When you should take your child to a psychotherapist
Seeing a psychotherapist for emotional difficulties is not very common in India, despite the fact that mental health disorders account for nearly a sixth of all health-related disorders. This means that 65 out of 1,000 persons are at some point of time in their life in need of psychological care for a mental illness. Yet we have just 0.4 psychiatrists and 0.02 psychologists per 100,000 people, and 0.25 mental health beds per 10,000 population.
While 65 million Indians suffer from mental illnesses (Ministry of Health and Family Welfare, 2009), India spends just 0.83 per cent of its total health Budget on mental health (WHO, 2001). There is a severe shortage of mental health professionals - psychiatrists, psychologists, psychotherapists and psychiatric social workers in urban and rural India.
These figures are for an adult population but it is well understood that the roots for emotional well-being or mental illness often lie in early life experiences. The burden of mental disorders, especially in urban India, is highest among young adults aged 15 to 44 years.
This implies that students in schools, colleges and universities are especially vulnerable to major psychological upheavals, be it depression, drug addiction, identity crises, emotional impact of conflicts in families, disturbances in the arena of sexuality and the body, aggressive and destructive urges, self-harm and/or suicide.
It is easier to communicate in words with 15-year-olds about their mental health difficulties and this makes it easier to identify. However, it does not suggest that younger children are free from emotional difficulties or that difficulties only begin during adolescence.
Parents are usually the first to feel that there is something "not right" with their child and they can be the best mental health radar (Acquarone, 2004). If freed from the coating of stigma, asking for attention to their baby's or older child's communications is the beginning of an important process, one where the parent's concerns are often validated.
There are many difficulties with children which a psychotherapist may help to resolve and it is not possible to list them all. The sections below are by emotional theme or psychological stages rather than problems, for example, a child refusing to go to school could be underpinned by a difficulty with learning, an attachment problem, a difficulty with transition, a previous trauma or difficulty in the family.
Symptoms
Refusing to go to school is a symptom and the psychotherapist will be interested in the underlying emotional reasons for it. Similarly, children may be very anxious or aggressive, fearful or precocious for their age, withdrawn or melodramatic in class.
Symptoms may be physical such as bedwetting, vomiting, eczema, frequent aches and pains or severe constipation; or they may be behavioural - nightmares, not eating, phobias, not being able to concentrate, being hyperactive, turning clingy, throwing tantrums, hitting, biting other children or deliberately hurting animals.
Any of these may be a problem for a school, family or child, or they may not - depending on how the child fits in with the environment. For example, four-year-old Ashish had been a difficult feeder from birth. He and his mother struggled with breastfeeding and he did not enjoy the bottle.
At age four, an only child, he was skinny, hyperactive and very anxious about separating from his parents, even at bedtime. Mealtimes were difficult and he was often ill. While there is nothing debilitating about his situation and he is on a continuum of many children similar to him, he would perhaps benefit from psychotherapy. However, his parents do not see the need.
Infancy: The early emotional storms
Concerns may begin in the first six months of life. Communication difficulties between parent and baby could be picked up very early and identified by the parent in themselves or the child. These could be in many forms: parents may be finding it difficult to enjoy interacting with their child; no attraction in the baby for mother’s face; interest in objects rather than people; lack of babbling and imitation; avoiding eye contact; dislike of being picked up or held; lack of curiosity; extremely stiff muscles that don’t allow the baby to mould to the mother’s arms – these are all a few early signs of concern that parents may notice. (Acquarone, 2004)
No parent is in tune with their baby 100 per cent of the time. Research suggests that parents and children are always moving between disruptions and being in tune (Stern, 1985). The aim in parent–child relationships is not complete understanding or full attunement but the move towards attunement after a disruption – to know how to communicate difficult feelings and the trust that it is safe to communicate them.
A sensitive baby can be extremely difficult to attune to and look after, and therefore is usually misunderstood. If very sensitive to light, touch or sound, a baby may be irritable or crying a lot of the time which makes it difficult for the mother to be around the baby. A sensitive child could turn out to have enhanced abilities in the fields of music, art or academics in the future but in the present it may be very difficult to understand and live with.
In the early weeks and months, our physical and emotional needs are not necessarily disparate. To have the physical needs satisfied at the right time, in a gentle, responsive way is love. Mothers know that to feed a baby when he is hungry is fulfilling at many levels – to both baby and mother.
They know, or soon learn, that babies like to be fed in quiet surroundings with little distraction so they can focus on the breast or bottle and on their mother. Yet, many babies have feeding or sleeping difficulties; some babies are experienced by their parents as crying too much.
These are ordinary experiences in all families but that is not a suggestion that they are not difficult or can be ignored. These are communications from the baby about their physical and emotional experience, and by paying attention to them parents and professionals can consider deeper underlying issues in the baby or the family.
Crying is how babies communicate their need for attention. As a result, there are different kinds of cries and anyone looking after a baby will be able to differentiate between the cry of hunger, anger, sadness or boredom (Winnicott D., 1991, p. 58). A lot of the psychotherapeutic work in such situations is to help the parent to observe, understand and then respond to the baby’s needs without becoming caught up in their own feelings of being manipulated by the baby, angry with the baby or hopeless about their own parenting capacities.
Many parents who may have had difficult relationships with their own parents, may have experiences of loss, traumas or rejection may be depressed. They may find it difficult to notice their baby’s needs or to attend to them (Murray, 1996). Life circumstances may be difficult for some families when quality time with a parent, affection and thoughtfulness may feel like luxuries which are unnecessary for learning to live in the world.
Yet it is these very early experiences that form the foundation for future capacities (Gerhardt, 2004). Shaky foundations make for shaky futures. Depression in parents in the early years of a child have been shown to have a long-term and wide-ranging negative impact on the child in areas of learning, emotional growth, ability to make rewarding relationships and to deal with their own feelings (Gerhardt, 2004; Hay, 2001).
There are parents who, after the birth of a child, may have feelings towards their baby or towards each other that are not positive.
Babies are extremely demanding and leave little time or energy for other activities or relationships. The couple relationship goes through a difficult transition when a baby enters the mix and it may not be easy for a new mother or father. A depressed mother or father may feel hopeless, angry or overwhelmed by the intense demands of their new baby.
Depression follows childbirth in 10 to 15 per cent of cases (O’Hara, 1996) and often goes unnoticed (Dennis, 2004). Feelings of hopelessness, helplessness, crying, low mood or high anxiety before or after a birth are legitimate experiences that need to be taken seriously and attended to (Milgrom, 2008).
Psychotherapy has been shown to be one of the more effective ways of addressing these difficulties (Milgrom, 2005) primarily because of the acknowledgement of the emotional support it provides.
(Re-printed with publisher's permission.)