WINDOWSILL SUMMER-FALL 2012
In this issue:
Ask Violet: Limited sessions
Felicia Carroll: Trainings Worldwide
Judith Yeager: Honoring the Resistance
You may send your questions for Violet to: email@example.com
Question: How do you fit this system into a managed care treatment plan — having a limited number of sessions?
Answer: With a limited of sessions I would follow a brief therapy model. This is useful not only for managed care clients, but also for other short term requirements.
1. See the situation as “crisis intervention.” Tell the child we only have a few sessions to make things better.
2. Look at the number of sessions and plan for what you will do (without expectation that what is planned will happen). For example, the first session would be used to establish the relationship by getting to know the child, engaging in nonthreatening activities and providing safety for the child. When the therapist is respectful, genuine, congruent and contactful, relationship and safety will be established.
3. List the issues that are involved and set priorities and goals. Cut right to the core of the issues and feelings you prioritize. Depending on the age of the child, the therapist can share some of these items with the child, giving the child the choice to decide what he or she wants to work on. Be honest and clear with the child about the reason he or she is having sessions with you. Even a very young child can understand if the therapist uses appropriate developmental language.
4. Include parents in some of the sessions if possible. Explain to them the process of your work. Assess the communication level. For example, a child I worked with whose father lost his job may have felt he needed to cheer up his parents, reassure himself, and look at the “bright side” of things, thereby totally cutting off his fears and anxieties. Symptoms, such as falling grades and inability to concentrate, prompted the parents to seek therapy for the child. In the family session he admitted that he was terrified about what was going to happen to the family. Both parents admitted they hid their own feelings of fear thinking this would be detrimental to the child. As they began to talk to each other, there was great relief and feelings of closeness and the boy’s symptoms gradually eased.
5. Remember that therapy is intermittent with children and that each developmental level brings new issues to deal with. Parents need to understand this.
I think that it’s difficult for therapy to be effective in just a few sessions with children who have experienced trauma, but we do the best we can in the time we have.
Ellen, a nine-year old girl, was brought into therapy with me because she refused to talk When children stop themselves from talking, they are restricting and inhibiting many aspects of the self. Ellen had been molested by a neighbor and was questioned repeatedly by the police and child welfare workers. She eventually refused to speak to them and this generalized to school and somewhat at home. (She would whisper, “Pass the salt.”) I was told all of this by her mother who came with her to our first session. Although the child was mute, I noticed she continually glanced at the sand trays and miniatures on the shelves. At our time together I asked her to make a scene in the sand and assured her she didn’t have to speak to me unless she wanted to. She made a very crowded zoo with lots of animals bordered by fences and lots of people walking around looking at the animals. She put a bridge at one end and on the bridge a duck. When she was done I asked her to nod or shake her head as I articulated what I saw: “This is a busy, crowded zoo,” She nodded. Finally I said, “I see this bridge over here and that this duck is all alone on the bridge. I wonder if it likes the space since everything else is so crowded.” Ellen nodded her head vigorously and said, very clearly, “I wish I had my own room.” I restricted my desire to cheer and instead we casually talked about her room, which she shared with two other sisters. This was the first session out of the five sessions I would be seeing her.
We made a list, at the next session, of things that were troubling her. I reminded her that we might not be able to work through all of them. We alternated choices (I chose one, she chose one, and so forth). My choice was anger. I brought out clay and asked her to pound the clay as she thought of the things that made her mad. She did not tell me what they were but smashed the clay with a rubber mallet with great vigor. With a big smile she asked me if we had time to play the game Connect Four which she noticed on a shelf.
At the third session she chose the folks that questioned her so much about the molestation. “They made me feel like I did something wrong so I didn’t want to talk to them anymore.” She then drew a rough picture of her molester and I helped her articulate what she wanted to say to him.
At the fourth session I chose the issue of fault. I did a little puppet show about a girl puppet that was attacked by a wolf and how at first she thought she had made it happen, but then the fairy godmother puppet told her it was definitely not her fault. With the next encounter with the wolf, the girl puppet began hitting the wolf till he meekly slinked away.
