Child Psychotherapy:

Core items

MiguelA. Rock
Index
CONTENT. PAGE

• Individualized child-centered attention........................................................................................33

• Parent-centered care.....................................................................................................................34
• Joint care for the child and his parents....................................................................................36
Dr. Miguel A. Rock........................................................................................................................80
BIBLIOGRAPHY...........................................................................................................................81

How to include the family in psychotherapeutic care for emotionally disturbed children?
The importance of understanding the child and its symptoms 48 for Child
Psychotherapy
• Individualized child-centered attention........................................................................................33
• Parent-centered care.....................................................................................................................34
• Joint care for the child and his parents....................................................................................36
Dr. Miguel A. Rock........................................................................................................................80
BIBLIOGRAPHY...........................................................................................................................81

INTRODUCTION.

A few years into the Third Millennium, knowledge of the intricate psychological mechanisms,
especially emotional, of human beings, remains as enigmatic as the attempts, of one type or
another, to increase their happiness, well-being and their quality of life.

In the field of Psychology and Psychiatry this can be seen in the vast existing scientific
production of Psychotherapy texts, that branch of knowledge that, etymologically, deals
with the “treatment of the psyche”, And if psychotherapy was ever restricted to "altered
psyches" or people with some mental disorder or condition, its sphere of action
expanded rapidly and sensitively to people "with" or "in" problems but who are not
necessarily "mentally ill" and to those essentially "normal" people. ” but with a desire to
function increasingly better in their daily lives, in accordance with what has very recently
been called Positive Psychology .

Thus, the amount of texts that are produced on the subject is enormous – both from a
rigorous academic and professional perspective, as well as from a popular vision with a
dubious scientific rigor – with the most diverse perspectives derived from the existing
psychological paradigms and their variations. .

But if we slowly stopped to scrutinize and identify common aspects within so much
information, we would find ourselves with a situation that, unfortunately, has remained
unchanged for several decades: Although a respectable number of Psychotherapy
professionals work with children and adolescents, Child Psychotherapy continues to be
the “Cinderella of Psychotherapy”. And this is expressed not only in the small number of

2
texts specifically dedicated to Psychotherapy with children and adolescents, but also in
the fact that when reviewing these materials, they deal mostly with the adaptation and
application to the child population, what is postulated for working with adults. And this is
common for both psychodynamic and behavioral, humanistic or cognitivist literature.

However, in my opinion, in psychotherapeutic work with children and adolescents there

are common elements that transcend the theoretical and methodological orientation that
support the existing models and that deserve to be systematized both for academic
purposes in the training of future professionals of Psychotherapy in undergraduate
studies, as well as for professional and practical purposes, for already graduated
students who seek to coherently organize their daily work.

With this modest purpose in mind, this material was constructed, which consists of three
basic chapters and an appendix that characterizes the so-called “problem child” who can
be conceived as an archetype of many of the children who, daily, are taken to the
service. care of any psychotherapist or child counselor.

The first chapter deals with an initial approach to Child Psychotherapy, highlighting
aspects such as the “triangulated” character (the child who is the main “user”, the
parents who bring the “demand” and the psychotherapist who “offers” the service. ) of
the psychotherapeutic relationship and the specificities of both the child and the
psychotherapist in this context, as well as the necessary use of instrumental resources
(game, drawing, puppets, music, etc.) to optimize the effectiveness of the process.

The second chapter deals with the role of parents in Child Psychotherapy, analyzing
various forms of parental involvement in the process and validating the usefulness of the
procedures proposed by Family Therapy without this meaning ignoring the central,
leading role, of the child, when he is the bearer - not always! - of a level of emotional
and/or behavioral disturbance that requires it.

The third and final chapter deals with the importance of understanding the child and its
symptoms to guarantee the effectiveness of Child psychotherapy, starting from the
fundamental assumption that the child is a developing being immersed in an intricate
family network whose complexities , in most cases, is where the apparent problem
emerges.

The text is conceived from the most rigorous academic, professional and scientific
experience of its author for more than 25 years, but it was also sought to use an easy
and colloquial language from which a much broader audience can benefit, even if it is
not a professional. Psychology or Psychiatry. Anyway,... no profession has as many fans
as Psychology!

I can only hope that the reader enjoys this proposal and takes from it all the advantages,
both professional and personal, that he or she can obtain from reading it.

3
 An initial approach to Child Psychotherapy.

When a certain discipline emerges into scientific work, the first obstacle encountered is
that related to the problems of definition , and from here - explicitly or implicitly - the
answer to the question "what is its particular sphere of action?" And what are your
own methods?" .

Perhaps the maturity of a science, or a branch of scientific knowledge, lies in being able
to precisely define its object of study , however it is obvious that this definition would
always have a limited scope, since the development of a profession itself or scientific
discipline regularly leads it to overcome the limits imposed by its definition and expand
its radius of action in new directions, especially when it is a relatively new branch in the
development of science,... and Child Psychotherapy it is.

It is obvious, therefore, that Child Psychotherapy is not immune to the definitional

problems referred to or to the questions that every branch of knowledge that aspires to
be respected in the scientific field is called upon to answer. In the case of Child
Psychotherapy, one is obliged, as a starting point, to answer complex questions, whose
fundamental dimensions are: (1) what is Psychotherapy? and (2) what does the suffix
"childish" imply,... what is its specificity in this direction?

What is Psychotherapy?: etymologically the answer would be simple "the treatment of

the psyche" ,... however, one might question what is meant by psyche? Is the
etymological translation enough to explain the work of one science or another? What
type of psyche does Psychotherapy take care of?

Indeed, when talking about the psyche – an object with which any psychotherapist deals
daily – we can refer to both the psyche of:

That person who, from a traditional psychopathological dimension, could be

considered "neurotic", "psychotic" or another type of "mental illness" or who is a
carrier of any of the abundant expressions of psychiatric semiology (anxiety,
depression, etc...) ;

That person who, within "normal" limits, is facing "problems" that limit, or even
make it impossible, in his daily functioning, but that do not make him "mentally
ill",... is possibly the type of person who with more frequently they receive the
services of those who are dedicated to the professional practice of Psychotherapy;

That person who, without presenting said "problems", is at risk of facing them and
would require prophylactic interventions with the aim of avoiding or evading them,...
or if facing them is inevitable, carrying it out successfully. ;

That person whose "problems" have already passed, have been -or not- resolved,
totally or partially, but their consequences (new problems?) remain that they have
4
 to face;

Those "normal" people, without present or potential problems, but who legitimately
aspire to function increasingly better through the development of efficient
mechanisms and the elimination of those other mechanisms that limit or stop the
development of their human potential and may hinder the development of their
daily life.

It is logical to assume that those professionals who carry out their work in the field of
Clinical Psychology and feel legitimately committed to it, feel - also legitimately - that any
of these spheres correspond to them because they are part of their daily activity, and
that any of them It is Psychotherapy!, although reference is made to apparently different
intervention strategies or styles such as education, counseling, traditionally seen
psychotherapy and rehabilitation.

Thus, the practical work of a psychotherapist, in principle directed at the "patient", at the
person with "problems" who needs to be "cured" or restored to the lost or damaged
psychic balance, has multiple points of contact with other diverse forms. of psychological
intervention on human beings, such as education, psychological orientation (counseling,
guidance, etc.), help or support relationships and rehabilitation, just to name a few.

In other words, although the force of tradition has reserved or assigned to psychotherapy
a secondary level of intervention (according to the classic model of levels of health
intervention proposed by Leavell and Clark) on people with problems or already "altered"
, this does not exclude that the real practical practice of a psychotherapist is not only
limited to it, but has points of contact and common functions with other related
disciplines, without intending to invade their field, but neither limiting itself, given the
existing permeability between they. Thus, the requirements of the professional practice
of Psychotherapy transcend the limits that any conceptualization may impose and - as
we already pointed out above - its spectrum of action expands extraordinarily.

This taking of sides would even transcend the "hardly surmountable" limit (Vega Vega)
of the conceptualization proposed by Leo Kanner, by establishing that "all the efforts
made to achieve the psychological balance of a patient is Psychotherapy"...

"These premises alone do not prevent us from considering as psychotherapy the

frequent "psychological help" in the form of advice, clarifications, etc. that any
person can offer to another person who expresses their personal difficulties (Vega
Vega, Pag. 6)

However, and for purely operational purposes, we will consider as a starting point the
fact that a person comes to request psychotherapeutic help with a problem and this
problem may have a dimension or real presence such that it practically invalidates the
person in their daily functioning. or it may be a problem that has not even appeared but
that the person foresees may appear and looks for ways to deal with it in advance. It
may be someone whose life is in itself a "problem", because his personal history has
conditioned him that way and he himself has contributed and/or contributes to making it

5
so, and it may be someone who really, in his here-now is facing a problematic situation
that threatens his well-being, for which he does not have sufficient resources or does not
know how to use them appropriately

On many occasions, in specialized literature, it has been pointed out that the
problem is not the problem, but the solution, or rather the non-solution, given that it
either does not exist because it is not accessible (both objectively and subjectively)
to the person, or does not fit the requirements of the problematic situation.

If the term "therapy" or "treatment" is used formally to care for people who present a
"problem", then what has been stated so far seems to be consistent and - at least
conventionally - we could agree that psychotherapy presupposes among its components
the " presence of a person with a certain degree of psychological alteration" that
requires and demands - directly or indirectly - the interventions of a specialist or
qualified person "duly trained in psychotherapeutic methods" , with sufficient
qualification and experience to respond to the requirements of the "problem" referred to.

This presupposes that psychotherapy is in its most basic form an interactive process
between -at least- two people , one who is subject to the type of psychological
intervention conceptualized as psychotherapy, due to presenting a certain degree of
psychological alterations, and another who is subject to this service with the sufficient
degree of qualification, “expertise” and willingness to provide some type of response with
a certain level of effectiveness to the requirements of a given patient.

Let us pause briefly at this point: many words in scientific and technical language, used
by both Psychology and Psychiatry, frequently go on to "enrich" everyday slang,
although too often with an oversimplified and even vulgarized meaning.

Perhaps this explains why few professions or trades have as many "amateurs" as
Psychology. How many times has a professional or student of Psychology not heard
expressions like the following?: "...Psychology is so beautiful! I would have liked to study
it...","...in my work I really need Psychology, that's why I know a lot!...", "...I don't miss the
opportunity to read anything about Psychology that falls into my hands...", "...look friend,
I won't have I have set foot in the University, but there is no one who can teach me the
Psychology of the street, that of life!

Among them are terms such as stress, neurosis, personality, etc. - and, of course, also
psychotherapy:

In this sense, it is common in everyday life that when a person is anxious, sad,
irritated or “unbearable”, those around them and who feel affected by their behavior
tell them: “You are for Psychotherapy!”

However, this "psychotherapy" can be offered by anyone who "gives advice", supports
you, "is a good person", tells you "what to do at the right time", etc.; But this, which can
be a very laudable and even effective human action, cannot be compared to the
complex and, above all, committed and qualified intervention that psychotherapy means.

6
The psychotherapist is above all a professional : someone with the most complete
knowledge possible about man, the dynamics that drive his behavior, the laws and
regularities that explain - or try to explain - his functioning, someone with a mastery of
methods, techniques. and procedures duly endorsed and accredited by professional
work; oblivious - but without denying a possible space when circumstantially necessary -
to the daily improvisation and empiricism that, far from helping, can harm the person
receiving its services; someone with a certain degree of expertise given by years of
professional practice in caring for human beings with “problems”, which validates their
academic and theoretical knowledge; someone with an "ethical" commitment to the
patient and to their profession that translates into attitudes such as responsibility and
confidentiality with the requirements of those who request their services

Conventionally then, and for operational purposes, we would have that psychotherapy
presupposes:

1 .- The existence of someone psychologically altered to one degree or another, who

presents one or another type of problems that lead him to seek specialized help and

2 .- The presence of a professional, a person duly qualified and trained in

psychological intervention procedures on that person.

However, in its concrete expression it should not be forgotten that the practical task of
Psychotherapy is not reducible to this elemental dyad, but rather its concrete
manifestations can be seen in an even more complex way.

Caring for someone who is psychically altered is not caring for a person abstracted from
the context of their real daily interpersonal relationships, but it also implies caring -
directly or indirectly - for those people who in one way or another influence, contribute to
maintaining or sustaining the problematic and may even benefit from the "psychological
disturbance of the patient" who comes seeking help,... or unfortunately harmed if the
psychotherapist loses sight of this.

It also implies the possibility of simultaneously attending to not only one but several
people with similar psychological disorders - just as occurs in group procedures in
Psychotherapy - and even includes the possibility of participation of more than one
therapist - use of co-therapists. or of people who contribute to psychotherapy after
having been beneficiaries of it without necessarily being qualified personnel for the
professional practice of psychotherapy.

Up to this point we have only talked about Psychotherapy in the abstract when this
project fundamentally refers to Child Psychotherapy . If we were to simplify again, it
could be said that it is the same thing that has been expressed up to this point,... but
with children, that is, we would be talking about a mentally disturbed child or a child
immersed in a problematic situation and perhaps we could think of these terms if we
were to locate ourselves in terms of the expected result of the psychotherapeutic
process, that is, achieving the balance or psychological well-being of this child; But this
would not be so simple when we think in terms of the process , that is, the ways, how

7
and at what cost the well-being of this supposedly sick or troubled child is achieved.

And even though general psychotherapy shares many aspects in common with child
psychotherapy, the latter involves essentially different aspects that impose very difficult
and dissimilar challenges on the child psychotherapist, as well as very specific
requirements to successfully carry out their professional work. starting from the
fundamental assumption, which we will comment on later, that the child -regularly-
neither feels sick nor, consequently, goes to the child psychotherapist of his own
spontaneity.

If up to this point we have been referring to two essential aspects in the

psychotherapeutic process - someone who is psychically altered and someone who is
professionally qualified - in child psychotherapy both elements acquire different
qualitative dimensions. Since a child is the main protagonist of the process, let's see it
in details:

1 .- The psychologically altered child is not necessarily or regularly aware of a certain

type of problem or psychological alteration and consequently does not demand volun
regularly be attended to or relieved. Very often the child, who is brought to the psycho
therapy for his symptoms, results in the emergence of a painful and complicated family
process in which the child and his symptoms become an "escape valve" that in one way
or another sustains a precarious family balance built on false or erroneous foundations
and which entails a significant cost to your health and well-being. In this sense, Leo
Kanner's statement that the child is the "entry ticket" that parents use to claim the
specialist's help is still valid:

The professional practice of Child Psychotherapy confirms Kanner's previous

assertion to which we will dedicate a space later. However, it is interesting to
anticipate that from an empirical point of view, when the psychotherapeutic process
begins to inquire with the parents about the Reason for Consultation for which the
child or adolescent is brought, it is common that they begin by making a vague and
sometimes little precise description of the child's symptoms ("he is very annoying",
"he gives me a lot of work", "he doesn't behave well", etc.) to surreptitiously slip into
talking about his own problems, both historical and current.

Thus, expressions such as “Of course, what happens is that the child is constantly
witnessing our discussions!” or “I remember that when I was a child the same thing
happened to me, look if that's the case...!” and many other expressions that distract
from the progress of the psychotherapeutic process of its main protagonist: the
supposedly “altered” child. And the interesting thing is that generally these are not
temporary digressions to then resume the course of the therapeutic interview focused
on the child's problem, but rather the dialogue continues for most of the time in the
digression proposed by the parent or child. Mother. In this way, it is common that if
the psychotherapist is not alert, most of the time is dedicated to the parents
expressing their own complaints and demands, and recounting their own individual
lives rather than dealing with the formal reason – the child. - for which they requested
specialized psychological care.
8
The child, for his part, by not being aware of the problem, is also not aware - as is the
case with adults - of the benefits he can obtain from psychotherapy and consequently,
and by not feeling motivated to collaborate, he may becoming a very inactive component
in the process, it is also pertinent to remember that motivation for treatment is one of the
factors that most contribute to therapeutic success. Hence, it becomes a primary task of
the child psychotherapist to "hook" the child in the psychotherapeutic process, motivate
him with it and achieve his active participation - an essential requirement in any
psychotherapy - for the sake of therapeutic success. It is worth remembering that
Psychotherapy cannot be administered "by the spoonful", nor through injectable doses,...
its effectiveness depends largely on the client's willingness to be a tributary of it and their
motivation for change or search. of new alternatives.

2 .- In apparent contradiction with what was stated in the previous paragraph, the
"psychically altered" child can be aware of problems and - consequently - consciously
experience that things are not going well in his life or at least as he would like and thus
require or need the help of someone to "put things in order."

However, his perception of the problem may not necessarily coincide with the reasons
why he is brought to consultation by his parents, and when he feels "misunderstood" he
may raise his defenses extraordinarily and begin to respond to the therapist's questions
with monosyllables or very brief statements that may satisfy an unskilled therapist who
addresses the problem directly from what the parents refer to, but which prevent him
from having access to what is really happening in the child's psyche and therefore will
continue to address the problem from the adult dimension. and not from the expectations
and needs of the child. This is possibly one of the most important requirements of child
psychotherapy, namely: that the therapist be able to relate to the child from the child's
logic and not from pre-established concepts or prejudiced by the complaints reported by
the parents.

Personally, it seems advisable to carry out the first interview, the one in which the
Reason for Consultation is referred, jointly, that is, with the presence of the parents
and the child, the supposed object of the psychological intervention and, precisely for
this reason I spend a good part of the time talking directly with him or her and in this
context I ask him or her about the reasons why he or she has been brought to see a
psychologist. Most of the time he can't say why.

It is necessary here to make a reflection to refer to the importance of understanding the

"internal world" of the child in child psychotherapy: Possibly one of the most serious
errors that education in general has is the "objectification" of the child, making him
tributary. of advice, good intentions, special attention, information conveying what you
"should" do and what is correct to do because it is what is best for you, etc. but without
considering that he is the main protagonist of the educational process and ignoring or
belittling his perceptions, feelings and intentions about what is happening around him.
Thus, child psychotherapy cannot be alien to what happens in the child's internal world;
Child psychotherapy is supposed to correct errors in the education and training of the
child and is itself in many aspects, also an educational and training process, hence it
should not follow the same routes that have traditionally been attempted to achieve
9
something from the child. and its results have not been the desired ones.

As a comment, people come to Psychotherapy who have tried to find a solution, in

one way or another, to their problems, appealing to common sense ,... but they
have worn themselves out in these attempts and have achieved nothing more than
“getting bogged down.” in the problematic situation; This is the moment when, having
exhausted their resources, they go to the psychotherapist and place a vote of
credibility in him or her, trusting that they will find something “new” or different
because they “have tried everything and without any results.” At this moment the
psychotherapist must be very responsible and professional so as not to disappoint
the user's expectations,... and there is nothing more frustrating for the user than for
the psychotherapist to treat him by appealing only to common sense, replying "more
of the same", which The person had already been trying.

On the other hand, the child may be aware of the problem but not want to change the
current reality, either because doing so would mean adapting to a context that he
perceives as hostile or unrewarding and against which he rebels, or because he knows
that his behavior is deviant. , difficult, etc. - is the one who maintains a family relationship
that would easily fall apart if it were not for his bad behavior and although this - his family
- is not ideal, it is his and he does not want to lose it or be disloyal: such apparently
contradictory behaviors how extreme shyness and the daily social transgression of two
adolescents can serve the same purpose of keeping both parents united in the common
effort to protect the "child in disgrace", thus managing to distract or mask the real fact of
being an emotionally dissolved marriage . Thus, the little patient may be aware of this
reality and not want to modify his behavior, knowing that doing so would result in a
"worse evil" which would be the dissolution of the family for whose unity he feels,
mistakenly, responsible.

It is nothing more than, ultimately, assuming a phenomenological position and accepting

the fact that the child constructs his own reality and from there interprets everything that
happens around him and acts accordingly. This is related to what Rogers (1961) said
about reality-as-it-is-perceived that practically all therapists assume regardless of their
theoretical position, when it comes to working with adults, but that they rarely do. when
working in the children's area.

