TIFT #1 The Stuck Inner Child

This is the first of a series of Tuesday emails offering useful tidbits for clinical psychotherapy. Normally this will be on Tuesday, but this is the first time. Oh well...

This post is about making sense of some very difficult problems in psychotherapy through a developmental point of view. For therapists and clients, a useful model can be thinking of an inner child confronted by some unsolvable difficulty, resulting in an area of developmental arrest. Not every patient suffers from this kind of problem, but it can sometimes explain otherwise baffling behavior.

How to spot this dynamic:

Indicators include responses that have a childlike or immature quality and may be inconsistent with the person’s general adult personality. Another tipoff might be a surprising lack of engagement in the process of therapy.

What’s going on is that, at some point in development, the young person became stuck. Often the stuckness has to do with needing parental support when taking a scary step in development. This can come up at any age and is universal. Whether it’s taking first steps, stepping onto the school bus, or stepping into adult life, these are points when we experience a heightened need to feel emotionally supported by asupportive parental other.

When this kind of support is unavailable, growth stops, at least in some area, but problem solving doesn’t. Children cannot let go of hope. They find some way tofind hope, no matter how dire the reality. How do children plan to solve impossible problems? The same way they solve any difficult problem. They focus on getting some parental figure to provide the missing support.

How it looks in the transference:

How does this look in an adult? They may wait for the right person to come along (therapists are excellent candidates). When they have a candidate, they may engage in covert signaling to motivate the parental person to help. this is where the situation may be baffling until we understand what is going on. Usually the signaling is not overt because the actual parents were most likely not responsive or unavailable. So the child may signal by getting into trouble or by waiting patiently and passively, or by seeming helpless. In each of these scenarios, a patient who seems capable of attacking the problem, fails to make progress.

This situation can generate a lot of countertransference. Therapists may not identify it, but feel the nonverbal tug to do something. They may feel uncomfortable either because of the patient's anger (residual from the child’s expectation of being rebuffed) or the feeling that they are being tested and that no amount of help will be enough to unstick the client.

What to do:

For both therapist and client, the answer to such a dilemma is understanding and compassion. Clients, especially, tend to harbor a very negative view of their “immaturity.” Therapists may feel irritated, too, by the seeming intractability of the situation. Understanding leads naturally to the compassion necessary to help the inner child take the risk of engaging again in growth.

Let’s think of what healthy, available parents do when a child is facing the scariness of stepping up to a new level of development. Development happens when we move out of our comfort zone, when do things we didn’t dare to do before. A good parent acknowledges the difficulty and remains emotionally connected while the child experiences the intensely uncomfortable emotions. Fortunately, that is an ordinary part of the “job description” of therapists. It doesn’t require anything unusual for us to understand and allow the natural result of understanding to happen, namely compassion.

There may be a drama around facing the uncomfortable feeling. Children, especially those who have experienced a shortfall of support, may want proof that the therapist is ready to provide the needed support. They may want tangible evidence of willingness. This is where the demands can go outside of ethical boundaries. As these issues come to light in a non-judgmental atmosphere, they can be identified for what they are and, hopefully, put to rest. Then the inner child will be ready to find the courage to take a deep breath and move ahead.

In the next post, I’ll talk about the surprising range of ages and stages of development at which this phenomenon can appear.

Jeffery Smith MD