The strategic intervention for preschool children

If there is something we wish to change in the child, we should first examine it well and see if it is not something we would do better to change in ourselves.
Carl Gustav Jung

During childhood the child builds the foundations of his own way of being and seeing the world. To accompany him on this journey of discovery, we must offer him stimuli and experiences in line with his growing skills and encourage the process of autonomy. The difficulties that may arise along the way will turn into complicated problems to be solved if the adult fails to change his attitude, remaining rigidly attached to what worked in the past even when it proves ineffective.

The intervention with pre-school children is indirect, it is avoided to involve them, indicating to adults the communicative-relational techniques to follow, which, on the basis of the effect produced, will be perfected until the problem is solved. In this way two important effects are obtained: the difficulty is shifted from the child to his relationship with the adult; the architects of change are made familiar and educators, thus increasing their set of skills.

A hint of strategic problem solving
Through Strategic Problem Solving, strategies are built on the basis of the objectives to be achieved and the characteristics of the problem to be solved, adapting them to the peculiarities of the different situations. The access key to intervene consists of what the people involved in the situation implement with the aim of tackling the problem which, if it does not allow it to be overcome, contributes not only to maintaining it but even to making it worse.

Blocking and replacing these attempted dysfunctional solutions allows you to reverse the trend, until you reach your goals. The strategies that allow to overcome the problem also explain to us on which interactive dynamics it was structured. The vehicle through which the interventions are implemented is represented by the communicative-relational methods adopted in the relationship with the child.

Communicate without words
The challenge is to translate the interventions into a language suitable for such young children with whom, particularly in early childhood (from zero to three years), the weight of non-verbal communication is even more relevant given their partial, or even absent, comprehension of verbal language. In the research-intervention work carried out, I was able to detect the particular sensitivity of children of this age group with respect to the attitude changes of adults along the following four continuums:

Attention/inattentiveness: a child is an attention seeker. This makes it a very powerful tool for the adult, to direct attention to certain behaviors while leaving out others. Presence / absence: temporarily removing the public from a child who acts a certain behavior allows you to strongly emphasize the message sent.

Gratification/absence of gratification: the reward, not necessarily of a material type (eg: a hug, a kiss, a compliment), is a clear way of affirming the appreciation or otherwise of a specific behavior of the child.

Proximity/distance (hot/cold): the emotional distance from our interlocutor, especially when it comes to a child, allows us to define the intimacy and exclusivity of the relationship between the interlocutors in that moment/context in an absolute sense and in relation to other figures present. By modulating the interaction in the four areas described above, we can make children experience an exhilarating or aversive effect on specific behaviours, thus contributing to increase or eliminate them.

Eat only if you like
Arm wrestling between adults and children occurs frequently in the field of nutrition. It often happens that we observe real competitions in the family as to who can get them to eat (grandparents, parents, etc.), resorting to the most curious and unthinkable stratagems. In these situations the child experiences that the less he eats the more he gets, quickly triggering an interactive dynamic that alters the natural function of food: pleasantly supplying the body with the nutrients necessary for its functioning/growth.

Lawrence story
Lorenzo is a three and a half year old boy who has often refused to eat for about three months. When it comes to meals, family members let him find his favorite dishes on his plate which, in most cases, he rejects by closing his mouth. At that point his parents and/or grandparents prepare him any other food he requests, which he only tastes while chasing him around the house with plate in hand.

It takes them at least an hour to eat something, often much more, dedicating themselves exclusively to the child and then, tired and worried, cooking for them or consuming the various dishes he discarded. Throughout this ritual, they continually urge him to eat to grow, promising him prizes. They also tried to give him punishments but to no avail. Outside of meals, Lorenzo eats pizza, schiacciata, chocolate or bread with jam. Meat, fish, vegetables, fruit have practically disappeared from his diet. The parents report that previously he was a child who went according to periods rather than preferences (for weeks he always wanted the same thing) but who had a much more varied diet.

They say it all started after a normal flu with vomiting and diarrhea. The pediatrician ruled out the presence of medical issues and advised them to come and talk to me. In addition to the conspiracy of silence[1] I propose to the parents to organize the meals in the following way: they will have to cook for all three at the same time, preparing Lorenzo what he likes best, putting only their dishes on the plates. Lorenzo's plate will have to remain empty while they start eating. When the child asks for his food, very calmly, apologizing for having forgotten to put it on his plate, they will give him a small portion, immediately resuming his meal.

If Lorenzo refuses him saying he doesn't like it, they will have to tell him to eat only if he likes. If he gets up from the table and starts moving around the house, they will have to avoid following him, tidying up the kitchen as soon as they finish eating. If the child asks for other dishes, they will tell him that they have not bought them. In the event that, after having set the table, he asks for the things he had left on his plate, they will answer him: "we thought you didn't like them anymore".

Outside of the main meals (breakfast, lunch, snack, dinner) they will not have to satisfy his food requests, postponing the next meal. The parents are amazed by the instructions but willing to follow them to the letter, also involving the maternal grandparents with whom Lorenzo spends most of the day while they are at work. At the second appointment, two weeks later, the situation changed considerably.

For a few days now, Lorenzo has started eating at the table with his parents, who have stopped chasing him, asking permission to get up to go and play after the meal. His diet has returned to being varied by eating what is prepared for him. Since there are no more family members willing to do anything to see him eat, he has interrupted the previous upward game with the adult reference figures, bringing nutrition back to his natural function.
I suggested to the parents to keep the same indications for the following month, after which they confirmed the consolidation of the results obtained.

Dr. Massimo Bartoletti (Psychotherapist and Official Researcher of the Center for Strategic Therapy)

Bibliography:
Bartoletti M., 2015, Changing to Grow them. The strategic intervention for preschool children, Ilmiolibro Self Publishing.
Nardone G., Salvini A. (edited by), 2013, International Manual of Psychotherapy, Garzanti, Milan.
Nardone G. and the team of the strategic therapy center, 2012, Helping parents help their children, Problems and solutions for the life cycle, Ponte alle Grazie, Milan.
Nardone G., Fiorenza A., 1995, Strategic intervention in educational contexts, Giuffré Editore, Milan.
Nardone G., Watzlawick P., 1990, The art of change, manual of strategic therapy and hypnotherapy without trance, Ponte alle Grazie, Milan.