3 .- The psychically altered child, even having a certain elaboration of what is

happening, and experiencing the need to be helped, presents a great "conflict of loyalty"
towards his parents that can restrict his participation in the therapeutic process when he
consciously hides or distorts information that could damage the image of their parents.
When this happens, even if you know the parental or family responsibility in what is
happening in your daily life and that is affecting your quality of life and well-being, you
will feel compelled and obliged to "protect" them, thus offering a favorable image of
them, to tone with what the culture advocates "should be." The child may experience
great guilt if he reveals the secrets and intimacies of what happens at home to the
therapist - who is ultimately a stranger - and multiply his resistance even more. The fact
that the child moves in the center of this contradiction means that the process must be
handled with extreme caution, since the child's high sensitivity around this issue
1
0
frequently leads to stops and setbacks in progress. therapeutic process:

"Therapists may be surprised by the sudden appearance of an unpleasant

inhibition after the trust he [the child] has given to the therapist has grown to the
point of having communicated experiences, feelings or secrets. Therapists must
remain alert to the possibility that what appears to be an especially rich therapeutic
session may be followed by an unprecedented silence, expression of the child's
guilt, or a loyalty conflict between the therapist and his or her parents. Generally,
the therapist's reassuring interpretation alleviates the child's concern, and there are
cases in which the therapist, anticipating this possibility, decides to delay the
child's participation. However, there are other cases in which these

1
1
 "Efforts are fruitless until the parents explicitly reiterate their permission to the child
so that he can confess and trust the therapist until he reaches the point of telling
him a secret that apparently not even they know" (KAPLAN, 2452)

4 .- Finally, it can be easily seen that child psychotherapy cannot be explained only as
the psychotherapy of a "psychologically altered" child, but that more often than one
might suppose, the child is the expression - perhaps more evident - of a family, school,
community context, etc. also altered and that the changes in the child can be difficult to
conceive if they are not accompanied by a change or intervention in the context; In these
cases the context, rather than the child himself, would be the main focus of attention.
However, it is appropriate to point out that it is not pertinent to assume a fatalistic
position and think that it is not possible to do anything if interventional work is not
simultaneously carried out on the context in which the child develops his or her daily life,
since with some frequency, changes that the child experiences during the
psychotherapeutic process has an impact on an improvement in the functioning of the
family system. We will refer to this when talking about the role of parents in Child
Psychotherapy.

Up to this point everything could lead us to think that the greatest complexity of the child
psychotherapeutic process lies essentially in the complexity of children's world and the
challenges of accessing it. However, the very dynamics, sui generis, of the child
psychotherapeutic process presupposes additional complexities. One of them is the
triangulated nature of the relationship, which we will analyze below:

Child Psychotherapy: A triangulated relationship?

The child therapist is subject to a greater number

of demands and pressures than what generally
occurs with psychological care for adults: The very
fact that the child does not spontaneously go to
seek qualified help, but rather is brought by the
parents, leads the therapist to have a double, and
even potentially contradictory, commitment: on the
one hand the parents expect a certain result from
him, that he "models" the child the way they
suppose he "should" be and behave, that he
becomes an ally, accomplice, or agent, to achieve
these purposes. On the other hand, he has a
moral and professional commitment to the child - who ultimately becomes his main user
-, even though he was not the one who requested his services, but it is the human being
- no matter how small - with whom he interacts and with whom it has to comply with a
certain ethic of respect for their individuality and responsibility for their well-being.

A therapeutic action that apparently favors the child and devalues what the parents

1
2
report can generate their hostility, their lack of collaboration and distortion of information,
and even the withdrawal of the child from the therapeutic process. On the other hand, an
action in which the child suspects that the therapist is an extension of the parents'
authority to exert their influence on him can distance him from the therapeutic process
and block the fulfillment of the purposes that the specialist had set for himself.

...The child therapist always keeps two threads in hand, that is, one towards the
mother and another towards the child (and, if necessary, a third thread directed
towards the teacher). This task can temporarily cause problems during therapy:
some mother jealously feels it is an offense to know that the therapist knows a
secret from which she herself feels excluded. At such a time the mother must be
actively included in the therapeutic plan if she had not been previously; given that
the mother's erroneous attitude represents an important fraction of the mother-child
neurosis. Biermann, (p. 661)

Thus, the therapist is "pressured" by the requirements, on the one hand by the child who
is his main user even though he was not the one who requested his services, and on the
other by the parents, who have expectations about a certain result that is not necessarily
congruent. with the real emotional needs of the child and the development of their
human potential.

However, analyzing the therapeutic process in this way can mean a unilateral view of the
matter and conceive the parents and the child as antagonistic entities vying for the
psychotherapist's favors. However, no matter how intense the conflicts between children
and parents are, are the human bonds between them non-existent? On the contrary,
usually, despite being plagued by contradictions and frequent friction, these bonds are
deeply intense and emotional, reaching intense loyalties:

In this way the child can extraordinarily protect the privacy of his home, to keep the
image of the parents intact in the eyes of the therapist, even if this does not lead to a
personal benefit for him. Thus, denials or minimizing responses in terms of importance
may be frequent when asked questions to the child such as if he is beaten or mistreated,
if the father drinks alcoholic beverages, if the parents argue violently in his presence,
etc.; In these cases the therapist can only extract said information through indirect
means or through the intense interpersonal relationship ( rapport ) established patiently.

These codes of loyalty and belonging to the family system are also appreciated in
parents, as they can give up things important to them - or at least declare that they
would do so - if it is considered important for the well-being of the child: "I can't stand to
the child's father,... but if you assure me that he (the child) will 'be fine' if we get together
again, then no way,... what a remedy!

This leads us to affirm that the relationship in Child Psychotherapy implies one with
triangulated notation, since it entails a challenge and an effort for the therapist, who has
to be very attentive to (1) his relationship with the child, (2) his relationship with the
parents and (3) his relationship with the requirements of the system. family as a whole,
contributing to a balance that is not always easy and that on more than one occasion

1
3
places it in conflictive positions.

In other words, if the relationship in Adult Psychotherapy is in its most elemental form a
dyadic relationship in its most elemental form, in the case of Child Psychotherapy it is a
triangulated relationship, in which the therapist receives pressures and demands from
the child. , demands and expectations of the parents, but also has a commitment to the -
family- system as a whole and to its needs that, as in any human group, transcends the
simple sum of the individual needs of its members. Possibly this is one of the reasons
that has contributed to the emphasis over the last three decades on a family therapy
model and a lesser emphasis on direct, face-to-face work with the child, while insisting
that the unit basic treatment is the family .

However, as we pointed out previously, the child occupies an essential place in child
psychotherapeutic care and with this, the specialist must assume a whole series of
strategies and attitudes that make his professional action viable based on certain
assumptions, which express the different ways in which a child or adolescent can benefit
from psychotherapeutic actions, despite not having expressly requested them.

What are these assumptions and how do they acquire such special significance in the
child population?:

a.) The therapist's relationship with the child must have an accepting connotation,
that is, accepting the child as-is and not as we would like or wish him to be: a child
who has not been wanted, who He is constantly censured for his bad behavior
(what a stupid child!), who is rejected for the slightest transgression of the
established norms, who is constantly expected to change !, or who is called upon
to finish to behave well !, if he wants to be rewarded, he will not feel accepted in
any context in which he even suspects or imagines that he is being criticized. A
child with these characteristics presupposes from the therapist a position of
unconditional acceptance that breaks the frameworks in which the child is usually
accustomed to interacting, at the same time that this acceptance does not generate
suspicion and mistrust when being treated in a way to which he does not. is used
to it

b.) The therapist must establish an empathetic relationship with the child, in which
he is able to understand him, from his own point of view; It is easy to understand
the reasons of a divorced mother who laments how much her young son, extremely
jealous, limits her from establishing new relationships and thus rebuilding her life,
while it would also be so necessary to understand in her objectivity and
subjectivity the reasons for the child for this type of behavior, before establishing a
priori conclusions. This is an important element to take into account, because even
accepting the child, parents are often insensitive to understanding their emotional
needs; Hence, the therapist becomes a being who understands the reasons that
lead a child to feel, and behave, in a certain way.

c.) When creating an accepting and understanding relationship, the therapist must
facilitate the expression of the child's experiences and emotions; Many human

1
4
 conflicts have their most critical aspect in the limits that the culture itself and the
forms of education impose on the free expression of emotion, which in turn has a
very unfavorable impact on personal well-being: A child who, since childhood, is
has taught that "men do not cry" and has learned not to express what he feels, that
he suffers enormously - although he does not express it - due to the recent death
of a beloved family member, he can find enormous relief when the climate of
acceptance, created by The therapist allows you to vent emotions and thereby
achieve a favorable emotional state.

d.) On the other hand, a therapist is never - even if he declared himself that way -
an absolutely passive entity; Without being someone who dictates what "should" be
done, the therapist helps them look for alternative ways to solve problems,
especially when the problem becomes more acute because the solution they have
stubbornly insisted on for a long time has already proven ineffective. . In this way,
an adolescent who repeatedly has friction with his parents due to the way he
responds to their restrictions, can learn to manage his situation more efficiently
when he is provided with alternative ways of coping with the problem that do not
lead to to such severe conflicts.

e.) Respecting their users and contributing to strengthening their self-esteem is

one of the most valuable elements that a therapist has to carry out their task
effectively: Any person - not least a child or adolescent - who comes to seek
psychotherapeutic help is He feels extremely comforted when, far from
accentuating his feeling of worthlessness or insisting on his insufficiencies, he is
comforted about his worth as a human being, he is reminded of how important he
is, and his self-esteem is strengthened . Possibly an objective, not always
declared, of every therapist, is that his client leaves his office feeling more
important or valuable or worthy than when he entered,... which in turn, indirectly,
reinforces the therapist's own self-esteem and his personal willingness to continue
working for the well-being of the child.

It is worth noting that any of the components we have referred to - acceptance,

understanding, venting of emotions, offering alternative ways native ways of coping with
problems, or strengthening self-esteem -, just to name a few, are shared to one extent or
another, under one conceptual guise or another, by specialists from the most diverse
and divergent positions or currents of thought. psychological and psychotherapeutic
development and as a whole they are facilitators of psychotherapeutic actions.

"In any theoretical framework, the child must be helped through sufficient
understanding and an accepting type of relationship, while at the same time being
provided with educational advice and an opportunity to freely express his
emotions" (KAPLAN, 2450).

The declaration of these assumptions lead us to the following conceptual reflection:

The proliferation of currents of psychological thought largely conditions the emergence

of the most diverse psychotherapeutic models and their expression in the child

1
5
population. Thus, there are multiple conceptual apparatuses from which it has been
attempted to define the professional practice of Psychotherapy using categories from
different models of Psychology such as catharsis from an analytical perspective,
modeling from social learning, or authenticity from a phenomenological model have all
sought to respond, from different conceptual angles, to what exists in a unique concrete
being: the human individual.

The latter has led to reflection about whether what exists are different forms of
Psychotherapy or whether what really exists is Psychotherapy with different approaches.
In our opinion, beyond conceptual devices that it is not the purpose of this material to
subject to debate, there are professional actions and attitudes that in one way or
another, with one nominalization or another, are carried out from any intervention model:

• Accept a person as they are without censoring their behavior;

• Being able to understand the reasons and dynamics that have led an individual
to be who they are today;

• Create a safe space where the individual can, without fear, express all their
emotions, fears and anxieties;

• Receive help or advice on other alternative ways to deal with problems;

•
being;
To be recognized and respected as a valuable, unique and unrepeatable human

1
6
All these attitudes and actions, in one way or another - with their various nuances and
specific emphases, according to the general tendency of a certain school or current of
psychological thought - are shared by almost all schools of psychotherapeutic work.
Hence, Witmer's almost century-old assertion that in real practice, the divergences of the
various theoretical frameworks of reference lose much of their meaning is still valid.

The Use of Auxiliary Resources in Child Psychotherapy.

The complexities of the child psychotherapeutic process do

not end with the demands of the triangulated nature of the
relationship, nor with the benefits that the child receives from
it.

Psychotherapy with adults presupposes a constant "give and

take", a professional exercise that can become a pleasant, as
well as challenging, adventure and a constant enrichment of
the therapist's personal life, all of which is extremely rewarding
and reinforces self-esteem. When a patient has been helped
to unravel and effectively confront a certain problem, the VERBAL channel being the
fundamental way through which said result is reached, does this happen with the child?:

Obviously not, and not only because the child does not have the communication and
language facilities that the adult does but because the child's "logic" (the development of
thought, critical judgment, worldview) does not coincide with the "logic" of the child. adult
world, hence communicating with the child presupposes alternative routes that may be
very little similar to the routes usually used in adult communication.

For example, the verbal exchange that becomes so rich in communication with the adult
is much more difficult with the child - and even with the adolescent - regularly requiring
auxiliary means through which the expression of the most important contents of the
message is made possible. child psyche, difficult to access to formal verbal
communication. Play, drawing, puppets, psychological tests, etc., are all means that the
therapist must have to optimize his communication with the child and that enhance its
effectiveness when the psychotherapist is able to productively manage childhood
fantasy .

There are multiple resources that a child psychotherapist can use and they can serve
the most diverse purposes:

• The game.

When faced with a child with a marked preference for physical activity, taking him to the
Play Room and not only "putting him to play", but "playing with him", allows the

1
7
 therapist a degree of trust and closeness, extremely beneficial for the therapeutic
process;
Play, one of the most widely documented resources in Child Psychotherapy, has a
special significance in the lives of children,... although possibly not only in the world of
children, but also in the world of adults. 1 Playing has an important meaning, particularly
in the roles we play in our daily lives, be it “boss”, “husband”, “father”, etc.

But for children, play is decisive, as it is both their fundamental way of learning and
relating to the world, particularly with the world of their peers; It is not by chance that the
most modern teaching techniques give fundamental value to what has come to be called
“ learning by playing .”

The Child Psychotherapist must then make effective use of play, both to “ win over ” the
child by offering an activity that is natural and attractive to him and in which he is willing
to participate, and to interpret r2 and understand what their recreational activity is telling
us, openly or symbolically, that it is information that could not have been accessed in any
other way, and even to teach more productive ways of behaving in everyday life.

The reflection that Virginia Axline proposes on the value of play in Psychotherapy with
children is extremely interesting:

“Therefore, the therapist never directs the game. Leave to the child what belongs to
the child: in this case the play material and the free use of it. When the child plays
freely and without external influences, he expresses his own way of being. Live and
experience, during a certain period of time, your own reflection, planning and action. It
gives free flow to the feelings and tendencies that existed stagnant in it” Biermann,
209).

• The
drawing When faced with a child who sits in front of the therapist and
his attention is distractible, looking at everything around him,
putting a box of colored pencils within his reach so that he
can draw whatever comes to mind, makes verbal
communication viable, while the child asks ("what do I paint?",
"did it look pretty?"), makes comments ("how good are these
colors!", "now I'm going to paint a war!") and all of this
together brings you closer to the therapist;

Drawing is probably the resource most frequently used by psychotherapists - not

just children's - given the enormous possibilities it offers, not only from a diagnostic
point of view, but even therapeutically: Putting a box of colors within reach of a
child, pencils and paper, and ask him to freely make a drawing (García, A. 1995)

1 Those interested in the topic can consult the pleasant and instructive text by Eric Berne, from the
perspective of Transactional Analysis, “Games in which we participate”.
2 This is not the place to talk about the advantages and disadvantages, the scope and limitations of
interpretation, but it is valid to legitimize its responsible use, as long as it is done from an ethical and
professional perspective, in Child Psychotherapy.
1
8
 offers from the beginning valuable information about who this child is, what content
he prefers and why, what colors he predominantly uses, what are the
characteristics of his strokes, etc.; It allows "breaking the ice" by facilitating rapport
and making verbal communication with the child viable because during the
communication process the child speaks, comments and asks questions that bring
him closer to the therapist; Through it, the child vents emotions by promoting
catharsis when the expressed, manifest contents are related to or associated with
their main basic conflicts; At the same time, by raising awareness of them, making
insight , you can learn alternative ways of coping. A very interesting form of
drawing is the so-called “finger painting” widely used in children with very rigid
habits or obsessive-compulsive characteristics. It is possible to use this resource in
a group context both for the collective control of emotions and to facilitate the
construction of situations that the therapist is interested in discussing or clarifying. It
is evident then, without further comment, that drawing becomes an important
therapeutic aid.

• The puppets.

When faced with an evidently fantasizing child, putting several puppets within
reach and asking him or her to act out whatever comes to mind, provides the
therapist with a significant amount of information about what happens in his or her
daily life;

Among so many accessible therapeutic resources, possibly one of the most valuable in
Child Psychotherapy is the puppet , which brings together many of the advantages
listed above plus additional ones:

The puppet is experienced as a play situation in which the child feels in his natural
context, enjoys it and does not feel evaluated or taken to a specialist to be attended to
while eliciting a multiplicity of experiences and attitudes. facially, verbally or physically
expressed that allow the therapist to gain greater knowledge about the child and their
problems, outlining diagnostic understanding more clearly, in the same way it becomes a
formidable didactic resource to model for the child, more socially adjusted forms or more
productive and less conflictive in dealing with the demands and problems of daily life.

It is a resource that allows reality to be duplicated without it being experienced as such.

The therapist can interact with the child from the dimension of the puppet and not from
that of the adult, which is actually the way to optimize and make communication viable:
Real problems are deposited in the puppet, but the child can still understand them and
incorporate them into their real world.

The puppet can - and this is what regularly happens - take place in a group context ,
with peers, which allows the child not only to feel in his natural environment and express
his experiences, but also to become aware - "insights" - of what It happens with other
children. In this context it can be dramatized both using human characters familiar to the
child and who represent everyday life situations, as well as with animals and fictional
characters (witches, wizards, goblins, etc.) that mobilize the child's fantasy and
1
9
creativity and that are more susceptible to interpretation and analysis of the motives,
feelings and thoughts of each individual child.

Finally, the puppet can even be used with the children's family and from here as a
resource not only so that both - parents and children - have a certain perception of a
certain problem and know their mutual relationships, but even to be used later for the
development of therapeutic groups with parents - parenting school - or for carrying out
family therapy.

• Psychological Tests.

We will allow ourselves to give Psychological Tests a little more space because they are
very frequently used in psychological clinical practice in a general sense. Despite having
been considered basically from their evaluative and diagnostic function, their use can
have an important psychotherapeutic function that facilitates communication with the
child, allowing aspects as important for them as the ventilation of emotions, the
strengthening of self-esteem, the clarification of conflictive situations and learning
alternative ways to solve certain problems.

During the application of the CAT Projective Test (Children Aperception Test), a child
can reveal relationships of jealousy and rivalry with a younger sibling but can also make
an express call that he or she would be much happier if they cared for him or her a little
more; A child can reveal conflicts with paternal authority but also alert the child therapist
to how much the mother encourages this conflict; A child may show marked insecurity
regarding relationships with peers, but at the same time make an anguished call to be
“taught” to relate to them. It can then be seen how this test is not a simple diagnostic
device, but can be a useful facilitator of the psychotherapeutic process.

Although the above is evident from the function of the so-called Projective Tests such as
the CAT, it is no less important in Objective Tests such as the WISC (Wechsler
Intelligence Scale for Children). Although, from what is stated, this Test has orthodox
rules of application, an experienced and flexible child clinical psychologist can both
obtain valuable information about the current and potential cognitive functioning (Zone of
Proximal Development?) of a child or adolescent, as well as take advantage of the
moment of application to encourage your communication with him or her and even
strengthen your self-esteem. Thus, for example, when the child manages to complete a
difficult puzzle, it is very pleasant for him to hear from the therapist expressions of praise
and recognition such as “How well you did!”, “How smart you are!” , stimulating both him
as a person and the results of the task carried out; Also when the therapist sees the child
insecure and hesitant about a complex block design, it is important to encourage him,
motivate him by saying “ try a little harder, I'm sure you can do it!” ”; But even a comment
from the child, during the execution of the Arithmetic subtest, that “ my dad is a
Mathematics teacher ”, can serve as a reference point for an exploration of the child's
relationships with his father figure.

Finally, one of the psychological tests that has been most used in Psychotherapy as an
auxiliary resource is the Sceno-Test, which has one of its most interesting expressions is

2
0
the MAPS. (Make A Picture Story) which presupposes the construction of comics based
on small “ dolls ” (representing boys, girls, adults, the elderly, etc.) and in different
scenarios for the child to create and express their own “ scripts ” that represent real
situations of everyday life to which you will give a certain outcome based on your
perception of what is happening or has happened. The comics can be deconstructed
and reconstructed on countless occasions, between the therapist and the child, seeking
the most complete understanding of the problem, as well as searching, between both,
for possible alternative solutions that maximize the positive consequences and
minimize the negative ones for the sake of the child. well-being of all those involved.

Let us put, however, due to the clarity with which it does so, in the words of Gerhild Von
Staab 3:

“The mode of action of the Sceno Test as an auxiliary means in Child Psychotherapy
is that, through the construction and activation within this miniature world, the child is
stimulated to represent, in a visible and recognizable way, his emotional
relationships with the people and things in their environment, that is, with the family
and the world. If the child is allowed to act according to his free ideas and without
regard to any objective, with the material of the Sceno-Test, he produces scenes that
reflect how the child experiences his environment in a conscious way, but often also
the way in which he unconsciously experiences it, lives it or adopts an attitude
towards it...

