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2 JUNE 2010
NO 1585
Direct gratification
For these children to get through the day relatively comfortably, the adults must gratify them much more directly than children are typically gratified. At the start of treatment, more normal children have had some history of positive relationships, which enables them to accept fairly rapidly that the therapist has some positive aspects. In effect, the therapist draws on what was positive in the children’s past relationships to build a therapeutic alliance. The therapist anticipates that this will lead to a healing relationship over time.
Children do not carry within themselves the concept that authority can be constructive unless they have once experienced it. Children with a previous poor experience can only fantasize about good relationships, and imagine them as ideal or total involvements that are all-gratifying and never frustrating. They exist somewhere "over the rainbow.” The dream is that the adults will be all-knowing, all-satisfying, and always available. Unfortunately, such an ideal can never be achieved in real life. These severely mistreated children have little sense that actual adults, despite their limitations, can be interested, understanding, and responsive; as we have indicated previously, their view of adults is very much the opposite. Clinicians who hope to build a positive alliance with the children must first counteract the children's view that real adults are destructive and their idealized view of how adults ought to be. To initiate this process, the clinicians must provide positive experiences. This can be done in many ways, depending on the particular child. The clinicians aim to gratify the child in some unique way that appeals to the particular child. The goal, however, is not to simply gratify, but to respond in a way that has special meaning, that conveys the message that the child has been listened to carefully, and that his or her desires have been taken seriously.
One surprisingly simple vvay to start is to see if the child can remember any positive interaction with an adult in the past. The clinician tries to understand what the child found gratifying about that experience, and then recreates a similar situation. A child who had multiple parent figures reject her described the fun she had had when her father’s girlfriend would take her out for exploratory walks and lunch. She enjoyed the friendly adult interest. Using this as a guide, the clinician initiated walks with stops at a local fast-food restaurant. The girl rapidly took to the clinician and the treatment went well.
Another child recounted how, when she was upset, her grandmother would take her out for ice cream and talks. Her treatment plan and the kitchen supplies were modified so that staff members could do the same. Although the girl had run away from other programs, she proudly announced later that she would not run away from this program because the people were “different, they were real friends.” Had the girl said that her grandmother had bought her favorite flavor, “Rocky Road,” “strawberry” might not have been adequate, for the goal was to treat her wishes as unique and valid.
The early phase of treating children who have had terrible life experiences is based on providing positive experiences that at least in symbolic form can serve as an antidote for the trauma they have experienced. As one boy put it, “You need ten good experiences to make up for one horrible one.”
Some programs discount these concrete needs, considering them trivial, since these children have massive psychological needs. One program dismissed the children’s complaint that they could not buy decent clothes on $50 every three months. After all, the program administrators reasoned, what needed remedy was the children’s low self-esteem. Yet, can self-esteem be improved when a child must dress shabbily in comparison to other children in the community? We think not. Furthermore, we think that buying children nice clothing is a concrete demonstration that the program is concemed about their appearance. This heads the therapeutic process in the proper direction; it lets the children know that the therapeutic team believes that they can go from being and looking like throwaways to becoming fine, valuable human beings.
ALVIN ROSENFELD AND SAUL WASSERMAN
Rosenfeld, A. and Wasserman, S. (1990). Healing the
Heart: A therapeutic approach to disturbed children in group care.
Washington, D.C. Child Welfare League of America. pp. 49-51.
