I. Analytical Psychotherapy for Children and Adolescents
A mental disorder is the result of an unconscious conflict that has not yet been processed by the psyche. The child tries to keep the painful or socially undesirable thoughts and memories out of the conscious mind by activating and using various so-called defence mechanisms. We use defence mechanisms to protect ourselves from feelings of anxiety or guilt, which arise because we feel threatened. They are not under our conscious control, and they are involuntary. They can be expressed e.g. through aggressive behaviour, oppositional defiance or eating disorders. This means that the conflict is not being dealt with. It stays present within the child and continues to influence all feelings, thoughts and especially relationships into which the child or adolescent enters.
Accordingly, it is the current main inner conflict on which we concentrate in therapy, like a specific problem area that leads to the current troubles, symptoms and diseases or it can be a mental illness or problems affecting the psychological balance of the child or adolescent. These pathological structures can hold them back from completing their age-specific developmental tasks at present.
The therapist will try to find the root of these mental illnesses and issues within the safe space of the therapy room. By gaining insights into one’s internal psychic structures and processes, through the help of the therapist the child can work on these conflicts to restore psychological well-being.
There are differences between the therapeutic approaches when working with children and adolescents.
The main psychotherapeutic tool for adolescents is the verbal intervention and free association. Free association means that the adolescents can express their thoughts freely and without having to censor themselves. Through guidance, the adolescent will learn to “look within themselves” and gain introspective abilities to recognise their own feelings, thoughts and experiences, understand causal relations and triggers and learn how to process them. This leads to better integration, an inner relief and resolution of the symptoms.
By contrast, in child psychotherapy it is not the spoken language that we focus on, but rather the child’s free play, using different kinds of materials, depending on the child’s age of course. These methods are the equivalent to the free association of the adolescent's therapy. The free play is seen as the “via regia” to helping psychologically struggling children to stabilise themselves emotionally, process traumatic events and restore a healthy development. In order for the child to feel safe, accepted and daring to look at frightening experiences, a trusting, protecting and supporting relationship between the patient and therapist is indispensable.
Within the free play, the individual toys are the child’s words and the play his/her language. Through the medium of arts and crafts, the child can express his/her mental state and “talk” about the things that preoccupy him/her. The therapist can take up on these issues, reflect on them and put them into words. Through the positive relationship that develops between the child and therapist through play, corrective emotional experience are possible for the child. These very experiences of the therapeutic reactions and emotions are necessary for the child's self-development. They also promote the child's cognitive development, reduce dysfunctional thought processes and enable the child to handle inner conflicts more competently.
II. Person-Centred Play Therapy
Through the therapeutic use of play in play therapy, the child develops the strength to explore and resolve problems, process difficult situations and utilise hidden abilities. By gaining more confidence and self-assurance, the foundation for a healthy development is laid.
Non-direct play therapy is meant as a short-term therapy for children who have experienced significant traumata.
Virginia Axline, one of the founders of this approach, believes that the time effectiveness of the therapy – namely how quickly children respond to play therapy – depends on their age, among other things (like the severity of the traumatic experience). Children up to 6 years of age usually show first positive changes within 4 weeks and significant changes within 2-4 months. However, children between the ages of 10-12 show minor changes after 4-8 weeks and considerable changes after 4-15 months.
Therapeutic play uses the great power of play itself to work with and help children with emotional and behavioural concerns. Playing is the ideal therapeutic method for children dealing with divorce, anxiety, death, trauma, anger, difficult life transitions and other situations that cause stress or emotional pain. Children are small and the world and life’s problems can be big. When using play materials, children are in charge and they are in their natural element. This allows them to explore feelings and situations in a safe and empowering way.
The person-centred/humanistic approach believes that there is a motivation in every human being to unfold, feel comfortable, be healthy, discover and experience oneself within all of us, to fulfil one’s potential and achieve the highest level of “human-beingness” that we can. This drive is called self-actualisation.
The child will be able to grow into an independent, healthy and social adult who is happy with and within oneself through the tools of sufficient freedom, protection, guidance, motivation, love, appreciation and relationships. If such aspects are missing in their lives, e.g. owing to traumatic experiences, the balance and healthy tendency for personal growth are disrupted.
Play creates a relationship, meaning that the child connects with the therapist through play, which eventually develops into a relationship. Due to the therapeutic relationship between the child and therapist and the therapeutic space – created by the therapist – the child feels safe and dares to explore, express and process emotions and experiences. By doing so, they gain emotional mastery and their personality can develop and grow. To make the child feel safe, the therapist must be genuine, appreciative, empathic, awake, attentive and interested. It holds utter importance to have faith that the child's soul wants to be healthy and is searching for open doors to develop freely and unburdened.
The therapist meets the child with empathy and unconditional positive regard. Whatever the child feels in that moment, whatever he/she does or thinks is an expression of one’s true experience and is important. Their behaviour is accepted compassionately and without any kind of judgement. Furthermore, the positive regard is not given to the child upon a condition (“I like you only if you are obedient, quiet, etc.), but rather it is given unconditionally.
As I offer non-directive play therapy, the child can freely choose what to do with his/her session. They can follow their own heart, leading the way while I follow, reflect, observe, facilitate or participate in their play. Boundaries are only set when it is deemed necessary to ground the therapy in reality.
III. Psychotropic Drugs
In general, I am usually critical towards an overly-fast and exclusive prescription of psychotropic drugs. However, this does not mean that I do not consider the administration of a medication in individual cases as appropriate and necessary. Sometimes, if the symptoms are too burdensome, e.g. in case of a depressive disorder, a psychotherapeutic treatment is only possible with the help of psychotropic drugs at first.
However, the medical treatment should be extensively discussed with the child, the parents and the paediatrician/child psychiatrist and should never be an exclusive treatment.
If a medical treatment is advised for your child, I will happily make an appointment for you with the practice leading child and adolescent psychiatrist.