The place of ego building work in psychotherapy with children

Ego building is essentially a name given to a variety of interventions used to support an ego hampered by regression or deviation. The term has its roots in the concept of ego support but evolved specifically as a technical term in contemporary ego psychology closely connected with the developmental theory of separation individuation. Using four vignettes of psychotherapy work with children all of whom suffered from unresolved conflicts and developmental interferences from the separation-individuation process, an attempt is made to illustrate the technical place of ego building in psychotherapy with children. It is suggested that the use of ego building, particularly verbalizing adaptive aims facilitates an alliance, supports a safety feeling and positive self-esteem. This contributes to providing a treatment experience that reduces over-stimulation and anxiety and frees the expression and understanding of aggression which ultimately promotes separation-individuation.in private practice.This paper was presented at the Conference on the Continuing Evolution of Psychoanalytic Thought: Infancy to Adulthood, N.Y.C., Nov. 1990., sponsored by the Committee on Psychoanalysis of the National Federation of Societies for Clinical Social Work.     

Clinical social work and the family court: A new role in child sexual abuse cases

Clinical social workers encounter difficult treatment issues when working with children where there is a suspicion of child sexual abuse, or where there has been an indicated child protective services case but no family court action. This article outlines a new role for the clinical social worker to play in relationship to the family court system. The author argues that the involvement of the clinician in an assessment process developed to aid the court can aid in the protection of children and set the stage for effective intervention and treatment.Director, Center for Training and Research in Child Abuse and Family Violence.     

Treatment of psychogenic seizures in adolescents

This article will review the problem of psychogenic seizures in adolescents and the impact of family therapy and individual therapy on treatment. Why particular individuals are prone to psychogenic seizures, the relationship between psychogenic seizures and family dynamics, and unresolved individual issues will be covered. The article will address a selected case, with a specific clinical paradigm for treatment.     

Assessing clinical progress: A case study of Daryl

In this single case study, the authors conceptually framed their understanding of dissociation and splitting as defensive/adaptive coping mechanisms through which children respond to abusive/neglectful environments and the developmental deficits of abused/neglected children as related to failure in separation/individuation. Case study methodology with a nested experimental research design employed content analysis of process recordings to identify targeted defenses and developmental themes and then to assess therapeutic effectiveness during the first six months of psychodynamic play therapy with Daryl. In-session cliniial progress was assessed through charting changes in defenses and developmental themes, identifying degree of goal achievement, and clinically observing treatment stage progression. Visual analysis of the frequency charts identified a slight cyclical decline in use of splitting and guarding against dissociation and a somewhat uneven increase in the developmental theme of coexistence/integration. While these changes in targeted outcome variables were not statistically significant, the amount of change did exceed the predetermined outcome goals for decreased splitting and increased coexistence but not the goal of decreased guarding against dissociation. Review of the process recordings also identified clear markers of treatment progression through two therapeutic stages in the first six months of long term psychodynamic play therapy and further supported the clinical meaningfulness of the observed changes.     

The person-in-environment reconsidered: New theoretical bridges

The theoretical gap between person and environment is the focus of this paper. Multiple determinants of human behavior are presented as they contribute to children's idiosyncratic comprehensions of their worlds or environments. Implications for development and for clinical social work intervention are presented.