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Therapy with Children: An Existential Perspective

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This book explores the existential themes and challenges present in all therapeutic relationships when working with children. Existential ideas and concepts are a rapidly growing influence on the practice of psychotherapy and yet their application to work with children remains largely unexplored. This book begins to redress this imbalance in a practical and engaging way by presenting an existential perspective on some key themes in practicing psychotherapy with children, including: play, anxiety, guilt, choice, family relationships, language and process. Each chapter is punctuated with engaging vignettes of case material, blending theoretical insight with the realities of practice. Through these narratives readers are challenged to question their own assumptions and beliefs whether they are new to existential psychotherapy or already immersed in its rich philosophical traditions.Children are born into the world without choice and are drawn towards making connections with others, developing self-awareness and personal identity. As contemporary psychology and psychotherapy with children focuses increasingly on the importance of the therapeutic relationship, Therapy with Children: An Existential Perspective takes this as its starting point to develop a powerful model for practice.

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CHAPTER ONE: Questioning and assumptions

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Questioning and assumptions

“The real is a closely woven fabric … Perception is not a science of the world, it is not even an act, a deliberate taking up of a position; it is the background from which all acts stand out, and is presupposed by them”

(Merleau-Ponty, 2002, p. xi)

“Science manipulates things and gives up living in them. It makes its own limited models of things; operating upon these indices or variables to effect whatever transformations are permitted by their definition, it comes face to face with the real world only at rare intervals”

(Merleau-Ponty, 1992, p. 159)

Much psychotherapy practised with children today seeks to objectify. Attempts to interpret what happens in a therapeutic relationship effectively close down possibilities and narrow the dialogue created towards a sense of “truth”. Existential psychotherapy does not do this. It aims to understand, not interpret. It does not seek an objective truth, or a quality of essential truth—a truth of essence. Instead, it uses the discourse of phenomenology to create awareness, and possibility. Analysis, as Heidegger tells us (in the “Zollikon Seminars”, Heidegger, 2001), is rooted in a definition of “breaking free”, not restricting, and it is the child who can be offered an opportunity to break free of, or transcend, their (family) history to become an individual. This is not an easy task, and not always immediately desirable by the family and professionals alike, but it is, I believe, the responsibility of the therapist to work towards this process.

 

CHAPTER TWO: A theory of existential practice with children

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A theory of existential practice
with children

“Theoretical behaviour is just looking, without circumspection”

(Heidegger, 2000, p. 99)

Before considering how a theory of existential psychotherapy with children would look, it is first necessary to consider how appropriate it would be to develop an all-encompassing theory of “existential child psychotherapy”.

Circumspection means to look around. This seems to be completely opposed to theory, which looks in one direction. In examining theory, the reader is looking for something, categorizing it, and jumping ahead of the text they are actually reading. A theory is formulated and examined in much the same way as a calculation. A calculation employs a process, which is already determined in some manner, since it must obey a pre-existing set of mathematical rules. We cannot, for example, decide to multiply in a new and original way. If a psychotherapist or counsellor aims to be truly open to the presentation of a child, then a theory must not be at the forefront of the engagement. If the therapist engages “theoretically” in a session with a child, it encourages him or her to be aware of what might be coming, and, in doing so, make what is close at hand further away; it confers to them an expectation or an idea of what is intended, but may not be realized. When travelling to work in the morning for my first session of the day, I might often be ahead of myself, in some way. In other words, I am perhaps thinking about how the child may arrive, whether they will be on time, how the session may go, and so on. What I am actually least attentive to is what I am actually doing: driving. This has become a pre-reflective activity. Similarly, within a session with a child, if I am too focused on how they may present themselves, and how their behaviour should be categorized or interpreted, what I am least attentive to is what is actively being revealed in our relationship.

 

CHAPTER THREE: The process of child therapy

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The process of child therapy

“Does the man who knows know something or nothing?”

(Socrates, from Plato, 1974)

It feels appropriate for a book that aims, in part, to initiate debate about existential considerations of therapy with children, to offer further questions and an opportunity to reflect on individual practice. This book is not a manual for the practice of existential psychotherapy with children. Instead, this book endeavours to function as a guide to a new land, offering individual opinions and reflections, reviews and experiences. As with a travel guide that recommends a new restaurant or hotel, the idea is that readers will be encouraged to sample this approach for themselves, develop opinions, and challenge the ideas proffered. This chapter addresses some of the key matters which must be considered when working therapeutically with children, and to reflect upon how an existential perspective on these issues may complement or question existing ways of working. In setting out practical steps for the context and introduction to therapeutic engagement, the practising therapist must remember that each new meeting or encounter with a family, professional, or child is a unique and singular experience.In meeting a child at a particular time, in a particular way, with a certain therapist, something new has been created which cannot be transposed and objectified into a seminal moment of the process. Each encounter is unique and special, and reveals something of the child in that moment. Upon meeting them again in a different time or place, this is, to all intents and purposes, not the same child. We are all active beings in the world, projecting ourselves forward into existence. The child who attends therapy is always active, always doing, always choosing, and, as such, is not a static entity that we can assess, measure, and treat.

