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                           Thoughts and Reflections...

 

The Usual Go To Therapy For Children and Why It’s Not Enough

11/14/2024

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Many people in the realm of caring for children, especially teachers and pediatricians, are quick to refer children to behavioralists or to suggest cognitive behavioral therapy. These approaches really miss the mark of how children actually communicate and learn. These assumptions regarding children and their needs can be harmful and provide a great disservice to children, due to their limitations. Let’s look closer at what these approaches mean.
 
Behavioralists: This approach is rooted in the study of Pavlov’s dog. Essentially, when feeding a dog, they paired the feeding with a bell tone. This they proved led the dog to associate the bell with food, thus when the bell would ring the dog would salivate. Once the food was removed from the equation, leaving just the bell, the dog continued to salivate. Essentially this is about creating new associations. I see this as a more antiquated approach to behavior, and here we see it is actually rooted in working with animals with less complex brains than humans.
 
Cognitive Behavioral Treatment: Here we are working on the idea that if we change how we think, we can change how we feel, and thus behave.  In this approach, we are also fully engaged in the analytical areas of the brain and the frontal cortex. Here is the problem, this part of a child’s brain is still developing. In fact, we now know the human brain continues to grow until the age of 25. Frankly, this higher-level thinking is the exact approach adults are using before a child arrives at my office. Everyone has already tried similar approaches through various forms of reasoning, and there has been no resolution. I also feel this kind of approach is fairly accessible through a Pinterest or Google search.   
 
When it comes to children, I believe both approaches are overly simplistic. Their common go to by professionals who work with children, both inside and outside of the mental health field, is rooted in essentially a lack of more complex thinking and education about children, their development, and it is an underestimation of children.
 
I agree with the idea of forming new associations that are positive. I also agree with the idea of teaching new ways of thinking to children, and new ways of coping.
 
But, I believe SO. MUCH. MORE. First of all, I know that by the time children arrive at my office, these two approaches have been tried and exhausted. This is how the world already approaches children, whether by parents, teachers, coaches, or whoever. And it is EXACTLY what has NOT been working. So, I ask you, why would I repeat that cycle? Parents, teachers and the like often expect me to. It might even be how they evaluate me, by how I can prove I am teaching them.
 
Instead, play therapists know how to reach the child where they are. In play therapy, the child goes to exactly what they need to work on in the play therapy room, without me directing them and telling them what they need to do - or should do. And frankly, kids are directed in their lives more than 80% of the time. In fact, I believe with all of my experience, training, and witnessing of children in play that if I did take the lead and direct it, I would only delay their healing process by getting in the way of that process, because…
 
Children know exactly what is causing them disruption in their lives, and somehow they know (when given the right conditions and support that we provide as play therapists) that it is safe to go there, and that is where they go. They may not consciously be aware of it, but at a deeper level they know it exactly. By not relying solely on words and abstract thinking (which fits for adults, and is how adult brains function), this frees up the child’s psyche to go where it needs to go, deeper and more fully than words permit.
 
This can take repetition. After all, our brains learn best by repetition. Through these processes there can be alleviation, processing, assimilation, and learning new ways of being in the world.
 
An Example:
I knew an adult who kept sending her daughter to a behavioralist at age 3, then again at 4, and then again at 5. As they focused on changing her behaviors, no one worked to address the real problems she was struggling with, that a therapist acting in the role of teacher, focusing on how to shift her behaviors could never get to:
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  • The child witnessed significant domestic violence in the early stages of life.
  • The child had spent the last two years watching her primary caregiver slowly and steadily getting sicker and sicker, going in and out of hospitals and care facilities. Her mother was essentially dying.
  • Daily life was focused on surviving day to day, and the home environment was fairly chaotic.
 
Nothing was being done to help her process her trauma. Nothing was being done to explore how the grief of watching the most important person in her life dying was affecting her. Instead, the system of adults involved in the child’s life were trying to change her behavior.
 
But I ask you, who wouldn’t be in a high state of turmoil given these realities? We as adults would be as well, yet somehow we perceive her, a small child living in a daily environment of stress, turmoil, and grief, as the problem. Here is the larger systemic break down that was occurring among the professionals involved with this family:

  • Everyone felt really good about what they were teaching her, they could write this down and say, wow, look what we did. We did good. We gave her SO much.
  • Insurance was happy with the service as it was concrete and measurable in tangible steps. The school was happy as it was very educational. The parent was happy as they advocated for their child and did what they could to support her and meet her needs. Everyone could feel “good” about their efforts and how they tried.
  • Their treatment sounded great on paper. Everyone could say they tried and contributed.
  • Except, nothing really did change, or it was very short lived.
 
But here is the biggest disservice of all: the failure that is then placed on the child for not changing.

  • Can you imagine what short- and long-term consequences this may place on this small child? What might the diagnosis be? Might there be a decision toward long-term medication? Yet, what the child really needed was to have their early childhood trauma addressed. What the child really needed was to express what life was like with their mother slowly deteriorating, every day of their life.
  • How would this impact you, an adult? Now imagine how it would impact you as a small child with a limited vocabulary to express these very complex realities. It’s difficult for adults to put into words. How can we expect a small child to?