At our last session she wanted to do another sand tray scene which involved her family having a picnic in the woods among lots of trees.
By this time Ellen was talking freely. She had many concerns that we did not deal with, but I do believe that the work we did was very helpful to her. Actually, a year later her mother brought her in again for a few more sessions and we followed the same process, though this time she made all the choices: more anger, her sisters, etc. Each time we focused on the issue through one of the projective techniques we often use.
Ten-year old Adam lost his father to suicide. His parents had been divorced since Adam, the youngest of three children, was a baby. Adam was very close to his dad who was very involved with his life. The parents agreed that it would be beneficial for Adam to live with his dad for a while and just prior to the move, the father killed himself. Six months later, Adam’s mother brought him into therapy when his behavior began to deteriorate into angry, aggressive outbursts. It is quite common for a parent to bring a child into therapy a few months after a traumatic loss such as this, when symptoms emerge and accelerate.
Session 1: The first session took place with mother and son. The mother stated that ever since the father had died, Adam had had difficulties. “Things are getting worse,” she said, “and not better as I thought they would with time.” Mom stated that she had very little time and money for any long term therapy. At this session Adam was quite withdrawn and would not participate until after I asked the mother to go into the waiting room. I then asked Adam to draw a house and tree and person on a single sheet of paper. Adam seemed relieved that he didn’t have to talk to me and worked diligently.
Therapist: Adam, this is really a test, but I’m not using it that way. I’m using it to get to know you better. It tells me some things about you and I would like to check them out with you to see if it’s right since sometimes it is wrong.
Adam: What does it tell you?
Therapist: Well, for one thing, it tells me you keep a lot of things to yourself.
Adam: That’s true — how do you know that?
Therapist: Your house has very small windows and sometimes when someone draws windows like that, it could mean you close off a lot of feelings.
Adam: (Showing interest) What else does it tell you?
Therapist: It also might show that you keep in a lot of anger because maybe you don’t know how to get it out. Does that fit for you? The person looks kind of angry to me.
Therapist: See how the house is tilting? Maybe you don’t feel very sure about anything right now. And the boy is at this corner, far away from the house. Maybe you don’t know where you belong.
Adam: (Very low voice) That’s right.
I noticed tears in Adam’s eyes and gently told him that we would try to work these things out together in the sessions. She wrote her findings on the back of the paper and read them back to him. Adam listened intently. We had some time left and agreed to end the session with a game. The relationship appeared to be taking hold.
Session 2: At the second session I asked Adam to make his family of clay. Adam fashioned his two sisters and his mother. When asked to include his father, he said, “He’s not here anymore.” I quickly made a rough figure and said, “This is your father. He’ll be over here.” I placed the figure at the far corner of the clay board.
Therapist: I would like you to say something to each person.
Adam: (To older sister) You don’t care anything about me. You’re always off with your friends. (To younger sister) I wish you wouldn’t tease me so much. (To mother) I wish you didn’t have to work so much and could be home more.
Therapist: Now say something to your father.
Adam: I don’t want to.
Therapist: O.K., You don’t have to. Adam, sometimes when a parent commits suicide, kids blame themselves and are ashamed to tell anyone. I wonder if that’s true for you.
Adam: Other kids feel that way?
Therapist: Yes, they are very common feelings.
Adam: I don’t know what I did, but I was supposed to move in with him and then he went and killed himself. I thought he was glad I was coming. I don’t want anyone to know it was because of me.
Therapist: It’s hard for you to feel those things. I’m sorry. No wonder you keep things to yourself.
Adam nodded and closed down and broke contact. This showed in his drooped body posture, and his decreased energy. I suggested we stop talking and play Connect Four (children love this game). Adam visibly brightened and took down the game with renewed energy. I told him that his mother would be joining us at the next session.
