ or ‘I don’t know’). John shouted,’I HATE those doctors!’ I quickly put a lump of clay in front of him and handed him a clay mallet. ‘Give it to those doctors;’ I said. John began to smash the clay with the mallet. I became a sort of cheerleader, urging him on. (This is not a time for the therapist to stay quiet). He smashed with lots of energy. ‘Yeah. Give it to them.  Tell them why you are mad at them.’ John began shouting, ‘I hate you. You wouldn’t let me see my brother. I never saw him again. I hate you.’ After a while I asked John to make a figure of his brother. He made a figure in the hospital bed. ‘If you could say anything you wanted to him, what would you say?’ Tears came down his face as he told his brother how much he missed him. There was silence as he intently looked at his clay brother. He said softly ‘Goodbye’, picked up the figure and kissed it, gently laid it down, and said to me, ’Do we have time for a game of Connect 4?’  We spent a few more sessions focusing on his brother, and John’s behaviour dramatically changed. He is now a happy, productive, well-adjusted boy.

Self-nurturing

A vital step in the therapeutic process is what I call self-nurturing work. In essence my goal is to help children be more accepting, caring and actively nurturing to themselves. This is a difficult task since children are brought up with the idea that it is selfish and wrong to care about the self. If the child says,’I’m very good at this’, she may be accused of bragging. The children I work with have introjected, swallowed whole, taken in many faulty messages about themselves from a very early age at a time they did not have the maturity and cognitive ability to discriminate what fitted for them or what did not fit.   These introjects cause children to restrict and inhibit aspects of self and interfere with healthful growth. These negative self messages tend to remain with them throughout life, and particularly emerge under stress. Children developmentally, in their egocentricity, blame themselves for the traumas that occur in their lives.

I find that even parents change their manner of relating to, and communicating with their children, their faulty belief system persists, often going underground to emerge at times of tension and pressure.

Even a young child, particularly the disturbed child has a very well developed critical self. He develops powerful negative introjects and often does a better job of criticizing himself than his parents do. This judgemental stance, often well hidden from others, is detrimental to healthful growth. The child may say to himself, ‘I should be a better boy,’ but the enactment of this wish is  beyond his power and compassion. The will to ‘be better’ enhances his despair. Self-acceptance of all one’s parts, even the most hateful, is a vital component of unimpaired, sound development.

Violet Oaklander (1982) page 74

Fragmentation is a disastrous result of self-deprecation. Integration begins to take place when we can help the child begin to learn to accept the parts of herself that she hates, and to understand the function and purpose of those parts. Through this process, children acquire skills for treating themselves well. This is a revolutionary concept for most children, since, as indicated above, they have learned that it is egotistical, self centered and frowned upon to treat oneself well. They will then learn to look to others to do this job, and feel let down when it doesn’t happen, further reinforcing the negative introject.   Adolescents feel guilty when they do nice things for themselves, which debilitates rather than strengthens.

The first part of the self nurturing process involves digging out those hateful parts of self.   Though fragmentation prevails, the child tends to identify herself totally with each hateful part. If the message is,’I’m stupid’, she feels that stupidity is her whole identity.   Comprehending that the hateful part is only one aspect of herself is usually a new concept. Once a part is identified, the child may be asked to draw it, make it out of clay, or find a puppet that represents that part. The part is fully described, portrayed and exaggerated.   The child is encouraged to talk to that part, and often critical, angry statements are directed at the hateful demon. In this way, she expresses her aggression outwardly, rather than turning it in towards the self. With this kind of outpouring of energy, she gains self-support for the next step which involves finding a nurturing component within the self. Sometimes the hateful part becomes a younger child, about four or five years old, an age when children absorb many negative self messages. The child then dialogues with this younger self. Realizing that the part is actually a belief from a much younger age often helps the child to develop a nurturing stance. Sometimes we use a projective technique such as a fairy godmother puppet who is loving, accepting and nurturing to the hateful part. The child is then encouraged to repeat the fairy godmother’s words to see how it feels to say them to himself.

Eleven-year old Joseph expressed much anger and disgust at a drawing of the clumsy part of himself that he named ‘Mr Klutz’. Mr Klutz couldn’t do anything right and fell down and bumped into things all the time. As the fairy godmother puppet, he told Mr Klutz after a while, ‘At least you try things!’  Joseph turned to me in wonderment and said,’That’s right, I do try things!’ A piece of integration took place at that moment right before my eyes. I suggested to Joseph that he imagine his  fairy godmother sitting in his shoulder each time he did something ‘klutzy’, and she told him that she liked him even when he fell or bumped into things, and she was glad he tried. Joseph reported in later sessions that he really wasn’t as clumsy as he originally thought.