 

CHAPTER FOUR: Play

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Play

“Child analysis of whatever school is built around the child’s
playing.”

“… It is play that is universal, and belongs to health”

(Winnicott, 1971, pp. 39, 41)

Play is an activity viewed by Winnicott as a form of growth. A healthy, growing child will need to play, and Winnicott also claims within his book, Playing and Reality (1971), that in monitoring a child’s mental health and wellbeing, it is almost possible to disregard all other social dysfunctions if they are able to play creatively. His premise appears to be largely founded upon the importance of play as a facilitator and catalyst for the forming of relationships. He asserts that these relationships, with other people and the child’s world around them, fall into categories of being healthy or unhealthy. The emphasis that play makes on the health of these relationships is in communication, and Winnicott suggests psychotherapy is, in some ways, just a specialized and advanced form of communication through playing. The play, in this case, simply aids communication between the two parties.

 

CHAPTER FIVE: Family and method

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Family and method

Even when a child is abandoned or orphaned, they always exist in relation to others, most significantly their family. The infant being with her mother is primordially constitutive of its very existence. There is never an infant without a mother. In psychotherapy, for many adult clients attending sessions, a discussion of their memories and understanding of their childhood and their family relationships are commonplace. For a child, the influence of their family is inescapable. It is important to consider, however, at least in a brief manner, what is really understood by the term “family”.

The word “family” can be used in two main contexts: as a primary social group, or in the biological sense as a categorization of animals into taxonomic groups. Importantly, the first meaning is imbued with the notion that its function is to provide for its members, while the second signifies that commonality can be found between its members: that is to say, the criteria for being classified in that particular way, for example, Felidae (cat family) as opposed to Canidae (dog family). From an existential perspective, however, the family should be seen as a specific context in which the relationships between each member can be highlighted. If being-in-the world always essentially means being-with-others, then family is no exception to this, and the abstract concept of a unique individual existing in isolation should be abandoned. The child always exists with their own distinctive history and their family environment, but an opportunity to transcend their context through awareness of choices and possibilities is still achievable. If, on the contrary, the family is seen as a system or a whole object, then it can become viewed as an organism in its own right, with its own “pathology” or patterns of behaviour. The family should be seen as an intrinsic part of the being-with, relational existence of the child.

 

CHAPTER SIX: Family and context

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Family and context

Existential psychotherapy holds no refuge for the reality of intrapsychic processes. The mind is not the home of the psychological challenges children may face in their life. These are found in the context in which they find themselves, essentially in their world. For the therapist to look at and try to understand these challenges, they must, then, do so not by uncovering internal, “intrapsychic” processes, but through an understanding of each child’s context. Traditional analytic thought is anchored by the interplay of individuality and consciousness and it assumes a Cartesian picture of the mind: children are effectively bodies and minds amicably brought together, accepted as givens and explored in a relational sense, not as a whole. The context in which we all find ourselves, however, is one of being in relation to others. The existential therapeutic process, which begins to develop then in light of a perspective of context, involves the opening up of possibilities. Each question or intervention provokes further enquiry, and so on, and so on, in order that any understanding for therapist and child is not reductive and limiting but each meaning creates new meaning. Without internal intrapsychic processes, the search for a “true” reality is meaningless and eachphenomenological disclosure speaks to us of the context and the child’s relationships.

 

CHAPTER SEVEN: Existential psychotherapy and psychoanalysis

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Existential psychotherapy and
psychoanalysis

“Tell me how you are searching and I will tell you what you are searching for”

(Wittgenstein, 1980, p. 3)

Central to the practice of psychoanalytic psychotherapy is an initial belief in the assumption that internal processes are at play with influences from the external world in shaping our emotional states and their development. The way in which these internal processes interact with their external counterparts, however, is something of a long-running debate within the psychoanalytic community (although, modern trends appear to lean more towards the importance of the intersubjective relationship). It has even been suggested that such divisions of internal and external influences are ambiguous or confusing unless one is viewed as directly influencing the other (Gill, 1994). Undoubtedly, these modern shifts towards further acknowledging the influence of the relationship as crucial to the psychotherapeutic process bring psychoanalysis closer to the ideas of existential therapies. Despite this movement, significant differences do still exist. Throughoutthis book, many points of convergence and divergence between existential and other (perhaps more traditional) psychotherapies practised with children have been highlighted. In order to provide greater clarification, however, this chapter aims to underline a more direct comparison of some of the core principles of practising existential or psychoanalytic-based psychotherapies with children.

 

CHAPTER EIGHT: Existential phenomenology

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Existential phenomenology

Jacob

Jacob was a child I saw for eighteen months, who was six years old when we began our work together. He was referred to me as a child in “need” of psychotherapy by his social worker. Throughout much of his life, he had been an unfortunate witness to the violent and often drunken abuse his father directed towards his mother. His only respite from this volatile environment appeared to be when his father went “missing” for several days, even weeks, at a time. Just prior to him being referred to me, however, his father had been arrested and charged with assault after his mother had gained the confidence to involve the police, and a social worker had quickly been appointed.