Session 3: At the third session with the mother present, I asked Adam and his mom to draw something that made them feel angry. Adam watched as his mother draw and finally began on his own picture. The mother drew an incident that had happed at work and talked a little about it.
Adam: I didn’t do what you asked me to. I just drew my family.
Therapist: OK. I notice that you didn’t draw your father. Just make a little circle here in the corner for him. Now tell each person something that makes you angry or something you don’t like that they do, like you did with the clay. You don’t have to say the same things if you don’t want to.
Adam complied but again refused to talk to the father circle.
Therapist: (To mother) I wonder if you would be willing to say something to your ex-husband over here. It’s very hard for Adam to do it. Is there anything you would like to tell him?
Adam’s mom immediately began to express intense anger at him for killing himself, causing so much hurt and pain to his children, especially to Adam, and leaving her solely responsible for the three children.
Adam began to cry and said he was angry too, and he was sure it was his fault that his father killed himself. Adam’s mother was astonished and emphatically assured Adam that this was not the case. “Your dad had a lot of financial problems and he was depressed about it and didn’t know what to do. It just got too much for him. He loved you very much!” Adam continued to cry as his mother embraced him.
Session 4: I suggested that Adam draw a picture of something he and his dad enjoyed doing together. Adam drew a picture of a swimming pool and talked about how much fun they used to have swimming together. Then he asked if he could do a sand tray scene, and proceeded to make a graveyard scene announcing that one of the graves belonged to his father.
Therapist: Adam, I would like you to talk to your father’s grave and to your father now.
Adam: Dad, I hope you are happy where you are. I miss you a lot. I’m sorry things were rough for you.
Therapist: Could you tell him you love him?
Adam: I love you, dad. (long pause). Goodbye. (To therapist) Do we have time to play a game?
Session 5: Adam and I had one more session together. His mother was unable to attend and sent a note saying that he was now behaving appropriately and she was very relieved.
I asked Adam what he would like to do at this last session, and he opted for clay. He made a pizza with various things on it. He said his dad’s birthday was coming up and he knew his dad loved pizza. “This is better than a birthday cake,” he said.
This work took five sessions. The issue of responsibility for his father’s death appeared to be dispensed with quickly. I called Adam’s mom to tell her that Adam had worked on the loss of his father at his particular developmental level but that deeper feelings might emerge at a later time, involving issues that Adam did not have the self-support to deal with now. I told her that how he was functioning in his life now and in the future was the best measurement for whether or not he needed further therapeutic work.
By Felicia Carroll, M.Ed., MA
My international training experiences began in 1989 when Violet recommended me to replace her at the Institut fur Integrative Gestalttherapie in Wurzburg, Germany. I was honored and thrilled when they followed up with her suggestion and invited me to teach their Kompaktraining for a week. In the 23 years that have passed I have now travelled to over 13 countries and the four corners of the US. Everywhere people become alive as the training progresses and they say, “I want to learn more. This is what I have been looking for.” I have also had the opportunity to provide support for the on-going development of institutes which have used the Oaklander Model of the Gestalt approach in their trainings. The application of the Oaklander Model of the Gestalt approach with children and adolescents is without question truly international. A few of these programs are described in this article.
