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Siskind, D. (1992) Ch 5 Toys and play in child treatment. In The child

patient and the therapeutic process: A psychoanalytic, developmental,
object relations approach. Northvale, New Jersey: Jason Aronson Inc.
5

Toys and Play in

Child Treatment

Therapist: On this day, for the first time, Cleo saw a patient come
out of my office. Until now, Cleo was my first afternoon
appointment . When I came to the waiting room to get her, she
jumped right up and led the way to my office, but when she got
to the door she said,

Cleo: Oops! I forgot to take off my jacket.

Therapist: I told her that she could do that in my office if she'd like
to. She came in and took off her jacket, threw it in the chair,
and said,

Cleo: Do you have a T.V.?

Therapist: You want to know whether I have a T. V.?

Cleo: Yes, do you have one? Do you have one here in this office?

59
60 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 61

Therapist: Do you see one here? Therapist: She hummed some more, and it was no longer the one I
had mentioned, but it was one that I knew well, so without
Cleo: It could be in the closet.
really considering what I was doing, I just joined her and
Therapist: I don't have one but would you like to look in the together we hummed a Beach Boy song.
closet for yourself?
Cleo: That's my sister's favorite.
Cleo: Yes. Therapist: I was very unsure about all of what I had just done:
Therapist: She carefully checked out the closet, looked in some of acknowledging knowing the Beach Boys, humming with Cleo,
the boxes, and then said, humming what she said was her sister's favorite song, but it felt
as if there was no time to stop and think . Cleo then pointed to
Cleo: I guess there's no T.V. here. I'm missing my favorite T.V. the toy drawer and asked,
show right now. It's ca ll ed Roaring Racers.
Cleo: What do you think? Do you think the toys can sing?
Therapist: I'd never heard of that program and didn't know
Therapist: Toys? Can toys sing? I'm not sure. It depends on
whether it existed, so I said, Can you tell me a little about
what you decide to pretend.
it?
And she opened the drawer and picked out a little boy doll
Cleo: Oh well, it's about racing cars. figure and pretended that he was singing.

Therapist: She started making racing motor noises and pretending Cleo: I gave him my voice because he has no mouth . See, he has
to race cars around with her hand, and then she hummed a little no mouth.
and said, Therapist: I was thoroughly confused at that point because to my
Cleo: And they have th ese California kids singing "do do do," you eyes that doll had no nose, but it had a mouth.
know, surfing music. What's their name, oh, yeah, the Beach Supervisor: What do you mean "to your eyes"? You have very
Boys. Do you know them? good eyes. Do you see how confusing she is? It's startling that
you would begin to question what you see, your sense of
Therapist: Yes, I've listened to the Beach Boys.
reality.
Cleo: Well, this is my favorite Beach Boy tune.
Therapist: Yes, I sound as if there's room for different interpreta-
Therapist: And she started humming, trying to · remember the tions of what ·w e saw. In fact it was a nose that was miSSing on
words, stumbling over them, saying that she couldn't remem- that painted doll face and my discomfort with her mistake
ber, and then remembering a bit. I knew the song and like it, so made me try to minimize the implication of why she might have
I just said, reasons to eliminate the mouth. I said, Oh, I thought that
what you were pointing to was a mouth and you say that
Therapist: From the way you are humming, and some of the it's a nose.
words, I think that you're trying to sing tel Get Around. "
Cleo: Oh yes! That's a nose, riot a mouth. These dolls have no
Cleo: No, that's not it. mouth and no teeth .
 TOYS AND PLAY IN CHILD TREATMENT 63
62 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS

Ther~pist: She then pretended that the man who operated the ride
Therapist: Then she suddenly got up and announced that she had to
go to the bathroom. She was in the bathroom for quite a while, stopped the ride. Then she had the adult figure who had
about 5 minutes, and when she came back she went over to the offered to help say,
play table, picked up a round basket that I use for some small Cleo: All right, now I am going to help you. I'll get on the ride with
figures, emptied it, and said, you.
Cleo: See this ride? This is a very, very scary ride. It's a ride for Therapist: Is that the kind of help that child needs? She didn't
teenagers only. Teenagers can go on it, and ,adults too. It's answer right away, she just started spinning the wheel. Then in
much too scary for kids. a deep voice she said,
Therapist: Then she picked up the smallest child doll, put it on the Cleo: I can make this ride go faster and slower. I can make it go
ride, and said: as fast or as slow as I want.