And later:

...all the more so since, in it, the multiple possibilities of expression that this play
material allows facilitate bringing to light, with constantly renewed variations and
nuances, the patient's relationships with the world.
To the extent that the therapist captures, in this game, the child's way of feeling, the
contact between both deepens.

• Music.

When a child is tense or needs to express his motor skills, exposing him to musical
pieces, encouraging him to sing or providing him with easy-to-use musical
instruments can both facilitate his relaxation and encourage his bodily expression.

Although little used, music becomes a valuable psychotherapeutic resource, particularly

in the field of psychotherapy with children and adolescents. By herself she is capable of
creating spaces for both relaxation and enjoyment and well-being that pave the way for
the establishment of good communication relationships, and in conjunction with dance4
It becomes a fabulous instrument of bodily expression that is so beneficial for people's

3 Von Staab, G. Role of the Sceno Test in Child Psychotherapy, in Biermann, G. (1973) Treaty on Child
Psychotherapy, ESPAXS Editorial, Barcelona, Spain, page 490.
4 In the Cuban environment, the procedure that has become known as “Psycho Ballet” proposed by
colleague M. has become a powerful psychotherapeutic instrument, not only for children. Sc. Georgina
Fariñas and to whom she has dedicated almost her entire professional life
2
1
well-being, as it facilitates the ventilation of “toxic” emotions while promoting the
enjoyment of “nutritious” emotions.

Similarly, the simple “production” of music (singing, imitating sounds, “inventing” are
apparently simple musical instruments such as maracas, claves, tumbadoras, etc. In
children without musical training it can produce pleasurable emotional states while
strengthening their self-esteem if it manages to produce “melodies” with an acceptable
musical rhythm and this is reinforced by the psychotherapist.

But perhaps one of the most valuable potentials of music is its use in group contexts.5
in which the joint “production” of music creates strong feelings of group cohesion and
belonging, as well as social communication skills, which facilitate discipline and self-
control in order to make viable a task that is the common interest of all: music

• The Plasticine.

When faced with a child who shows restlessness, bites his nails, does not stop
touching the objects around him, it is extremely useful to put portions of plasticine
within reach so that he can model something (on his own initiative or suggested by
the therapist) and this reduces the anxiety, while making the communication
process more fluid;

In any case, the use of auxiliary resources that are varied and go beyond those
described here 6, can serve the most diverse purposes in Child Psychotherapy, such as
facilitating communication, having a clearer understanding of the child's problems,
reducing his reluctance and anxieties or motivating him ("getting him hooked") to get him
involved in the psychotherapeutic activity. .

What has been said so far should not lead us to conclude that verbal communication
with the child is only feasible through non-verbal means and auxiliary resources. It is not
pertinent to undervalue the possibilities of oral communication with the child, since it
would be making the same mistake that we have already referred to of "objectifying" the
child and ignoring everything he or she is capable of expressing through language.
There are children who from a very early age have an impressive use of verbal
language.

"But while child therapists should know that verbal expression is not essential to
therapy, this is not the same as saying that verbal expression is
insignificant . Some authors claim that one must consciously remember one's
own childhood in order to be able to chat comfortably with children. This ability to
chat calmly refers to the flow of communication and the various connotations linked
to the same words and phrases by people of different ages, which can be
relearned and increase with practice" (KAPLAN, 2454)

5 The musical experience with the “Ismaelillo” Group, a few years ago, attests to this.
6 In recent times, zoo therapy, that is, psychotherapy using animals, has gained some popularity.
2
2
What has been expressed at this point might seem that the specificity of Child
Psychotherapy lies in its main tributary: "the psychically altered child", the dynamics
around him and the resources used to optimize his access to him; However, the other
dimension of the child psychotherapeutic process, the therapist , must also meet a
series of requirements that are no less important:

Who is the Child Psychotherapist?

The demands and requirements expected of a professional to be recognized as a

psychotherapist are multiple and well-known: Thus, a high qualification and
knowledge of Psychology, the human factor, the dynamics that move man to act, the
how environmental and contextual factors influence human functioning; He is expected
to be competent in the use of effective methods and techniques to influence - in the
sense of human improvement and optimization of the quality of life - those people who
are dependent on his services; High ethical involvement is expected of him, reflected
not only in his responsibility, commitment to the profession and to human beings,
confidentiality, etc. but in his public image , as a respectable and consistent citizen in
his personal life with everything he promotes in his professional practice; He is also
expected to have the experience that gives him credit for the success in his previous
professional actions; the practice supervised by professionals with recognized
experience, and it is also expected that they have been the subject of analysis and self-
analysis that allows them to resolve, or at least be able, to face many of their own
anxieties and insufficiencies, especially at the time of Psychotherapy. .

It would seem that there are too many and very complex demands, and perhaps this is
the case, that the serious and responsible exercise of psychotherapeutic practice calls
for. However, these demands seem to multiply when we talk about Child Psychotherapy,
that is, Psychotherapy offered to children, adolescents and their families; And we could
say that each of the components - whether childhood, adolescence or family life - entails
a special complexity. Let's look at some of these aspects:

First of all , the therapist has to feel attracted to the child's world - its experiences,
its behaviors and contradictions -, accept its specific peculiarities, understanding and
assuming that the regularities of the child's "logic" differ substantively from the adult
world and assuming that in order to To penetrate the complex child's world it is essential
to do so through its "logic", having the desire to help the child for the child's own sake
and not to please the wishes and expectations of the parents or to resolve one's own
unresolved needs.

No matter how technically qualified a specialist is, it is virtually impossible to be a good

child psychotherapist if the therapist does not have the empathic capacity towards the
child and adolescent population , if he or she is not identified with their typical ways of
reacting and if he or she does not have a sufficient degree of tolerance and
understanding for the communicative process with the child.

It is evident that these requirements seem to be much more rigorous and demanding
than those of Adult Psychotherapy. It is significant in this regard that many graduates of

2
3
university classrooms and many of those who are yet to graduate and plan to dedicate
themselves to clinical-psychological practice, openly express their predilection for
Psychotherapy in Adults and their rejection or indifference towards Psychotherapy with
children.

It is interesting, however, that both graduates and those about to graduate, who report
not liking Psychotherapy with children and prefer Psychotherapy with adults, report that
they would gladly accept work with adolescents. In this regard and only with the aim of
inciting controversy, I would like to leave open the following question: "And isn't the
adolescent closer to the child than the adult, since he has already passed - at least
chronologically - his entire childhood as his adulthood remains - also all - to pass?

In fact, many of those who are dedicated to clinical psychological care for children put
the weight of their actions on the parents or on the family dynamics, insisting little or
downplaying the importance of direct, face-to-face, face-to-face work. , with the child
himself who is ultimately the reason why psychological attention is requested. As the
therapeutic process progresses in these cases, the child is relegated to the background,
he loses his leading role and the problems of family coexistence, the complexities of the
interactions between its members and - interestingly - traumas emerge. and conflicts of
each of them that almost always go back to childhood, an aspect that we mentioned
previously.

That is, the first requirement to practice psychotherapy with children is that the
professional is committed to working with children and enjoys it. Failure to do so can
seriously compromise the effectiveness of your actions. Secondly, it is important that the
child psychotherapist, in addition to feeling attracted to and enjoying the child's world,
respects the existence of the child as an individual, which implies assuming that the child
is not an inanimate object, subject to attention and actions, but rather he is a little
person with a certain role in his current problems.

It is possible that at the base of this are the socio-cultural factors that attribute to the
child a very passive role in the construction of his own existence, with frequent
expressions such as: "he does not understand", "don't talk to him about those things".
that he cannot realize", "he will have time to be older to understand", "someday, when
you are an adult, I will explain it to you", or the very vulgar expression of "children talk
when chickens urinate." ", all expressions that express a reification of the child that
reveal the belief - explicit or implicit - that the child begins to be a person, to be a
legitimate member of "Homo Sapiens", only to the extent that he or she approaches the
world. adult,... meanwhile it is just "Homo Ludens".

And if we are fair, it is possible that the literature and scientific production in Psychology
itself very often gives greater weight, in terms of the development of self-awareness
and self-regulation, to more advanced stages - in particular, adolescence - of
psychological development. which may be minimizing the importance of the child's
internal world, of his experiences and experiences around everything that surrounds
him, about which, although it may seem otherwise to the adult, he forms his own
opinions, no matter how Even if they are loaded with fantasies or ruminations typical of

2
4
childhood, they are still very important and loaded with meaning for the child, at the
same time that they can have profound implications for their later development.

At this point, and in the apparent role of "devil's advocate", it seems pertinent to allow
myself a small digression that in my opinion is extremely significant in working with
children, both from a psychotherapeutic and educational point of view:

At a popular level, the population considers that psychologists, by giving greater weight
to the internal world of the child, by recognizing their existence as a person and not an
object, by highlighting their identity and individuality, are calling for a "laissez-faire", to a
"let him do it" so that he does not "frustrate" or "traumatize", which translates into his
total self-determination and having participation (with voice and vote) in all the affairs of
the adult world.

Also at a professional level I have witnessed on more than one occasion sharp
controversies around this topic that can range from the staunch defense of orthodox
humanist self-realization to the also orthodox Behavioral Psychology control . Is it
necessary to go to these extremes?: In my opinion no: recognizing the internal world of
the child, his existence as a little person, should not exclude the fact that he is a being
in formation that needs guidance and direction , and this guidance presupposes
hierarchical relationships. of authority capable of establishing norms and limits that
must necessarily exist in any human group. Both parents and the therapist are authority
figures and authority - to be conceived and respected as such - must be exercised, it
must be used, but not abused.

Here is the difficult limit - not described in any manual or treatise - between respect for
the child's internal world and allowing him "free will", which violates the rights of others
and does not in any way violate the rights of others, which It does nothing to benefit
children's psychic development, as well as the difficult limit between the necessary
authority and the "authoritarianism" that violates the individuality of the "victim",... in this
case the child.

On the other hand, the child therapist is a professional who must not only like,
understand and enjoy the world of children and adolescents, but must also have skills
to communicate with them, know the idioms and preferences that characterize that age
group in a certain moment, and even have a certain degree of preparation and physical
disposition to play with a child and "keep up" with his tireless energy and demand for
attention as well as a significant degree of patience and tolerance for frustration when he
cannot penetrate the childish logic as soon as he would have liked or finds resistance in
the child or adolescent to his good professional intentions.

Previously we talked about the importance of auxiliary resources, of instruments in

children's psychotherapeutic practice,... but all of that only acquires its real value in
the hands of a skilled therapist: it is of no use to a therapist to have nice toys,
abundant colors or attractive puppets, if you do not know how to use them or do not
have the “charms” to involve the child in the psychotherapeutic process.

2
5
This implies that the role of the child psychotherapist is not merely passive or
contemplative, but rather presupposes intense participation to "engage" or involve the
child in the process, taking advantage of his or her own potential.

The significant fact that the child is not only aware of the illness, but above all
understands it and the factors that condition it, implies in the child therapist a special
effort, an active posture, to achieve the child's involvement in the treatment. Although the
use of the instruments available to the therapist depends on what is proposed, at the
same time the child expects the therapist to not be a simple spectator of how he plays,
but to be very actively involved in any of these activities. .

This active role of the therapist not only presupposes encouraging the child's
collaboration, but also establishing precise limits on the child's activity, especially
destructive aggressive behaviors whose harmfulness can affect not only the therapist
and his environment, but also the child himself. At the same time, they do not constitute
an advantage of any kind - but rather a disadvantage - in the psychotherapeutic process.

The fact that the child therapist assumes an active stance during the psychotherapeutic
process is consistent and complementary with the fact that the child is characterized,
given his or her chronological stage, by a natural tendency to development and growth,
to which we will refer later. , which, if encouraged by the therapist's position, constitutes
a valuable help for the course of the therapeutic process.

"The child therapist is in no way, for his patients, a shadow, but with his ACTIVE
INTERVENTION, he represents an important help in Child Psychotherapy."
(BIERMANN, Pag. 658)

Seen up to this point, everything could make the reader think that the basic attitudes of a
child psychotherapist are oriented "outwards", towards the child, that is, to enjoy this age
group, understand and respect its peculiarities, have skills to relate to them, at the same
time as assuming an active stance, of "engaging" the child in the psychotherapeutic
process. The demands for the child therapist are, however, much more complex and
have to do extraordinarily with the child therapist's own internal world:

One of the basic requirements of the therapist - not only for children - is that he be
knowledgeable about himself, that he be aware of what his most vulnerable points are
and what resources he has to face the challenges of daily life in general and of the
practice of psychotherapy in particular. This makes it easier for their involvement in the
therapeutic process to be neither impersonal nor irrational, as they do not distance
themselves emotionally from the human being to whom they provide their services, but
neither do they become emotionally involved with them in an irrational way, based on
their own experiential world. This is related to the necessary congruence that must exist,
in the psychotherapist, between his personal life and his professional life.

In the case of child therapists, it is advisable to make an additional effort in this sense
and that they have clear or at least partially "resolved" their experiences. personal ties
with the world of childhood; whether those referring to its history per sonal and of course

2
6
his own childhood and the conflicts or dissatisfactions that existed in that period - and
that can still carry over into his adult expression if he has not been able to resolve them -
or his current experiences with his own children.

In either case, not having clarity and awareness of what is happening within himself, can
introduce "noises" or biases into Psychotherapy that affect the expected result: Thus, the
younger therapist, who still has the conflicts with his own parents fresh in his memory,
sometimes still active, can "ally himself" "with the child or adolescent, taking their side
and thereby responding to their own personal needs. The older therapist, in turn, can
reissue his own current conflicts with his children and assume an attitude of censure or
disapproval towards the child, "allying himself" with the parents against the child or
adolescent and thereby gratifying his or her present needs. .

The previous statement is not intended to identify one or another type of bias with the
therapist's experience or chronological moment, but to highlight the fact that the
psychotherapist must insist on a constant "looking inward" to achieve compatibility
between the interrelationships of the professional and the person - who are himself - in
his daily work.

On the other hand, it is important for the therapist to be clear about how his own
experiences with his childhood influence his current professional actions in one sense or
another, at the same time that his professional actions are sufficiently mature and
responsible, putting his interest and responsibility towards the child, beyond the content
of their own childhood. Thus, among the multiple attitudes of the therapist in his intense
involvement in the process, he must have an important capacity for retrospective
memory, without giving up his role as a current adult therapist (Biermann).

Finally, it is important to give supervision a role that contributes to clarifying one's own
personal conflicts and erroneous therapeutic attitudes, and that should not be limited to
the first years, but rather to the entire professional life of a therapist. In this way,
constant self-analysis and reflection about one's own internal world contributes
substantially to the objectivity and quality of professional actions. Anna Freud's
statement that "a child therapist must always be aware of what he does and why he
does it" is still valid, not only with regard to the child in question, but with regard to
himself as a person. .

The child psychotherapist must be a flexible person, easily able to accommodate the
specificity of each child and the peculiarities of the child's personality and context, hence
the therapist must be a person with a varied and flexible therapeutic arsenal. , adaptable
to these specificities, especially to the fact that each child is different: some prefer to play
and involve the therapist in their play, others draw, others work with puppets and others
model.

"...to the extent that there is no unique clinical case, both in terms of
symptomatology and character structure, that is totally superimposable to another
almost..." Biermann, Pag. 657.

2
7
Finally, the therapist must have a special ability to manage what we previously defined
as a triangulated relationship, particularly with regard to parents. The therapeutic
process implies, to be more effective, a relationship of trust and fluidity in communication
between the therapist and the parents, while the parents' incomprehension and
intolerance towards the child and/or the psychotherapist's actions frequently leads to to
the cessation of treatment, with negative consequences for the child as not only is his
access to the help he needs limited, but the possibility of another person being able to
provide him with similar help in the future is compromised in a prejudiced manner. Anna
Freud's studies are illuminating in this regard:

“Thus, the child analyst effectively turns to the child's parents to complete the story,
leaving him with no choice but to take into account all possible inaccuracies and
deformations arising from personal reasons” (Freud, A. , 40)

The child therapist cannot be unaware of the fact that in one sense or another his work
assumes a pedagogical content, of modifying erroneous attitudes, a task that must be
carried out not only with great caution, but above all with great ethics and respect. by
the functional patterns of each family, preventing their interventions from being
interpreted as an undesirable invasion of family privacy. The therapist, thus, must know
clearly not only how much he expects and how much can be achieved from the child, but
also what the expectations and limits set by the parents are, hence it is essential for the
child psychotherapist to understand and manage the role of the child. Parents in Child
Psychotherapy.

2
8
 The role of parents in Child Psychotherapy.

"Freud not only does not attack the family, but on the
contrary, he establishes it as an irreplaceable stage of
human life. It is the impassable framework within which it
moves from birth to death. The internal structure of the
personality and the family correspond..."7

Common sense rarely assumes as reality the fact that the child is a little person who
feels, that he has a rich internal world and that he forms an opinion (distorted or
objective) of what happens around him, no matter what the opinion is. whether distorted
or objective, but it is his own and from it he constructs his existential reality by appealing
to one of the most substantial possessions in the world of childhood, and one that is so
essential to foster and not destroy: fantasy . It is impressive what a child can do trying to
understand and find “logical” and coherent explanations for what is happening around
him:

Just as an illustrative comment, let the reader remember that gem of children's
literature that is “The Little Prince” by Antoine de Saint Exupèry who asks the pilot -
Please... draw a sheep ! and he makes his best efforts from the conventional graphic
image of a sheep without, however, managing to satisfy the creature's expectations,
until, exasperated, he draws a box with holes and says: -This is the box, the sheep!
What you wanted is inside!,... to which the little Prince responds: -Exactly how I
wanted it!

Despite this, the child is rarely considered responsible for his actions - especially the
younger he is - and responsibility for these actions is assigned to his parents;
Furthermore, it is not only that parents are attributed responsibility for their children's
7Sarró, R.;Introduction to the text "The Meaning of Life" by Alfred Adler, Anthropology Library. Luis
Miracle Editor, Barcelona, Spain, 1948.
2
9
behavior, but that they are blamed , that is, they are negatively censured for not having
done what they "should" do or for having done something incorrectly in the process of
raising their children,... and we all know how relevant the understanding of guilt is, not
only in professional practice but in everyday life itself. Thus, it is common to hear different
expressions depending on a child's behavior, for example:

When faced with a child who behaves correctly during a visit, the expression of
"what a polite child! You can see how well his parents have raised him"; but if their
behavior is casual, irreverent or causing disorder around them, then the expression
of censure is caustic: what brattiness!

When faced with an inhibited child, one hears expressions such as: Oh, what a shy
child!... his parents have to take him out for more walks and play with other
children";

When faced with an unruly or restless child, expressions such as "what a spoiled
child, it seems that his parents have him very poorly educated!";

When faced with a child who looks unclean, one hears expressions such as "poor
thing,... what negligent parents he must have!";

When faced with a child with good results at school, one hears expressions such as
"he is very intelligent!,... of course, his parents are university students and they
surely make an effort to help him learn"; But if the child has poor school results and
only learns with difficulty, then the judgment is one of condemnation: “evidently the
parents do not ensure that the child does his homework,... of course, if they never
go to school!” .

What is appreciated in these cases? That the child is the immediate result of the action of
his parents, that they have done things "right" or "wrong", "correctly" or "incorrectly" and
that is why the child is as he is today. That is to say, parents regularly find themselves
sitting in a kind of "defendant's dock" , where they are "judged" for responsibility for the
actions of their children, and are always called upon to make amends for what was
wrongly done. This way of thinking even comes to permeate the thinking style of the
children themselves, who from a very early age become "judges of the parents" - with
or without "justice" - and these "judgments" serve as their justification to refer to both their
successes and their insufficiencies, failures or frustrations, with common expressions
such as “it's your fault I was late for school!” or “it's your fault my dad scolded me!”

In this same sense, it is not uncommon to hear statements from already adult people,
many of them who have already accumulated many years of life, in which the years of
childhood and adolescence are far away but who, in crude retrospective reproach towards
their parents, express reproaches. such as:

"...you never showed me affection, and that is why today I have such a bitter
character";

3
0
 "...you always loved my brother more than me and that made me suffer
enormously!" ;

"...you didn't want me to marry that boy and that's why my whole life has been a
disaster";

"...if you had allowed me to study Medicine, I would never have been the totally
frustrated person I am today";

And as the reader familiar with current trends in Cognitive Behavioral Therapy (CBT) can
see, overgeneralizing elements (never, always, everything, never, etc.) and magnified
elements (enormously, disaster, totally frustrated, etc.) predominate in these expressions.
In all cases, responsibility has been shifted towards the style of upbringing and training
received, externalizing the causes without recognizing multiple other contingencies -
such as responsibility for one's own existence from a certain moment in life! - that are
inevitably present. in the destiny of every human being.