Gaby Enders told me in 2001, “You have inspired me to start my own institute in training others in psychotherapy with children” as she showed me her new facility in Koln, Germany. She called it KIKT, Koln Institut fur Kindertherapie. She had attended a training with me about trauma which focused on the effectiveness of the Gestalt approach as represented in Windows To Our Children and the Oaklander Model of Gestalt therapy with children and adolescents. The focus of that training was with children who were coping with trauma resulting from war and emigration. I presented for two years at KIKT until Gaby and other professionals took on the training program there. She added a store site and online commerce offering toys, games, and materials from around the world to be used in therapy. For more information go tohttp://www.kikt.de/
I trained young professionals for 13 years at the Institut fur Integrative Gestalttherapie in Wurzburg or IGW. They had started a program with Violet as their trainer around 1980. I came on as trainer in 1989 around the time the Berlin Wall fell and the Unification of Germany began. Many of the trainees were making major adjustments to the changes in their country. During that time, the program at IGW was strong with several trainers specializing in child therapy. We worked with groups in Florence, Italy and Zurich, Switzerland as well as Bregenz, Austria and Schorndorf on the Ammersee. Even today, I feel like Wurzburg is my home away from home, having been a regular visitor for 13 years. For more information go tohttp://www.igw-gestalttherapie.de/
Since 1996 I have made annual trips as a trainer to the Symbolon Institut in Nurnberg for extended basic trainings as well as advanced programs. The director of Symbolon, Georg Meier, who died two years ago, was a child psychologist who respected deeply the theoretical and clinical approach of the Oaklander Model. He was also a visionary who supported my love of the Pinocchio story. He sponsored trainings in Lucca, Italy allowing me to visit the Pinocchio Museum and Archives in Collodi. The child therapy program grew at Symbolon and today under the leadership of his daughter, Carmen Suleiman, it is meeting the needs of many seeking training in Gestalt therapy with children. Several distinguished child clinicians provide the fundamental training through Symbolon. For more information go tohttp://www.symbolon-institut.de/
I met Adriana and Rodolfo Ribas from Rio de Janeiro, Brazil at a casual gathering in Santa Barbara. They had come to meet Violet more personally having been inspired by Windows. We began a correspondence and wrote a joint publication. Adriana and Rodolfo are researchers and professors in child development and psychology. Both are distinguished professors at universities in Rio. Five years ago, they invited me to present an open lecture and do a basic training in the Oaklander Model of Gestalt Therapy with children. Over 150 people came to the first lecture and over 40 people attended the training. This success inspired Adriana and Rodolfo to do more training for professionals throughout Brazil. I continue to work with Rodolfo and Adriana. A core group of 40 participants is developing their competency in using the theoretical and clinical approach of the Oaklander Model. Adriana is now doing her own trainings in Rio as well as continuing her research, publications and teaching. I think a Brazilian institute may be in the works. For more information go tohttp://www.quartetoeditora.com/
A new training institute in Singapore was developed to meet the needs of school counselors and other professionals working with children for on-going training. This institute, Creative and Experiential Therapy Institute of Singapore (CRaETI) decided to seek out someone to lead their first training to counseling professionals. “We found you on the internet and liked what we saw, so we decided to contact you to see if you would be interested in coming to Singapore.” I was excited to accept their invitation and have continued to work with them. This program is well coordinated by Hwee Boon Toh. I am now preparing for my fourth visit to Singapore. They are considering expanding their programs in the Gestalt approach and the Oaklander Model as well as including trainers of other orientations. Singapore offers such a unique experience of teaching in a very diverse culture. In the groups I have had many of the major world religions and cultures are represented with an ease of interaction. In working with this diverse culture, I have been challenged to examine and adapt my Western ethnocentricity. I am drawn by the commitment and sincerity of the professionals I have met there. For more information go tohttp://www.craeti.com.sg/
The experiences described above have been invaluable in my understanding and appreciation of the cross-cultural applicability of the Oaklander Model of the Gestalt approach with children and adolescents. This approach is effective because it is grounded in an organismic paradigm of human development. Even though we are all very different, we share in the basic fundamental dynamics of being human. It is my pleasure to represent this to so many partners around the world. For more information on trainings worldwide you can contact me at firstname.lastname@example.org or go towww.feliciacarroll.com
THREE LITTLE WORDS: Honor the Resistance
By Judith Yeager, MFT, A.T.R.