Seven-year old Lisa thought she was stupid because she had trouble learning to read.    Her fairy godmother puppet said,’You’re pretty good in maths so you’re not so dumb as you think.’ (These were Lisa’s own projected words.) Lisa was able to say these words to the drawing of her dumb self, without the use of the puppet, with sincerity. She reported later that she was reading pretty well now.

Seven- year old Zachary admitted that deep down he felt he was a very bad person and deserved his abuse and abandonment. He made a figure of a four- year old Zach, the age that he remembered his first beating. It was not difficult for him to see that this small figure of a small child had not deserved such treatment, and he was able to talk to his little boy self in a nurturing way. I asked Zachary to find something at home to represent this young child part of him, a pillow, a stuffed animal, a ball, and to talk to him every night before he went to sleep, telling him what a nice kid he was and that he did not deserve the beatings. I especially wanted him to tell this part that he would always be with him, that he would never leave him. We practised this in the office after I explained that, even though this exercise seemed strange and weird, it was extremely important that he follow these directions. He did as directed, and exhibited a decided improvement in his demeanour.

Persistant innapropriate process

Generally the inappropriate behaviours that have brought children in therapy have diminished or completely disappeared by the time we have worked through the various components of the therapy process. After several months of therapy, Janine gradually grew to trust others and develop a strong sense of self. She began to express her emotions clearly and transformed herself from a meek, timid child into one who could comfortably stand up for herself. Joseph, who had presented himself as severely hyperactive, no longer needed to move incessantly in order to avoid contact. He now had good contact skills, and was calm and present in most situations. We were able to focus on the deeper emotions of anger and grief that lay within.

There are times, however, when certain behaviours tend to persist, and it is at this time I focus on them. When a child initially comes into therapy, I do not confront the behaviours. I don’t say, ‘Let’s talk about your fighting.’ I might ask the child to describe the experience of fighting, paint his feelings during the fighting or draw a picture of one of the fights. But we don’t discuss the fighting with the intent of changing behaviour at that time. (I do confront trauma fairly early on, however.) I see the behaviour as a symptom of something deeper. When the child does not appear to be happier, stronger and functioning well in his life, I need to first evaluate my work carefully. If the child and I have a good relationship, he is able to sustain contact, has been responsive, and has shown a fairly healthy process during our time together, then I know I need to focus on that behaviour that is still causing concern and distress.

Since Gestalt Therapy is a process–orientated therapy, rather than a content-focused therapy, helping children become aware of their particular process takes precedent over modifying the behaviour through specific problem solving, rewards, lectures, or other types of intervention. It is through the awareness and experience of their actions that change begins to take place. Change within this context is often paradoxical in nature. Arnold Beiser states,’Change occurs when one becomes what he is, not when he tries to become what he is not.’ (1970) Following this principle I will devise activities and experiments to direct the child’s awareness toward his behaviour. Prerequisite to these experiments is the child’s new feelings of self-worth and self-support, as well as skills for appropriately expressing his feelings. Twelve-year-old James was very shy. He lived in a large, chaotic family and somehow had been lost in this atmosphere. I worked with the family as well as James individually, and though much good work was accomplished, James remained painfully shy with other children. A therapeutic group would have been helpful, but one was not available. Together we delved deeper into his shyness. He made a clay sculpture representing his shy self, and one for the self he wished for. He discovered that his shy self was quite young and had some poignant dialogues with his little boy self.   He discovered that he had had very good reason to be shy at that time as a way of coping and protecting himself. I devised an experiment whereby he would approach a group of children at school at lunch time, and pay full attention to the feelings in his body and the thoughts in his head. This was a painful experiment, but with his newly developed sense of self, he agreed to carry it through.

At the next session he drew a picture of his feelings using different colours, and listed his thoughts: ‘They don’t like me. I’m not good enough.’ James was surprised to recognise these thoughts as old messages about himself. A further experiment was suggested involving taking the younger James by the hand (figuratively) and talking to one boy in his class about an assignment. We talked about rejection, something he usually expected.   And so with my support and with the idea that this was an experiment, James carried out the assignment with great success. Further such experiments, along with their successes, helped him realise that he could discard that old, shy self.