Added to this is the fact, already mentioned previously, that culture assigns the child a
very passive role in life , objectified , extremely moldable and vulnerable to parental
influences, which has led many child psychotherapists to assume that It is impossible to
address a child's problems without addressing those most responsible for his or her
education : his or her parents. Hence, the role of parents in child psychotherapy has often
been exaggerated, and work with the child has been relegated to a very secondary level,
especially in the case of those therapists who - for one reason or another - have
difficulties in interact directly with the complexities of the children's world.

What would then be the real role of parents in Child Psychotherapy?: Possibly one of the
clearest answers to this question is offered by Harrison (KAPLAN, p. 2457) when he
states:

"Child Psychotherapy is characterized by the need for parental participation. This

need does not necessarily reflect their culpability in the child's emotional difficulties,
but is a consequence of the child's state of dependency."

This statement deserves a comment regarding the conceptualization of the supposed

guilt of the parents and the management of it in the therapeutic process. Although it is
true, for the reasons given, that culturally parents are censured for their children's errors,
inadequacies and inadequacies, the therapeutic management of guilt must be a skill
that the therapist develops with a high level of professionalism. for the following reasons:

1 .- From an ethical point of view, the specialist is called upon to dedicate his
professional actions to the Well-being of the User and not to become a judge of
what was wrongly done in the past, and which can no longer be reversed; Taking
this position can be more iatrogenic than therapeutic and distance parents from the
therapeutic process by feeling censored. In any case, the therapeutic action must be
directed in the future direction, to call the mother or father to act more in the
direction of what can still be done for the well-being of their child, rather than

3
1
recriminations for previous errors.

2 .-Even if it is legal to judge parents based on their child's current behavioral

results, the extent of this guilt is always relative and rarely, if ever, can it be
objectively evaluated regarding the existence of a child or adolescent. There is not
only one parental determinant, but current behavior has been shaped by the
confluence of multiple contingencies. Among them we can mention, in a decreasing
degree of generality, the socioeconomic determinants and cultural influences (the
action of the media) and community influences (school, neighborhood), the influence
of other significant people (relatives, peers, etc.). ) and the child's own level of self-
awareness and behavioral self-regulation that is formed throughout his or her
individual existence.

This is not intended to relieve parental figures of responsibility; on the contrary,

parents have a high share of responsibility for the destiny of their children, since the
decision to bring them into the world - responsibly or irresponsibly taken - is their
responsibility. The child was brought to the planet, he did not ask for it and he did
not even have the opportunity to select which parents he would have wanted to
have. But if we want to call the specialist to reflect that before evaluating a priori the
guilt of the parents in the problem of a child with emotional and/or behavioral
difficulties, he should assess that this relationship cannot be deduced mechanically,
as if cold Syllogism ("If the child misbehaves, then the parents spoiled him") of the
parents' failures, but that the child has been exposed to many other influences
(virtually impossible to be controlled by the parents in their entirety) that Taken
together, they can be more powerful than parental influence.

3 .- Despite the above, there are extremely self-punitive parents, overwhelmed by

guilt and who flagellate themselves and hold themselves responsible for any deficit
or maladjustment in their children's lives, tending to magnify and absolutize their
responsibility for everything. what he did wrong and what he "should" have done
better or didn't do. An inadequate therapeutic management, in which the therapist
establishes himself as a disapproving prosecutor, would contribute to further
exacerbate an unpleasant emotional state in the parental figure that -paradoxically-
is characterized only by moving on the level of lamentations, self-reproaches and
palliative actions (directed to "pay the blame") that rarely translate into effective
actions aimed at resolving or modifying the child's situation.

The following example is illustrative of the last two points:

"A mother comes to the consultation extremely upset by the dissocial behavior of
her 14-year-old teenage son, stating that she is "the only one responsible for
everything that happened" because by making the decision to divorce, she
deprived the child of the presence of his father. and she made him grow up in a
"broken home!", saying that she would never forgive herself for having made
such a decision and that she would be willing to do the unspeakable if it would
bring her son back to the "right path." Despite these statements, the functional
analysis of the situation revealed that the father manipulated what happened,

3
2
 using the son to "get revenge" on the mother, inducing behaviors (ingestion of
alcoholic beverages, absences from school, devaluing the importance of study,
etc.) to the adolescent that disqualified the real efforts made by the mother to
benefit her son's education. At the same time, in the neighborhood of residence,
the adolescent who until completing his primary education had been a model,
established interpersonal relationships with peers (and it is unnecessary to say
how significant the group is at this age) with clearly antisocial behavior. Despite
this evidence, of the multicausality of the son's maladaptive behavior, the mother
insisted on being the only one responsible for it, and only a delicate and
prolonged therapeutic work managed to reduce her excessive guilt, make an
objective causal attribution of everything that happened and make it move to
the level of concrete actions..."

In any case, beyond blaming or assigning responsibility, the child psychotherapeutic

process must be conceived with the participation of the parents (preferably both), due to
their involvement in the confrontation aimed at resolving the child's emotional problems
and of course, the greater the The younger the child being treated, the more likely this
implication will be.

However, how to materialize this purpose does not follow universal pre-established
recipes , but must be done based on the clinical assessment of the specific individual
case , which will ultimately determine the degree of paternal participation in the process,
and this is the responsibility of the specialist. Hence the existence of:

Possible forms of parental involvement in Child Psychotherapy:

• Individualized child-centered attention

It occurs in treatments in which the child is institutionalized and the parents are kept very
distant, with limited or practically no participation in this care. An example of this
procedure is when the child has very severe psychopathological alterations that make him
or her subject to institutionalized treatments or when it involves minors with disruptive
behaviors, with such negative social consequences that make it necessary to admit them
to a Reeducation Center, these may be examples. when this type of psychological
intervention is carried out that excludes or reduces the involvement of parents in the
child's Psychotherapy.

The two fundamental objections to this procedure could be: how is it possible to achieve
changes in the child without doing something similar with his parents, who are,
supposedly, responsible for the problem? How is it possible -even achieving the above- to
stabilize the improvement achieved in the child if he has to return, sooner or later, to the
home that is the source of his problems?

Despite the sharpness and objective nature of both questions, the answer to them may
have an affirmative connotation, although not without controversy: The simple change of
environment, the qualitatively differentiated communication styles of the Health Team, the
attitude of respect and understanding towards the child or adolescent can have beneficial

3
3
therapeutic effects on their attitudes, behaviors and personal well-being - even more so
when the home situation had reached unsustainable levels of stress -, contributing to a
favorable evolution.

The mere fact that children are separated from the family environment, the experience of
their absence and not feeling involved in their care and attention - added to the guilt that
can be elicited - can lead parents to reconceptualize what has happened. been happening
not only with the child but with their own lives, as well as their attitudes and the extent to
which they have taken care - or not - of satisfying their children's emotional needs. Their
return home, with a series of attitudes and behaviors different from those previously
expressed, especially those that caused confusion and discomfort in family life, can also,
by themselves, have a beneficial effect on the family system and contribute to maintain
the stability of the changes achieved during the institutionalization period.

However, this type of intervention is more the exception than the rule and even if it is
advisable to focus the weight of psychotherapeutic attention on the child or adolescent,
most therapists prefer a certain informative alliance with the parents to have greater
clarity of the situation at home and verify the progress of psychotherapy in the family
context.

One of the pioneers of child psychotherapy, Melanie Klein, insisted on a style of work that
minimized parental participation, however she did not underestimate the importance of
some type of information, despite insisting that it should be an extremely discreet link. and
protector of confidentiality with the child.

Although it could also be controversial, it is indisputable that in the same way that a child's
"inadjusted" behavior, it further "disadjusts" the family dynamics - which possibly has a
great responsibility in this "inadjustment" of the child -, "appropriate" behavior or
“adjusted” of the child can contribute to eliminating tensions in the family and thus
contribute to its better functioning and, as a consequence, to stabilize and make possible
the therapeutic achievements on the child's behavior achieved through individualized
psychotherapeutic actions. A child who ceases or decreases his or her behavior of being
destructive, verbally and physically aggressive, with frequent tantrums, creates a more
favorable climate in the home and is more willing to provide "adjusted" care to the child.

• Parent-centered care
Here it is also about assuming a position in which attention is focused on one of the poles,
in this case the parents with the assumption that they are not only the ones who want to
change, but who should do so to achieve the well-being of the child. This form of
intervention is characteristic of psychological counseling relationships, in which parents
seek advice on how to treat their child with problems or when the child is essentially
"normal" and the problem is the family relationships around him. However, even in these
cases, some attention must be paid to the child - no matter how small - both to confront
what the parents say and to respect his value as a person and not conceptualize him only
as the 'object' of the parents' concern. parents.

3
4
In professional practice, it is interesting that even in extreme cases in which only the
parents are cared for or oriented, they themselves demand that the child also be "seen",
with frequent expressions such as: "And you don't want to talk?" with the child?", or more
demanding, such as: "although you are right, I would like you to talk a little with the child
so that he can verify what I tell him."

However, in this type of intervention, family counseling is fundamentally pursued

regarding what to do in certain situations that confuse parents, such as forming certain
habits, structuring the family dynamic in order to optimize its functioning, satisfying the
emotional needs of the child. child without compromising his/her personal development,
etc. All this can be done when the problem seems to be related to any of the previous
issues, but the mother - or the family - is an essentially healthy person from an emotional
point of view, without major difficulties that prevent her from responsibly assuming the
education of her child. her children, without necessarily having another person influence
her.

"This type of procedure presupposes that the mother is emotionally capable of using
such knowledge for the good of her child and without too much impact on her own
personality" (Biermann, 676)

From the above it is deduced that treatment focused on parents presupposes "normality"
in them. However, such a conclusion should not be categorical since many times the
child's problems are related to an emotionally and/or behaviorally altered parental figure,
and the child's maladjustment is derived directly from this: an alcoholic father or a neurotic
mother are elements with a high psychopathogenic potential on a child and that cannot be
resolved with a simple educational or counseling intervention, which is not aimed at
directly influencing the dynamics and internal world of the disturbed parent.

In these cases, it is primary in the psychological intervention strategy to focus ("Target")

the treatment on the problem of the disturbed parental figure, in order to enable him in his
functioning as a person, so that in this way he is able to influence later positively in your
child's educational process. Although in this case the reader could object that this is not
Child Psychotherapy per se, it is possible that this is the most positive way to influence
the child, although in this case, it plays a secondary, much less leading role... even
though he is the main beneficiary of its effects. In both cases, everything seems to
indicate that the well-being of the child is sought indirectly, through a "carom" effect, in
which the knowledge, skills or improvement in the personal functioning of the parents
results in a psychological benefit for the child in question.

In summary, this type of intervention focused on parents is extremely important, when the
child's possibilities of evolution are closely related to the parents' attitudes and personal
characteristics. The father will only be able to face tively the formation of your child, once
you have resolved a good part of your own problems and conflicts, once you have
achieved a certain modification of your personality.

• Simultaneous attention to the child and his parents.

3
5
It is possible that for a long time this has been the intervention strategy preferred by child
psychotherapists: while on the one hand the child is treated for his "emotional
disturbances" either individually or in a group - given the characteristics of his problem -
On the other hand, parents are also subject to simultaneous psychological care. This
parental participation can take on the most diverse nuances:

• Parents receive information about how the child's evolution is going and in turn
provide information to the therapist about how the child manifests himself at home;
Likewise, they are advised on how to proceed with the child, while doubts are aired
about certain forms of behavior manifested with the child and what to do in this
case. It is essentially an educational and advisory intervention.

• Groups of parents - as occurs in the so-called Parent Schools - receive advice on

general topics of Education, Child Psychology and childhood problems; They
subsequently submit these general contents to discussion, progressively introducing
the problems of each specific child and promoting group discussion with the
advantages inherent to any group psychotherapy (universalization, reality testing,
ventilation of emotions, etc.) without being a specific form of Group Psychotherapy.

• Parents are treated not only as parents of the "child with problems", but themselves
as "people with problems", with psychological alterations or unsatisfactory
interpersonal relationships that conspire against their emotional well-being and thus
have a negative impact on child care. son. It is assumed that before, or
simultaneously with, helping the child to resolve his emotional difficulties, these
parents have to begin by resolving their own emotional difficulties. Child therapists
know from experience that in many cases, when interviewing parents, a good part of
the time is spent talking about their own problems, not only current ones but those
referring to their own childhood and personal history.

Any of these forms of participation can assume the most diverse forms of
psychotherapeutic intervention: the same therapist can care for the child and the parents
simultaneously or different therapists can be used to work as a “team”, in close
interrelation. In any case, when intervening simultaneously on the child and the parents,
the therapist(s) must remember that it is a triangulated relationship, in which they must
simultaneously take into account the interests of both the child, the parents, as well as the
family system as a whole.

• Joint care for the child and his parents

Recent years have witnessed a growing trend in this direction. The impetuous rise of
Family Psychotherapy in the last three decades has insisted on attention to the family as
a unit, as a system , rather than on attention to what they themselves call the Identified
Patient. Thus, from this point of view, the therapist jointly cares for the child and his
parents, confirms the communication styles between its members, the characteristic
family mechanisms, power relations, established limits, existing alliances, etc. and
progressively "dismantles" those mechanisms contributing to family dysfunction and
hence contributing to the emotional alteration of the identified patient. In any case, it is not
exclusive - and sometimes it is necessary - the possibility of providing care in divided
3
6
parallel to any of the family members who require it, as long as this does not contribute to
worsening the functioning of the family system.

In my personal professional experience I have as a rule - with few exceptions

expressly requested by parents - to receive parents and children together, focusing
attention essentially on the child, being him or her the one I first address and with
whom I establish communication most of the time, especially in the initial moments of
the interview,... most of the children feel satisfied with this procedure and become
active and collaborative protagonists of the psychotherapeutic process while the
parents do not miss the opportunity to treat to intervene and guide their children's
responses...

There is also the possibility of carrying out joint psychotherapeutic groups including
several families, promoting the advantages of both styles of intervention - family therapy
and group therapy - but at the same time enhancing their risks, given the difficulty of
managing large therapeutic groups where each of its subgroups does not have a
connotation of situational relationships, but rather they have an entire history - both
retrospective and prospective - in common.

Joint attention to parents and children can also be used as an occasional resource in a
more general strategy of simultaneous intervention. In this way, a therapist who uses
puppet representation as a resource for psychological intervention in children can
program specific content and invite parents not only to observe but also to participate in
the dramatization; and vice versa, a psychotherapist who uses psychodrama as a
resource for intervention in adults, can use the children of the group members to give
greater relevance to certain dramatized contents; A joint therapeutic film-debate session
between parents and adolescents can be extremely valuable.

In any case, the form of strategic choice of intervention, regarding the role of parents in
Child Psychotherapy, I insist, will depend on the specific case and its specific problem:
children with symptomatically similar problems may require totally different intervention
procedures, derived from the study. prior diagnosis and clinical assessment by the
specialist or therapeutic team. With any of the procedures, however, it is clear that Child
Psychotherapy cannot be outside of a Systemic Conception , in which it is possible to
influence the system, both by intervening on its components in isolation, and by doing so
as a whole. And the most important system in which a human being is immersed is the
family, hence the strength with which the Family Therapy Movement emerged
decades ago.

Family Therapy in Children:

Family therapy has had a notable impact on the most diverse currents of psychological
thought during recent decades - particularly the decades between 1960 and 1980
witnessed a great proliferation of schools and family intervention procedures. It is enough
to point out only the interventional procedures derived from the psychoanalytic and object
relations approach that has AC among its most important figures. Robin Skyner; intergene
approaches rationals that have among their most important figures James L. Framo and

3
7
Ivan Borszomengi-Nagy; behavioral approaches with special mention to the work of
Patterson and his influence on Behavioral Parent Training (BPT) and the work of Lo-
Piccolo & Lo-Piccolo applied to the treatment of sexual dysfunctions.

However, the most important current in Family Psychotherapy is that represented by the
impact of Systems Theory with a proliferation of approaches that in turn multiply in
different - although not exclusive - ways of seeing family intervention, such as the
structure proposed by Minuchin and the variety of strategic approaches proposed by the
group, and its associates, of the Mental Research Institute (MRI), known as the "Palo Alto
Group", with renowned figures such as Don Jackson, Gregory Bateson, Jay Haley, John
Weakland and Virginia Satir, without ignoring one of the most important precursors of
Family Therapy, Nathan Ackermann, and may have omitted no less important figures.

The reader will then be able to appreciate, given the proliferation of literature and
approaches8 , that being an expert knowledgeable in the family therapy movement is
almost mastering a second career, hence we do not intend in this chapter to exhaust all
the information on the matter, but only to present the author's points of view.

How to include the family in psychotherapeutic care for emotionally disturbed

children?

This question constitutes my starting point when conceiving the use of family therapy in
children, since the points of view are dissimilar in this regard:

There are positions that have ignored or minimized the role of the family in the
psychological care of the child, such as M. Klein who emphasizes the role of individual
analysis of the child and keeping the parents as far away from it as possible, giving them
only minimal participation in terms of taking data that is of interest for the child's
psychotherapy and communicating to them the type of information that the child is
receiving. to receive and make periodic reports on the course of events. Family changes
would be fundamentally given by the changes that the child was going through or by the
possibility that the parents would undergo parallel analysis , which as a whole would
contribute to well-being, but without "contaminating" both procedures. .

"...For this reason, one of the results of early analysis must be to enable the child to
adapt to reality" (KLEIN)

The purpose of this text is not the polemic or critical analysis of any author. 9 However, if I
had to take sides, I would defend in this author the importance of working directly with
the child, no matter what their age, trying to understand their internal world and not
ignoring the fantasies derived from it, while at the same time I accept and respect her as a
"little person",...although this is not the scientific language used by the author.
8To obtain a general systemic view of these approaches, we recommend the reader read the
"Handbook of Family Therapy", edited by Alas S. Gurman and David P. Knirsken, Edit. Brunner Mazel,
1981, who greatly contributed to the preparation of this section.
9Furthermore, I always recommend to students that when studying any author, no matter what their
theoretical position is and how much they disagree with it, before gloating from the position of the "sniper" in
a critical analysis, look for some element of value and usefulness in your work,... you will surely find it.
3
8
I would express my reservations, yes, with keeping parents away from Psychotherapy,
since the family is the basic group, the human context in which an individual develops his
existence during most of his life cycle, being extremely dependent on it, especially all in
the final and initial stages of said life cycle. This does not mean that in the intermediate
stages the individual becomes independent from the family, because although he only
depends very limitedly and partially on it for his autonomy, he continues to take care of
and worry about other members who depend on him, so this dependence is reciprocal. At
the same time, a good amount of emotional needs are satisfied in the family context.

Let us speculate something about this to illustrate the omnipresence of the family in the
life cycle of the human being: in the initial stages of development, a child depends almost
entirely on the adult world (fundamentally his parents and relatives and with special
significance the Mother Figure ) for satisfying practically all your needs. Their emotional
life will be colored by their membership in a certain family, which becomes the transmitter
of values, norms, experiences and habitual styles of behavior that are strongly
incorporated into the structure of the personality: here the individual has a clear role as
the son of a family. His parents . Throughout the course of individual existence in which
the individual becomes increasingly autonomous, immediate ties weaken (not so much
the more mediate ones as the affective and experiential ones that usually accompany
individuals throughout their entire lives, of his life cycle, as a silent and invisible, but no
less active "umbilical cord") and the individual becomes increasingly autonomous, which
can achieve its maximum expression in the second half of the third decade of his life in
which He still does not have a family of his own, he has achieved financial solvency and
his parents are still strong and capable of taking care of themselves. Without attempting
to establish precise time limits, this is possibly one of the periods of greatest autonomy
and independence of the individual, when there are no distorting elements of this "normal"
course of existence.

However, when creating a family and having one's own offspring, this autonomy is
modified, every plan or project appears mediated by the expected parental responsibility,
important decisions are discarded, postponed or only partially assumed, because the
individual has begun to assume the role as a father to his children, making a good part
of his work depend on the well-being of his children, with the consequent loss of
independence, to which is added that he is often still emotionally dependent on his
parental home despite having formed his own family.

The next two decades will witness their increasing status in life,... but not necessarily an
increase in their independence. Even though his children grow up and become
independent, he still feels responsible, worries and takes care of them, concern and
responsibilities that externally could last until the moment when his children begin to build
their own existences and leave home with the appearance of the so-called "empty nest
syndrome" in which formally - although not intimately or experientially, as happened to
him himself - he would conclude his role as "parents of his children",... although basically
from the formal, but even in the idiosyncrasy of the common Cuban, extremely gregarious
when it comes to family life.

