Developmental therapy

Charles Holton, LCSW

Some one asked how I might think about working with a three-year-old who just lost his mother:

At a workshop I attended on treating children who had been sexually abused, the psychologist suggested the best treatment was intermittent brief therapy. In other words, checking in with the therapist for bits of work over the course of the lifespan. Like seeing a dentist regularly. The meaning of a trauma will change as the person develops. Sexual abuse means something very different to a five-year old than it will mean when she is eight, when she reaches puberty, when she starts dating, when she gets married, when she has a child, when her child is the age at which she was abused, etc. And you can't treat someone for a developmental stage they're not at. You can't treat an eight-year-old for what the trauma will mean to her when she is eighteen. So you just focus on helping them function easily and comfortably in their life at the age they're at, and schedule a routine check-in every so often, perhaps yearly or every six-months, and alert the parents or caregivers about what to watch for both in terms of normal development and what might suggest problems are developing. So the therapeutic focus in this approach is about staying on track, or getting back on track, supporting the development of the person, not curing pathology.

So likewise with a three-year-old boy who has lost his mother, this event will accrue very different meanings, ranging from simply missing some one he needs, to what it means to be an orphan, to expecting those he loves to disappear, etc., etc., over the course of his life. What you work on is what seems to be troubling to him now, and at what level reassurance, support, or skill building would be helpful now. In his loss he's certainly not alone: remember the classic blues song "sometimes I feel like a motherless child...” This is archetypal stuff. Heart centers just spring open and start resonating with it. So sad. So compassion inspiring. Good to remember other stuff is happening in his life, too, that this need not be the central identity-defining moment for him. And good to help his caregivers remember that, too.