Child Psychotherapy: From Initial Therapeutic Contact to Termination (Book Review)

Author:  Lovinger, Sophie L.
Publisher:  Northvale, NJ: Jason Aronson, 1998
Reviewed By:  Diane Gartland, Spring 2002, pp. 43-44

As one of Dr. Lovinger’s devoted former students, I was quite pleased to be the beneficiary of a collection of her many teachings about child psychotherapy compiled into one small, interesting and practical volume. How many times I thought to myself, while attending to her instruction in supervision or in class, “I wish everyone who sees children in therapy could hear this.” I got my wish. Now everyone can know what I learned from Sophie Lovinger. Of course, the wisdom one has access to as a reader is not equal to that of a supervisee but Dr. Lovinger has done a marvelous job of providing an inkling of what it was like to sit in her office and process sessions with a child.

One is drawn in by her perspicacity in capturing the charms of childhood while regarding this most remarkable of populations in a sincere and mindful manner. As well, her volume is an easy read; free of the tortuous, abstracted, and alienated treatment of the subject that characterizes so many similar works. She writes about children and psychotherapy like an Olympic diver dives, with an easy grace both captivating and effortless, insinuating that anyone could do it if they only had the courage and motivation to try.

Lovinger’s book is reminiscent of the writings of Selma Fraiberg, the distinguished Michigan social worker-psychoanalyst, in one essential aspect. It consists in the prodigious capacity for slipping inside the skin of the child and to know (remember) what it is (was) like in the child’s world. Dr. Lovinger is the quintessential child psychoanalyst in the only way it makes sense to be one: firmly ensconced in the developmental perspective and perennially concerned for looking at life from the child’s point of view. In this regard, there is always a respect for the cognitive skills, the developmental summons, the family circumstances and the conditions upon which the therapeutic contract and frame is founded...all areas which are frequently dismissed by the untrained and/or indifferent would-be professional.

We begin at the beginning, naturally enough. A parent calls the therapist. The therapist thinks about the child, the parents, the family, the sessions for parents and child in this child-centered (but not child-only) endeavor. An assessment is initiated. The therapy situation is created. The adventure as experienced by the pre-school child, the latency aged child, the adolescent is embarked upon. The objective? To help the child establish or re-establish himself/herself into his/her appropriate developmental level sans the internal conflict, symptomotology and isolation with which he/she entered the therapeutic relationship. Another objective that Dr. Lovinger keeps in mind is the finding and re-establishing of the “lost empathic bond” between parent and child which is assisted by conjoining on the parents the job of being “co-therapist(s) at home with their child.”

Ever the analytically-informed and inclined therapist, Dr. Lovinger discusses resistances, transferences, countertransferences, dreams, interpretive stances, termination issues...always within the context of the principal child therapy modality—play—and always with an eye toward the developmental vicissitudes. But this work is no pedagogic declamation. Dr. Lovinger provides much down-to-earth guidance about such ordinary matters as establishing a child therapy (play) room, stocking it with suitable toys, utilizing psychological tests for evaluation and understanding refusals, rage reactions and enactments. In this respect, her work is much like a manual of operations and would be an excellent resource for the beginning clinician.

Dr. Lovinger strengthens her “how to” approach with caveat and commentary. One pertinent dictum is the notion that interpretations should be specific and concrete. “What is addressed or attended to by the therapist could be looked at as an interpretation even though it is not technically considered one” (p. 98). The process is similar to all analytic therapy but the attitude toward interpretation in the case of children is distinctive: “interpretations should not provide children with information they would not have been expected to gain given their developmental status”(p. 101). In consideration of the frequently found unevenness in development; the lags and premature advancements created by hyperstimulation (often sexual), this counsel seems apropos. To do otherwise, to adultomorphize (or, for that matter, infantilize) would appear to sabotage the goal of integration in personality elaboration. While such a caveat may seem trite to those of us who dedicate many of our waking hours (and often sleeping hours) to the cause of understanding others and ourselves through psychoanalytic thought, it is by no means a self-evident proposition. In the average managed-care clinic, more preoccupied with financial than with clinical solvency, there seems a real need to restate the obvious for “clinicians” who will see children from exigency rather than expertise.

As I read, I was occasionally absent and preoccupied by memories...of my own childhood, my child patients, my training years and “Sophie-isms.” “During this practicum, you are not to ask questions in therapy. It will be difficult.” Difficult it was-- but easier to be with my patients than it ever had been before. And it struck a chord of awareness and conviction. Of course. How could it be otherwise? The only way to help was to reflect the substance of the individual, not to always grasp for more in an unsatisfied manner and, indeed, as a starving child who always wants to know why but never really hears the answer despite many offerings. Such was the opening of a particular “door of perception” courtesy of Dr. Sophie Lovinger. As she tells it in her book: “Confrontations are experienced by the child as a violation of his integrity. A direct question is experienced as a confrontation and an expectation to give of an already impoverished store of childhood experiences” (no less true, I’ve found, of adults in most of the states of mind with which they typically enter therapy).

Furthermore, insights about past occurrences, behaviors, and relationships are beyond the ability and contrary to the developmental pushes of children across the childhood and early adolescent years. Children have greater interest and investment in the here-and-now aspects of their lives. Putting the past in perspective, understanding past relationships, and the ability to reflect upon oneself are functions usually beyond the abilities of children” (p. 100).

Dr. Sophie Lovinger has been a member of the Michigan Psychoanalytic Council since its inception. She has served in many capacities, most recently as the Vice President for Education and Training. She and Dr. Robert Lovinger have been staunch believers in the value of an analytic education at the graduate school level. Having moved to South Carolina, their influence on our searching, curious lives will be sorely missed. However, their legacy of psychoanalytically-informed practice survives through their indulgent mentoring of many students and supervisees in Michigan. It is a happy day that has seen a portion of this bequest endowed in “Dr. Lovey’s” most recent published work.

Reviewer Note

Diane Gartland is a clinical psychologist in Farmington Hills, MI. This review was previously published in the newsletter of the Michigan local chapter.

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