The Application of Psychodynamic Theory to Therapeutic Work with Children and Young People


By Annabelle Rose


Children are generally in my class at the Mulberry Bush School as a result of extreme neglect or trauma. For the purpose of this article I shall discuss ‘Janey’, a child born to drug addicted parents who has experienced a series of foster placements. Attachment theorists predict that such disruption in early life experiences affects attachment style, the ability to form relationships and to learn (Bowlby, 1998). On referral Janey was described as a disturbed child unable to show remorse for her actions. She had a history of being antagonistic, physically abusive to others and had regularly talked about suicide.


The purpose of this essay is to highlight any unconscious dynamics such as transference and countertransference that occurred within a discussion I held about Janey. In the context of a therapeutic relationship, Gelso and Hayes (1998:4) define transference as ‘experience that is shaped by his or her own psychological structures and past, and involves displacement of feelings, attitudes and behaviours belonging rightfully to others in earlier significant relationships onto the worker by the client’.


It is too easy for me to ignore Janey’s needs within the group I teach. She is quieter, more compliant, is the least mentioned child during meetings and is rarely involved in incidents. My first task in the discussion was to establish what my colleagues already knew. The lack of knowledge confirmed my view and perhaps mirrors both what happened to Janey in her earliest relationships and now takes place in my classroom; that Janey is a child easy to remain detached from. Other children, with more disorganised attachment styles, have a higher profile within the school and I wonder how much we have subsequently been able to help Janey. Diamond (2015) argues that ‘the therapeutic milieu of the school is designed to facilitate a sense of belonging through providing consistent emotional holding for children’. If Janey’s needs are in any way being ignored, then this opportunity will have been lost.


To provide a context, I outlined the potential effects of attachment styles on classroom relationships. Bowlby (1988) summarised the outcome of a ‘secure enough’ attachment as an internal working model of the self where the infant feels valued, learns to trust that the outside world is safe enough to explore and turns to others for protection (the secure base) when challenged by uncertainty. This is the basis of engaging successfully with a teacher. I suggested that Janey suffers from an as yet undiagnosed ‘insecure avoidant’ attachment style. She has limited experience of a secure base from which to explore and is likely to have experienced carers that were insensitive to her needs. It is possible that her fears were not contained and the secure base was therefore experienced as unreliable. Janey might have learnt to fear rejection and so has defended herself against that rejection. Approaching anyone for support became avoided at all costs.


Colleagues were interested in knowing that Janey’s attachment style in the classroom is dominated by a desire to be self-reliant. She initially had great difficulty in trusting adults; and found it virtually impossible to ask for help. During this section of the discussion I did begin to reflect on my own desire to be self-reliant. I find it difficult to delegate and to ask for help. Whether this is due to some fear of failure or rejection because of my own possible insecure attachment style is an issue worth exploring. Perhaps this is the reason I highlighted Janey for this discussion. In the feedback from one of my colleagues it was suggested that I appeared to be ‘attunded to Janey’s needs’.

During the discussion I outlined what I had learnt from Geddes (2006) about the intervention implications of working with avoidant attachment in the classroom. She suggests that the teacher is imbued with negative expectations. The challenge of learning triggers uncertainties and so a need for support and proximity, which for the sake of Janey is denied in favour of a valency for self-sufficiency. When I began working with Janey all help and proximity was rejected. On occasion anger was triggered which was often expressed towards objects. She regularly communicated that people should not get too close to her.


In relation to the ‘learning triangle’ and avoidant attachment, Geddes (2006) recommends that the teacher pupil relationship is made safe by the presence of a task. A well delivered lesson with a plan made clear at the beginning with simple structured tasks can reduce the perceived threat of ‘not knowing’ something and feeling unsupported. Janey prefers concrete activities over open ended imaginative tasks. Geddes (2006) suggests that this kind of activity helps the pupil ‘experience being thought about and held in mind’ – an ‘empathic attunement’ which was likely to have been absent in infancy.


