Indirect therapy with children and operative diagnosis

When the patient is a child, the strategic approach involves a completely original way of working: indirect therapy. In fact, excellent results are obtained by working with the parents, who in this case will become real "co-therapists", since they will be the ones who will personally put into practice the indications provided by the psychotherapist and propose the prescriptions to the child. that the latter has identified for them.

We talk about indirect therapy whenever the recipient of the intervention is not the person who arrives for consultation in the therapist's office.
The choice not to see children under 12 is dictated by various and important reasons:

• first of all, avoid labeling, that is, the pathologization of the little patient ("primum non nuocere" already said Hippocrates);
• moreover, it is more useful to work with adults, especially in a brief therapy approach, because the child could boycott (consciously or not) the therapy;
• and again, it serves to empower parents, who become collaborators of the expert; this also means that their resistance is lowered, given that we raise them to the role of helpers and that above all we absolutely do not accuse them.

Regarding the need or not to make a diagnosis, we believe that the diagnosis of an expert (be it a doctor, a psychotherapist, a psychiatrist) can function as a prophecy which then tends to come true (and in this case: totally negative prophecy).

Through the short strategic intervention many difficulties and many ailments presented by children can be overcome by guiding the parents and providing them with the most effective tools and strategies. On the other hand, all the other therapeutic approaches include descriptive diagnoses and direct therapies even with very young children, through the use of interviews, free or structured games, drawings, stories, tests, etc. Precisely because they consider the relationship with the child to be fundamental. and the observation of the same and his interactions with family members, the therapy includes both individual and family meetings.

The biological-psychiatric perspective brings the disorder back to bio-physiological characteristics; the psychodiagnostic one, makes use of tests of various types and nature to arrive at diagnostic pictures based on personality traits; and finally, the psychodynamic line deals with reconstructing personal and family history and going to reveal childhood traumas. Common to all these perspectives are: the search for causes, the formulation of the diagnosis and the direct involvement of the child.

From a strategic point of view, this way of operating would lead to a considerable increase in confusion, staging a whole series of dynamics and new variables that are difficult to manage, with the result of considerably lengthening the time and stopping the finding of a concrete solution.

We must also point out that these perspectives tend to overlook the fact that there is a continuum between a "normal" and a pathological behavior and that when it comes to psychological disorders linear causality is not valid but rather cause and effect feed on each other. This is why a different evaluation criterion is needed, as well as a different way of intervening.

The strategic intervention is decidedly pragmatic, in line with its constructivist matrix, therefore it aims at operational and not descriptive knowledge; and the data on effectiveness and efficiency reported by the Strategic Therapy Center amply support this way of proceeding, and it is precisely based on the data that we reaffirm the importance of not pathologizing / labeling young patients and of operating through their parents.

I conclude by borrowing the words of the philosopher William of Occam: "everything that can be done with little is done in vain with much".

Dr. Daniela Birello (Official Psychotherapist of the Strategic Therapy Center)

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 Dictionary of Psychotherapy, Garzanti, Milan.
Nardone G. and the team of the strategic therapy center, 2012, Helping Parents Help Their Children, Life Cycle Problems and Solutions, Ponte alle Grazie, Milan.