The situation, however, is not so simple: long before the children become "completely"
3
9
independent -and the nest becomes empty-, the individual's parents, upon beginning their
path towards senescence, begin a process of decline, since They are not strong, ailments
begin and they increasingly depend on others and then it is necessary for the individual to
take care of them and assume the role of parent to their parents , which - to further
aggravate their situation - sometimes overlaps. for long periods of time with that of "father
of their children". This moment frequently corresponds to the so-called "mid-life crisis." in
which the individual feels overwhelmed and evaluates that everyone demands and
demands something from him, while no one stops to understand or help him, appreciating
here what many have defined as a “sandwich” position in which the individual feels
trapped between the demands that are “above him or her” (their own parents) and those
who are “below him or her” (their children).

Subsequently, the individual begins his own personal decline, with the consequent loss
of autonomy and status, and consequently of self-esteem - even more so in Western
cultures in which old age is not regularly revered, but on the contrary relegated to the
background when the individual begins to stop being efficient - thus becoming the child
of his children .

This speculation can be further complicated, as many of these roles are easily
overlapping. Thus, there are extremely insecure adults who, with more than half a
century of existence, continue to feel like "children of their parents", or vice versa,
extremely dominant elderly people who inflexibly assume their role as "parents of their
children" even though they have been there for a long time. They are people who "comb
gray hair" and are capable of taking care of themselves and being people of
achievement and social recognition, or extremely dependent women who demand
emotional support who become "children of their children" since they are still very
young. and they make them responsible for their happiness from very early stages,... in
all cases with the consequent impact or effect on the other.

Where do we want to go with this speculative reflection?: to the essential fact that the
entire life of an individual takes place in a family context , to the fact that the family is
the human group in which most of an individual's needs are satisfied ( material attention,
affection, security, etc.) to the fact that the family is the context in which the personality
of an individual is shaped par excellence, both with a positive and negative connotation
and that both the genesis of many of its problems and the potential to achieve Higher
levels of health and well-being lie precisely in the family institution. Hence, without
intervening on the communication patterns and educational styles of a certain family, it
is extremely difficult - although not impossible as we mentioned previously - to achieve
changes and, above all, to maintain them in a child who is treated psychotherapeutically
and who is extraordinarily dependent. of their family, especially in the initial stages of
their development.

On the other hand, it is pertinent to reflect on the fact that at some point family therapy
has been considered, since it was conceived as the most important human group, as a
peculiar form of Group Psychotherapy. However, the family is not just another group, it
is, according to what has been stated, the most important human group, and its
existence is not limited to a specific time-space - like any group psychotherapy - and the
4
0
 links between its members are not occasional. , but it is a group with extraordinary
temporal continuity , both in terms of the preceding history that (includes multiple
generations 10) as in the future temporal dimension in which this family will continue
developing. Hence, any intervention on the family must take this reality into account and
not act on it as if it were just another group, but take into account that it is a sui generis
group, with a temporal continuity that can be damaged by clumsiness. or inability of a
therapist to ignore his ethical responsibility given the fact that these people will continue
to interact long after the psychotherapy process has concluded.

"Group therapy usually contains people who do not know each other before therapy
and who will go their own separate ways after therapy,...families have a history of
interaction and an expectation of interaction and independence. Thus, the political
power that is so passionately debated in family conflicts has only a pale counterpart
in ordinary therapeutic groups. What happens in these groups can conclude at the
close of each session; What happens in a family therapy session can have
profoundly desirable or undesirable consequences. (Gurman).

What has been exposed so far highlights elements that support the importance of the
family as a psychotherapeutic factor in the care of psychologically altered children, either
through any of the aspects of family psychotherapy or through simultaneous treatments
for parents, or through group procedures. such as parenting schools or through
individualized psychological attention referring to both the child's problems and the
parents' own problems. This possibly justifies the fact that when talking about child
psychotherapeutic care, there is an abundance of literature referring to family
psychotherapy and much more limited literature referring to psychotherapeutic care for
the child itself, and this elicits a necessary reflection:

It is a true fact that psychological care for emotionally disturbed children presupposes
attention to their life context, fundamentally their family context, fundamentally for reasons
to which we have already referred. However, shifting the emphasis from the child to the
family, neglecting direct individualized attention to the child, can lead to "objectifying" the
child, ignoring his or her internal world and his or her leading participation in a certain
problem, to which we referred in the Initial chapter,... especially, taking into account that
the reason that justifies psychotherapy is the reason for the consultation for which the
parents bring the child, or returning to Leo Kanner's statement, the "entry ticket." Not
attending to him directly means both neglecting his personal worth as a human being, by
devaluing or ignoring his internal world, and disappointing the parents' expectations
that the child should be cared for..., although this is possibly due to the prevailing
opinion in the population that psychological care is similar to medical care in that it is
necessary to perform clinical tests and analyzes to know the state of health of the child,
also demanding that the psychologist "see" the child:

In this regard, there are many recurring anecdotes that child psychotherapists can
relate:
10In this regard, it is important to reflect that in the Cuban context in particular the concept of
"nuclear family" is regularly biased by the coexistence of several generations (it is not uncommon for up to 4
generations to coexist under the same roof and play multiple and complex roles.
4
1
 Very recently a mother told me in the office: "before coming here I saw the child with
psychologist 'X...' she was very good and very serious, but she only talked to me and
my husband, she suggested what I had. to do with the child and I wondered how
things were going,... but he never spoke to the child more than a few words.
Coincidentally that same day, I was talking to a mother who was requesting care for
her child and I asked her to come with the child's father for a joint initial interview. She
made a face of disappointment and asked me 'and you're not going to see me at the
time?' child?".

It is not about satisfying or pleasing the parents' expectations, but on the contrary,
respecting the child's right to be heard, whether away from the censure or disapproval of
the parents or (and?) in their presence, which provides the therapist "first-hand" with the
possibility of directly knowing the child's problems and verifying the degree of objectivity
of the Reason for Consultation referred to by the parents. The therapeutic possibilities
offered by family intervention should not exclude, but on the contrary complement, direct,
face-to-face work with the child, providing them with all opportunities (confidentiality,
acceptance, respect for individuality, etc.) that individual psychotherapy usually provides
in the office to the adult user, which is a space - in my view - irreplaceable for confronting
problems that affect the individual very intimately and in which very people are involved.
close to him, with whom he would prefer "not to have problems", at least until he feels
prepared for it and the consequences are as favorable as possible.

Like any procedure in Psychotherapy, the specialist who uses family intervention
techniques must do so, not as a panacea or universal remedy, but based on the
requirements of the specific case and what seems to be advisable to provide answers to
the requirements of the patient. "problem" of the patient. We reiterate once again that
although the fact postulated by the various currents of family therapy is valid that the
basic unit of treatment is the family, and its purpose must be to achieve the optimization
of its functioning to achieve the well-being of its members, this It should not exclude direct
and individualized work with the child.

This is particularly important for those psychotherapists who have difficulties or poor skills
in dealing with and communicating with children and prefer interaction with adults based
on a common logic,... but by limiting their communication with the child, they also limit
their possibilities to influence him, leaving this influence indirectly in the hands of the
parents themselves.

Despite the risks and complexities involved in getting involved in family dynamics for any
psychotherapist, doing so is tempting and challenging for most specialists. However, its
materialization must include a serious ethical analysis about its objective convenience,
without ignoring the willingness and voluntariness of all the members who will participate,
including children and adolescents. With adolescents in particular, it is very important to
ask for their willingness to participate, as well as motivate them with the benefits that they
can extract from this type of activity. (GURMAN)

In any case, family intervention in Psychotherapy must contribute to optimizing the

functioning of the family as a basic treatment unit, but without neglecting attention to the

4
2
individual needs of each member, clarifying the main conflicts, offering alternative ways to
confront the problems. , promoting communication patterns, etc.

As we pointed out previously, in the same way that an individual cannot be understood
apart from the understanding of his History, possibly a family cannot be understood apart
from the understanding of its history, and this has been the object of peculiar interest in
many currents. of Family Therapy. This history may be what explains many of the current
conflicts and dysfunctional family relationship patterns, in conjunction with the current
cultural influences present, and is important for the therapist to know and understand.

The significance of history for the understanding of a certain family is what has led many
psychotherapists in their professional practice to insist - in the same way that they insist
on knowledge of a client's personal biography, on their anamnesia - on a Methodology
of Reconstruction of the Life History of the Family, following the family tree
(genogram), since events that occurred a long time ago, in other generations even, can
have a potential negative effect on the here now of the family and the specific child with
What is being worked on:

"I know that I have to be more affectionate with the child, but I am a very
inexpressive person and it is difficult for me to tell him how much I love him... I
remember that my mother was also like that and she told me that It was all my
grandmother's fault. My grandfather abandoned her when she was pregnant with
my mother and then it was my mother who paid for the "breaks" and the
consequences all her life,... the poor thing, she suffered so much! (testimony of a
mother).

For the specialist trained in child psychotherapeutic care, it is known that during the initial
interviews, in which an attempt is made to construct the child's biography and the factors
influencing it, the person interviewed, usually the mother, progressively begins to refer
more than to the child's personal history, to his own personal history, emphasizing his
early years, his childhood and the conflicts he had to face at that time. The way in which
the mother experienced her life during those periods thus acquires, in the eyes of the
therapist, great significance due to its influence on the child's current problems.

Finally, a systemic approach to family psychotherapy should not ignore the fact that the
family not only interacts with the individual, but take into account that this family develops
in a certain culture , under certain socioeconomic and sociopolitical conditions and at a
certain socio-economic moment. -historical, in a certain community , which as a whole in
one way or another qualifies the lifestyle and current relationships of each particular
family,

At the same time, culture can directly influence the individual in the formation of his
personality, his norms, values and lifestyles beyond the values that his family advocates
and produce important conflicts when facing contradictions, including principles, as occurs
in the most acute intergenerational conflicts.

This means, in summary, that in the same way that a therapist accepts the modulating

4
3
role of the family on the individual psyche, he also assumes a sociohistorical position
and conceives both dysfunction and individual emotional imbalances in a complex
interrelation with culture, history and the peculiar chronological moment in which it
provides its services.

We do not want to conclude this chapter without emphasizing - even if it is reiterative - the
central role of the family for individual existence. Engels' brilliant statement that the
family is "the basic cell of society is not a simple slogan or slogan: the family is to
society what the cell is to tissue, just as the existence of healthy tissues is not
possible." If the cells are sick, there can be no healthy society if the family is sick.
However, understanding and knowledge of the family does not exhaust the need to
understand the individual needs and dynamics of its members, particularly children, who
have a high development potential. We will refer to this below.

The importance of understanding the child and its symptoms for Child
Psychotherapy

How many times have you not heard this expression?... If we were to do a survey on the
perception that the population has about what a psychologist does, perhaps we would find
very frequently the opinion expressed in the previous statement, perhaps one of the most
rigid and stigmatizing stereotypes that exists about the profession: There are people who
do not go to a psychologist or psychiatrist, even knowing that they need specialized help
to face one or another type of problem that compromises their well-being, just because
they are not branded as “crazy” or “mentally ill” ,... and even deciding to seek help, they
do so by avoiding by all means others finding out.

In my student years, when we had practical classes on Psychopathology in Psychiatric

Institutions and some of us would think of commenting “today we are going to see the
crazy people!”, we were immediately reprimanded by our teachers.11 who immediately
corrected us “not crazy,... sick!”, thereby eliminating the pejorative connotation of the
word, but still continuing to conceive the actions of the profession within the scope of
Mental Illness.
11 Brilliant teachers, by the way, María Elena Solé and Nury Teresa Cao!
4
4
Fortunately, the perception has been changing and the growing health culture achieved
by the population has allowed it to be understood that the psychologist can be assisted
not because he is sick, but because he is facing a problematic situation that affects or
compromises his well-being or simply to seek guidance that enhances or optimize your
daily functioning.

But it is indisputable that for a long time psychological intervention actions have been
permeated by the Medical Model : people go to the specialist to "cure" a symptom or
"diagnose" an illness, the psychotherapist himself feels trapped by the immediate and
insistent requirement that the patient demands that he "take away" or solve his problem.
Psychotherapy students are the first who, when faced with their first cases, with
“cookbook” thinking, ask the question of "what type of psychotherapy should I do to solve
this person's problem?" This denotes the prevalence of a style of thinking much more
focused on the symptom, on the problem, than on the person who is the carrier of it:

A mother with a child with difficulties - school, emotional or behavioral - goes to the
specialist demanding that he tell her if what her son has is illness or "shamelessness", so
that she can then know how to behave: "If he is sick, I justify everything to him, But if
not,... get ready!" Even the very terms of "therapist", "patient", "illness", "treatment", etc.,
have a notable influence of the Medical Model, and psychotherapists rarely manage to
free themselves from such influence.

The medical model, however - despite the indisputable elements of value it has, such as
its taxonomic connotation that takes into account oriental parameters factors such as
etiology, syndromic organization, assessment of the course and recommended prognosis
and treatment, etc.-] does not cover all the requirements and specificities of the
psychological intervention, in which it is necessary to take into account not only the
specific clinical picture, but also to give response to questions such as: Who is the
specific individual subject to psychological care? At what specific moment in his or her life
cycle is he or she? In what family and sociocultural context does he or she develop his
or her daily life? What function does his or her problem play? in your daily life?, etc.
Hence, the answer to questions such as: When is a person psychologically altered and
when not? What type of treatment is most effective for a certain type of alteration?, do not
have universally accepted answers, but depend essentially on the clinical assessment
of the specific person and their specific situation, all consistent with an idiographic
conception.

This statement takes on special significance in the child and adolescent population, since:

-Extreme behavior such as aggressiveness can be, in one child, an expression of a

marked psychological imbalance, while in another child it can be an effective
adaptation mechanism if the specific contexts in which both children develop their
lives and require them are valued. coughs and challenges that such contexts
impose on them.

-a severe manifestation of maladjustment, such as excessive shyness, can evolve

very favorably in a child in a group context, while in other children this context can

4
5
 be extremely harmful -or iatrogenic to continue using the conceptual advantages of
the medical model- the use of such procedures.

-the same psychological expression, such as excessive assertiveness and defiant

rejection of adult authority, can be very "pathological" in one child, while in another
child it can be extremely "normal" and "natural" when living in an environment
extremely hostile, in which, metaphorically, he perishes if he does not assume such
positions. In the same way, this assertiveness or self-affirmation in an adolescent is
a normal expression of development,... perhaps the insufficiency or absence of it
would be atypical, for a human being at this moment in the Life Cycle.

-a child with a very severe alteration may require long periods of treatment to obtain
some improvement, another with a similar problem may evolve spontaneously
without major complications in his or her condition.

adult life, according to the specific, unique situations to which he is exposed that
include the possible contingencies of development but that do not ignore his
individual psychological structure.

Where do we want to go in our analysis? The fact that although requests for clinical
psychological care for children are extremely frequent, and even necessary, this is not
always - or even mostly - an indicator that the child is a carrier of a "disease." " or a
certain degree of severe psychological alteration.

A correct understanding of the complex and dynamic relationships between health and
mental illness (valid for health and illness in its most general meaning), in which both
poles of the problem are not conceived from diametrically opposed and exclusive
positions, is extremely valuable from a methodological point of view for the professional
actions of the specialist who works in the field of Child Psychotherapy.

"Numerous studies have demonstrated the fact that most children present with
isolated psychological problems at one time or another and that many have
transitory periods of emotional disturbances or behavioral difficulties. To a
considerable extent, these are part and parcel of development and are not in
themselves a cause for concern."

And later:

"...For the most part, alterations do not constitute diseases that are qualitatively
different from normality. There are a few conditions, such as childhood autism,
which could be conceptualized as diseases in this sense, but this is not true for the
vast majority of disorders. Most conditions differ QUANTITATIVELY from normality
in terms of both severity and associated limitations, but small variations of the same
thing can be found in many essentially normal children" (Rutterd, 16-17)

Many of the concerns mentioned by parents about their children can be perfectly "normal"
from this model, based on the fact that:

4
6
 An apparent "problem" may be nothing more than the expression of a normal
developmental crisis, such as occurs in occasional periods of self-assertion and
apparent rebellion and even dissocial behavior;

An apparent "problem" may be nothing more than the behavioral expression of

hereditary and contextual factors that energize the behavior of an otherwise healthy
child: as occurs in some extremely healthy children.

"sanguineous" who are erroneously classified as hyperactive, but who are capable
of developing a normal life, with a good level of learning and social integration;

An apparent "problem" may be nothing more than a child's adequate adaptive

response to a hostile environment that demands an active mobilization of his or her
resources if he or she wants to survive in that environment.

In any case, the limit between a common and natural problem in the development of the
child and a clear psychopathological alteration does not constitute a clear line of
demarcation between the healthy and the sick, but rather constitutes a wide strip where
not only aspects indicative of alteration coexist. psychological with aspects indicating
normality, but where, at the same time, lie the potential forces that can determine whether
a child tends towards normality or tends towards the exacerbation or pathologization of
their problem.

"Health and illness must be seen as a unity and struggle of opposites, where there
are moments in which disintegrating and morbid aspects coexist in the individual,
with integrative and harmonious aspects. When integrative aspects predominate we
talk about health; while when the disintegrating aspects prevail, we refer to the
disease. Conceiving health and illness in this way, dialectically, gives us elements to
understand how a healthy subject can present a tendency toward illness and how a
sick subject can present a tendency toward recovery or improvement." (Alonso,
Armando and Roca, Miguel, 14).

That is to say, the fact that someone goes to seek psychological help is not necessarily
an indicator that there is an illness or severe psychopathological condition requiring
psychological care. And at the same time, the fact that there is no clear
psychopathological alteration should not lead to the early conclusion that the person is not
eligible for psychological care. The truth is that when the child is brought for consultation,
it is because behind it, someone is worried and needs or demands attention. Identifying
the magnitude of the concern and determining what should be done is up to the specialist,
who, to do so, must understand , as clearly as possible, what the child's problem is.

By making this statement we are alluding to the necessary unity between diagnosis and
psychotherapy, in which to intervene psychologically on a person it is necessary to know
who they are and what their problem is? In the same way that this relationship is not
conceived as unilateral, but as bilateral, assuming that at the same time that the
diagnostic process guides and directs the psychotherapeutic process, the intervention
process itself better outlines the diagnostic understanding of the individual in question,
4
7
becoming a reformulator of new avenues of intervention. This reinforces Gordon &
Davidson's statement about the fact that "the distinction between evaluation and
psychotherapy is often not clear; in many cases they are one and the same thing"
(GURMAN, p. 526).

Whether or not it is a minor illness or problem, the client's complaints to the specialist
pursue one or another purpose to which he or she is called upon to respond: whether it is
a severe psychopathological alteration of the child, an existential crisis of the child, or the
use of his/her problematic for someone to intervene on a more acute problem such as
severe family dysfunction. In any case, the child psychotherapist is obliged to provide a
care response based on the child's specific symptoms and their specific context.

In this regard, Leo Kanner's statements are still valid, about the fact that the symptom ,
that is, what for which the help of a specialist is requested, serves different functions ,
which we will briefly comment on, without concluding that they are the only possible ones,
but If trying to instruct the specialist in the multiplicity of functional implications that a
certain symptomatology can have in a certain system:

1 .- The symptom is an Entry Ticket , an indicator that there is a problem that must
be studied, or that someone is interested in having it studied and that it is not
necessarily declared in all its objectivity from the beginning. This means that the
therapist should not give absolute credit to the reasons (Reason for Consultation)
why someone seeks his help, but must be open to the possibility that behind this
Reason for Consultation there are other reasons, possibly more important than even
They have not been declared and are possibly the real reason why someone wants
your attention. Thus, when a mother begins to refer, during the first moments of the
consultation, to her concern about her child's disobedience, she surreptitiously slips
into her own difficulties and personal conflicts such as the dissatisfaction of her
expectations not only towards the child. , but even towards his own personal and
family life.

Experienced therapists know that it is often not necessary to play the "game" of
asking parents the reasons why they bring their child for consultation, but as general
data is collected, particularly in conflict areas (family , school, interpersonal
relationships, etc.), real information and motives flow easily, directing the course of
the interview. In my personal experience I have preferred to follow this procedure
and at the end of the interview I ask "naively": "Well, let's end today where we
usually start, "what made you come to seek the help of a specialist? ". When faced
with this question, the person usually responds: "I've already told him everything!",...
and I spare him expressions as imprecise as "he is very aggressive", "he doesn't
want to sleep alone", "he has problems in school", "does not like to play with
children his age, etc. and that ultimately they are nothing more than the visible face
of much more severe problems, which are not necessarily directly involved in the
child's existence.