I look forward to a future where all child therapists are play therapists, because play allows children to express their inner reality in a manner that isn’t limited by words. We really need to move beyond our adult limitations and see children as unique and complex people with a language of their own. And if we hope to reach them, we need to learn how to bridge the language gap. Play is the vehicle to do this.
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A Royal Pain

3/9/2021

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A Royal Pain:
The Unspoken Link That Meghan and Harry Spoke Of, But Never Said

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​What is the common link threaded through the Sunday evening bombshell interview between Oprah Winfrey, Duchess of Sussex Meghan Markle, and Prince Harry? One simple yet unstated word – by the royals themselves and the media coverage:
Abuse.
When it comes to abuse, people are quick to think of child abuse or domestic violence. When people think of domestic violence, they often think of physical abuse that involves bleeding and hospitalization. I am here to tell you the truth.

Abuse is so much more.

​And abuse is all I could hear as I listened to the scandalous accusations from Sunday night’s interview.  
 
Many of my clients with a history of abuse report a more insidious form of abuse, that is abuse of a more verbal or emotional nature. This is the type of abuse that gets minimized. I would argue it is as damaging, or even more so, as it hits in a way that can be hard to put your finger on; hard to define. But it wreaks havoc on the psyche and soul; it does so in such a way that it is hard to lay out and explain to others who are not living it.  
 
I will venture to lay out eight parallels, labeled in the interview as a lack of “support”, and explain how they actually fit clearly in the paradigm of abuse. Don’t let the fact that this doesn’t involve a parent to a child, or a spouse to a partner confuse the situation. This is an institution acting as all of the above, after all, the institution is made up of individuals acting in accord. 
 
Power and Control: Abuse is all about power and control, this is the tool used to maintain power. The extent of the control is laid out at every corner of the interview. Here, I will go into more detail. 
 
Medical Neglect: This is quite simply the refusal of providing medical care to an individual. Ms. Markle identified many efforts to go to an “institution” due to experiencing suicidal thoughts so intense and dire she had to say it out loud or she feared she would act on them. “The Firm” as they referenced it, or at times “The Institution”, would simply not allow her. This places this larger bureaucracy in a parentified role. Both the Duchess and Prince Harry spoke of many attempts to get mental health care, yet their attempts were denied. Normally we don’t think of neglect in relation to able bodied adults, but this type of institutionalized system creates a unique dynamic. 
 
Removal Of Personal Effects: Ms. Markle reported when she entered the marriage her passport, license, and keys were taken from her. This is an example of abuse, cutting an individual off from their identity and ability to freely leave their home. Essentially, the interview seemed to suggest a sense of being imprisoned in their own estate, as Meghan referenced not leaving in four months. 
 
Isolation: To the prior point, clearly removing personal effects isolates a person, but Ms. Markle further went on to state she wasn’t approved by the staff to go dine with a friend. This type of permission requirement again brings us back to a highly parentified system, and one that marks how she didn’t even have control over her own whereabouts.   
 
Punishment: I want to make this very clear, when abusers do not get their way, they resort to punishment. Punishment was such an ongoing theme in the interview that it seemed at the slightest push from the couple, punishment ensued. Some examples include: Prince Charles not taking Harry’s phone calls, removing titles for their children (with far reaching effects that extend beyond mere words), and not allowing them the privilege to work part time as their cousins and other family members are naturally afforded. Furthermore, more punishment and intimidation appeared to be present a few days before the airing of the interview, when negative staff reports were released accusing Meghan of being terrible to work for. Here’s another fact of abusers, they often accuse their victims of abuse, I suspect this could be in operation here: Abusers Often Accuse Their Victims Of Abuse.  
 
Placing Them In a Dangerous Situation, Intentionally: Perhaps the most devastating of all the admissions in my opinion, was the outright punishment and intimidation by “The Firm” in their reported decision to remove the family’s security. This is a shocking move, and possibly the cruelest of those reported. Prince Harry said so himself, he was born into the risk that goes with being a royal. Removing security detail from a royal, whose own mother was killed due to a paparazzi car crash, could result in so many dangerous possibilities, even death, like his mother. Punishment like this goes hand in hand with another abuser tactic: Intimidation. Oxford dictionary defines this verb as: (To) "Frighten or overawe (someone), especially in order to make them do what one wants."
 
These are simply a few common examples of how abusers manipulate and abuse, but to me they were the heavy hitters presented in Sunday evening’s interview. There are likely so many more.    
 
The reported racism of the royal couple, and clearly demonstrated in the print media is another topic entirely. But these acts are also abusive: commenting on the potential skin color of a future child in a degrading manner, comparing their precious son to an animal that has been historically used as a racist euphemism, providing the Duchess and Prince with a different set of rules to follow…the list goes on and on. I would even argue that not providing the Duchess with professional support, such as in learning the National Anthem are more examples of neglect, in that it left me wondering if the monarchy was quite possibly hoping to watch them fail, but utilizing a passive aggressive approach to avoid the appearance of any direct responsibility.

Last but not least, I applaud Prince Harry and Duchess Markle for having the courage and strength to stand up to such an overwhelming system, and their move to shifting what has likely been centuries worth of generational patterns of abuse for their family, which direly needs to be addressed. Prince Harry is a courageous and brave husband, Duchess Markle is a bold and strong woman, and their son is very fortunate to have them as parents. 
 
What did I leave out? What would you like to add? Please feel free to comment. 
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    Jordan Prebys, MA, LPC,
    ​RPT-S, RSP

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