Cleo: This ride is too scary for kids and there is a kid on it. Therapist: And she started spinning it slowly but soon she had it
going faster and faster, and then she said in a thoughtful, almost
Therapist: She then spun the kid very fast on the ride, going around wistful voice,
and around as fast as she could. I said, My goodness, what is
going to happen to that child? Cleo: Once, when I was at a dude ranch I was on a ride that was
cal led "lightning spin." Tina and I went on it, and you went
Cleo: Oh! Mommy, Mommy, Mommy, Mommy! Help me! around and around and then you went up and down and
Mommy, Daddy help! sometimes you were upside down. It was real scary. My mom
didn't know that it was so scary. She said that if she had
Therapist: And then Cleo pretended that someone tried to help the
known she wouldn't have let me go on.
child but then somebody else told the child that it had to stay
on until the ride was over. I asked, How long is that scary Therapist: Now the session became choppy and hard to follow. She
ride going to last? got the child off the ride and the man who was the operator of
the ride did something that "wasn't right" so that something
Cleo: 17 1/2 minutes. happened to the two children. Then Cleo said,
Therapist: Is that a long time or a short time? Cleo: This kid has a very dumb father. This father doesn't know
Cleo: It's a very long time. It's longer than 15 minutes . what to do. When these kids fight, the father always says the
wrong thing.
Therapist: Isn't there any way that this child can get help?
Therapist: Then she took out another adult figure, one that was
Cleo: All right, all right! very plain looking, and she took this figure and handled it as if
it was somebody very special, a hero, and she made it very clear
Therapist: And she took an adult figure out of the toy drawer who that this hero person was in charge. This person now took care
said, of the kids. He spoke softly to them and acted protective but I
Cleo: All right. Stop the ride, I'll help you. couldn't hear what he was saying. It was not real words; it was
64 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 65

just sounds that had a tone of protective caretaking. I waited a Therapist: Boy, these kids are supposed to be in school, and
bit and said, Well, now you have someone really helping. instead they're shopping for a car and playing in the
But as soon as I said that, the helping stranger was discarded playground. What is that about? Then I paused and blew
and the two children were with their father and the father was my nose.
shopping for a car. She got out all of the toy cars and had the
father looking through them. Then the discarded hero figure Cleo: Why are you crying?
returned and got into what she called The Horse Car. She Supervisor: I sensed that she was going to say that! It's that trigger
commented that the cars were going very fast and The Horse response again.
Car was the fastest of all.
I was having a hard time following this. It was much more Therapist: It fits, doesn't it . I said, I've noticed this about you.
disjointed then it sounds in my description. I also felt as if I was You hear a sound and you make up a whole story about
very much of an outsider and I wanted to place myself back it. Then I had to blow my nose again.
into the session so I said, The cars are going very fast. Is Cleo: What is that sound? Is there an elephant here?
that very important? Is it very important for a car to go '
very fast? Supervisor: She has to be humorous to undo a real feeling. She
cannot be reflective about your intervention. Not at this point
Cleo: Well, that isn't the anly important thing about a car. It's also in treatment. She has to play the comic.
important for a car to be safe. Now the horse car, it can go
zoom here and zoom there. Therapist: Yes . My intervention was too much for her . Our time
was up at this point and when I said that to her she answered,
Therapist: Now she was suddenly acting the part of the salesman
who was telling the father what some of the attributes of the Cleo: In stead of cleaning up I feel like breaking thi s thing.
cars were, and the father was trying out all of the different cars. Therapist: And she held up the father doll. So I said, When I said
Then the father and the salesman began to try to make a deal that it's time to stop and put the toys away, you say that
and were talking about numbers, and then Cleo looked at me you feel like breaking things.
and asked, She picked up another toy figure and said:
Cleo: Do you know how much $20,000, twenty hundred, and three Cleo: And I feel like breaking this one too, and this one.
hundred is?
Therapist: And she was squeezing and bending these dolls. I said,
Therapist: Do you want me to tell you? When I tell you that our time is up you have some strong
Cleo: Well, I know how much it is. it's $23,000 and that's a ·Iot. feelings and you feel like breaking things. It's better for
you to put these feelings into words so we can under-
Therapist: Then, without any transition she had the father in the stand them. Breaking things doesn't help our under-
playground with the children and they were going down a standing work.
slide. She then had the father tell the kids, She didn't say anything, but just put everything away_
Cleo: Come on kids, it's time to go to school, let's go! You're going Supervisor: She didn't say anything about not wanting her time to
to miss th e whole school day if you don't hurry up. be up?
 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 67
66

