Recognizing Guilt and Shame: Therapeutic Ruptures with Parents of Children in Psychotherapy

Abstract

The parent-therapist relationship is one of the most important facets of child psychotherapy. Guilt and shame are common sources of rupture between parents and child therapists. Overlooking such ruptures with parents can interfere with or even halt psychotherapy with children. A review of empirical and theoretical literature on ruptures in the therapeutic relationship is followed by discussion of how clinicians might identify guilt-and shame-based ruptures in the parent-therapist relationship. The process of repairing parent-therapist ruptures is emphasized as one process that can assist parental growth and development, which in turn can create space for children to grow and develop in tandem with their parent(s). A case study illustrates how guilt and shame manifest in the form of a race-based rupture in the parent-therapist relationship. A discussion of guilt, shame, and oppression concludes this article.

Avoiding a clash of the titans: A literature- and experience-based discussion of considerations for preventing and managing challenging caregiver behaviors throughout child-focused family therapy.

“…Such discussions can also bolster the caregiver's ownership of treatment through emphasizing that their perceptions are crucial to the process given their intimate knowledge of the child, as well as their positioning to best facilitate positive change. This technique may allow for additional information gathering, and an opportunity to repair the caregiver's sense of ability that may have been damaged leading up to therapy (i.e., the caregiver feels inadequate in their ability to effectively help their child leading to feelings of ineffectiveness in other areas of parenting; Baldwin, 2014). Provided that prompting for opinions may not always immediately facilitate complete open responding, additional strategies may include the use of encouraging feedback, insights, reflections, and elaborations to demonstrate respect and foster a positive relationship (Tryon, & Winograd, 2011).…”

“…A common confrontation topic relates to the efficacy of treatment (Baldwin, 2014). Should a caregiver present with a strong belief that the treatment is not working; the clinician can begin by respectfully pointing out session-to-session gains (e.g., observations, tracking data trends).…”

“…Determination of optimal techniques may then be used by training programs and clinical supervisors to provide supplementary specialized training regarding child-focused family therapies. Although child-focused treatments are often addressed in a mental health professional’s education, working with caregivers within treatment has been identified as one of the least emphasized factors throughout psychotherapy training programs (Baldwin, 2014). To address this, a proposed hypothetical training path could begin with a class involving foundational coursework focused on discussion and dyadic practice of general clinician-caregiver-child therapy skills.…”

“…For novice graduate students or clinicians more familiar with adult care and limited child-related experience, working with caregivers throughout a child or pediatric psychological intervention may present unique challenges. It has been concluded that a mental health professional will likely encounter difficulties in both establishing a relationship and effectively working with a caregiver at some point during their practice (Baldwin, 2014). A challenging caregiver can present as stressed due to psychosocial difficulties, overly critical or questioning of psychological services, noncompliant with treatments, or rude.…”

“…Although some research has addressed challenging patients within adult therapy and reactively repairing ruptures (e.g., Arnkoff, 1995; Safran, Muran, & Eubanks-Carter, 2011), limited work is believed to be available that has translated such findings into the child-focused literature. As Baldwin (2014) has identified, the process of navigating a caregiver–clinician alliance difficulty, rupture, or repair is believed to differ from that of adult psychotherapy and therefore warrants specific discussion. For this reason, the information presented aims to provide interested novices (i.e., graduate students) or experienced practitioners seeking additional information regarding child-focused family work with a concise series of considerations and recommendations to preventatively establish and maintain a strong therapeutic relationship with a family, and manage caregiver-related challenging behaviors.…”