Recently I accepted a case as a favor to a colleague who was managing a difficult custody case. My responsibility sounded simple enough as she briefly outlined the situation. The parents had never been married but shared custody, the Mother had been accused of abuse, the supervised visits could not be managed at the central Child Protective Services facitily because the ten year old child had autism, the father was willing to pay for the supervision hours for the mother to see the child. I agreed to do the supervised visits with the stipulation that each parent schedule a session prior to scheduling the supervision. This was a court ordered case. Child Protective Services was in charge of how to proceed in the child's best interest, not the parents. My determination was that I would proceed with "sessions" to build a comfort level in my office environment before I scheduled a supervision session for the Mother and child. An additional stipulation was that I must see evidence that the Mother was following through with court ordered evaluations and therapy. These parents, after eight years of court involvement, were not in a position to refuse to comply with court orders after the most recent allegations of abuse. What I call "sessions" really amounted to setting the stage for visitation between a child with severe autism, PTSD, and a mother with complicated mental health issues.
The first session was scheduled for the mother. By then I had received paperwork outlining eight years of court related history (for a ten year old child). Within the first 15 minutes of the session it became apparent that the mother struggled with serious mental illness. She was never able, during our session, to focus on questions about her child.
At the second session with the father, he outlined the education plan and therapy resources that filled the week for his daughter. His goal to give her every opportunity to progress despite her autism seemed to be on point.
At the third session I met a beautiful child. Neither parent had offered the information that their child was completely non-verbal and highly self injurious nor did any of the court documents give me this information. I was frustrated with myself for not asking more questions and with the court for not outlining such important details. I had, however, committed to the case and wanted to follow through.
Nothing I had learned in my years of working with children would apply here. This child could not sit down and draw. At ten she couldn't speak her name or draw a safe place or, for that matter, sit anywhere in my office for more than two minutes. She had to be afraid, as children are when they come into a new situation, of being in a room with a stranger.
Many times, since my first training with my "guru", Dr. Violet Oaklander, I have called her when I felt overwhelmed with a difficult case involving a child. Her response has always been one that has directed me to focus on my "real' task....therapy. (It's my nature to want to correct the court system and adopt wounded children but I need to be reminded, now and again, that it's not my job.)
As I looked at this beautiful girl wandering around my office that first day, I heard Violet's words as we had consulted other times, "HONOR THE RESISTANCE".
Honor the resistance became my mantra at each Friday session. I had agreed to the task of supervision, not therapy, and I proceeded accordingly. Week after week, the father or the au pair brought the child to my office. I honored her resistance by allowing her to bring her father and/or au pair into our session until she became familiar with her surroundings and with me. After several sessions I opened the door to the reception area where she sat with her father. She bounced up from her seat, walked inside my office, alone, and closed the door. After that appointment she continued come in alone and extend the time she spent with me.
I honored this beautiful, dimpled ten year old by setting clear boundaries with her mother, the social workers, the attorneys. Their goals were to accommodate the parent wish, to close a case for CPS, to win a legal battle. As Violet had pointed out, repeatedly, my task(and goal) was to do therapy, therefore, even in a "supervised visitation" assignment I saw my task as one of creating a safe environment for visitation to occur.
Because this non-verbal child reacted negatively to the words "mommy", "mama", or "mother" when I read them to her as we looked at a storybook, I knew I must honor her resistance by giving her the time she needed. She taught me that honoring resistance meant genuinely being present in her world. The I-Thou relationship took on a new meaning as I entered this space of gestures, quiet, vigilance, and consistence in behavior and expectation. I honored her resistance by letting her dictate the length of sessions. She taught me when she was finished by taking my arm and walking to the door. Crayons and paper were placed on the table and offered each week. She resisted, I honored the resistance.
The day she sat down, picked up a crayon and made circles on the paper felt like true success. A few short minutes of eye contact, holding a crayon to paper, putting it back in the box and closing it, then taking my arm and gently pulling me toward the door where her father sat in the waiting room where he had been waiting for the entire length of a scheduled session, success? Yes.
Thank you Violet, for keeping me on track over the years with those three (not so) little words, HONOR THE RESISTANCE. With NO actual words, I saw the concept you emphasized in action with a child who desperately needed to be heard. You can contact Judy at email@example.com
|© 2011 All Rights Reserved. Web development by Katz & Mouse & Paul Mercurio.|