Heraclitus once wrote: the kingdom is a child.
What else does a child embody but hope, the concentrated power of the seed, the expectation of a better tomorrow, innocence, excitement, the endless joy of play, the tireless will to start over, the cloudless joy, the unbridled sky full of kites?
What else does a teenager embody, other than boldness, belief in the impossible, questioning all forms of authority, existential anxiety about the meaning of life and death, the search for identity, the awakening of sexuality, the passionate pursuit of beauty?
First of all, it seems exciting for the child psychiatrist that the child can include him in his wonderful world. To win the opportunity to influence tomorrow's adult.
The child who visits the specialist is characterized by the solution of the continuum of development. A rust eats the noble metal. There are inappropriate factors in the environment that are not conducive to growth. The goal of the child psychiatrist: to identify all those elements that inhibit the little prince, to lead him from dependence to autonomy, from fragmentation to integration.
The child psychiatrist is also called upon to deal with the child within the parents. The child within the parents demands, it is absolute, it demands on behalf of the child, while in essence it demands for itself. The parent's immanent child does not compromise, awakens and becomes narcissistically affected when the biological child is affected – it seeks a second chance to nurture this deprived, immanent child.
The mother who tries to experience through the child what she herself did not experience as a child. I remember the anger and disappointment of a young woman when she realized that her mother was not only reading her diary but also commenting at the bottom of the page: today he kissed her for the first time. Or on another point: today they argued for no reason.
Very often a mother worries that the child has acquired whatever negative element or weakness afflicted her as a child. She experiences enormous guilt over the child's problem. She puts herself in the child's place by recalling her own memories of when she was a child and believing that she can fully understand it through her own experiences. It is very important that the mother does not get trapped in her own experience because she becomes a child again and feels helpless again. It is a redemptive process when it allows the father to enter into the relationship and broaden the horizon of understanding of things, otherwise history repeats itself. Corrective experience is judged right there: in a functional loving couple relationship. When the mother tries to understand the child as a separate being, she acquires skills as she cares for him by transcending herself, and then she also cares for the little girl inside her.
Also, to be able to understand the inner child, she needs to move from the position of the child to the relationship with her own mother and understand her as an adult.
The child in the mother anxiously seeks to fill the gaps of the previous phase at the expense of the present, with the result that she risks sacrificing femininity on the altar of childhood needs.
The couple who come to my office are concerned about their 14-year-old daughter Silia because she constantly complains of physical pains and illnesses, which ultimately turn out to be completely unfounded and manipulative.
The parents have a significant age difference of 65 years for the father and 47 for the mother.
There is an older daughter of the father from the 1st marriage, 37 years old, who two years ago had her first child.
The father constantly gives in and indulges in Silia. Both parents see her as gifted, stretch her with the vision of Medicine, and then ask innocently: she asked us to buy her a Cardiology book, shall we, or will we increase her anxiety about physical ailments?
It seems contradictory, but the fact that Silia very often goes to the parents' bed and asks for childish to infantile caresses, even kicks her father out of the bed, completes the picture.
The mother would have liked another baby, but she could not have one and favors Silia to remain a baby. She herself feels that she has lost her husband's tender gaze that brought out her girlish cool side, which preeminently determined her choice of partner, being the child of an overbearing mother. If the mother is fixated on the relationship with the man who reinforces her childish side at some point he gets tired and moves on and she risks losing her femininity and deriving pleasure from a motherhood that does not allow the child to grow.
Silia oscillates between the contradiction: small – big
children's needs – vision of Medicine
and is steadily led to somatization.
Interestingly, the symptoms began when the father's first grandchild was born and Silia was threatened by his presence as it undermined her own position. The father is ashamed to hear the address "grandfather" he feels his age is betrayed and his current family is threatened. As a result, he avoids the relationship with the first daughter and her family.
What is Chile's real age?
How does he oscillate between two unrealistic ages?
How are her difficulties related to the parents' difficulty in reconciling with their own and their partner's existing child?
The child psychiatrist is called upon to confront the child within him.
He gets in touch with sides of himself that his parents ignored when he was a child. When you are ignored at some stage of your life, you risk ignoring the children at a corresponding stage. There had been a survey of adults who had been institutionalized teenagers during the war. The conclusions showed that they found it very difficult today to understand their own children who were going through the corresponding phase of life. The therapist risks becoming punitive or overly permissive, fantasizing about the adolescent outside of reality, reliving his personal deprivation: he may painfully realize that he did not experience freedom, was not allowed to challenge, was a good, compliant child.
The specialist who has not previously experienced the satisfaction of his personal dependency needs when working with emotionally deprived children. Satisfies a part of his own dependency needs. It risks reinforcing children's dependence on treatment and lack of progress.
Some child psychiatrists want to prove that they are better mothers or fathers than their own parents. The therapist's great, unsatisfied need to be loved causes him to strengthen the children's attachment to the therapist, which is most easily achieved when working with emotionally disturbed children and trying to prove that he is a better parent than the real parents - he gets caught up in fantasies of salvation.
The child in the expert resents the parents as if they were his own, may subtly encourage an adolescent rebellion against parents or other forms of authority, or acts as the child's advocate in order to satisfy his personal needs.
In this way, the child psychiatrist risks becoming frustrated, frustrated, angry or competitive. The therapist who has identified with the ideal parental figure cannot avoid tension when confronted with the child's real parents.
Do you have kids; Parents usually ask not only when they see a young therapist, but especially when they experience guilt, rejection, misunderstanding on the part of the therapist. The specialist becomes a surrogate parent when he basically wishes to take care of his inner child. He is called upon to face his own desires as well as the projected desires of the child.
The child psychiatrist may identify with the child against the parents or with the parents against the child.