Therapist: No. That stays unsaid. Does she even let herself know Cleo's mother: "Cleo doesn't know"? Well, not knowing is an
that she doesn't want her time to be up? I know that at some important theme in this child's treatment for both of you.
point I will have to interpret those' 'breaking" feelings, locate What about the rest of the session? Did the conte·n t of her
them as coming from inside her, and address the conflict they play make you anxious?
cause within her. I will have to again introduce the notion that Therapist: I did feel a little disturbed. The comment about the
putting them into words is a way to have control over them. father being out of touch with his children for instance. That
But we're not yet at that point in treatment . So she left on what was so blatant.
I experienced as a very unsatisfactory note. I felt that I had
sounded a touch teacherish. I was unhappy about the way the Supervisor: It seemed to come out so suddenly, didn't it?
session ended and so she left. Therapist: Yes. There was also something very sudden about her
having to go to the bathroom. It followed the business about
Supervisor: How do you handle the leaving? Did you walk her back
the doll having no teeth. I had trouble understanding her at
to the waiting room?
times. Her speech is still immature and her enunciation is at
Therapist: I walked her out the door. I can't see the inside of my times poor, so I find myself saying things like, Could you
waiting room from the hall outside my door, so I didn't see her repeat that? I didn't understand. Sometimes she talks very
baby-sitter. I waited until I was sure that she saw her baby-sitter fast and then her speech becomes really indistinct. Then it gets
but I didn't take those few extra steps to see them together. I to be a strain to follow what she's saying.
went back to my office and just as I was to cross my doorway Supervisor: And then there is her humor, which can be sophisti-
she called out, cated, for instance 17Y2 minutes, that type of thing.
This was, as usual, a very interesting session. More and more
Cleo: Goodbye linda Small!
Cleo is getting the idea that this is a special place where all sorts
Therapist: And I called back, Goodbye Cleo! She always calls me of feelings can be expressed. I don't mean that she is con-
by my full name, Linda Small. sciously aware of this, or of the degree to which she's revealing
her feelings. She isn't, and what child is? What is happening is
Supervisor: What do you make of Cleo calling you Linda Small? that a process has been set in motion, the process of treatment.
I don't want to sound mystical. That would be inaccurate and
Therapist: I don't know. She calls me that in her play. She says my
not helpful. Very simply, she has understood the specialness of
full name a lot. At her school the children call the teachers by
this place and time, and that it is solely for her benefit. Perhaps
their first name. Her teacher is Susan. Could she enjoy the
because she senses this already, she is less defended and her
formality of my full name? Is it perhaps like a title? Something
feelings take over to the point of bringing her to the edge of
official? I just don't know.
feeling too much anxiety, recovering from this precarious
Supervisor: Your not knowing is the leitmotif, isn't it? You don't position, and getting close to the edge again, and so forth ....
know whether "Linda Small" is an expression of affection, In this session more than any before, I sensed that you were
formality, possessiv~ness, a combination of many moods and constantly trying to anchor her · in a more reasonable reality
affects or what. Remember the message that you were to give than the one she kept creating in her play. It's because I noticed
68 THE CHILD PATrENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 69