2 .- The Symptom can be a real sign that something is not working, or is going
wrong in the child . This means that the apparent insignificance of the symptoms

4
8
referred to should not be underestimated, but rather that it is necessary to
investigate more into the child's real problem: the mother who uses the child's
"bullshit" to have access to the specialist for her own concern or personal suffering. ,
possibly unaware of the child's real suffering and how much his or her personal
development may be compromised. Also here the specialist must go beyond what
the mother reports and penetrate into the child's internal world to find out if his
imbalance is just an external or behavioral manifestation that worries or bothers the
people around him or if something is really wrong. in him and is lacerating his
personal well-being and the sensitivity of his internal world.

3 .- The Symptom can act as a safety valve to release the accumulated tensions in
the face of an intolerable situation. Thus, when the child behaves "nasty", the
mother becomes irritated, shouts,... the child becomes offended because he feels
mistreated and rebels by shouting defiantly, while the father intervenes abruptly and
authoritatively. All of this together can be a way out of the accumulated tensions that
the symptom allows to vent , although by alternative means that are not necessarily
effective, but palliative to preserve the precarious balance of the system.

4 .- The Symptom can be a means to solve existing problems ,... although not
necessarily in the most effective or adaptive way. This means that the therapist must
be very aware, not only of understanding the manifestation of the symptom, but also
of understanding the function it serves, that is, its purpose - although this is not
always, or even necessarily, always made aware of by the therapist. the child- Thus,
the child's "majority" can serve as a DISTRACTOR from the real problems existing
in the home, or a claim for attention lost after the birth of a sibling or any other
environmental event that has restructured the family dynamic and the child feels that
he has lost a space or certain prerogatives in it.

5 .- The Symptom is an annoyance or annoyance for someone. Any behavioral

manifestation of a child can remain unchanged and without major consequences in
a given context as long as no one worries or bothers him, however, once someone
worries, upsets or irritates him, it may be reason enough to refer him for care. from a
specialist.

A characteristic example of this may be the presence of “manias”.

4
9
 (mannerisms of one degree or another of intensity) in children, such as shoulder
movements, picking their noses or ears, “twisting” their hair with their fingers,
making sounds like "throat throat" or nervous cough, etc.,... frequently these
manifestations can go unnoticed or ignored by family members, but when they
reach a certain level of frequency and/or intensity, they can no longer be ignored
and make the family members uncomfortable. Therefore, they come to present
an exaggerated susceptibility to the slightest expression of “mania” and this is
the moment when they decide to bring the child for consultation.

It is possible that a mother does not mind at all, ignores or prefers not to see, the
"bullshit" of a child, but the constant complaints of others around her are what
compel her to seek specialized help.

Possibly one of the aspects to which a therapist must pay the most attention is
precisely the understanding of the function of the symptom , identifying how it
manifests itself in its specific context, knowing who and why is worried about the
child, knowing if it is worried now or for some time, and identify who (or who) and
how much they gain or lose with the referred symptom.

• Entrance ticket
• Real sign that something is not working,
or is going wrong in the child
• Security valve
• Means to solve existing problems,...
• Annoyance or annoyance to someone
FUNCTIONS OF
THE
SYMPTOM:

5
0
As the reader will be able to appreciate, the symptom does not have isolated functions,
but rather they can interfere or condition each other, each one providing, within the
framework of the whole, a greater understanding for the therapist about the problem that
has to be studied. and for which a solution is demanded from him.

Understanding the child as a developing being.

Notwithstanding what has been stated so far, it is important that the child therapist
assumes that he does not treat symptoms or problems, but rather children who have
them, which presupposes understanding the child who is his main user and the reason
for his professional work. .

Understanding a child's problems presupposes conceiving him as a developing

individuality , which means that the child psychotherapist must be qualified in
understanding the normal and pathological development of the child, at the same time
that he must be able to identify variations in this pattern of development. development
derived from individual differences and external sociocultural factors that may introduce a
certain bias or degree of variation.

A productive way of proceeding in the psychotherapeutic field to facilitate the

understanding by those involved, including the psychotherapist himself!, of the
significance of development processes in people's lives, is to appeal to the following
question and subsequent reflection , as well as their possible answers:

Do you remember your past? Can you imagine what has happened in your life from
the earliest stages of your childhood to the present day. How many things have not
changed?!,... although you are essentially the same, there are many things that have
changed, some for the better, others for the worse, some barely imperceptibly, others
dramatically,... so much that you yourself It would be difficult for you to recognize
yourself. Well, this happens with all human beings, including your child.

And staticity is not among the attributes that distinguish man - and I am not saying
anything new, the ancient dialectic already expressed it clearly: "no one bathes twice in
the same river" - on the contrary, they are the changes that distinguish man, no matter
whether they are subtle or very obvious, specific or very general,... they will always
accompany man throughout his entire Life Cycle – one of the concepts that has the most
relevance and popularity. achieved in the scientific and professional practice of
psychologists in recent decades, altering their existence in one way or another, for better
or worse, with or without the person's participation, whether they like it or not.

Having a Worldview of human development in general, and of the child and adolescent
population in particular, is a valuable help for the professional practice of psychotherapy
with people of these age groups, and can help in many directions (Hoffnung), but above
all in the direction of having a realistic optimistic position - not the dangerous naive
optimism! - that a child can change, for the better, if throughout his life he finds the

5
1
conditions that enhance his well-being,... and in For this, the adults around him have a
high responsibility. In any case, understanding the child as a developing being can bring
important advantages:

It allows us to have realistic expectations about each child or adolescent in particular: it

can be as naive and counterproductive to demand a high level of independence and
autonomy from a three-year-old child as it can be to demand absolute docility from a
fifteen-year-old adolescent. And all this, also and no less important, in a specific socio-
historical-cultural-economic context for each generation. Not knowing the above can
lead to a professional practice isolated from the reality of the children and adolescents
they serve.

To the adult who was young in the 60s, who assumed the values of the “hippie”
movement, long hair, tight or tube-cut pants, or not bathing in weeks may seem very
natural to him (although perhaps now , almost four decades later he denies and
reproves those behaviors!), but he does not agree with the idea of dyeing his hair
green, opening a hole in his ear or getting a tattoo! And each generation has its
distinctive seal,... although the waters sooner or later take their level: having clarity
about this will not limit the inevitable generational worldview frictions, but it will
facilitate the acceptance and dialogue so necessary to promote optimal social
integration of new generations in the future.

As a consequence, the therapist knows – and can teach parents – how to respond to
the current behavior of a child or adolescent , avoiding unnecessary conflicts derived
from necessarily different points of view. In a general sense, all of this enables the child
psychotherapist to discriminate what is normal and expected for a certain moment of
development, from what is not, and thus resolve doubts and concerns in parents due to
their lack of knowledge of the regularities of the development of their children. children.

It is then legitimate to reiterate that at the different stages of each period of development,
the child's behavior is different, hence it is important to know what behaviors and
regularities are expected for each age. At the same time, all children are different, each
one has a certain range of variation in their behavior that must be taken into account to
better understand their specific problems. It is not just about understanding when things
happen during development, but about understanding how they happen and what
processes are involved.

Using the principle of development not only has value for the field of Child
Psychotherapy, but for the entire field of therapeutic work; It implies conceiving the
individual as a developing whole, in which it is not only important to identify the factors
that generated the current problem, but it is also important to identify those factors that
contribute to its current maintenance or exacerbation and that do not have to be coincide,
they can even be diametrically opposed.

This is what, in the exercise of teaching, and from professional practice, leads us to
affirm that an individual - in the case at hand, the child - cannot be understood apart from
their Personal Life History in the which we can find the causal factors that explain who
5
2
he is today; But neither can it be understood apart from your current situation , what is
happening in your here-now and the extent to which this is challenging your real
possibilities. It is as if history had a longitudinal connotation that denoted the temporary
, developing existence of a certain individual, while the situation had a transversal
connotation that reflected the current demands and demands that in a finite space of
time, the environment imposes on the individual. individual in question, and which is
precisely the intersection of both forces, the moment in which the specialist in question
receives the child in his office.

Current situation.
History
Staff

Unfortunately, this conceptualization of the child as a developing individual is not

always understood by all child psychotherapists who in some cases tend to stigmatize
the child - and its development - through diagnostic "labels" that practically become
lapidary, and that lead to the conceptualization of the child as a static being, which leads
to fatalistic forecasts.

• A child may appear to be very far behind in his or her learning, even being
characterized as having problems with dyslexia or dyscalculia: a static, non-
dynamic approach to his or her problems can lead to him being marginalized in
classes, to "evicting" his learning possibilities and even to referring him to the
Special Education System. Any of these decisions can greatly compromise their
future development, if they ignore that the child's cognitive development does not
occur linearly but "in leaps" and may be hindered by certain environmental
events,... a study of the Zone of Proximal Development (ZPD) of this child,
possibly shows that he has a potential that will allow him, with a minimum of help,
with a correct Guidance Base and access to effective and efficient Social Support
networks, to perform in a short period of time in a very similar way to how they do
their "normal" contemporaries.

• A child may present as extremely dependent on the mother, not wanting to let go
of contact and physical closeness with her, and burst into tears every time she
leaves his field of vision. A static approach would lead to predicting a passive
dependent adult, with little personal validity, with the characteristics of what in
some literature has been defined as a creeper child (Vega Vega), always in need
of someone to lean on to carry out the slightest activity. ... However, the course of

5
3
 his own life, the expression of his human potential and the requirements and
demands that his existence imposes on him, can lead him to a totally different
result than predicted and become a highly autonomous adult responsible for his
existence.

• A child may seem extremely "surprised", with very aggressive behavior, with
difficulties in interpersonal relationships with peers and little respect for the rules
of social coexistence, which together predicts a personality with difficulties in
SOCIAL ADAPTATION and even with clear criminal potential,... However, once
again the course of his life and the contingencies to which he is subjected
throughout his existence, together with the development of his self-regulatory
processes, can make him a socially useful human being of high value as person.

We could continue citing examples, let the reader think only of those everyday
expressions of mothers who say: "It seemed like he was going to be mute, he was
three years old and didn't speak,... and now he's a parrot!" or "do you remember
when he was little that he didn't eat anything,... and he has become a bottomless
barrel" or "when he was a child he was very docile,... but since he entered high
school, he is a beast! ".

It is pertinent to draw attention to the fact that this understanding of child

development does not necessarily always occur in a positive sense, but rather its
course can bring about negative results: Any of the examples cited can be reversed
in terms of its formulation and Thus, an apparently extremely talented child may have
very poor performance when the academic demands of the higher grades increase
and require greater dedication and personal effort for which he or she is not
prepared; A highly independent child can become someone extremely insecure and
demanding of social support when the contingencies of his or her personal life were
very adverse or extremely threatening; A child with a very "conscientious" and formal
behavior can become a fraudulent and deceitful adult in his adult life if his educational
influences had a connotation of "double standards" and the visible part of his
behavior responded to what was socially expected and positively valued, without a
real commitment to a position
Moral and ethic.

Upon reaching this point, the reader could legitimately question: "So, is it impossible
to work with prediction criteria in the field of Child Psychotherapy?... what science is
it that cannot extract predictive elements from empirical data? What do you work
with?" Such questions deserve a careful answer, not only because of their conceptual
implications, but above all because of their practical implications for the work of the
child psychotherapist:

Firstly, all science presupposes -supposedly- prediction as a criterion of effectiveness

or veracity of the way in which it processes the data with which it works, reaching its
highest degree of accuracy in the Exact Sciences and to a decreasing extent in the
Natural Sciences and Social, for obvious reasons of the complexity and mutability of

5
4
 its object of study.

The precision or accuracy of the prediction is subject to limits , limits that are
imposed both by the maturity of the Science from which it operates, and by the
conditions under which the events from which a certain prediction is to be made
take place. as well as the internal complexity of the object of study that is intended
to be evaluated.

That is to say, it is not about discarding the prediction, with which we would be
dismantling the entire conceptual apparatus of Psychology, but about recognizing its
limited nature, of clear validity in some spheres and conditions and less so in others.

In Social Sciences - and possibly not only in them - prediction has an approximate
character, not as something that necessarily and invariably must occur in this or more
way, but as something that is possible and probable to occur whenever the conditions
and circumstances remain static or as expected. This type of prediction, expressed in
the form of a forecast, must take into account the way in which the course of
environmental events themselves or the development of the individual themselves
can change the expression of said events.

"A scientific prediction can fail because the theory that makes it possible is
not true enough, because the information used is not precise enough, or
because something has failed in the derivation of the prediction itself, due
to errors or too drastic meanings in the prediction." application of theory.

And later:

"The root of this puzzle is, naturally, the conjecture according to which perfect
prediction is possible, in such a way that we could accurately foresee every event
and every possible error, thus giving us all the means to avoid it. But the fact is that
to reach that state of bliss, we would need to have every conceivable theory and
infinite elements of information, which is technically impossible. 12 (Bunge, pp. 675-
677)

In this way, we want to emphasize that the life cycle of the human being is a
continuous process of development and continuity in which the contingencies to
which it is exposed can become facilitators or hinderers of said development, at the
same time as the development of the Self-regulatory processes that the individual
progressively achieves become modulators of these contingencies and qualify individual
existence, which in my opinion explains the variations found in the previous examples.

Where do we want to go with this reflection? The fact that although the child therapist
can - and in fact must - make a prognostic assessment of the potential of the child with
whom he works to know how and where to direct his intervention actions Psychologically,
this prediction should not have a static character, labeling or stigmatizing the child, but on
12Bunge, Mario "Scientific Research", Pages. 675-677, Editorial de Ciencias Sociales, ICL, Havana,
1972
5
5
the contrary should increase their professional actions in order to optimize the human
potential of each child with whom they work.

In the understanding of child development, labels - which ultimately are the legalization
or legitimation that what is predicted at a moment must invariably occur - are extremely
harmful and limiting of child development, since they become self-prophecies that
fatalistically qualify everything. the course of the individual existence of the "labelling",
especially due to the effect they have on self-perception and self-esteem, as well as on
the behavior of the child who together are responsible for validating the prophecy.
Examples of labels turn out to be both psychopathological classifications ("retarded",
"aggressive", "shy", etc.) and the qualifiers, both positive and negative, that are usually
applied to describe the behavior or performance of a child ("clumsy"). " vs. "clever",
"affectionate" vs. "surly", etc.)

To understand it better, the reader supposes hypothetical examples of two children with
equal potential (with a similar "baseline", to paraphrase the terminology usually used by
behavioral orientation literature):

The first of the children is encouraged to learn, their achievements are constantly
recognized - even when they do not try very hard - and they are verbally reinforced with
expressions such as "what a smart child!" ; This leads to a strengthening of feelings of
self-worth and an active search for recognition, which in turn contributes to a further
reinforcement of their supposed intelligence. Upon entering school he will try to validate
his "talent", participating in classes and responding quickly to the teacher's requirements,
who in turn will feel satisfied with a student who participates so much and contributes to
the flow of the class, continually. It will stimulate him and highlight his value in the context
of his peers, which further feeds his already high self-esteem. If this process continues
throughout the Life Cycle - and other unfavorable contingencies do not get in the way! -
then upon reaching adulthood, the prophecy will not only have been fulfilled but, above
all, self-fulfilled , since in some way one's own individual and his beliefs and
expectations reinforced by others have contributed to this.

Now suppose the opposite case with the other child, all of the child's achievements are
poorly evaluated, he is constantly told "how clumsy you are,...!" , or the even more
cruel "what a brutal little boy!", which creates in him a growing sense of personal
handicap that leads him to unsafe executions that generally, and in logical consequence,
conclude with a poor result and a poor trial. external -and internal- of "how hard it is for
you to do things well!". The cycle continues when he arrives at school, his low self-
esteem and insecurity make him reject it, since she is an additional source of negative
evaluations and frustrations that confirm the initially distorted belief of "how clumsy I
am!" . As in the previous example, if this process continues throughout the life cycle -
and other contingencies, in this case favorable, do not interfere - the prophecy will also
be fulfilled and self-fulfilling, but in this case with very negative effects on the well-being
and social integration of the individual.

The idea that we have wanted to convey through this section is the one that gives its title:
the child is a being in development , the script of his existence has yet to be written and
5
6
although his current characterization allows us to predict what his potentialities may be,
The therapist should not assume a static and fatalistic conceptualization of it, orienting
his psychological intervention actions in the direction of promoting and optimizing the
child's full potential.

Despite the above, the specialist should not assume a naively optimistic position and
ignore or disqualify the existence of psychopathological alterations with a certain level of
structuring; on the contrary, he should keep in mind a whole series of indicators of the
presence of a psychological alteration that They serve as effective indicators of the way
to structure one or another type of psychotherapeutic strategy:

When to evaluate the presence of a psychopathological alteration?

An extremely important element in child psychotherapeutic practice is to identify when a

child is eligible for one or another type of psychological assistance, due to presenting one
or another type of psychological alteration, and specifying the indicators to reach this
conclusion. The answer to this question could be seen, according to Rutterd (p. 18) from
two dimensions: a first dimension that considers whether a child's behavior is normal or
abnormal in statistical terms with a more normative connotation, in terms of its
frequency or concrete manifestation or pattern and a second dimension referring to the
extent to which The psychological alteration limits or invalidates the child in terms of his
social functioning, with a more phenomenological connotation.

Regarding the first aspect, in normative, statistical terms, different criteria can be
indicators of the abnormality of a child's behavior, which explain the alteration in their
combination and not by the presence of each of them separately:

• The adaptation of the child's behavior to what is expected for his or her
chronological development and particular gender : a dog can be very "natural"
in a child at two years of age while very atypical in an adolescent, wearing heels
and putting on lipstick can be being a behavior highly valued, and even
applauded, in a 5-year-old girl while it is highly censored in a boy of the same age;

• The persistence of behavior valued as inappropriate, beyond the expected or

tolerated limits for behavior: school refusal can be very "natural" in a child who
has just moved to a new school, after having moved to a new neighborhood. ,
while the same rejection is no longer so natural when its manifestations continue
several months later;

• The norms that evaluate one or another type of behavior in the specific
immediate socio-cultural environment of the child: A child who violently attacks
another can be highly censured if he or she comes from a family or community
with ethics - such as some religions - that are very foreign. to any type of use of
violence, however, it will be highly valued if it comes from some type of group -
such as some levels of marginality - in which violence is seen from a different
perspective that can even be encouraged;

5
7
• The extent of the alteration, whether it manifests as an isolated symptom or a
group of symptomatic manifestations and the extent to which several areas of
psychological development are compromised: an isolated enuresis, in the context
of a child with good school results, satisfied with himself and with good social
integration is less worrying than a child with similar symptoms but who also has
poor self-esteem, difficulties in social integration and poor school performance;

• The type and apparent degree of severity of the symptom, which given its
qualitative significance is associated with a severe psychopathological alteration:
onychophagia is much less worrying than alopecia, an occasional nightmare is
much less alarming than a night terror,... no However, onychophagia that leads to
significant lacerations in the cuticles, or frequent nightmares that compromise the
quality of the child's sleep, acquire a severity that makes them subject to more
complex psychological intervention actions;

• The frequency of appearance of the symptom and the intensity of its

manifestations , beyond its own content as an indicator of psychopathological
alteration: aggressive behavior can be very natural in a child when faced with a
situation that challenges him, the same behavior, even without being justified, it
can be conceived as natural if it only manifests occasionally mind, but it is judged
as an indicator of alteration when it begins to establish itself as a pattern of daily
response to any demand or claim in its context.

• Likewise, the intensity of an expression becomes an important indicator of

psychological alteration: verbal aggressiveness can have degrees that range from
expressions of anger and irritation whose function is clearly to vent emotional
states, to very sadistic, ironic and humiliating expressions towards others.
Furthermore, physical aggressiveness can range from tolerable violence in
everyday childhood fights without significant physical damage, to extreme
degrees of cruelty and destructive behavior towards others;

• Changes in the habitual behavior of a specific child , indicators of how

individual differences should be understood in child psychotherapy: the alteration
of hygiene habits is more alarming in a child with traditional obsessive-compulsive
behavior and marked neatness, than in a child who has not previously exhibited
similar behavior;

• The specificity of the situation as a problem that manifests itself in a single

specific context is less alarming than a problem that manifests itself in multiple
contexts: a child who is aggressive and irritable at home, but behaves well at
school, with good interpersonal relationships with peers and good behavior when
visiting other family members, it may be indicating that the child's apparent
alteration is referred above all to the specificity of the family situation,... if, on the
contrary, the alteration is manifested not in one but in multiple contexts, this could
be an indicator that the problem, rather than referring to the context, should be
sought in the child's own individual psychodynamics;

• The vital circumstances that the child is going through and that can determine

5
8
 the content of their alteration: in the development of their life cycle, people (not
least children) go through periods in which they are more vulnerable and periods
in which they are more resistant,... However, there are specific circumstances that
influence the child's behavioral adjustment in one way or another, such as:
parental divorce, the death of someone significant, the transfer of the place of
residence, and others that are defined in some literature. as life events .