Over-identification of the therapist with the child when the parents cause envy or competition, e.g. wealthy, professionally successful, or with colleagues who bring the child to therapy.
When they encounter problems in the child corresponding to the problems they had as children, they also run the risk of over-identifying with the child and seeing him as a victim.
The therapist's need to be liked by the child, or to give him satisfaction, blocks his freedom, a necessary condition to function as a specialist.
It is therefore imperative that the specialist has felt his dark spots - difficulties encountered in respective phases of development and not processed - which, when he succeeds in processing, become sources of wisdom.
If it constantly returns with nostalgia to the trauma and the deprivation, then it maintains the trauma, on the contrary, good care towards the child, as it transcends itself, is addressed as good care to the existing child as well.
The awareness of the unconscious motivations for choosing a profession helps to free the Child Psychiatrist from delusions, bitterness, refutations of fantasies of omnipotence and above all from professional burnout.
But there is the eternal teenager.
There is also Peter Pan: the child who does not want to grow up because the world of adults causes him fear and threat.
Peter Pan was a sad child and Barry's author created him to mourn his own childhood.
According to Lene, when a baby is cradled firmly in its mother's arms, a sense of gravity begins to build within it, and with it the reassuring impression that it is building its "I".
Babies who were unable to gain weight in their mother's arms, or those whose sense of belonging was abruptly cut short by some tragic event, run the risk of becoming sad children, fluttering through time in search of a lost piece of their childhood. It often happens to a grieving child, in his attempt not to mourn his lost childhood, to lose his ability to feel.
A child does not want to grow up when the parent's needs prohibit growth because they fear their autonomy and in the end the child is convinced that they will not make it in the big tough world.
When the child psychiatrist remains a Peter Pan or a perpetual adolescent he will be engrossed in dealing with the child or adolescent, but will disdain working with parents, and then reconciliation of the child with his parents will not be possible.
When the child psychiatrist cannot work therapeutically with parents there is a mistake from the beginning, a disorientation that fatally negatively affects the therapeutic work with the child.
When the child psychiatrist devalues working with parents, he devalues parenthood itself and isolates the child from his reality.
Does this not ultimately signal his own difficulty in reconciling his inner child with his adult side?
It is very important to utilize the principles of existential psychotherapy in child psychotherapy.
First, the respect that the child is entitled to as a person, no matter how small. The recognition that he is a unique person, a unique existence and the meeting with him at this particular moment is unique.
Our existence is defined by our choices and actions, by the limitations of our existence and freedom, and by our relationship with others.
It is very important to focus on the concepts: experience, choice, responsibility, meaning of life, personal responsibility in relationships with others.
When I first saw Fotini, her face was scarred by her mother's uncontrollable anger. the mother suffered from manic depression and had a history of hospitalization in a psychiatric clinic. It seemed harsh when I told her in confidence: make sure you don't screw up again.
She looked at me in amazement, worried if I could finally understand her. After a month he told me with confidence and relief: I understood very well what you meant. Later in treatment she fought valiantly not to follow her mother's path. he was realizing the limitations and unleashing the possibilities. For the record, the referrer was giving her the same medications that the mother was taking.
While someone else may be bringing the child into treatment, how does the child themselves decide to commit and get involved?
The child psychiatrist is invited to give the child the opportunity to choose, while the framework is already decided. In the treatment process the child has a say.
It is not possible for a specialist to work with children and not serve development.
How will the therapist incorporate the many different developmental aspects of the child? The sadness as the child grows up and mourns the alienation and childishness, as well as the unconditional care, the sadness as he gives up the good things of the previous phase, the many separations he has to manage and the new openings he has to approach – finally how will the expert go along with him if he is not happy to evolve himself?
How will the child psychiatrist inspire life if he has given up, if he feels small, miserable, disappointed?
The child struggles to assimilate the constant changes occurring in his body, mind and heart. He stands dazzled by the beauty and horrified by the cruelty of the world. He tries to explain the contradictions of the great.
The specialist is called upon to mediate between the child and reality. He becomes a translator of riddles.
In a counterpoint process: the child invites the expert to stand honestly against the fragmented internal staff of the map and revise it. If his truth cannot stand up to innocence, he has no substance. His dark, tormenting parts resurface as the child reveals them. At the same time, the child offers a continuous broadening of the view and understanding of the world.
The questions that children ask, even if they require painful processing, can become an occasion for personal fulfillment. The child's questions are always existential, as in his innocence he asks to connect simple things with the depth of existence.
The specialist is called upon to lead the child beyond his own achievements, beyond his own difficulties.
For the meeting to be meaningful, it requires the recognition of diversity, the metabolism of the other's experience.
The personal inner process, the search for one's own history, the existential anxiety to answer the children, the power to process one's dark points offer the expert the possibility to mature, while maintaining a coolness and a freshness of renewal offered by the contact. with new children.
The continued development of the child is an ongoing challenge that requires the future to enter the present of the relationship.
Loving the growing child means that today's responses aim long-term at the gradual building of tomorrow's adult.
We approach the child in therapy like poetry: we expect surprise, each word can be used in a unique way changing the meaning. Symbolism very often provides the space for the true encounter between therapist and client.
On the other hand, poetry is nothing else than the secret relations of concepts.
BIBLIOGRAPHY
• "The Child's Psychotherapist", Mary Boston, Dilys Doss, Kastaniotis Publications
• "Countertransference in Psychoanalytic Psychotherapy for Children and Adolescents", Tsiantis Yiannis, Kastaniotis Publications
• "Teenagers", Dolto Francoise, Pataki Publications
• "Peter Pan or The Sorrowful Child", Kathleen Kelley – Lainè, Agra Publications
Eleni Karagiannis
9th Panhellenic Child Psychiatry Conference
November 27-29, 2015
School of Nursing EKPA, Athens