I explained to my colleagues that we try to provide clear expectations. Tasks often involve box filling, brief sentences in defined spaces and scaffolding rather than open ended tasks and this seems to help Janey considerably. As I have progressed through my Foundation Degree I have noticed how easy it is to be drawn into behaviours that exacerbate the problems experienced by the children I work with. Bion (1952) identified this aspect of countertransference as ‘a temporary loss of insight, a sense of experiencing strong feelings and at the same time a belief that their existence is quite adequately justified by the objective situation’. As the relationship has developed over time, I have realised that when Janey says she does not want proximity, she means in fact the opposite. I have learnt that detachment is not what she needs. Our relationship has improved beyond measure since the introduction of play fighting, bear hugs and tickling at just the moments when she has communicated ‘don’t touch me’. When I mentioned this in the discussion there was a palpable feeling of relief, release and joy.


Hannon et al (2010) argue that if children are to develop in a psychologically healthy way, in the holding environment they need to experience ‘authoritative’ parenting which provides a combination of responsiveness and demandingness (or warmth and consistent boundaries). This kind of ethos was first identified by Winnicott (1965) who helpfully suggested the use of a ‘holding environment’, which refers to the provision of a compassionate, understanding and tolerant place that also has firm and robust boundaries.


When reflecting on this discussion now, I am compelled to observe how much my approach to the discussion reflected my style of teaching Janey. The feedback from my colleagues suggested that my presentation was well prepared, clear, with brief interjections of playfulness. I offered new information and provided short spaces for discussion but that it possibly lacked any mention of my feelings. Geddes (2006) suggests that activities with rules, defined procedures and concrete structures which are so helpful when working with avoidant attachment styles are essentially left brain functions which help to keep strong feelings at bay and prevent flooding of the brain with intolerable emotions which can trigger reactive behaviour. Whether or not it is the right approach for a discussion with colleagues remains to be seen. My colleagues did however appreciate the containing sense gained from a one minute warning prior to the end of our discussion!


The remaining discussion centred on helpful interventions. The importance of being held in mind and of continuity of relationships over time was highlighted. Janey responds well to predictability in relation to timetables, transitions and changes. I couldn’t help at this point of the discussion notice that guilty thoughts about my maternity leave flooded my brain. This is where reflective spaces come in. Emanuel (2002) suggests that practitioners working alongside children with complex needs need a regular space to think therapeutically about children’s communications and behaviour to help remain receptive and thoughtful when under bombardment by disturbing projections.


It is inevitable that the powerful experiences that Janey has had will in some way be felt by the adults working alongside her. As I sit here writing this assignment I can feel stress hormones coursing through my body. I have, like Janey, avoided this task at all costs. I feel bleak. All I want to do is run away and hide in a darkened corner. I will instead, like Janey probably do the bare minimum. At various times of trying to teach Janey I have felt the helplessness and rage that Janey perhaps is unable to bear so maybe unconsciously projects elsewhere. It is of course highly possible that none of these feelings are hers and that they are my own feelings but either way, whilst alongside Janey my role is to provide consistent, reliable, loving care.


There remains to be seen any reliable, empirical evidence for psychodynamic theories or suggestions. De Rementaria (2011) highlights that waning academic interest in psychoanalytic ideas is generally attributed to its faltering status as a science. Psychoanalytic knowledge is gained from subjective experience of relationships with patients; valued for its capacity to describe complexity but unable to meet the requirements of scientific research for positivists.


Neuroscientists might suggest that Janey’s behaviours are little to do with parenting and attachment and much more to do with innate characteristics built into her DNA or indeed brain damage due to alcohol and drug misuse whilst in utero. There remains wide debate about whether psychotherapeutic intervention has any lasting impact. Even if our temporary provision is ‘good enough’, the conditional nature of her foster placement might never lead to the sense of belonging necessary for long term repair. Emanuel (2002) highlights that many children in care who have been abused still have access to their birth parent(s) and that there is a reluctance to move towards permanency and adoption because of the implications for reduced contact. This leaves a child such as Janey in a situation of unbearable uncertainty.


This has been an interesting process. I have oscillated from depression to joy on a number of occasions and I wonder how much this mirrors Janey’s feelings during her placement at MBS. I feel more comfortable working in structured ways and I undoubtedly imposed this on the discussion group. Much more might have been learnt by the injection of greater levels of spontaneity and creativity. Rollinson (2015) argues that working alongside children such as Janey does not lend itself to fixed command and control approaches as this can quickly become routinized rigidity. The challenge ahead for me and my team is that of personalised flexibility rather than micro management.



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