Some Thoughts On How to Learn What to Do in Child Therapy

By Andrew Guthrie, Ph.D.

When I began to practice psychoanalytic therapy in 2000, I was not sure what to do or how to behave. Therefore, I learned what to do by experimenting with various actions made in response to a child’s play or words and reflecting on these actions. To simplify the problem and cut through the confusion, I initially fell into what I consider to be the normative but problematic tendency of beginners to split theory into clear compartments in an attempt to unambiguously identify the single best theory that could rule our competing theories and indicate what precisely I should be doing. This made my patients and myself susceptible to dangers that can potentially be minimized if other beginning therapists have access to data that directly expose the epistemological tensions and practical problems they face. Risks cannot be eliminated completely, nor would this be desirable, as it is assumed that valuable lessons are learned in all practical fields by trial and error. In fact, it will be suggested later in this study that beginning therapists may need to patiently live through and grapple with the problems in their practice in their own way without letting their desire to find definitive, absolute answers to their questions oversimplify or short-circuit this process. However, if beginning practitioners had access to a document that frames the challenges of this work, learning might occur more expediently with fewer errors. Perhaps the learning experience of the therapist would be enriched by reading stories about the struggles of beginning and experienced therapists, enabling the beginner to feel that he or she is not alone with his or her problem. This is why the method of interviewing child therapists can be useful: for the beginner it will mean exposure to the reflections of people just like him or her, as well as clinicians that have been in a position of not knowing, and now know more than they did before. By studying such an account, therapists will make contact with reflections on learning to practice therapy that are often left hidden within procedural, intuitive knowledge, and this exposure has the potential to enrich and improve therapeutic practice.

 Some therapists (i.e. Strauss, 1999) have expressed the view that, because  psychoanalytic therapy  has more in common with the “mysterious realms of the unknown” than with hard science, it is impossible to say concretely what we, as psychoanalysts, have done to enable change in our patients. Often espoused by thinkers within the relational model, this view has also been described as “finding things to talk about while change goes on silently” (Caspery, 2003). While I agree that studying the relationship between the therapist’s actions and the responses and changes that occur within children is a very complex problem, I also think it is one that can be made less mysterious if we try to slow it down and inspect it piece by piece with the aid of useful literature on the subject, in conjunction with our reflections on our own therapeutic actions, especially through the medium of in-depth interviews with therapists about their work. It may be true that the “major feelings a child psychoanalyst must endure in his work will be bewilderment and complete disorientation” (Strauss, p. 82). However, if this assumption can be accepted as inherent to an investigation into this discipline’s theoretical and practical problems a priori, then it can also be dismissed a priori. The difficulty of a task should not preclude an attempt to confront the task and develop interesting and tentative answers to problems that did not previously exist.                                   

I restate my idea that studying actual stories of therapists may yield more compelling and persuasive data for the beginning therapist about learning to practice therapy than the comparison of competing theories about what therapists ought to do that may be removed from actual practice. Knowing in advance that finding a definitive solution to my problem is not possible or desirable, I hope to listen to other people’s stories about how they grapple with their practice and possibly uncover more complex but less obscure knowledge about the problems in the work and how people live with them.

In-depth interviews with psychotherapists about the evolution of their work is more common in adult psychotherapy (i.e. Rudnytsky, 2000, Mullan, 1996, Dryden, 1991, Wolff, 1956, Molino, 1997, Raymond & Rosbrow-Reich, 1997), but virtually invisible in child therapy (exceptions include Sandler, Kennedy & Tyson, 1980, and Hunter, 1994). This is paradoxical when one considers that child psychotherapy is arguably the more complex of the two practices, especially in connection with therapeutic action. Reasons include the child’s ongoing development in all areas, the problem of the child remaining in the home environment that may have contributed to the problem, the need for therapists to flexibly move between playing and talking, and the common resistance of the child to reflect on his or her worries. Therefore, a document that exposes the stories of child therapists about their problems can be considered a necessary addition to the existing literature.

Strauss (1999) agreed that there is a notable dearth of research about what makes a child therapist effective. We have no adequate theory either of the therapist’s act of understanding or of making an interpretation (Edelson, 1988). Existing attempts have not specifically responded to the beginner’s struggle in learning to do this work, nor have they shown the inner, self-conscious debate that occurs in the therapist during therapy. These attempts tend to exclude the personal feelings of the therapist as they struggle toward understanding. Other studies have not considered the intersubjectivity of child therapy, instead focusing on the therapist as the deliverer of unconscious truths. These therapists have been “ . . . led away from the impact of their own actions and interpretations in their child patients . . . We need an approach to the psychoanalytic interaction that takes account of both what the child brings and the analyst’s input” (Altman, 1994, p. 393).

This study is such an approach. Not only does it consider therapy to be a mutually interactive process that requires deconstruction, it also presents a fresh, beginner’s perspective on the epistemological mental work that therapist’s can adopt to better understand the challenges they confront and to help them become more thoughtful, reflective therapists. Among other things, the study will suggest that what is required is “ . . .  an inner act of freedom that allows the trainee to respond with excitement that is both emotional and intellectual, to correct not by applying insights from theory to practice or translating from clinical work to the literature, but to living and dreaming in both” (Lomas, 1987, p. 127).

© Andrew Guthrie 2006