Parents know their children's problems best and can therefore be their therapists. This is the basic premise of Filial Therapy, not yet known here, but recognised around the world as one of the most effective methods of helping toddlers who are struggling with big problems. What exactly this therapy consists of is explained by psychologist Nina Ambroziak.
Filial Therapy is a parent-led therapy based on the same principles as Play Therapy, i.e. therapy through play (we wrote about it in more detail in ?Hear? no. 5/2014). Play is the child's language. By playing, the child communicates everything he or she is unable to express in words. Grief, pain, fear. The therapist, by carefully observing the child's behaviour, discovers what might be the source of the child's problems. He creates an environment for the child in which he feels accepted with all the feelings he is experiencing. Filial Therapy, on the other hand, assumes that the parents, who are the most significant people in the child's life, can be the child's therapist. They just need to be properly prepared for this role. Mothers and fathers are therefore taught the same skills as Play Therapy specialists. First, they learn the basics of communicating with their child in a session with a therapist, and then they carry out play therapy with their daughter or son at home on their own.
Crucially, Filial Therapy can only be led by parents who are mentally ready to do so. Not everyone qualifies to start it. Mothers and fathers, especially of those children born with disabilities, are usually overwhelmed by the diagnosis. In their heads, they create a false image of the child. They imagine them as if they were completely fit and healthy. This means that they have not yet come to terms with the problem. They are still going through a period of so-called ?mourning? caused by the diagnosis of their child's disability. Only when they have come to terms with it, can they lead play therapy for their children.
Deciding whether parents are already at this stage is the first task for the therapist. Unfortunately, practice shows that only one in 10 parents who come to his or her office can actually start preparing for Filial Therapy. It is not often that mum or dad sees the child as he or she really is, recognises his or her problems, e.g. with peers, and talks about it in an empathetic way. A large proportion of parents do not have this approach to their child. Yes, they care about their child and really do a lot to help them. They take them to speech and language therapy classes, speech and language therapy, psychomotor classes, etc. They also take their children to the classes. We have everything under control, they convince the therapist. However, they contradict what they say with their attitude. They claim that they have become accustomed to the idea of their child's disability, while they avoid contact with them. They entrust the upbringing to specialists. All the activities they mention are suitable for deaf children, but it is the daily, authentic contact between parent and child that is essential for their development. It is therefore necessary to find time during the day, even if only half an hour, in which to devote one's full attention to the little one. If mum or dad has a problem with this, it means that they are unable to delegate themselves to contact with the toddler (in play it is impossible to deceive the child by delegating a false self). To expose this truth, moreover, it is enough to ask the simplest questions: What do you play with your child in your free time?, How do you spend this time, just the two of you or together with the whole family? If, when answering, the parent talks mainly about what he/she does for the child, it means that he/she is focused on combating the child's disability. He or she sees only his or her commitment to make the child ?fix? The whole sphere of the child's psyche ? leaves out! With this approach, she cannot be an effective Filial Therapy therapist. If, on the other hand, during the initial conversation, mum or dad says: ?Son likes to play with a ball during bath time?, ?He doesn't like to wear a hat?, ?When I have free time, we go to the park to collect leaves?, it means that they think of the child as a feeling little human being. Such parents are able to acquire the skills to lead Filial Therapy.
As an introduction, parents undergo a training session where they learn the rules of Play Therapy. This serves to master the not easy skill of listening empathically and reflecting the child's emotions. Mothers and fathers learn to observe the child, read his or her behaviour and respond to it. In a way that expresses concern, but not intrusively.
When dealing with deaf children, this part of the training is particularly important. Without verbal contact, parents often become insensitive to their child's messages or behaviour. Filial Therapy training makes them realise that every gesture, grimace, sound or way of moving has meaning. You just have to be able to read them. They therefore learn to observe the child and understand non-verbal messages. After such training, many parents are amazed that, by increasing their sensitivity to the here and now of their child's presentation, it is possible to communicate with them as with a child who does not have a hearing problem. Some parents are also surprised that empathic listening and responding is of great importance even for the youngest children, up to the age of three. At this age, the toddler does not speak or speaks very little. It is therefore difficult to read their emotions accurately. However, it is precisely with such young children that investing in good relationships is extremely important. It is therefore worth keeping an eye on the child and trying to communicate with him or her non-verbally. For example, if the child bangs the spoon on the table and the mother ? mirroring his behaviour ? she also bangs the spoon, this sends a message to the child: ? "I am the most important thing to her? And this is a situation that every child aspires to, whether they are a few months old or a few years old. By expressing the child's acceptance, the mother automatically triggers positive emotions in the child.
The so-called stone face experiment is described in the literature. At the request of scientists, mothers who were caring for infants only a few days old stopped smiling at their children for a moment, speaking to them ? their face would freeze, ceasing to betray any emotion. Psychologists noticed that the toddlers did not remain indifferent to this. Their behaviour became disorganised. The results of this experience best demonstrate that the relationship between mother and child is based on interaction. That every signal ? verbal and non-verbal ? matters.
