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Psychotherapy with Children Whose Families are in Crisis

When a playful quality begins to enter sessions, child psychotherapist Deirdre Dowling knows an important shift is occurring for her client. In this blog to coincide with Children’s Mental Health Week, the author considers the challenges of working with young people who, due to crises in the family, have experienced the cumulative trauma of unmet developmental needs. What can get missed in brief interventions, she suggests, is the vital importance of developing these children’s capacity to play.


Developing the capacity to be playful and imaginative is a key achievement of childhood. It provides the basis for self-discovery and mutual relationships as the young person matures. Yet many young people may never discover this potential within themselves as they have been emotionally scarred by early experiences of trauma or long-term family distress.

In Children’s Mental Health Week, I am thinking particularly of those young people who have experienced the impact of acrimonious divorce or chronic parental mental illness. These problems are so common, yet young people often do not receive the help they need because their distress is hidden. They don’t talk about the stress they are under to those outside the home, due to shame, or a sense of loyalty to their parents, or because they just don’t have the words to say how they feel.

It is only if they reach breaking point, and maybe act out in difficult behaviour or become very withdrawn, that they get noticed. Then there is often a crisis response addressing their ‘worrying’ behaviour, not the underlying causes which may not be recognised. Brief interventions may be offered in school but I believe what is needed is longer-term child psychotherapy to address their unmet developmental needs as well as their anxiety and anger, combined with supportive intervention for the parents.

The challenges of working with this client group

In my recent book, An Independent Practitioner’s Introduction to Child and Adolescent Psychotherapy: Playing with Ideas, I discuss psychotherapy with these children whose parents are in crisis as I find it very challenging. These young people often find it hard to allow themselves to be helped. They appear to be self-reliant. In their view, adults, including psychotherapists, are likely to be useless, and they cannot bear to feel vulnerable or weak. Often, they are preoccupied with their parents’ needs which they can find so hard to differentiate from their own, not having had enough experience of empathic parenting.

I think the challenge to us as psychotherapists is to treat these children’s emotional distress but also help them develop their capacity to be playful. If they can discover the quiet, formative experience of what Winnicott called going on being in their sessions, without any demands to adapt to another, this will be, for many, a new experience that will help every aspect of their development.

We usually think of trauma as a response to a major event. But the ongoing anxiety and frustration that these children suffer, the moments of rejection and disappointment, can constitute what Masud Khan called cumulative trauma. This can be as damaging to their development and as hard to bear, as often the parents themselves are too distressed themselves to offer support

The role of the therapist, and the parents

So what can child psychotherapy offer? A therapeutic relationship that encourages shared exploration so that children are as likely to find the answer to their dilemmas as the therapist. A creative space where feelings and thoughts can be explored in safety.

I think parents have to be involved to achieve long-lasting change as their relationship with the children is crucial. But this parallel therapy work is complex and often easier done by a colleague. An ill parent who has not experienced psychotherapy may be suspicious of its value, and dread facing the guilt of the impact of their ill health on their child. Similarly, a couple in conflict will not find it easy to meet together to consider their child’s needs. But seeing them form some sort of parental alliance may be as important to children as the recognition that they are not responsible for their families’ difficulties.

A slow approach to psychotherapy is needed, as it takes a long time for children to recover from such disruption to their lives. By this, I mean, for them to make sense of what has happened over the years, and why they have felt so distressed. Its value shows when a playful quality enters our sessions as it suggests that the young person has found a new self-confidence and optimism despite the challenges they may continue to face.


Deirdre Dowling

Deirdre Dowling is a child, adolescent and adult psychoanalytic psychotherapist trained at the British Psychotherapy Foundation (BPF). She worked for many years as Head Child Psychotherapist at the Cassel Hospital, an NHS inpatient psychotherapeutic hospital, before becoming Curriculum Lead at the Independent Child and Adolescent Psychoanalytic Psychotherapy training at BPF. She set up the Lantern Family Centre in Bookham, Surrey with a colleague, providing a private therapeutic service for children and families, and training for professionals. She has a particular interest in parent-infant psychotherapy, working with families with complex needs, and teaching and consulting to other professions interested in applying psychoanalytic ideas to their work with families.

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