In keeping with our tradition of discussing child or adolescent case material during the annual meeting of the Child & Adolescent Initiative, Valeria Pulcini of Milan presented her work with Titti and Sonia. This presentation, entitled “And Analyst Makes Three: Reaching Empathic Depths in the Treatment of an Adolescent and Mother”, Valeria’s sharing of evocative, even painful process as well as her open self reflection and disclosure, allowed participants at this Chicago meeting to empathically imagine their way into Valeria’s Milan consulting room.

As Sonia, the mother talks about feeling rejected by her daughter’s angry hurtful behavior, she associates to her own sense of rejection when she felt invisible after the birth of a younger brother. In response to Sonia’s vulnerable revelation, Valeria is catapulted back to a traumatic memory of her own-her own rejecting mother, when she herself was overshadowed by a needy, dyslexic younger brother. But the intertwined subjectivities continue to unfold: Sonia is mother to both Titti, a successful medical student as well as to a dyslexic, and therefore preoccupying son. In the mother daughter session, Titti opens with her aloneness and resentment, describing how she has to take care of everything on her own as mother exclusively cares for her younger brother. Titti is disappointed and injured; Sonia feels equally unrecognized, and shamed as her own developmental trauma is reiterated through her daughter’s rejection of her. And then there is Valeria, who is drowning in baffling, overwhelming feelings of her own. Valeria wonders about her own intersubjective influence in this treatment. She is desperate to have this pair come together in some way, yet confused by the intensity of her own distressed reaction and desperate need to make things work. Valeria shares with us, ” instead of experiencing and understanding towards them, when Titti speaks I feel annoyed, and I feel close to the mother in need. When Sonia speaks an irritatin surfaces, for a mother who doesn’t see a lonely and sorrowful child.”

So, Valeria shares yet another twist, in this saga that unfolds as a complex interwoven plot in a novella. Valeria, too, is not only the overlooked sibling of a dyslexic brother, but she is also the mother of a dyslexic son. As she stands in the space of utter saturation in both mother and daughter’s affective experience, she finds that she had not succeeded in conveying to either Sonia or Titti how well she understands their individual and intersubjective experiences. With much consternation, Valeria summons her courage to reveal herself in all its vulnerability in order to finally allow all three of them-Sonia, Titti and Valeria to finally be seen and fully recognized by another. She reveals her own loneliness growing up with a critical, sarcastic mother who was absorbed with her dyslexic brother. She tells Titti that consumed with her own pain, she failed to see her own mother’s problems adding that her mother had no capacity to explain them to her. “Now”, Valeria adds, “I understand a lot of things…I’m the mother of a dyslexic son.” She triggers curiosity in both members of the dyad, as finally they are open to seeing another’s experience without risking their own experience goes unseen. This careful, thoughtful self-disclosure opens up a space that colors future sessions with ever deepening implicit and explicit communication as the pair begins to listen to one another with interest and acceptance. In a final session the two collaboratively create a joint and special gift for Valeria.

As Valeria read her case presentation with the warmth and emotionality inherent in her, in her beautifully accented English, attendees were both touched and illuminated as we were privileged to understand the true understanding of empathy as an intersubjective experience. A discussion, facilitated by Christine Kieffer followed.

Please join us in October at the Child and Adolescent Initiative meeting at the 2018 IAPSP Conference in Vienna. At this meeting Ruth Gat-Dubrov of Israel will present her engaging work with a four year old girl who is on the high functioning end of the autistic spectrum and Ruth Burtman of New York City will discuss the case. This clinical work will provide a beautiful description of a self psychological treatment with a child on the spectrum.

COLUMN TWO

The Child and Adolescent Initiative 2016-2017

IAPSP’s Child and Adolescent Initiative, again hosted an exciting panel at IAPSP’s 2016 Boston Conference. The international panel, entitled “Critical Moments at Crucial Developmental Times” brought a child and adolescent treatment perspective to the Conference’s overall theme of “Critical Clinical Moments”. The panel, featured Taly Hochstadter, MA from Israel presenting the case of a young adolescent, Christa Paulinz, MA MEd from Austria presenting a child case, Anna Ornstein, M.D. of Boston discussing both cases and Amy Joelson, L.C.S.W. from New York moderating the panel. Since so many of us have relied on Anna’s wise guidance about child and parent treatment, the room was filled beyond capacity with eager participants.

Taly presented her skillful work with Nimi, a 13 year old boy who expressed his emotional needs through aggressive, sometimes violent complaints about disappointing food available to him. Through both verbatim process and description, Taly illustrated the experience with Nimi and his parents that expanded his parents’ empathic understanding of Nimi and facilitated Nimi’s capacity to express his needs more directly. In discussing the case Anna distinguished between therapists’ provision of parent guidance and the therapist’s important efforts to make contact with the parents’ subjective experiences in order to evoke the parents’ empathy toward their child. Taly connected with Nimi’s struggling parents by imagining her way into their subjective experience, much as Anna was suggesting. Taly’s empathic connection with the parents strengthened them, helping them to see beyond their own internal experiences and resonate with Nimi’s loneliness.