• We can "complicate" all of this even more by stating that there are periods in
which, against all "logic" and without anything to justify it, children can display a
series of "symptoms" apparently indicative of psychological alteration, but which
can disappear so abruptly. as they were installed, without major consequences,...
that's life!

Although all these indicators are important from an operational point of view for the Child
Psychotherapy specialist, they have a connotation "from the outside", from what others
think or value, and not from a dimension referring to experiences and one's own.
subjectivity of the child, which is the second criterion to which we referred at the
beginning of this section:

"Judging behavior in terms of its abnormality simply means the evaluation of a

criterion about "oddness." This offers some measure of its meaning, but it is also
necessary to ask whether this behavior is doing any harm and whether it matters -
or not - to the child. This is a totally different type and ultimately the most
fundamental and important" (Rutterd 21)

Taking into account the second criterion means assuming a position closely related to
the human factor in particular, that is, with a phenomenological connotation of how
much the symptom impacts or affects this particular individual, how much it limits its
social expression and how much it affects those who They surround him. In the same
way that the normative criteria must not be understood in isolation, but in their entirety,
the criteria used here must be understood in a holistic way in relation to their mutual
conditioning, both among themselves and in relation to the normative criteria, previously
described:

• Suffering or unpleasant states : regardless of the fact that many normative

criteria point to the fact that a certain behavior can be an indicator of psychological
alterations, the specialist cannot ignore the fact that how does the specific
individual perceive his or her particular problem? To what extent does the individual
perceive his or her particular problem? The individual suffers or has some
discomfort with it, no matter that it may seem simple and foolish to the rest of
Humanity to worry about it? To what extent does he consider that he can or cannot
be helped?... and above all everything, are you interested in being helped? This
indicator has an indisputable phenomenological component of understanding reality
as-it-is-perceived by the individual, which should not be ignored in the professional
practice of child psychotherapy;

• Social Restriction, this indicator refers to the degree to which the problem referred

5
9
 to limits the child in carrying out the daily activities expected for his or her age,
whether for objective or subjective reasons: Excessive overprotection may not have
visible effects on the child's behavior. , even this one may not feel upset or
dissatisfied with the situation,... however, the possibility of interacting with other
children, learning rules of coexistence, sharing and tolerating others, as well as
defending their rights in the socially expected way, leads to serious difficulties in the
child's socialization process, with - in the long run - potential negative effects on
their personal well-being and social integration;

• Interference with development, this indicator refers to the extent to which the
child is limited or not to cope with the different requirements of each stage of
development, seen both in terms of a delay in this development compared to the
same or in terms of deviations from this.

"As children grow, they need to progress in their psychological development to

cope with the various crises of life, to pass through certain phases and to
advance in their mastery of the environment." (Rutterd 23)

In this sense, it can be just as harmful for the child to delay in his development as to
anticipate this “burning through stages”: A child who is not allowed to go outside to
play with his peers, who therefore has limitations in his development. and
expression of their vital energy and does not develop certain motor skills, they may
have many difficulties to function easily in certain contexts later:
On one occasion I attended to a child with characteristics similar to those
mentioned above because the teacher systematically reprimanded him for his
indiscipline. When I interviewed the mother, she lamented and told me: He does
the same bad things as the others but, since he is so clumsy, he is the one who
is always caught!

In the same way, a child who has had to assume, for one reason or another, very
serious responsibilities at home and “mature” before his time, may have later
difficulties in his social integration, because he cannot stand the “nonsense” of his
parents. supposedly immature contemporaries.

Effects on others : Virtually all psychological disorders have to be considered in an

interpersonal context. No human being is isolated, absolutely within himself, but develops
his entire life in a context of interpersonal relationships,

"...with exceptions such as Robinson Crusoe who was completely alone on a

desert island for several years,... but even so his reflections and experiences
had as a point of reference the society, the culture where his conception had
been shaped. of the world and personal existence. However, in the last years of
his "stay" on the island, he needed the native Friday to keep him company,
despite the enormous cultural gulf that separated them. Even if it had not
appeared objectively, perhaps Crusoe would have "made it" in his own
imagination and fantasy, just as small children who have limited interpersonal
relationships with peers do, who create their own "imaginary companions." ,...
6
0
 Would this constitute a psychological alteration or is it possibly one of the most
adaptive of the child's responses to be consistent with its basic essence: its
social character? (author's digression).

In the case of the child, this is possibly one of the most important indicators of emotional,
psychological or behavioral alteration that the therapist faces, since it is usually his
parents or others who are bothered or irritated by the child's symptoms: Enuresis It rarely
bothers the children themselves, who usually remain peacefully asleep on the "wet bed"
or immediately move to their parents' bed... these are the ones who become irritated and
bothered by the child's symptom.

6
1
This reflection is also valid for the adult world: the alcoholic who does not want to accept
that he is one, extraordinarily harms those around him, mainly family, friends and co-
workers, however he does not recognize that he needs specialized help. Consequently,
an ethical education and training for coexistence must presuppose transmitting to the
child the teaching that one's own rights (so magnified in some existential currents) have
their limitation when they begin to violate the rights of others.

The elements expressed above are summarized in the following Table:

Criteria to evaluate the presence of a psychopathological alteration in the child.

Normative Criteria. Phenomenological Criteria.

Adaptation of Behavior to
• Chronological Development and • Suffering or State of
Displeasure.
Particular Gender.

• Compor Persistence treatment. • Interference

Development.
with

Valuation Standards of the Com

• behavior • Degree of Social
Restriction.

• Scope of the Alteration. • Effects on others

• Type and apparent degree of
severity of symptoms.

• Frequency of Occurrence and

Intensity of Manifestations tations.

• Changes in Habitual Behavior.

• Specificity of the Situation.

• Vital Circumstances.

We insist on the operational nature of these criteria, which the specialist must look at with

6
2
a practical perspective that implies being able to adjust and adapt to the specific case
before him, both for his diagnostic understanding and to define the way in which he will
intervene on the problematic.

In short, it is impossible to understand the psychological problem or alteration of a child if

the therapist does not assume a flexible and dynamic position both in relation to the
development possibilities of a child and in terms of the confluence of factors present in
the appearance of said problem.

♦ ♦ ♦
Up to this point we have referred to conceptual, definitional and methodological aspects
in psychotherapeutic work with children. Likewise, psychotherapeutic practice
presupposes knowledge of the various methods , procedures and strategies of
psychological intervention in children and adolescents with some degree of psychological
alteration, which nourish the professional actions of the child psychotherapist, both the
classic and traditional ones and the most current ones. and innovative. Those who
dedicate their professional life to the practice of Child Psychotherapy must aspire to
its domain.

6
3
APPENDIX 1

“Problem” children... Guilt of the Parents?

Dr. Miguel Angel Roca Perara.

It is usual that when a child exhibits maladaptive behavior, which generates problems
both at school, in the community and at home, the parents are immediately blamed for
the absence, insufficiency or inadequacy of "correct" educational procedures, etc. Is this
absolutely true? Is it not possible that parents become more victims than culprits of the
inappropriate behavior of the “problem” child?

♦ ♦ ♦
There are children who exhibit non-adaptive behaviors that have been called “problem”,
“difficult”, “impossible” children or with behavioral disorders. In any case, children, the
idea is present that this is a disorderly, irreverent, defiant, destructive, undisciplined child
and who knows how many other epithets.

The presence of a child with these characteristics causes discomfort and subsequent
rejection in those who are in its range of action and which is usually expressed with the
expression of censorship of “what a spoiled child!” . And here begins precisely our
reflection and analysis on which we would like to pause briefly.

What does it mean to be “spoiled”? If we break down the term, it means “spoiled”, that
is, rude! And whose responsibility is it to raise and educate the new generations?
Obviously, the parents! The “logical” conclusion then is that the parents are responsible
– or rather, guilty! – for the difficulties in the behavior of these children,... and therefore
they are judged and censored with as much or more severity than their children. for
tolerant, indifferent, not very energetic, lazy and another series of adjectives.

Is it really like that?... few things in life can be answered categorically with a yes or no,
due to the multiplicity of aspects that everything has in human existence. Nothing
different happens then in the matter at hand, but it is up to me to take sides and avoid
ambiguous answers, so I would then dare to affirm that many times parents are victims
rather than guilty of their children's unwanted behavior. What happens is that the family
is a complex system and like any living system it evolves over time, so all the factors
present enhance each other throughout the temporal dimension, making it very difficult
to identify - if not impossible - where it is. the cause and where the effect. Therefore,
lapidary blaming the parents would not only be unfair, but

6
4
It would hinder finding solutions - which is ultimately the most important thing! - to the
behavioral problems of the “impossible” child.

c. Webster Stratton & M. Heller refer to this topic with the statement

“Being Parents of a Child with Conduct Disorders: Families Under Siege —

which implies that parents who, unfortunately or unfortunately, have a child with
behavioral disorders are under constant harassment derived from the bad behavior of
their children, not only because of the discomfort and disorder that these cause and that
becomes uncontrollable, but due to the “ ripple effect” that occurs and in which, as we
will see later, the relationships of the parents are affected both inside and outside the
family system and –as a vicious circle- as a consequence negative, worsens the child's
maladaptive behavior.

Ripple Effect
Let's start by trying to understand how these children are perceived by their parents and
what are the behaviors that stand out the most when outlining their characteristics: The
first of them is that the child is seen as a "despot" or "tyrant" who seeks to impose his
desires. or points of view, ignoring or devaluing those of others and appealing to one of
their most unpleasant peculiarities: aggressiveness .

This aggressiveness is expressed against parents as well as siblings, peers, animals or

objects, being particularly destructive with the latter. Aggression towards other children
can be particularly complicated because not only will they tend to reject the “problem”
child, but their own parents will prohibit them from playing or interacting with them. This
is not only harmful to the “impossible” child's socialization and experience of being
accepted, but it will hurt the sensitivity and cause anger in his or her own parents, as
they perceive that their child is discriminated against and/or rejected not only by his or
her peers. , but for their parents.

“Problem” children are also frequently perceived as disobedient and defiant and that
they constantly “test strength” with their parents, raising their demands in an infinite
spiral every time they give in to their pressures and demands. As it is logical to assume,
the parents' resources are exhausted, they feel more and more tired until they reach a
literal state of hopelessness - in which everything was tried and nothing worked! -, in
which the "dictatorship" is imposed. ” of the “impossible” child given the parents' inability
to handle it.

It is interesting that although parents report many other undesirable characteristics such
as habit disorders (sleep, eating, hygiene, etc.), poor social adaptability, learning
difficulties (not attributable to Mental Retardation), distractibility and hyperactivity, etc.
They insist on placing special emphasis on the presence of certain positive qualities in
the child, particularly the fact that he is a loving child,... but who changes, for the worse,
his mood very quickly when he dislikes something, which makes him very
unpredictable. their behavior and leads parents to always be on guard, expecting that
something bad is going to happen, given that problems and difficulties can emerge at
any time and place.

It is logical to assume that living with a child like the one described, for whose well-being
and social adaptation one is responsible, has a devastating impact on the entire family
system, starting, - very in particular! - with the parents' own marital relationships. , given
that in the effort to control the child, parents have very little time to dedicate to cultivating
their intimacy, a space that must be given special attention in any family system:

Making a family is much more than having children,... it is something that began with a life
project between two who loved each other, and who should not stop doing it, even if it was in
different ways.

6
6
But unfortunately when you have a child with a certain behavioral disorder, on the few
occasions when the couple has some time to intimately dedicate to each other, they
“waste” it in long conversations about the “problem” child.

Here it is necessary to point out that it is the mother who stays most of the time with the
child and is therefore the most “ besieged ” and has the greatest drain on resources, her
relationship with the child being more tense, and her relationship being more
compromised. emotional well-being. The father, on the contrary, spends less time with
the child, with whom he usually has an easier relationship; The “problem” child is
generally much less despotic and tyrannical towards the father figure, whom he tends to
respect much more than the mother figure.

The above can contribute to complicate or “conflict” the relationships between both
parents, given that each of them will have different appreciations of the child's
problematic behavior: The father complains that the mother not only takes less and less
care of him, but who is continually reproaching him for his lack of collaboration in the
management of the child whom he does not see as so problematic,... the mother, for her
part, will reproach the father for being distant and not very involved, as well as for
supposed insensitivity and passivity. in the face of the child's behavior that she
perceives as chaotic. This mutual resentment only intensifies the home tension and the
ineffectiveness in the educational management of the child, legitimizing the old saying of
“a troubled river, fishermen gain.”

In this context, mothers report a feeling of incompetence (of being a failure!) not only
because they feel guilty for having failed in raising their children - strengthened by the
constant criticism of their husband and other significant people - but also because of the
feeling of that his marriage and his entire life are a disaster . The result is a paralyzing
depression and/or a hostile attitude towards everything, which together is nothing more
than a feeling of hopelessness and helplessness that does no favors for the education -
or re-education? - of the child.

The impact of the presence of an “impossible” child in the home, with whom one lives
daily, expands both directly and indirectly to the siblings . The siblings are directly
victims of the impossible child's physical and verbal attacks, making them feel bad at
home and developing hostile or maladaptive behaviors themselves. Indirectly, the
siblings' relationships with their parents can be compromised, as they will feel relegated
to the background when they perceive that almost all of the parents' concerns revolve
around the impossible child, robbing them of the attention and affection that they believe
they deserve, which It can lead to maladaptive behaviors, competing for parental
attention.

The latter, in turn, may have high compensatory expectations for their siblings, with
demands that they be a paragon of virtue, a kind of “model child” who vindicates the
educational “failure” with the “problem” child. These are usually such high expectations
that, far from favoring, what they do is cloud relationships with parents and further

6
7
complicate the already complex family situation,... which again does nothing to improve
the child's behavior.

But the impact of the problem child's maladaptive behaviors is not limited to family life; it
frequently generalizes to other members of the extended family (grandparents, uncles,
cousins, etc.) who generally distance themselves or assume critical and critical
positions. rejection of the bad behavior of the “problem” child, insisting on advising the
child's parents about how they “should” treat the child. The latter sometimes - ironies
and paradoxes of life! - is reinforced by the fact that, according to Webster-Stratton and
Séller:

“...sometimes children don't behave as badly with grandparents as they do at

home..."

which means an additional devaluation to the already hopeless parents who further
deepen their sense of helplessness and incompetence ; feeling that in no way
contributes to greater control of the “problem” child and on the contrary strengthens his
or her maladaptive behavior.

Finally, the impact of being a parent of a child with behavioral disorders extends to
almost the entire system of interpersonal relationships with the community. The
maladaptive behavior of the “problem” child leads to a rejection by many members of the
different human contexts in which the parents operate, to stigmatization and social
isolation,... which is even more complicated, since the Parents will “self-isolate” to avoid
reproaches and censure, becoming “entrenched” in home life, worsening the situation,
given that constant daily coexistence in the reduced physical space of the home, far
from relaxing, what it does is make it even more tense. a complex situation that
becomes intolerable.

And it is unfortunate, according to our professional experience, that when this happens it
is the mother who - according to the popular expression - has to "dance with the ugliest",
who is left in the most disadvantaged position, not only because she is the one who
stays the longest. with the child and must, consequently, be the one who imposes (...?)
the authority, but because more frequently than desired other members who could help
literally flee from an already exhausting situation: the siblings, as soon as they can , they
do not stay at home for a minute and the father goes out to look for “fresher” air that
usually leads to marital breakdowns and parental distancing from the home,... which
continues to aggravate the situation because now the “problem” child is not only the
child has seen the father's authority lost or weakened (which, as we said previously, can
be an effective retaining wall for the child's inappropriate behavior), but the mother will
feel even more helpless, emotionally abandoned and therefore more self-devalued.

So, dear reader, are parents really that guilty for having a “problem” child? Aren't they
also, in reality, a bit of a victim? Wouldn't it be preferable in many cases - not all! - to try
to understand and help them before censoring them?

6
8
A few final words -for now!-, concluding here may leave parents who read me and are
going through similar situations a devastating feeling that there is nothing to do!...
nothing could be further from the truth, it is much What can be done in order to, at least,
improve and face situations like the one described with a more optimistic perspective,
but this space is limited, let's leave it as a quick continuation of this work!

Recommended Readings:

Lane, David A. (1992) The Impossible Child. Trentham Books.

Roca, Miguel A. (1998) Basic Elements of Child Psychotherapy. Academia Publishing.

Webster Stratton C. & Heller M. (1994) Troubled Families-Problem Children, John Wiley
& Sons

6
9
APPENDIX 2

Article: “Problem Children,... Guilt of the Parents? (2nd. Part)

Dr. Miguel Angel Roca Perara

Faculty of Psychology, University of Havana

For any family, the education of their children is a fundamental concern. For many it is a
task that, regardless of one inevitable skirmish or another, involves great complexities.
For others it is a much more difficult task, especially when they have children who
exhibit, to a greater or lesser extent, problematic behaviors that hinder their education.
Understanding what is happening is very important,... but more important is knowing
what to do.

♦ ♦ ♦
“I have tried everything with the child ,... but nothing works anymore! With this
declaration, the parents of almost all the “problem children” begin to tell their worries,
hence their implicit, unstated demand is “Offer me something different!”

For those of us who work in any of what is defined as helping professions, the
temptation quickly arises to have on hand and immediately offer that “ something
different ”,... without taking into account that we can simplify or trivialize a highly complex
matter. and, again, offering “ more of the same ”, exacerbating the situation of
hopelessness and helplessness that had already taken hold of the parents of these
children.

What to do then?. Without the intention of prescribing or offering non-existent panaceas

for an issue that is difficult to predict – not because of the issue itself, but because of the
multiplicity of contingencies surrounding it and which often escape control – and taking
into account the enormous variability of individual and contextual differences present for
each child, I would dare to make some reflections:

First of all, it is pertinent to offer a simple answer to the question that gives the title to
this work: Guilt of the parents? NO, Responsibility to a greater or lesser extent? YES.
It may seem simple, but it is almost a declaration of principles so that parents can take
an effective stance when facing their children's difficulties, even if they are not problem
children!

7
0
 I apologize to the reader for a momentary digression that I
want to make – polemical with all intentions – and that will
help me to comment on some ideas that I want to express
below. My father liked to say that when you have a horse and
live in the mountains, you are obliged to take it to the river
every day to drink water.
The way you take the horse to drink water is your
responsibility and your business, you decide if you take the horse down the
mountain at full gallop, giving it spurs of all kinds, if it goes down slowly, if it goes
down walking at its side, and Even – if you are strong enough for it – if you put the
horse on your shoulders,... As you, dear reader, can appreciate, any of these ways
- like almost everything in life! - has its advantages and disadvantages. But once
the horse reached the river, whether it drank water or not, and even how much
water it drank, is a matter for the horse! As a well-known television program says,
draw your own conclusions!

In the previous situation, you can see that in life some matters are in one's hands, but
many others escape control, even with our best intentions, hence the risk of feeling
guilty for everything that happens around us... including parenting. Because when a
person feels guilty about something, they feel bad, ineffective, incapable; They try to
solve things by their own means to “ pay for what they have done wrong ,” which not
only deprives others of their participation in solving problems, but also makes them
comfortable censors of everything that goes wrong. As it is logical to suppose, this leads
the person to feel very alone, hopeless and helpless to face the even simpler problems
of daily life, especially the education of children! Paradoxically, many times, when the
person is truly guilty of something, they barely experience anything of what is said.

For this reason, and taking into account the real fact that it is impossible for someone to
be guilty - which does not exclude the responsibility that people have for certain events
in life - for everything that happens in their daily lives, in the Sciences Social, and
particularly in Psychotherapy, the confusing term “ empowerment ” has been included –
coming from the expression in English, difficult to translate, “empowerment” – which,
beyond complex semantic considerations, is telling us about the intentionality of make
parents experience the feeling of power (Webster-Stratton and Herbert).