I always looked forward to my sessions with Jacob. Although often sombre and, indeed, rarely laughing or smiling, he carried with him an air of maturity and sophistication which belied his age and circumstances. He was six years old, but conversed with me in a very adult way, and I often reflected to colleagues in supervision that if he were twenty or thirty years older, he could almost be a friend. During the beginning of our work together, Jacob chose toplay little, instead preferring to sit and chat about the events of his week and what he had done, generally in a quite factual manner. He would tell me what he ate, what lessons he enjoyed at school, and so on, rarely mentioning his family relationships or his emotional response to recent events, even when prompted to do so.

 

CHAPTER NINE: Knowing and not knowing: existential perspectives on truth

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Knowing and not knowing:
existential perspectives on truth

The archaeological paradigm within psychoanalysis, in which the therapist adopts a role of explorer, seeking for the “hidden” latent truth in a child’s presenting pathology or narrative, does not hold true for existential practice. When presented with the playful and creative narrative of a child, a traditional psychoanalytic model of practice may encourage the therapist to distinguish between the surface presentation and a deeper underlying truth. It becomes a necessary part of the therapeutic process to endeavour to uncover the true meaning of what is actually being revealed by the child. The objects presented lose their surface meaning, turning into symbols of deeper representation.

At a very simplistic level, a toy animal figure stuck in the sand, for example, could be interpreted as representing the troubled mother paralysed by her own anxiety and fear. The figure is not just a figure, but becomes imbued with additional meaning and symbolism beyond what it actually is. When working through an existential–phenomenological framework, this distinction is unnecessary and unhelpful. Instead, the presentation of the child and their story can simply be understood as a truthful representation in itself. Any greater understanding, which the therapist may strive for, arrives subsequently, not through the interpretation of a theoretical framework or scientific knowledge, but from an establishment of ever-widening contexts. In the case of the toy figure in the child’s narrative, this may be a matter of considering what type of toy this is. Perhaps it is a wild or domesticated one. Perhaps the child has chosen a different figure to last time. This, in turn, raises questions about how the child may view and perceive this animal, and the sensation of it being stuck. A mutual understanding is developed through the phenomenological disclosure of the choice of animal, its context, and so forth. As the context and understanding expand, so, in some ways, do the choices and possibilities. This process of existential practice does not establish a system for interpretation, but a context for understanding, which includes the world as a whole. The meanings of each toy chosen to construct the child’s narrative already arrive in the play with values that may or may not be explicitly acknowledged, but are, none the less, present. The child may use a toy lion as a mother, but it is still initially a lion, unless we are told otherwise.

 

CHAPTER TEN: Language

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Language

Working phenomenologically with children, the therapist is offered an insight into their world-view through their language. This may also present a greater possibility of disclosure, if they are able to take into account the assumptions that we all make towards another’s understanding of a given word.

Each word a child uses may have a different meaning attached to it, a less rigid understanding than the way in which I may use or frequently encounter it. The world of each new child is like a foreign land with a unique culture different to my own, and yet grounded in historical context. The therapist’s challenge, then, is to remain aware of the need to be mindful of different ways of understanding and coping with the world. Poetry, for example, as described earlier, is typically read in a different way to how a novel might be read. The reader expects the unexpected. The words, syntax, and grammar may be familiar, but we anticipate that each word will be layered with meaning beyond its everyday use. Similarly to the reading of poetry and verse, the language of children should not be analysed through an exploration of every possible interpretation or a search for a “deeper”, more real, allegorical meaning. Instead, the therapist must be open to question and consider what first comes to mind and be alive to the narrative and disclosing message of the language.

 

CHAPTER ELEVEN: Authenticity and anxiety

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Authenticity and anxiety

If an object is described as authentic, it is taken to be genuine and real. If buying a particular brand of watch from a shop, I might ask if it is an authentically made watch by the manufacturers it claims to be from. In order to test this, I may look at an example of one I know already to be genuine. If asked to look at a painting and provide an opinion as to whether it was painted by a particular artist, an expert would be expected to have studied other works by the same artist known to be authentic with a strong provenance. Is it an authentic Picasso, Rembrandt, or Cezanne? To test the painting’s authenticity, as with the example of the watch, there must be a comparable and original template. In essence, this template is the “true” and authentic example against which comparisons are made. When we consider the authenticity of what it is to be human, however, it is not possible to find a definitive template. There may be people we admire or look up to, but there is no quintessential human being. There may be habits, behaviours, and actions about which we may feel more proud than others, but none of them is more authentically “us” than any other. In different places and under differing circumstances, every child will act and behave differently. At school, they may be described as very well behaved and well liked, but at home the same child may act in a frequently aggressive or violent manner. No one state or pattern of behaviour is more authentic than any other. They are simply two aspects of the same child.

 

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