Psychotherapeutic Communication, Relationship and Process when working with children and adolescents

In Gestalt therapy, language and the spoken word are very important and great value is placed upon it. The semantics and linguistics are valuable tools, which are used frequently. Using language efficiently and with curiosity gains a greater understanding of the child’s inner working model. I always ensure that I use appropriate language in relation to the child’s age and understanding.

As a holistic therapy emphasis is put upon body language and the internal somatic feelings. Often within my child and adolescent work I find that many children I see are unable to name/label feelings that they are experiencing. It is generally part of my work to share my own thoughts on what the ‘buzzy’ feeling in the tummy maybe, or say what I feel in my body when I feel scared for example. This use of role modelling is often needed when working with children and adolescents who have not had adequate parenting or there has been a breech in their developmental experience. I will view with curiosity any non verbal leakage, whilst not shaming the child or putting my own interpretation upon their body movement, until it has been considered by the client.

There are times when there can be barriers to communication, this can be with children or adolescents that are scared, angry or have gained their own ‘way’, by simply refusing to work with professionals. Indeed there have been times when I have worked with clients who have physical impairments, which challenges usual forms of communication. Examples of these times have been when I have worked with children and adolescents with autism and once when the female had no speech at all. In these situations I have found Theraplay © invaluable and of great therapeutic advantage.

Of course, there maybe a counter transference and the barrier may be mine, this is when supervision is supportive and of significant value and my own blind spots can be reviewed and considered. It is imperative that a therapeutic relationship is gained. Many adults have concerns about how different the therapeutic relationship is to any other form of contact, so it is understandable when children and adolescents who may have never been able to trust an adult previously, or have done so with great difficulty have issues with accepting trust and being trusting to a professional. I believe that if the only work that is done with children and adolescents that a relationship is formed, it is a skill and an experience they can use for the rest of their lives (Bowlby etal)

For most children, although not all adolescents I am generally taller and bigger than they are. I generally guide the sessions and I do believe in being directive within therapy sessions when and if appropriate. I have very simple and steadfast rules that I follow, in turn expect that the child will follow too. These are all discussed either prior to the therapy beginning or as they arise within the session. All of the rules are there to keep the child and adolescent safe.I am happy to explain why the reason is there, although I will not get into a debate.  It is my room and I am in charge to keep the client safe whilst they are in my session. The fact that I am a middle aged, white, middle class, educated, professional woman does mean that it is impossible for the relationship to be horizontal. I do not believe that with any client, therapy would work if there was not a power imbalance, however that does not mean that the client, no matter what age is subjected to marginalisation or patronisation. For children, adolescents and adults that have been compromised by either neglectful or over bearing parents can benefit from having solid boundaries in place. This when working means for a practitioner to, ‘say what they mean and mean what they say’. The therapeutic relationship is honoured, as are the participants by having firm boundaries. There can be a ‘meeting’ in the Buber (1938) ‘I-thou’ sense with children and adolescents that is both confirming and healing. Whilst difficult it is not impossible and honouring their sense of self and their differences can erase the power imbalance within the work.The relationship building is not only with the young client it also needs to be to a lesser and still important extent with their families and/ or caregivers. A professional relationship with other practitioners and professionals is also necessary in this field of work.

For some children, for example for those that are ‘superficially charming and engaging’ ( in an attachment theoretical way) maybe difficult. They have learnt to exist by being ‘seducers and /or non confrontational’. These children and adolescents will be well practised at ‘pretending’ to engage, whilst never truly investing in another, due to early experiences.

It is likely that during the therapeutic process that I may need to change my theoretical thinking, as the child or adolescent progresses or I gain a greater insight into their world view. This often happens following the child or adolescent having tested the boundaries, I have found. It is then that it can be valuable to have a number of various theories to consider different therapeutic requirements the client may need.In this changing world of media appropriateness and new technology it would be incongruent with what is happening in the world for children and adolescents not to have knowledge of, use the internet and other forms of communication. These tools can be used therapeutically however it is important to ensure that young people are keeping them selves ‘safe’ online and are not being bullied or groomed. Part of the communication process would be working out their reliance on the internet, social networking sites and RPG sites. Again open communication with the young person and the adults around them to gain an idea of how much energy and time is spent in the virtual world is necessary. It is also important I believe for professionals to have an idea, although not necessarily an indepth knowledge of all player platforms and games, or sites and new fads.

I believe it is appropriate to communicate by email with other professionals however it is important that the e mail is professional the way that it is written and that no confidential information is enclosed when the mails are not encrypted.  It is possible that when working for an agency that has stringent policies, either time limiting or with significant financial constraints that it maybe in direct conflict with therapeutic tenets. It is as this time, as a practitioner I need to balance between being realistic and maintaining and protecting the therapeutic process.

As a practitioner I am willing to promote my beliefs and stay my ground, if I believe cutting the process short may damage the therapeutic relationship or process.In relation to endings I always keep in mind the child’s or adolescents previous experience of endings. This may influence the way I choose to end. Whatever my decision is, the ending when possible, will be planned, spoken about and I will be a role model during the closing process. I will always do some amount of preparation and often involve the child or adolescent in the planning.  Generally I ensure that if a work book has been completed it is available for the client to take it home and it is quite ordinary that I will, within the penultimate session integrate a piece of craft work that they can take home with them, as a memento if they wish.All parents care givers and agencies will be informed that the therapy is in the final stage.I explain in great detail how I have experienced them and will often refer to how I have seen a change in them between the beginning and end of therapy. I will let them know how they have impacted me and how I recognise this is a goodbye. I will help them process that the relationship will end and it is ordinary that they at times, as will I, will think of them and that is ok.There are times when an unplanned ending happens. If this were the scenario then I would generally write to the child, using age appropriate language (and font) a short note, saying goodbye. I would use a card, with an appropriate picture on, that is age and relationship appropriate which is hand written.

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