how eager you were to improve the reality she portrayed that Supervisor: I think you were very eager to snuff out some of the
I asked whether you felt anxious during parts of the session. danger and the affect connected to danger, the excitement of
You must have felt uncomfortable with the world she created, the danger. It felt as if you wanted to shorten the dangerous
a world where children are placed in dangerous situations by ride, and to tone it down.
their parents, and are left to fend for themselves most of the
Therapist: Yeah, I guess I did. (laughs)
time . I sensed that you wanted to tell her that the world is not
supposed to be that way, that it's supposed to be a good, safe Supervisor: Your mommy side came out, and you felt protective.
place . I understand why you were taking that position. After That's pretty understandable, but in our work we sometimes
all , Cleo is revealing something of the chaotic nature of her have to dull that maternal urge so as not to place an obstacle
actual life, as well as of her fantasies. It's difficult to accept and in the path of treatment.
endure the fact that this little girl, with her still immature
Therapist: So I could have said Oh my or What is this about or
speech, lives in such a frightening place.
maybe not have said anything at all?
Here is the technical dilemma. You, the therapist, want to
provide a safe place in the therapy room, but if the whole Supervisor: Well, yes, some of those very neutral things like .that,
therapeutic hour is spent on scary and dangerous escapades, like Oh dear, the kinds of bland things that confirm that we're
how is this going to happen? Will her experience of the listening but are not directive at all. The point here is that you
therapeutic hour be any different from her general experience want to see what she will do on her own. If you step in you will
of being alone with her fears? Yet how can you interfere with not know whether she (her ego) will be able to regulate the
her self-expression? anxiety . Look at what she did on her own. She got the owner of
I have a hypothesis here that might help you. I think that the ride to go on the ride with the child. That might not have
Cleo has already found a way to bring safe figures into her seemed such a great solution but then she went on and had the
danger situations and I assume those to be transferential. For owner announce that he can make the ride go slower and
instance , the person that you described as the least unusual, the faster . So here she has established some sort of regulatory
most ordinary, I'm assuming that that was a transferential functioning. You do need to know what her capacity to
figure. Did you make that assumption? organize a chaotic situation is like . Then your interpretation
can be a dynamic one and not just a description of the cop,tent
Therapist: No. (chuckles) I think I was too caught up in the play to of her play. Remember, the same rule applies to children as to
think that clearly . J was relieved to think that she had it within adults : we interpret defense first, not content (Fenichel 194 5).
her to know that some safe figures exist. So you could at that point say, I can see that when things get
really scary, you can think of a way to make them a
Supervisor: Well, she does have an ego that can regulate and regain little safer. That's an interpretation that can be very helpful
some equilibrium, but that does not exclude the transferential and can open up the way for a series of interpretations that
aspect. could go like this:
Do you sometimes wait too long? Do you sometimes
Therapist: I think that you're saying that I was directing her too allow it to get a little too scary before you stop it? Do
much. you sometimes like it to get so scary?
 70 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 71

Remember what she does is both scary and exciting. Some- little about not having enough supplies for her. In fact, I have
thing made her have to go to the bathroom very suddenly. It wanted to discuss with you the toys that I have and whether I
followed the part about the doll having no mouth. should buy more. What I have now is some puppets, a bunch of
Therapist: No mouth and no teeth. play figures, paper, crayons and Magic Markers, scissors, tape,
paper clips, and a box for her pictures.
Supervisor: This little girl frightens and excites herself a lot. She is
Supervisor: Are any of the figures babies?
unable to sufficiently regulate the frightening fantasies or the
states of excitement. It's going to be our job to help her in this Therapist: One baby doll, and one plastic figure is a baby .
regard. I'm talking about strengthening the ego . Her ego is not
up to the job of dealing with her drives, reality, and her Supervisor: Do you have any blocks?
superego.
Therapist: I was wondering whether I should get blocks and more
Let's get back to the beginning of the session. She said that
baby dolls.
she was missing a television program called Roaring Racers.
Does such a program exist? . Supervisor: Let's talk about toys in both practical and conceptual
terms. Let me tell you what I have because I find that it fills all
Therapist: I don't know. I'll have to ask my kids or look it up in the
play needs very effectively.
paper.
I have a sturdy wooden box full of miniature blocks of
Supervisor: It's useful to know things like that. If there is such a various shapes. All of my cars and trucks are picked to fit the
program it would be helpful to know what it is so that you can blocks so that the building of roads and bridges and garages
talk to her about it in an informed way, and if she made it up, would all work well together. Then I have a collection of
that's also important. Some kids make things up a lot and we plastic people of all ages that fit the blocks so that the building
can become devalued if we let them fool us too successfully. If of houses and rooms and furniture also all work well together.
a child patient tends to fool us a lot we can ask, whenever we're I have a nice box full of bits of fabric and a needle and thread so
unsure, Are you pulling my leg again? If we can be too that blankets and pillows and clothes can be cut and sewn for
easily fooled we are not perceived as strong and reliable. When the people and animals . I also have a collection of small
we're uncertain, just to simply ask whether this is a fooling animals, wild and domestic, also of the size to go with the
time is a perfectly good approach. It clarifies our position as blocks . I have cowboys and Indians with weapons and a dozen
being neither mind readers nor accusers, nor fools . It's just finger puppets of firemen, nurses, doctors, policemen, and
right and helps the therapeutic alliance. other kinds of people who are a part of children's lives . I have
I wasn't clear about her question about your having a a basketful of snowflake-shaped plastic pieces that can be fitted
television set. How did you understand that? together to make various shapes. I have a small Lego set, a set of
dominos, and two decks of cards . I also have very good yet safe
Therapist: I was unclear too. I sort of jumped ahead of her and let scissors, rubber bands, toothpicks, scotch tape, a very good
her look in my storage closet. I thought that maybe she wanted stapler, pens, pencils, erasers, Magic Markers, crayons, and
to watch television with me and perhaps I let her look in my toy typewriter-size paper.
and storage closet as a substitute treat. I guess that I worry a I keep all of the toys in a cabinet next to the play table. The
72 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 73

