Healing Young Minds: A Deep Dive with Rachel into Child Therapy

Chen: I mainly work with adults and adolescents. When working with children, compared to adolescents and adults, are there any unique challenges? What are they?

Rachel: I can think of two challenges. One is that working with children requires more consideration of the systems/environments in which children are situated, because even if some changes are produced in therapy, when the child returns to that old pattern/environment, these changes are difficult to maintain. The second, in discussions with colleagues, I've found that many therapists who haven't worked with children find it challenging to "play" with children, because we are so accustomed to using verbal communication to work with adults, and the experience of play seems more distant for us adults.

Chen: Yes, verbal interaction alone is not enough when working with children, because children develop their various abilities through play. So how do you overcome these challenges?

Rachel: For me, working with parents/caregivers is an important component. Many experienced therapists even suggest it's an indispensable part. In my work with supervisors, we often discuss the part about working with caregivers, especially in the initial stages. Being able to establish a cooperative relationship with caregivers is key to the smooth development of child therapy work.Regarding "playing" with children, I think I'm good at this, which might be related to personal traits? I can feel the other person's experience in the process of playing games with children, understanding the deeper meaning conveyed in the play process. Even if I don't capture it at the moment, I might have an epiphany during reflection, and then we'll have a meaningful response. This process can happen instantly, or it might be a deliberate, conscious response made at a later moment after careful consideration. Although this is also a challenge, this process is precisely the part of child therapy that attracts me the most. On the surface, we're helping the child, but in some sense, this process is also healing the therapist's inner "child".

Chen: I can feel your love for working with children as I listen. I know you have a background in long-term psychodynamic training. In Australia, psychologists who have both long-term psychodynamic training and an interest in working with children are relatively rare. What unique characteristics does your psychodynamic training background bring to your work with children? Can you give an example of how you help children deal with anxiety and emotions during play?

Rachel: That's a great question. Every child's anxiety, frustration, sadness, or fear might look different. For example, two children with separation anxiety might present differently in therapy. One might anxiously want to complete various art projects, want to touch everything in the room, want the therapist to do this and that together. But another child might tell the therapist in a "fierce" way during play: "You're nobody, I don't remember who you are anymore," even hitting the therapist's toy with their toy to express the pain that separation brings to them, wanting the therapist to feel it too.In the play process, after a comprehensive assessment of the child, I make a judgment for this unique individual about how the emotions troubling them are presented, and how these troubles have developed step by step from possibly before birth, infancy, and early childhood to what they are today. This is also an aspect that psychodynamic child therapy pays close attention to.

Chen: During the consultation process, if parents want to provide you with background information or want to know how they can help their child in daily life, how do you usually collaborate with parents?

Rachel: Based on my experiences, such parents are rare - those who want to actively provide information and are willing to follow up on progress during treatment. So I just act as a curious "student". Ideally, after entering the treatment phase, I would discuss with the parents to agree on a suitable frequency, fixed time and place. We meet regularly (sometimes flexibly arranged according to the parents' situation) to update on treatment progress, ensure there's enough space and time to explore what difficulties they're encountering, encourage them to make some attempts, and then we discuss together the difficulties encountered in practice. Some parents might develop their own ideas during the discussion process, while others might need more guidance and exploration.

Nevertheless, I think what parents need more is encouragement and recognition. Raising children itself is such a difficult, labor-intensive process, even requiring parents to give up many of their own needs. Some parents may not have received good enough nurturing in their early years, so parents and caregivers also need a lot of support, encouragement and affirmation. It's important to recognize that caregivers want to put effort, time, and energy into their children, and that these contributions are seen and crucial.

