Mankind is the only animal that spends 18 years at home and 40 years getting over it.

I talk about childhood, anger at parents, and stress and social pressure from school all the time in therapy; but I don’t work with children or teenagers. Early on in my career as a psychotherapist I wanted to think that there was nothing that I couldn’t do. I wanted to be all things to all people. Slowly you, if you are self aware, discover what you are good at and begin to find the clients that you are better able to help. I stopped working with kids one Saturday while my family was on vacation at the beach. I had spent the entire evening on the phone with a fourteen year old patient whose mother had kicked him out of the house in twenty degree weather. He called to ask me if I could come pick him up so that he wouldn’t freeze.

It is not uncommon for me to spend weekends on the phone with patients in crisis. Not all therapists take crisis calls, but I think that it is an important part of healing patients. When a therapist is doing psycho-dynamic work they are temporarily acting as the patient’s parent in order to reparent the patient in a healthier way. Psycho-dynamic therapists do this in order to replace the critical or abusive voice that we internalize voice from our parents with a more adaptable and caring one.

Part of this reparenting process is teaching a patient that it is beneficial to reach out and ask for help. Many patients with abusive or neglectful caregivers have learned that they will not receive help or that they do not deserve it. While many therapists are adamant that therapy takes place only within the therapy room, I don’t find this to be the case. I believe that if we are going to repair a patient’s ability to ask for help we need to show them by example that asking for help is beneficial.

I stopped working with children in therapy because; while I can tell adults with abuse in their home to “Get the hell out of your environment or let’s talk about why you don’t think you can” ; I can’t say that to a child. In fact I found myself that Saturday not knowing what to say. I can report the experience to DHR, in fact by law I have to, but this seldom changes the child’s reality. That Saturday, while I waited on the phone for my patient to be picked up by police, I made the decision to stop working with children and adolescents forever.

Later I was talking to a colleague who exclusively works with children about my admiration for his ability to do that work. “I just can’t do anything, and I can’t stand that” I told him about working with teenagers. “I don’t know how you work with adults,” he told me with a wry smile. “I feel like I can’t do anything, it is already too late” he continued. “I am doing something with teenagers, I am being present in crisis and letting them know they deserve love” he finished.

Our feeling that there was nothing to be done was mutual but we were looking at the problem from two different sides of time. I felt like it was hopeless to work with children because I couldn’t stop the abuse or neglect caused by their parents. My colleague thought it was hopeless to talk to adults who had needed someone to love them long ago that would never be there. I was drawn to psychotherapy because it allowed me to stop people from hurting. My friend was drawn to psychotherapy because it gave him the ability to make people who were hurting feel less alone. For me it was enough to allow patients to forgive themselves and heal from a childhood that I couldn’t change from their past. For my friend it was enough to be present with another person who was in pain he couldn’t change at that moment.

Bibliography

Books

Bowlby, J. (1969). Attachment and Loss: Vol. 1. Attachment. New York: Basic Books.

This foundational text by John Bowlby explores attachment theory, essential for understanding the therapist’s role in reparenting.
Freud, S. (1917). Introductory Lectures on Psycho-Analysis. Standard Edition. London: Hogarth Press.

Freud’s lectures provide an introduction to psychoanalytic theory, relevant for understanding the historical roots of psychodynamic therapy.
Winnicott, D. W. (1965). The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. New York: International Universities Press.

Winnicott’s work discusses the importance of a supportive environment in emotional development, relevant to the therapist’s role in reparenting.
Kohut, H. (1971). The Analysis of the Self. New York: International Universities Press.

Kohut’s exploration of self-psychology provides insights into the therapist’s role in addressing narcissistic injuries and fostering a cohesive sense of self.
Rogers, C. R. (1951). Client-Centered Therapy: Its Current Practice, Implications, and Theory. Boston: Houghton Mifflin.

Rogers’ humanistic approach emphasizes the importance of empathy and unconditional positive regard in therapy.
Articles
Barker, C., Pistrang, N., & Elliott, R. (2002). Research Methods in Clinical Psychology: An Introduction for Students and Practitioners. Chichester: John Wiley & Sons.

Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press.

This article explores the concepts of affect regulation and mentalization, which are crucial for therapists working with patients on emotional and self-development issues.
Goldsmith, R. E., & Freyd, J. J. (2005). Awareness for Emotional Abuse. Journal of Emotional Abuse, 5(1), 95-123.

This article discusses the impact of emotional abuse and the importance of awareness and intervention in therapy.
Levine, P. A. (1997). Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.

Levine’s work on trauma and somatic experiencing offers insights into therapeutic approaches for trauma recovery.
Siegel, D. J. (1999). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: Guilford Press.

Siegel’s book provides an understanding of how early relationships influence brain development and subsequent emotional and psychological health.
Further Reading
Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror. New York: Basic Books.

Herman’s work is seminal in understanding the stages of recovery from trauma and the therapist’s role in facilitating this process.
Miller, A. (1981). The Drama of the Gifted Child: The Search for the True Self. New York: Basic Books.

Miller’s exploration of the effects of parental expectations and emotional neglect on children provides valuable insights for therapists.
Perry, B. D., & Szalavitz, M. (2006). The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook. New York: Basic Books.

Perry’s case studies illustrate the profound impact of trauma on children and the therapeutic interventions that can help.
Schore, A. N. (2003). Affect Dysregulation and Disorders of the Self. New York: W. W. Norton & Company.

Schore’s work on affect regulation and the development of the self provides a neurobiological perspective on therapy.
Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.

Van der Kolk’s comprehensive exploration of trauma and its effects on the body and mind is essential reading for therapists working with trauma survivors.