Ending of therapy

I am often asked about how I know when it is time to stop the therapy. If the child is doing well in his life, and our work has taken on as aura of just hanging out together, it’s time to stop. If the child, who once couldn’t wait to come to the sessions, becomes very busy in her life with friends and activities and says she doesn’t have time to come, it’s probably time to stop. If the child is doing well in life and our sessions are still fruitful, it is NOT time to stop. If nothing much is happening in our sessions and symptoms persist at home, it is time for me to take a good hard look at what I am doing or not doing. If resistance comes up and persists, even though I know there is more work to be done, we sometimes have to stop for a while. This often happens with children who have undergone severe trauma, particularly molestation. The child can only work through certain aspects of the trauma at her specific developmental level.

If a four-year-old has been traumatised in some way, she may work through her anxieties and feelings over that trauma, but only to the extent of her four-year-old cognitive and emotional abilities. At various stages of her life, issues may present themselves related to that early trauma, causing inappropriate behaviours or symptoms to emerge, calling for further therapy suitable for her current developmental level. Further, children often reach a plateau in their work and need time to integrate what has been accomplished.   Sometimes parents take their children out of therapy for a variety of reasons, as financial and time constraints or insurance company limitations. When this happens I must respect the parents’ wishes and leave the door open for subsequent work.

The length of time of therapy with a child is quite variable depending on many factors.   Sometimes we work for a few sessions, sometimes three or four months or a school year, and sometimes for two years. Regardless of the length of time or the reason for ending, special attention is given to closure. Closure is not taken lightly – it is an important aspect of the therapeutic process. In a sense, therapy has been the foreground, a vital figure in the child’s life, and the completion of this gestalt allows the child to move on to a new place.   As needs are met, new masteries achieved, new discoveries are made, blocked feelings expressed, there is a period of homeostasis and satisfaction. This is closure, and from this place, the child can grow and develop in healthy ways.

Our last session can represent a rite of passage. To honour this event, we pay homage to our sessions. We talk about all the various activities that have taken place. The child and I look at her folder together much as a photograph album, remembering the various drawings and sand scene photos. Depending on the child’s age we decide on the final event. We may make goodbye cards for each other, or the child might choose a favourite game to play. We talk about endings and beginnings. I have asked adolescents to create a sand scene representing our time together, or the feelings accompanying the ending or one thing that stands out for them from our time together. Some children will draw pictures of their mixed feelings: sad to be leaving and happy to be leaving. Such drawings can relieve the confusion they feel over having opposing feelings. What we do to honour our final meeting is a co-operative decision.

Parents and families

The focus of this chapter has been the therapeutic process with children and adolescents. Working with parents and the family is certainly part of that process, though at a different level. I do, as a general rule, see the parents with the child at least every four to six weeks, if I am seeing the child individually. I will bring in other members of the family as necessary, sometimes seeing the child and his siblings without the parents. Occasionally I have seen a child alone every other week, and with her mother or both parents the alternate week.

Educating parents about the therapy process is essential. Unless parents understand and know what I am doing, they can easily sabotage the work. Parent education becomes a vital part of the therapy process and most parents are grateful for it. If the parents are hostile and angry, I must honour that resistance, offer my support and continue my attempt to establish a working relationship with them. I know that often the hostility is a mask for their own pain, anxiety and feelings of failure as parents. If parents refuse to participate at all, but continue to bring in their child because they must, as by court order, I will continue to work with the child, often addressing the issue of their parents’ attitude with the child. Every session can give that child inner strength to cope with his family.

Even when parents willingly participate in sessions, there is a decided difference in family work and individual child work. Children are certainly relieved and happy when parents change dysfunctional ways of relating to them, but often the negative introjects are just buried deeper only to surface at a later time. The child does not automatically become emotionally healthy when his family begins to make changes. He still needs to gain a stronger sense of self, express buried emotions, learn how to get his needs met or to meet his own needs appropriately, learn to be self-accepting and self-nurturing, and begin to learn how to manage faulty messages of the self that have already become ingrained as part of his belief system about himself.

This is  the concluding part of an article  from a book in process by the author

Violet Oaklander PhD is the author of Windows to our Children, A Gestalt Approach to Children and Adolescents (1978) New York; (1988) The Gestalt Journal Press and is the Director of the Violet Oaklander Institute in Santa Barbara, California, USA. She may be contacted at 3761 Gregory Way,#5, Santa Barbara,CA 93105 USA

armisa@silcom.com or oaklander@gestalt.org

www.violetoaklander.com

References

Beisser.A.(1970) The paradoxical theory of change. In Gestalt Therapy Now.

Ed. J.Fagan & I.Shepherd. Palo Alto, CA Science and Behaviour Books pp77-80

Buber, M. (1958) I and Thou  New York: Scribner

Oaklander, V. (1978, 1988) Windows to our Children New York: The Gestalt Journal Press.