Chen: 我自己是主要是和成人和青少年一起工作，和儿童一起工作，比起青少年和成人来说，有没有一些独特的难点是什么？

Rachel: 我想到两个难点。一个是与儿童的工作需要更多地去考虑儿童所处的系统/环境，因为即使是治疗中产生了一些改变，当孩子回到那个旧有的模式/环境中，这些改变很难维持。第二个，在和同行讨论的过程中发现，很多没有和儿童工作过的治疗师会觉得能和孩子”玩儿“起来是一个难点，因为我们是如此地习惯于使用语言交流去和成人工作，好像玩耍的体验离我们成年人更远。

Chen：对，和儿童工作光靠语言互动是不够的，因为儿童是在游戏中发展自己的各方面能力，那你会怎么去克服这些难点呢？

Rachel: 对我来说，和父母/照顾者的工作是很重要的组成部分，很多有丰富经验的治疗师甚至提出这是不可或缺的一部分。在我和督导的工作中，很多时候都在讨论与照顾者工作的部分，尤其是在开始阶段，能和照顾者建立合作关系是儿童治疗工作顺利开展的关键。

关于和孩子“玩起来”，这方面我认为我自己是擅长的，这可能和个人特质有关吧？我是可以在和孩子游戏玩耍的过程中去感受对方的体验，理解游戏玩耍过程中，传达出来的更深层的意义。即使当下没有捕捉到，在反思过程中也会恍然大悟，然后我们会有一个充满意义的回应， 这个过程可以是瞬间发生的，也可能是经过深思熟虑，在后来的某个时刻有意识地做出的回应。虽然这也是个难点，但是这个过程恰好是儿童治疗最吸引我的部分。表面上是我们在帮助孩子，但这个过程从某种意义上讲，也在疗愈着那个治疗师内在的”孩子“。

Chen: 我听着也能感受到你对和儿童工作的热爱。我知道你有动力学的长程学习背景，在澳洲，既有动力学长程系统培训，又有兴趣和儿童工作的心理师还是比较少的，动力学的培训经历给你和儿童的工作注于什么样的特色呢？你可以举个例子说一下和儿童游戏过程中，如何去帮助孩子处理焦虑和情感呢？

Rachel: 这是个很好的问题，每个孩子的焦虑、挫败、悲伤或者恐惧都可能是不同的样子。比如，同样有分离焦虑的两个孩子，一个可能在治疗中展现出焦急地想要去完成各种各样的艺术作品，想要去触碰房间里的所有东西，想要治疗师一起做这做那，但另一个孩子可能会以一种”恶狠狠“地方式在游戏中告诉治疗师：“你谁也不是，我已经不记得你是谁了”，甚至用手上的玩俱撞击治疗师手上的玩俱，以表达分离给自己带来的痛苦，想让治疗师也感受到。

在游戏过程中，我会在对孩子有一个全面的评估之后，针对这个独特的个体，做出一个判断，对于这个孩子来讲，TA所困扰的情绪是以什么样的方式呈现出来的，而这些困扰，从可能未出生开始，婴儿期、幼儿期是如何一步步发展到今天这个样子的，这也是动力学儿童治疗非常关注的一个方面。

Chen: 咨询过程中，如果家长有背景信息想要提供给你，或者想要知道自己如何在日常生活帮助孩子，你一般会有怎样的形式和家长合作呢？   

Rachel: 实际工作中这样的家长很难得，想要主动提供信息，还会愿意在治疗过程中跟进进度。那我就做一个好奇的“学生”就好。最理想的情况，进入治疗阶段后，我会和家长商量好一个合适的频率，固定的时间和地点，我们定期会面 （有时候可以根据家长情况灵活地商量调整），更新治疗进度，保证跟家长有足够空间和时间探索他们遇到的困难是什么，鼓励他们做出一些尝试，然后我们再一起讨论实践中遇到的困难，有些家长可能在谈论的过程中，自己就会有了一定思路，有些家长或许需要更多的引导和探索。

但我觉得家长更需要的还是鼓励和认可。养育孩子本身就是一个如此艰难、劳心劳力的过程，甚至需要放弃家长自身的很多需求，有些家长可能自己早年间都没有得到过足够好的养育，所以其实家长和照顾者也是需要得到很多的支持、鼓励和肯定的，能够觉察到照顾者想要为孩子付出努力，时间，精力等，他们的这些付出是被看见的也是至关重要的。