cabinet has doors on it and those doors are always closed when games often require one's entire attention and very little
the child arrives for a session. The only exception to this rule is therapeutic work can take place under the structure of the
the first session with a child. Then the doors are left open so the board game with all of its rules. But I also know that some
child can see where the toys are kept. After the first session, it's therapists find board games useful. Maybe they're just better at
up to the child to seek out the toYS.l I would, of course, remind transforming them into a useful adjunct to the play aspect of
children that they can use the toys whenever they wish. treatment. I feel more strongly ,,-bout the negative use of books
The guiding principle is to provide the child with tools for in the treatment room.
self-expression through play but to provide a minimal amount I want to explain the purpose of leaving my toy cabinet
of these tools so that the play can be used for the purpose of doors closed in all but the first session. I always ask parents of
therapy and does not become so entertaining and gratifying very young children to tell their children prior to the first
that it becomes a form of resistance to the work of treatment. session that I have toys and that they will be able to play if they
Our goal is to use the play on the way to verbalization. When wish. The open toy cabinet is intended to serve as a transitional
the child can put into words what the play signifies, then the offering that affirms their sense of anticipation to this other-
observing ego and the experiencing ego are working together. wise unfamiliar place where there is going to be a "Mrs . Siskind
I'm describing an aspect of a child's treatment that is analogous who knows a lot about children and who has toys." The reason
to a point in adult psychoanalysis, when the analysand begins that the toy cabinet is never open in advance again is because
to really listen to his or her own free association and use the while I have toys, playing with toys is not a requirement. It's
insight so gained to deepen the analytic work and promote voluntary, and having that toy cabinet open with all of the
self-knowledge. attractive baskets holding all sorts of toys is suggestive and even
You might have noticed that I did not mention books or seductive. There is an implied expectation that the child should
board games on my list of toys. I do have a board game and a go over there rather than begin where he or she might have
couple of books locked away that I sometimes used with a begun were those toy cabinet doors closed. The child should
psychotic boy who occasionally experienced overwhelming begin his session in the same way as the analysand begins a
panic attacks during his sessions. Reading to him was soothing session- with absolutely no interference or suggestion. Any
and helped h(m regain his equilibrium. I think that it was the directives from the therapist, however silent and indirect, are a
familiarity of the book and of my voice reading those well- form of interference .
remembered words that had the restorative effect. This often To continue with the subject of play materials, I have a group
was followed by the equally familiar and structured board of stacking boxes so that each child has his or her own place to
game, and the combination aided him in maintaining his keep special toys that are not part of the general toy pool, as
calmed emotional state. But in most cases I find that books and well as pictures and other projects that are completed and/or in
board games are counterproductive. A book tells the author's progress. There are many reasons for that private box, which
story and we want our patient to tell his or her story. Board was the creation of Anna Freud at the Hampstead Clinic. There,
each child had a private cubby that was locked between
I am grateful to Eva Landauer of the Child Development Center for
1
sessions. My version is not as elaborate and does not lock, but
suggesting this very useful approach to the presentation of toys in the I believe that it fulfills some of the same purpose.
treatment situation. Now, let's talk a bit abou"t that private box that nobody else
 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 75
74

