Termination as a therapeutic intervention when treating children who have experienced multiple losses

Abstract

Children who have endured traumatizing events often have a history of prior disruptions and losses which also have been experienced as traumatic. Termination of therapy with these children, therefore, provides a unique opportunity for the clinician to provide the traumatized child and his or her caregiver with a new experience of loss; one that is controlled, predictable, and paced. Through this experience, the child and caregiver can develop a new model for loss, one that permits for losses that are a natural part of healthy growth and change. This article outlines one approach to utilizing termination as an integral component of the therapeutic process with infants, toddlers, and preschoolers and their caregivers. Using a psychodynamic model and working dyadically with the child and the caregiver, termination is approached as a primary intervention, pivotal to the successful treatment of this vulnerable population.RESUMEN: Aquellos niños que han aguantado eventos traumatizantes a menudo tienen una historia de trastornos y pérdidas anteriores que también han sido experimentadas como traumáticas. La terminación de la terapia con estos niños, por tanto, es una oportunidadúnica para que el clínico les provea al niño traumatizado y a quien lo cuida con una nueva experiencia de pérdida, una experiencia controlada, predecible y medida. A través de esta experiencia el niño y quien lo cuida pueden desarrollar un nuevo modelo de pérdida, el cual permite que una pérdida ocurra como parte natural de un crecimiento y un cambio saludable. Este ensayo describe un acercamiento para utilizar la terminación como un componente integral del proceso terapéutico con niños pequeños, infantes y aquellos en edad prescolar, y quienes les cuidan. Al usar un modelo sicodinámico y trabajar con la díada del niño y quien lo cuida, la terminación es vista como una intervención primaria, esencial para eléxito del tratamiento de este vulnerable grupo de la población.RÉSUMÉ: Les enfants qui ont enduré desévénements traumatiques ont souvent une histoire de disruptions et de pertes précédentes qui ont aussiété vécues de façon traumatique. L'interruption de la thérapie avec ces enfants, dans ce contexte, offre une opportunité unique grâceà laquelle le clinicien peut donnerà l'enfant età son mode de soin une nouvelle expérience de perte; une expérience contrôlée, prévisible, mesurée et dosée. A travers cette expérience l'enfant et le mode de soin peuvent développer un nouveau modèle de perte, un modèle qui permet les pertes qui sont une partie naturelle de développement sain

Breaking bad: an attachment perspective on youth mentoring relationship closures

“…Clients react with feelings of abandonment, rejection, anxiety, anger, despair, confusion, fear, helplessness and sadness (Joyce et al 2007). A history of loss, particularly a traumatic loss or one that occurred during childhood, can intensify feelings among individuals of all ages (Stroebe et al 2005;Roe et al 2006;Joyce et al 2007;Many 2009).…”

“…While this tactic decreases felt emotion, those individuals often show somatic symptoms that betray their internal distress (Wayment & Vierthaler ). Youth with previous experiences of loss or disorganized attachments may find the ending of mentoring relationships particularly difficult (Stroebe ; Many ). The loss may feel catastrophic and lead to turmoil.…”

“…Learning to cope with distressing feelings and losses prepares adolescents to face and negotiate future stressful life events (Delgado & Strawn ). For youth who have experienced previous losses and trauma, an emotionally supportive termination may also constitute their first experience of a non‐traumatic loss (Many ). However, when youth or mentors avoid the work of termination, they tend to dismiss the relationship and its importance and defensively invalidate and devalue the accomplishments attained through that alliance.…”

“…These may include conflicting reactions such as sadness about saying goodbye, fear of the impeding loss and pride in accomplishments. Part of this task entails helping youth to verbalize feelings that they lack the knowledge or language to express (Many ).…”

“…The tools needed to manage that phase, especially for youth with insecure or disorganized attachment patterns, require skill building and rehearsal. Plenty of natural opportunities present themselves for developing and practicing those skills during the course of a mentorship: vacations, missed meetings, sickness, ends of meetings, times the mentor may be emotionally less attuned or distracted, misattunements in the relationship or during the emergence of strong negative feelings such as anger (Zilberstein ; Many ). Sensitive and repeated handling of those incidents, in which mentors inquire about and show understanding and reflection of feelings, repair ruptures and resolve difficulties, promotes coping and security on which youth can draw during difficult times.…”