Did you know that over half of all mental health issues are established by age 14 and up to three-quarters of them by age 24? (SOURCE 1). To me, this isn’t a surprise considering that the brain isn’t fully developed until we’re about 25 years-old (SOURCE 2). The adolescent mind is therefore highly susceptible to negative stimuli and a breeding ground for inner-conflict. Considering this, how does the treatment of children and adults differ in psychodynamic therapy?
In psychodynamic therapy, we look at the impact of past events on behaviors and thought patterns in the present. When treating adults there is no difficulty in doing this since there is a lot of material to work with, but when it comes to treating children we have to change our approach slightly. Most children are in the process of shaping their inner-conflict when coming to therapy. In other words, their psychic wound is still fresh and their mind fragile. There is a lot of debate within the psychotherapist community as to whether or not traditional therapy treatment is beneficial to children who have experienced traumatic events, since the repeated analysis of the traumatic event and the reflection on how it impacts thought-processes in the present, keeps the psychic wound fresh, intensifying the impact of the traumatic experience. Most children and young adults also don’t have the same capability to reflect, making the comparison between past and present difficult.
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Psychodynamic therapy with children is all about relationship building. A lot of children who come to therapy do so with a weak connection to their parents. For whatever reason, be it absentee parenting, parents with a history of drug abuse and criminality, parents with psychic disorders or simply parents who have put a lot of pressure on their children, the child’s attachment to their parents has not become as secure as it is supposed to be. In psychodynamic therapy we offer children the ability to establish a secure attachment to an adult. It is through the experience of having a stable relationship to a reliable, objective and non-judgmental adult that the healing of inner-conflict takes place. This is not to say that the relational aspect of psychodynamic therapy is less important when it comes to treating adults. The difference however lies in how the relationship is built. In therapy with adults, trust is established by showing the adult patient one’s competence as a therapist. In most cases, we’ll only need one session to do this. In therapy with children however, trust is established by meeting the child on an emotional level. In order to achieve this, the therapist must avoid being overly focused on the therapeutic process and must allow the child to lead the way.
One final difference in the therapeutic treatment of children and adults is the fact that children are, by nature, not as active in the dialogue. When an adult finally musters up the courage to enter a therapist’s office, they have built up inner-conflict over years and decades and are ready to spill their guts out. In the first few sessions with an adult patient, the main focus for a therapist is to collect information that they can work with at a later date. This is not the case when it comes to treating children. When asked where they want to begin, what has happened since the last session or how are you feeling, the child patient most often responds by saying “I don’t know” or “I’m okay”. In other words, the child patient offers little material to work with. This leaves the therapist with the difficult task of dragging the information out of the child patient. This can be achieved by rephrasing their answers and building more expansive questions on top of them. “How does it feel like to be in a therapist’s office and not know what you want to talk about?” and “What does feeling okay look like to you?”