And achieving this – by one means or another – presupposes that parents increase their
self-esteem , that they feel that they are not simple puppets in the hands of their
children, that
feel that they may have done many things wrong but that they have also done others
77
better things, that they train themselves in more effective forms of communication that
allow them to assert their rights, that they are capable of engaging others - who also
have responsibilities! - in making their children good citizens. Achieving it is not an easy
task, but when it is achieved, the feeling of authority increases, which is perceived by
their children as a sign that the impunity , in which things were going until now, can very
soon begin to be extinguished: When a child sees To his weak and powerless parents
he feels that he can do whatever he wants because “ nothing happens ”,... but when he
sees them as “powerful”, he controls himself a little more.

In any case, I began by saying that I was going to be controversial on purpose, and
leaving things here would be, paradoxically, confirming that parents ARE to blame for
their children's problems and that if they only attended to and guided them everything
would be resolved.

Nothing could be further from the truth, the simplest of problems in early childhood
education is always multi-caused and each and every one of the causal or influential
factors must be taken into account in the search for an optimal solution.

In a problem child, constitutional and genetic factors mix with cultural and environmental
factors in such a complex way that none of them should be ignored.

Because the lack of concentration, motor clumsiness, hyperactivity, criminal behavior of

a child, etc., can be supported by some type of neurological dysfunction or injury, and
even certain temperamental conditions given by the type of Higher Nervous Activity,
which If they are not properly cared for and treated, they can make the most elaborate
educational strategy fail. It is indisputable that effective and timely medical treatment to
correct or optimize any health condition, not only neurological, that compromises the
normal functioning and daily performance of the child, can contribute very favorably to
eliminating or reducing problematic behavior.

Notwithstanding the above, I insist on the interdisciplinary approach, because a child

can have very maladaptive and problematic behavior despite having optimal physical
and health conditions, and vice versa, a child with significant neurological injuries can be
very well integrated and adapted to their social environment. It is here, then, where
learning and the socio-cultural context, particular but not exclusively family, in which a
given child has had to live must be seriously taken into consideration.

Because from the earliest childhood, children are exposed, and learn well from them, to
certain models ,... which are not necessarily the best bearers of the norms and values
that society calls for. It is unfortunate, but when a child has been exposed from early
childhood as part of his daily life - especially in the family context, but also in the
neighborhood, at school or in society as a whole - to violence, to destructive behaviors,
irresponsibility and violation of the most basic rules of coexistence, including the rights of
others, and reproduces these behaviors in other contexts, he is behaving in an
“adaptive” way, doing so in accordance with what he has learned... . although this has
nothing to do with or even contradicts what culture and society intend.

7
2
In these cases the prognosis is much more reserved; Experienced psychotherapists
know that it is very difficult - although not entirely impossible! - to encourage social
behavior in accordance with socially desired expectations when the child is constantly
exposed to undesirable models that contradict these expectations,... without lapidary
pretensions we could quote the wise saying “ son of cats, catches mice ”. The truth is
that it is much easier, starting from scratch, to promote the positive than to “dismantle”
unwanted behaviors (Reinecke, et al.) and then implement other more desirable
behaviors and attitudes.

But even in these cases, although conservative, I prefer not to be fatalistic and to be
consistent with what I have defended until now about multicausality. Because many
problem children, despite a high and real responsibility of the parents in their behavior,
become good citizens thanks to the educational effectiveness of other influences (other
family members, neighbors, school, social institutions, etc. ) and even thanks to your
own self-development and personal growth.

Implicit in the previous paragraph, then, are two other fundamental ideas to provide care
to the problem child and achieve optimal social insertion: the role of other people and
institutions beyond the family and the human potential of the child in question.

Other people and/or institutions can thus be decisive in reversing, for the better, the
condition of problem children. Many things can be done by other family members,
neighbors and especially the school, but the essential thing is not to stigmatize,
discriminate, or “label” the problem child and his or her family; This would only
exacerbate the problem, as we pointed out in the first part of this work.

Assuming a position of inclusion and acceptance is always much more beneficial than
the harmful exclusion that makes the person - in the case at hand, the child and his or
her family - feel discriminated against and marginalized, which generates irritation and
resentment, which is far from If they favor, what they do is aggravate the problematic
situation. Any human problem is solved more effectively when you have access to solid
and effective social support networks (Roca, Pérez) than when you are deprived of
their very beneficial potential effects.

Likewise, the use of “labels” (“spoiled”, “irresponsible”, “unbearable”, “pre-delinquent” ,

etc.) must be eradicated because they “stay” and the person may tend to behave
accordingly. with what they express.

Fortunately, this does not always happen, even if the labels “remain”. From an
anecdotal point of view, I have a good friend from adolescence and youth who,
because of his disorderly daily behavior, was called “the crazy one.” More than 30
years later, he has never visited a Psychiatric Hospital, he is a calm family man
and an excellent engineer,... but every time we meet he is still “the crazy one”;
Fortunately, he doesn't believe it.

To conclude, we also do it by polemizing, since we have been talking about the factors

7
3
present in the problem of the problem child and we have barely talked about the main
protagonist of the entire process (Roca, 1998): the child in question himself.

Because it is not enough to modify, even if it is for the better, everything that conspires
against the optimal social integration of a problem child; It is essential to work with the
child himself, especially because he has regularly been a child who has been very
mistreated in his self-esteem and personal worth, who has few skills to communicate
productively with others and who, for that reason, has been rejected so many times, that
Their behavior and attitudes toward others are regularly hostile...

You have to dedicate time to these children and have a lot of patience with them. It is
very important to focus on the good they do rather than reproach them for what we
assume they do wrong and should do better:

It does more good for a child who worked hard for an exam and obtained scores of
89 points when we put a hand on his shoulder and tell him with satisfaction that “you
almost got an Excellent,... next time you will achieve it! ” that when we looked at
another child who got 99 points with a disappointed face and asked him “where did
you lose the point?” Usually the problem child is treated in the latter way: magnifying
his inadequacies and minimizing or ignoring his achievements...

It is equally important, when it is inevitable to reprimand him, to censure his actions and
not him as a person: telling a child “you told a lie !” is not the same as telling him “ you
are a liar !” In the first case the act is being sanctioned, in the second a person is being
classified; In the first case it is a casual fact, in the second it is being said that the person
IS like that and therefore has little chance of changing.

In any case, with these children -beyond individual differences that always give a
specific direction to professional work-, they should not miss any opportunity to praise ,
to recognize what they have done well and to strengthen their self-esteem, at the same
time. not to miss any opportunity to foster in them any skill that helps them function
effectively in the complex network of their daily interpersonal relationships.

As you can see, dear reader, many vectors of force revolve around a “problem child”
that must be taken into account, both when seeking to understand and when seeking to
achieve ways to implement their optimal social insertion, which often transcend the no
small important responsibility of parents.

So, dear reader, returning to the initial story, why does one horse not want to drink water
and another does, or why one drinks more water than the other?

RECOMMENDED READING.

Lane, Davis A. (1992) The Impossible Child, 2nd . Edition. Trentham Books Limited, UK

7
4
Reinecke, M., Dattilio, F:, & Freeman, A. (1996) Cognitive Therapy with Children and
Adolescents. The Guilford Press, NY

Roca, M. (1998) Child Psychotherapy: Basic Elements. Academia Publishing. Havana

Cuba

Rock, NM. And Pérez, M. (1999) Social Support. Its significance for Human Health. Félix
Varela Publishing House, Havana, Cuba.

Webster-Stratton, C. & Herbert, M. (1994) Troubled Families-Problem Children. John

Wiley & Sons, Ltd. England UK

7
5
APPENDIX 3 “That Child is Impossible!”

By: Miguel Ángel Roca Perara

(Taken from the Health section of the Workers newspaper)

What an idiotic child!", "That little boy is a nightmare!", "what an impossible creature!",
"what a heavier boy!" Although the majority of children receive these evaluations
occasionally, which are not repeated later, there are children who are frequently
subjected to them because their behavior is usually censored by those around them,
due to the discomfort they cause.

How many times have you heard similar expressions? Possibly on many occasions,
although most of the time children receive these evaluations situationally, as a
consequence of behavior that is not appropriate or not well regarded by those around
them, which is not repeated later and does not have major implications. However, there
are children who are regularly subjected to them, since their way of acting is almost
always censured by those around them, given the discomfort they generate.

In close relation, judgments and evaluations also appear about the responsibility of
parents in the appearance and manifestations of unwanted behaviors and frequent
expressions such as: "the parents are to blame for spoiling them so much!", "what kind
of parents should have it, look how they have it!", "how lazy your parents must be!" Seen
this way, everything seems to conform to an old assertion that says: "child with
problems... family with problems!"

The role of the family in the appearance of disorders and difficulties in children's
behavior is indisputable; The deficit in educational skills and interpersonal conflicts
between parents negatively influence minors in establishing limits and self-control of
behavior. But establishing this relationship in a linear way is simplified and hasty, and
leads to putting parents in the dock.

Childhood behavior is multidetermined and a child's behavior has many more causes
than the educational rigor or non-rigor that parents can use. Genetic and temperamental
factors, physical appearance, intellectual abilities, etc., are elements of the child himself
that can constitute fertile ground for the establishment of difficulties in his behavior.

This is the time to approach the issue with a circular vision in the sense of seeing how
having a child at home with severe behavioral difficulties very seriously affects family
dynamics. It is not for nothing that it has sometimes been stated that the parents of
these children are parents "under siege", whose lives revolve, almost entirely, around
the child's behavioral problem. They always live apprehensive, making sure that the
child does not break something, that he does not steal an object, that he fulfills his
duties, that he does not fight with other children, that he is respectful... and in the event
of the slightest failure in these purposes, they feel it as a personal failure, as a feeling of
ineffectiveness that turns into a strange mixture of hostility and compassion towards the

7
6
child..., which worsens their unwanted behavior. They experience very intensely the
rejection and disapproval of others, including close family members, and come to feel
stigmatized. Just as an example, parents of "normal" children forbid them from company
with the "impossible" child. When this occurs, parents not only withdraw from social life,
but develop a reactive feeling of excessive protection towards the child, and create
conditions that increase unwanted behavior, confirm the opinions of others about their
responsibility, and They further exacerbate the stigmatization situation.

As a consequence of the above, hypersensitivity is generated in family life, which leads

to frequent conflicts between its members for the most insignificant reasons: siblings feel
neglected, parents fight and end up separating, offensive and disrespectful treatment
becomes legitimized. ...and again, as a consequence, the manifestations of unwanted
behaviors become more acute.

It is not my intention to legalize and passively contemplate the unwanted behavior of a

child, but to draw attention to the fact that we have the possibility of contributing to their
improvement and progressive social adaptation: parents must seek qualified
professional help, family members must become more in collaborators than in judges or
prosecutors, teachers must take on the correct education (or re-education!) of these
children as a challenge, the community must contribute so that parents do not feel
isolated or the child "labeled."

The word "impossible" is too damning for the charm of the children's world. If we all work
together for their well-being, it will always be possible to bring out all that is good in a
child and make him or her a socially useful person.

7
7
APPENDIX 4 “Help me,... my son is unbearable!”

By: Miguel Ángel Roca Perara

(Taken from the Health section of the Workers newspaper)

Not long ago, in this same Section Y on this same topic, I wrote an article titled “That
child is impossible” (July 30, 2001); For this reason, I had a certain objection to writing
“more of the same” again despite it being a fascinating issue for professionals in
Psychology,... but the thing is that although I don't like to repeat myself, there are topics
like the one at hand that are inexhaustible and always current no matter how much you
insist on them. Add to this that, without reaching the undesirable saturation of
information that only achieves the opposite effect, the dosed and repeated information of
a message contributes to its better assimilation; I think this has special validity for
today's issue.

Because if something encouraged me to write about the subject, it is the “call for help”
that in different ways, not rare by the way, I have received from “desperate mothers” (it
is the expression that is repeated) for not knowing what to do with their children. (usually
males) between 2 and 15 years old who are impossible ! and with whom “they have
already tried everything and nothing has worked.” And it is true that these manifestations
are declared in specialized literature to refer to children whose behavior is disordered,
out of control, destructive and frequently aggressive, in practically any context (family,
school,...) and with any person, despite of multiple attempts and of different types for the
child to “change”,... in any case he persists in his unwanted behavior.

But thinking like this can be very fatalistic and stigmatizes the child as an inevitable
misfit, prophesying future dissocial behavior, treating him as a “ criminal pigeon ” and
therefore later making the prophecy come true. I therefore resist this way of thinking and
I will never stop trusting that it is possible to optimize a child's human potential... if the
minimum conditions are made available to them.

Due to the diversity of aspects that we encounter when analyzing each “impossible”
child individually, I do not dare to affirm anything absolute or conclusive (almost nothing
is in real life!), but if we take a quick look at what Some of the people who demand help
to raise these children tell us, we find some regularities that are something to think
about,... or at least to discuss:

The anguish of not knowing what to do almost always comes from the maternal figure,
from mothers who describe themselves as “single mothers” where - self-explanatory! -
the paternal figure is absent or - even worse! - It is harmful to the child. I do not intend
here to make an apology - although it deserves it! - for the meaning of the physical and
spiritual presence of the father in the education of children, both females and males,...
but with a sui generis connotation in the case of the latter, both for what they represent
as a model to imitate and for their function of “containment” of a being full of vital energy
that is the child, but who recognizes and respects his father as a figure of authority:

7
8
Many times, When the father is absent, the mother intends to assume both roles herself
– “I am her mother and father at the same time!” - which is a good intention, but it is still
a chimera, even when the children are achieved as good human beings.

In the same way, the responsibility that falls almost entirely on the mother becomes a
heavy burden for her because, in addition to the experience of loneliness that takes
away her energy - or disorganizes it! - to deal with the child's problems, it is constant
victim of criticism and reproaches from those who accuse her of her weakness,
inadequacy and failure in raising her son... this makes her feel guilty or irritates her, but
in any case it makes her relationship with her child even more complex and strained.
son, with the consequent negative effect on his behavior.

But let's not recreate our analysis only in the family component and continue
investigating the factors present around the “problem child.” Many times the child's
unwanted behaviors are expressed in Educational Institutions such as Schools and
Daycare Centers, places where the child spends a good part of the day: do his teachers
and educators collaborate so that the child organizes his activity, integrates into the
other children and is motivated by school activity, in an attitude of humanistic vocation
and commitment to the profession and the students?,... I reiterate that I do not believe in
“absolutes”, but when a good teacher fulfills his mission in this way, Problematic
behavior is noticeably weakened when it does not disappear.

But when, unfortunately, this does not happen and the teacher validates the label of
"problem child" - without having exhausted all possibilities of influence and without
having done everything that was humanly and divinely within his power to integrate him
with his contemporaries -, it is not treats him in a kind way, discriminates against him
and even goes so far as to think and suggest that the child should be sent to a Behavior
School, then the child's human situation becomes even more compromised.

In another sense, when it comes to a child with these characteristics, the people around
him generally focus on the negative aspects of his behavior, on what bothers him, and
rarely stimulate him and recognize his positive facets. Not feeling accepted exacerbates
their manifestations of maladjustment which, like a vicious circle, increases the
lacerating expressions of rejection from those around them.

We could continue commenting on “reasons” that can enhance the “impossible”

behavior of a child, both sociological and living in communities or neighborhoods with
the presence of criminal attitudes and behaviors or promoters of dissocial behavior,
where “ unbearability ” becomes “normal.” ” and even well valued; as psychological
when the child comes from families with people with little emotional balance and daily
indicators of psychic alterations that make family life a true battlefield; and even reasons
of a neuropsychological nature, when an illness, structural injury or functional
conditions of the Central Nervous System that compromise their motor skills, facilitating
hyperactive or destructive behaviors, their self-control facilitating episodes of
aggressiveness, or their attention facilitating episodes of distractibility in the fulfillment of
their duties. schoolchildren that can compromise learning,... but this space is small and

7
9
does not allow us to exhaust all the aspects of a human situation of such magnitude and
sensitivity as the one we are dealing with.

As you may have realized, there are no complete answers, there are many
contingencies that revolve around an “impossible child” - who is inevitably unique and
unrepeatable - and the ideal is to go to a trained specialist who can assess the weight of
the child. each and every one of the alternatives, looking for how to find the optimal
solution to each of them.

Just a suggestion: avoid physical punishment and verbal insults that denigrate the child!
Any type of violence begets violence and its behavioral effect may only be apparent
although ephemeral, but its long-term consequences can be destructive for the
formation of the personality of the specific child and the future social adaptation of the
adult he or she will be.

If with these opinions we can get our readers, especially the desperate mothers who call
us to this and who, very distressed, ask us “ I would like you to help me so that my child
is normal like everyone else! ” – literal expression of a mother –, think differently about a
child's problematic behavior, taking into consideration the issues we have talked about,
then we will all be contributing a precious dose of good will to achieve a fuller and
happier childhood.

Dr. Miguel A. Rock

8
0
BIBLIOGRAPHY

Abelastury, Arminda: “Theory and technique of Child Psychoanalysis.” Editorial. Pious.

Buenos Aires. 1962.

Anderson & Anderson; "An Introduction to Projective Techniques", Edit Prentice-Hall,

Inc. 1982.

Avendaño, Rita and Minujin, Alicia: “A Different School” Editorial Pueblo y Educación.
Havana. 1980.

Axline, Virginia: “Play Therapy” The Riverside Press. Cambridge. AND. OR. 1947.

Bernal del Riesgo, Alfonso: “Errors in raising children” Cuban Book Institute. 1970.

Bierman, Gerd: “Treatise on Child Psychotherapy” Espaxs Editorial. Barcelona. 1973

Volume I and II.

Biermann, Gerd; "Treatise on Child Psychotherapy", ESPAXS Editorial, Barcelona,

1973.

Bozhovich, L. YO. ; "Personality and its Formation in Childhood", Edit. People and
Education, 1976.

Bunge, M.; "Scientific Research" Cuban Book Institute, 1972.

Bustos, D.: “Psychodramatic Psychotherapy.” Paidos Editorial. Buenos Aires. 1975.

Duque de Estrada, A: “Play as a way to integrate children with behavioral problems”

Editorial Pueblo y Educación. Cuba 1988.

Freedman, Alfred M: “Treatise on Psychiatry” Volume IV. Chapter 40: Child Psychiatry:
treatment. Scientific – Technical Editorial. Cuba. 1984.

Freedman. A., Kaplan, H. and Sadock, B.; "Treatise on Psychiatry", Revolucionarlas

Editions, 1983.

Freud, A.; "Psychoanalysis of the Child", Editions lmán. Buenos Aires, 1951.

Gurman, S.; "Handbook of Family Therapy." Edit Brunner-Mazel, 1980.

Kanner, Leo “Child Psychiatry” Zig-Zag Publishing Company. Chile 1951 Consult
chapter XVI: Projective methods in Child Psychotherapy.

Kanner. Leo; "Treatise on Child Psychiatry" Zig Zag Editorial, 1951.

Klein, M., "The Psychoanalysis of the Child." Ed. The Ateneo, 1948.

8
1
Klein, Melanie: “Child Psychoanalysis” Editorial el Ateneo. 1948.

Lebovici, S. and Diatkine, R.; "Meaning and Function of Play in the Child"

Makarenko, Antón: “Conferences on early childhood education” National Printing Office

of Cuba. 1961.

Minujin, A and Sorin, N: “Introduction to Psychodrama” University of Havana. Faculty of

Psychology. 1990.

Pavlovsky, Eduardo: “Group Psychotherapy in Children and Adolescents.” Search

Edition. Buenos Aires. 1987.

Reca, Telma: “Psychotherapy in Childhood” Editorial Psique. Buenos Aires. 1960.

Roca P. Miguel A.; "Selection of Clinical Psychology Readings" EMPES-MES, 1979.

Roca, M. and Rojas, R.; "Some aspects about Play Psychotherapy." Cuban Journal of
Psychology Vol. 1, no. 3, 1984.

Rutterd, Michael; "Helping Troubled Children." Great Britain, Con & Wyman Ltd., 1987.

Santrock, John W.; "Adolescence. An Introduction" Fifth Edition Brown & Benchmark
Publishers 1990.

Satir, V,; "Joint family psychotherapy, Ed. The Mexican Medical Press, 1980.

Slavson, S.: “A. Texbook on Analytic Group Psychotherapy.” International Universities

Press. New York. 1954.

Vega Vega, René: Child Psychotherapy” Printer Andre Vaisan. Cuba 1989 “Parents
School” Scientific – Technical Editorial.

Vega Vega, René; "Child psychotherapy", Combined Polygraphic "Evelio Rodríguez

Curbelo", 1989.

Xavier Méndez, F, and Macia Antón, D. (coordinators), "Behavior Modification with

Children and Adolescents. Case Book". Ediciones Pirámide SA, Madrid 1990.

Záldivar, D.; 'Psychotherapy Topics'. EMPES-MES, 1989,

8
2