can open and that stays in the therapy office between sessions . break the doll, you asked her to put those feelings into words.
First of all all of my child boxes are identical but each has an I thought that maybe you could have been a little more
identifYin~ symbol that is devised and executed by the child but ehcouraging of some elaboration of those feelings. Maybe you
does not include a name, for the children have been told about could have said, What are those feelings of wanting to
the confidentiality of treatment. I impose certain rules of break the doll? Could you tell me what that feels like?
treatment. One sacred rule is that you cannot take any of the Had she been in treatment a longer time, you might have tried
therapy toys into your private box. The therapy toys. always to connect those feelings to her time being up. I think that it's
stay the same. What can go into the private box are th~ngs the too early in treatment to do that. She is much too proud to
child has made or is making. These things can only go 1OtO the admit that she cares that much about her session being up.
box as confidentiality prevents them from being displayed in
Therapist: I felt that I was making an attempt to connect when I
the office and another of my rules prevents them from going
said, When I say that it's time to clean up you say that
home. I do not let children take things home except in special
you want to break things.
circumstances . Things made in treatment become part of treat-
ment history and stay in the office . There are many good Supervisor: Yes, I forgot that. That is just about perfect because you
reasons for this rule . Some of the things made. in treatment are offering a connection but not imposing it on her and she can
would receive a not-so-welcoming reception were they to go ignore you if she wishes.
home. Many a parent has looked at highly valued pictures and
Therapist: This discussion is helpful. I realize that my main effort
exclaimed "Is scribbling what you do in treatment? Is that
has been to help Cleo contain her feelings . The idea of allowing
what I pay' all of that money for?" Another good reason for t~iS
more of her state of chaos to emerge in the treatment situation
rule and the really important reason, is that things that a chlld
is outside of my thinking . If I allow more to come out here .. .
makes during a session are communications to his or her
it's hard to imagine. This child thinks that a match is a fire . How
therapist. That communication is private therapy business and
do I deal with the inner chaos?
not something to be shared with anyone else.
This has been a digression, but one that I hope can be useful Supervisor: Very carefully. Very slowly. For instance, in the play
to you. To get back to Cleo, it might be nice for you to ~et s~me where she has a child go on a ride that is not for children, you
bl~cks so that she can create a setting for all sorts of SltuatlOns can comment, That child does not say that she doesn't
that she might want to show you and play out in your presen~e . want to go on that ride, that the ride is too scary.
But remember, this child needs your attention and the qmet
Therapist: To comment on the controls of the child?
structure you provide. She is bombarded by inner and outer
stimuli. She does not need a playroom with easels and basket- Supervisor: Well, yes . It could go like this : You told me that the
ball hoops and pinball machines . She has a vivid imagination ride is for teenagers and adults only because it's too
and she is very resourceful. She needs a quiet office and a scary for anyone else. Then the child goes on it but you
chance to sort things out. She needs an "average expectable didn't tell me how that child feels about going on that
environment" (Hartmann 1939). Look at how much she can ride? Then, if she says, Oh, this kid is so to ugh , this kid can go
create with the toys you have right now . o n a ny adult rid es. If she says that, I think you would have to
Now let's discuss a point in technique . When Cleo wanted to leave that alone for the time being. That's the macho part of
76 THE CHILD PATIENT AND THE THERAPEUTIC PROCESS TOYS AND PLAY IN CHILD TREATMENT 77

speaking and keeping you at a distance. But if she says, Oh, thi s you should have addressed it, or when and how. I'm saying you
kid is really scared, then you can say, Well, but Inotice that should be aware of any major change of routine like that . It
the kid just goes on the ride and doesn't say that it doesn't go unnoticed. It's significant and has an impact. Just
doesn't want to, that it's too scary and stop it, or keep it in mind .
anything like that. Why doesn't the kid speak uP? These I think we got a lot of mileage out of this session. It's so
interventions would be aimed at trying to engage her observing interesting at this stage of treatment. We just don't know how
ego in addressing the situation with ~ome awareness that she it's going to go, but we seem to be moving along, and with Cleo
had regulatory capabilities at her disposal. it's sure to be unpredictable . I loved that little touch of hers at
There is in Cleo that tricky combination of toughness and the end of her session when she calls out, Goodbye Linda Small.
compliance . We can safely speculate that the toughness is a She was being proprietary about you . She was already outside
pseudo toughness that covers extreme vulnerability. She does of your office but she still owned you.
sound tough though, doesn't she?
Therapist: Yes, but also delicate. My goodness, I don't think I've
ever looked so closely at what it means to treat a child.
Supervisor: Even the word treatment sounds odd in this context.
What are we treating here? This is a little girl who lives in a state
of anxiety; she feels unsafe. How do you treat somebody who
feels unsafe? What are you treating? You're treating a state of
being.
Therapist: An internal state.
Supervisor: Yes . You are treating an internal state, so you have to
help that child become aware of that internal state in a con-
scious way . Then you have to help that child's ego deal with it
and that takes a long time, a lot of attunement on the part of the
therapist, and a lot of trust on the part of the child!
Therapist: Well, she's not near to trusting this process, but I think
she knows that something is being offered here, something she
wants . And maybe her not being so compliant and wanting to
break things is a good sign . At least she can test me a little to see
what I'll do if she's rebellious and not so ready to put things
away and leave .
Supervisor: Yes, I agree . Before we end for today I just want to
mention the fact that she saw another patient leave your office
for the first time and that it didn't get addressed . I'm not saying