It is the parent who brings their child to us, not the child who comes asking for help—and this could complicate matters!

OUR OBJECT RELATIONS THEORIES OF DEVELOPMENT can be misused to support a view of the child as passive recipient of parental input. This might lead one to have no appreciation of the complicated active processes within the child. Appreciation of the child’s role in assigning meaning to perceptions in the light of developmentally determined capacities and drive propensities, is essential to a reasonable stance with parents who come to us with their concerns.

A misrepresentation of the classic analytic model can be used to distance the analysts from parents who make them anxious. It is easy to see parents as pathogenic, intrusive, disruptive, and unempathic with “the child’s needs”—the analyst may ask why can’t parents just let their child have the experiences or treatment that he/she needs and leave us alone? It is not easy for analysts to see the treatment process, itself, as an intrusion into the family and recognize their own aloofness, unavailability, criticism, exasperation, and even discourtesy as a problem. It is hard to examine the disinclination to understand the parental resistances and work with them rather than applying labels and attempting to dispel such matters from an authoritarian position.

ONE OF THE BEST PREDICTORS OF A SUCCESSFUL TREATMENT is support from both parents—which translates as the parents’ general understanding of the treatment process. A major difference between the treatment of adults and children is the nature of the working alliance. An adult may be swayed by intense transference swings in therapeutic regression but will still, generally, maintain the treatment contract of hours, fees, and task. A child must rely on his parents to support the treatment in the face of major affective shifts which cannot always be contained in session. For parents to assist their children in continuing treatment, they must have a working alliance with the therapist—this can be exceptionally demanding on therapists when parents are involved in acrimony (with or without divorce).

The therapist needs to make an attempt to engage both parents at the start, before the child is seen, whether they can be seen together or must be seen separately. The diagnostic process reflects a series of decision points all of which include the parents in an educational/therapeutic fashion. The initial work of consulting with parents is done before seeing the child. The process of obtaining the history of their child’s symptoms and unfolding development can highlight interactions with the parents which may have acted as a developmental interference. Parental behavior, attitudes, and misunderstanding their child are frequently found to support the current symptoms. A clear view of the diagnostic process allows an engagement of the parents at the level of a search for meaning—of their own behavior as well as that of their child.

This approach allows the parents to be introspectively and empathicly engaged in understanding their child’s difficulties. This approach, also, allows the parents to make changes in their own parenting from understanding rather than compliance. Parental shifts in understanding can have dramatic effects. The simplest intervention might be an interpretation of a parent’s transference induced misunderstanding of their child’s behavior, eg. the parents feeling that their infant’s colic or their toddler’s negativism is a condemnation of them by their child with the full force of their own introjected parents’ disapproval.

IF NO CURRENT STRESSORS ARE FOUND, the parents can consider their child’s developmentally influenced understanding of an earlier period as being pertinent to the current symptoms. Parents thus engaged have a first hand experience with exploring the internal factors that influence their understanding of the world and an appreciation of such factors in their child as well. They have an opportunity to effect a change in their behavior or puzzle over their own inability to do so. Before seeing the child, we have movement toward a “good enough” environment for child rearing, an appreciation of the impact of earlier perceptions as determinants of present symptoms, and/or an inclination on the part of the parents to seek their own treatment. Beginning a treatment process in this way may take considerable time, but the benefits are that the parents have either a working alliance with the therapist that will support the treatment, a sense of a working alliance which will support a treatment, or a sense of mismatch which should lead them to search for alternate resources without having exposed the child to an unnecessary diagnostic intrusion.

If the alliance has been established and the current family setting was (or has become) reasonable, the parents can also see that the symptoms of their child are beyond modifications through their own efforts and, therefore, represent an internalized issue for their child—an earlier adaptation accessible only by a treatment orientation similar to the investigative approach that they have already experienced in the diagnostic process. At this point,the child can be seen for evaluation. A familiar process is involved in assessing the child’s specific needs. Does the child need assistance managing an acute situation or a developmental hurdle? The analyst must consider many possible dispositions including medication, psychotherapy, or further environmental intervention.

IS AN ANALYSIS INDICATED? The analyst must weigh the child’s capacity to benefit from the therapeutic regression which accompanies a transference neurosis; we must also consider the parents capacity to support such a process which ideally will be limited to the analyst’s office—but, at times, will not be. Alternatives of psychotherapeutic, educational, or pharmacologic intervention must be considered. An alliance, set in motion with parents during the diagnostic process, will give the greatest support for whatever treatment modality might be recommended. In making the transition to a specific treatment, parents must be encouraged to maintain contact with the therapist.

Each contact allows an assessment of parental positions which could enhance or interfere with the therapeutic process. Parents may need assistance with their own transference issues and/or a current predicament. The child may need to use his parents to communicate important matters highlighting interpretable (or non-interpretable, at the time) resistance. Parental information may be directly valuable in psychotherapeutic work with a child and his family, but, in any treatment, what parents have to say is always important. Receiving their information does demand that the therapist is clear about his/her role and technical tasks. In an analysis, where all interpretive material is to come from a managed transference neurosis, parental material cannot be discouraged, if to do so would interfere significantly with the alliance or establish a fortress of resistance outside of the treatment process. The difficulty managing parental concerns rests not on the shoulders of the parents but, rather, in the hands of the analyst. An analyst must be able to manage this information from outside the transference as other external information is managed whether it is presented from an unfolding education, reflections on the counter transference, or a generally expanding knowledge of the world.

Parents are reluctant to entrust the care of their children to people whom they cannot easily talk to — and they are right!

Barry L. Childress,M.D.