In the case of children who are born deaf, the interaction is severely disturbed. The mother, who finds out about the child's problem, becomes depressed, becoming psychologically unavailable to the child. Such a child becomes an emotional orphan. For there is no one in whom he can see himself. This is important because, from a psychological point of view, it is only through interaction with another person that we become a person. Therefore, if the mother, due to grief or depression, cannot emotionally tune in to her child, she is denying her child the chance to develop properly.
In learning the basic skill that empathic listening is in both Play Therapy and Filial Therapy, parents should master a few rules to follow during therapy sessions and in everyday behaviour.
Clear boundary setting
Parents of children with disabilities, especially deaf children, often have a huge problem with this. They think that a deaf child is disadvantaged by fate and therefore allowed more. This is a mistaken assumption. The lack of clearly defined boundaries violates the child's sense of security with their parents. The child needs to know that when a parent says ?no ? (e.g. not allowing an activity or behaviour), it is binding. A mother who says ?no? and at the same time allows the child to do something against this prohibition becomes unpredictable, unreliable as a caregiver.
Two phrases are very helpful in setting boundaries: ?want? and ?don't want? If the mother says: ?Please put the toys away? or ?You have to put the blocks away?, a two or three year old often doesn't understand this message because he doesn't know from whom it comes. If, on the other hand, he says: ?I want you to stack the blocks?, the child knows that this is the parent's will. The ability to use the words ?want? and ?don't want? has a specific function ? It serves to build a boundary between mother and child. It enables the process of separation from the mother and thus the creation of one's own independent identity.
Non-directive play with the child
In Filial Therapy, as in Play Therapy, it is assumed that play is chosen by the child. Such non-directive play is difficult for most parents, especially parents of deaf children. They are convinced that by playing with their child, they should teach them something useful or develop their child's skills. So they leave the child with no choice ? they suggest ?let's play with blocks?, ? "let's build a house? It is widely believed that building with blocks shapes the child's spatial imagination. A toddler with hearing and speech difficulties can learn the new word ?house? However, playing like a lesson does not fulfil its therapeutic purpose. The child cannot express his emotions and needs through it. He cannot show himself.
Creating therapeutic conditions
This skill becomes important when a parent starts to use Filial Therapy at home after training with a therapist. It is important to have a separate place in the home (it does not have to be a room, just a small corner), a so-called Play Room, for therapeutic play. It is important to respect the boundaries, including time, while in it. If, for example, the child goes to the toilet, when he or she returns, the parent communicates clearly ? you are back and now you are in the play area again. This is important because the child needs to know that ? even though he or she is not leaving the house ? he or she is in special conditions, in a dedicated space that is only used during therapy. On the other hand, the parent himself must not interrupt play either, for example to switch off the washing machine. Filial Therapy assumes that parent and child are continuously with each other for 45 minutes. They are only there for each other.
Filial Therapy assumes that the first two or three sessions between parent and child should take place under the guidance of a therapist, either in the office or ? better ? at home. This stage is surprisingly difficult for parents. You can sometimes see how embarrassed they are when playing with their own child. How difficult it is for them to delegate their own person to play with their toddler. They feel that playing is an almost intimate activity, because it shows what kind of parents they really are. Therefore, the therapist who ?visits? parents, must be very delicate in his or her assessments and comments. He or she must not alienate the parent or shake their confidence in their parental competence. The aim is to make parents aware of what they can still improve in their relationship with their child, what needs further training. If the therapist determines that the parents know and can put into practice the principles learned during the training, he gives them permission to do the therapy without him. This does not mean that he disengages from the therapy completely. He acts as a supervisor who ? in case of difficulties or problems ? is always there to help and advise.
Filial Therapy, or parent child therapy, should be used for at least 3?6 months. And it is rare for parents who have acquired the skills to communicate with their child in a new way to stop using it earlier for lack of visible results. They are usually surprised at how quickly their newly acquired skills change their child's behaviour. And even after the initial time period ? often habitually, in a way that is not always conscious ? they continue the therapy and use its principles in everyday life.
The effectiveness of Filial Therapy is high, according to research conducted in the USA. Why? I know from my own experience that even parents who love their child very much can be the perpetrators of their child's problems. During Filial Therapy training, they learn model ways of communicating with their children. This helps them to figure out for themselves what mistakes they have made in their parenting. Some have the courage to say this out loud, others prefer to keep this information to themselves. The important thing is that after training with a therapist, they stop repeating it. This is what brings the most tangible results.
At Filial Therapy it is recognised that every parent should be trusted. I always stress that they are the ones who know the most about their own child. A therapist who only has contact with them in the office is not able to get to know them as well as a mum or dad. Therefore, a properly prepared mum (or dad) can help the child just as effectively ? or even more effectively? as a therapist.