Christa presented her touching work with Adrian, a depressed and anxious seven year old who initially withdrew from Christa’s attempts at empathic understanding and avoided engagement in play with her until one surprising day when Adrian shyly initiates a game of filling and throwing water balloons with Christa. Christa responds with robust, balloon-slinging enthusiasm as the pair navigate their way towards a warm and playful communication, developing what Christa calls “a common language that helped us deal with all the issues important for his temporary world.” The water balloon play followed a session in which Christa invited Adrian to bring in his favorite computer game. Anna’s discussion of Christa’s work focused on the need to actively engage the child patient in a verbal or play process that facilitates understanding of the motivation of symptomatic behavior rather than simply forming an attachment. Anna suggested that Christa’s desire to enter Adrian’s world (the computer game), as well as her perseverant determination to understand him, facilitated the therapeutic engagement. We look forward to hosting another exciting panel at the 2017 IAPSP Chicago Conference, hopefully in a larger room!

The Child and Adolescent Initiative invites both child and adult therapists to join our upcoming online journal club that runs from February 13-26, 2017. The journal club will focus on Anna Ornstein’s article, “Why Kohut’s Ideas Will Endure: The Contributions of Self Psychology to the Treatment of Children and to the Practice of Psychotherapy” (IJPSP, Vol. 10, 2015) Discussants for the journal club are Shelley Doctors (past president IAPSP), Eldad Iddan (IAPSP president) and Andrean Harms (Director of the Vienna Circle). We are delighted that Anna Ornstein will participate in the discussion as well. I look forward to moderating what promises to be a lively and decidedly clinical online conversation.

COLUMN ONE

The IAPSP Child and Adolescent Initiative, chaired by Amy Joelson and myself, Denise Davis, provides an opportunity for members working with children and adolescents to share and expand their use of self psychology in child and adolescent therapy. Equally important is the Child and Adolescent Initiative’s mission to help clinicians working exclusively with adults understand the value of treating children and utilizing the knowledge of their child therapist colleagues in their work. Since self psychology is a developmental model which recognizes that developmental longings based in childhood are mobilized in treatment, it is natural that child therapists’ experiences deepen the understanding of adult therapists. In addition, almost all of the members of the Child and Adolescent Initiative treat adults as well as children. Updates to this column will keep IAPSP members informed of the activities of the C&A Initiative.

Attempting to integrate the experiences of adult and child therapists, and to highlight the overlap, the C&A Initiative hosted a forum at IAPSP’s 2015 Conference, entitled, Working With Children, Adolescents and Adults’: How Does One Form of Treatment Inform the Other? Presenters on the panel moderated by Amy Joelson were Denise Davis, Shelley Doctors, Eldad Iddan and Karen Kay. All utilized clinical vignettes to illustrate their responses. My discussion cast Louis Sander’s recognition process that transforms patients’ locked-in mental states as a remobilization of the capacity to play. Two examples depicted this-one involving a depressed, agitated adult who spontaneously engaged the therapist in a puppet show in the midst of an episode of extreme dysregulation and another of an eight year old girl whose imaginative fairy play with her therapist stretched her notion of what is possible in relationships, leaving her feeling she could finally be understood by another. Shelley Doctors’ informal discussion described the relaxed sense that the therapist has when working with adolescents that attunes us to using language that our patients can relate to since they so overtly demand that we allow them to use us in the way that best fits their needs. Eldad Iddan’s presentation raised the question of interpretation, when he recalled an early supervisor remarking to him, “Remember, a child’s play is an excellent metaphor for his inner experience. Don’t spoil it. Remain with and within it. That’ll do the job.” In the case of the encopretic child with whom he worked, that meant helping the boy carve a trigger out of a gun he was creating to help him have a sense of control, rather than humiliating him with interpretations about his difficulty with control. His empathic grasp told Iddan that actually fashioning the trigger was the most sensitive and useful interpretation. Karen Kay, asserting that child work is FUN, emphasized the intersubjective in her moving presentation of a child struggling with a congenital bowel anomaly. Keenly attuned to the impact of the child’s surreptitious deposits of feces in her plants, Karen sensitively responded metaphorically to the gift the child was providing Karen as she invited her therapist into her painful world.

The Child and Adolescent Initiative is a fun, playful, thoughtful group of clinicians who welcome all who are interested to join our list serve. Future activities include an online journal club as well as another interactive panel at the Boston IAPSP Conference in October 2016.