Working With Parents Makes Therapy Work (Book Review)

Author:  Novick, K.K. and Novick, J.
Publisher:  Rowman & Littlefield
Reviewed By:  Jill Bellinson, PhD , Fall 2008, XXVIII, No. 4, pp, 43-44

A book on working with parents in child therapy is sorely needed in the analytic community. Every child in treatment comes attached to one or more parents—parents who have to provide transportation and funding for the therapy to even begin—and every child therapist faces a myriad of questions about how to treat those parents. Should they be seen with the child or separately? By the child’s therapist or a different one? How often? Should they be talking about their own issues or just the child’s?

We make decisions about how to work with the parent(s) of every child we see, yet we get comparatively little training in this part of the work, and there is relatively little written about the topic. The Novicks, who have provided us with decades of wisdom in the child analytic field, have now offered a remedy in this valuable resource, Working With Parents Makes Therapy Work.

There is little new material in the book; it is largely a compendium of papers published in the Journal of Infant, Child, and Adolescent Psychotherapy and the Journal of Psychoanalytic Social Work in 2001 and 2002. Yet it reads like a new work, since the authors have woven their previous papers together to form a new whole: a whole book about working with parents, beginning to end.

The book begins with two new chapters, outlining the history of parent work in analytic treatment and the assumptions behind working with parents. The history of publications in the classical analytic field can be described in less than a page. Other than a handful of papers written by the Furmans, to whom this book is dedicated, there is very little literature. From Freud’s first work with Little Hans’ father, (1909), to the current book, the authors cite fewer than a dozen papers on parent work.

The Novicks offer several interpretations of this neglect: Freud’s minimizing the role of the preoedipal mother in his concentration on the rivalrous father; classical analysis’ focus on the internal world rather than external influences; early child analyst’s attempt to apply adult principles, without parents, to child work; the practice of assigning parents their own individual analysts; child therapists’ rescue fantasies and concomitant hostility toward actual parents; the transferences and “counterreactions” stirred up by the parents we believe to have failed our young patients or who may be judgmental or jealous of us.

The authors largely ignore the literature in relational analysis (cf., for example, Altman et al (2002), Pantone (2000), Spiegel (1996)), where there has been more consideration of the significant others in children’s lives and to therapists’ attention to those objects. The book does not contradict the relational approach, merely fails to make use of the contributions there.

Chapter two discusses the theoretical assumptions underlying the Novicks’ work with parents. They suggest that the goals of child treatment are twofold: to return the child to a better developmental path, and to reestablish a good parent-child relationship. The rest of the book goes on to elucidate a number of therapeutic tasks with the parents of children in treatment to fulfill these dual goals.

The Novicks have two basic concepts that are woven throughout the book: that there are phases of treatment with parents just as there are phases of treatment with patients, and that there are “closed” and “open” systems of self-regulation which define people and relationships.

I found the first idea—that parent treatment proceeds through discrete phases—to be the most helpful aspect of the book. The Novicks suggest that just as with any patient of any age, therapeutic work with parents moves from evaluation and beginning treatment through a middle stage of working-through, to a termination and posttermination phase. The book lays out full descriptions and careful prescriptions for each of these phases of parent work, in a book rich with clinical examples.

So, for instance, the authors say the first meetings with parents should be directed toward information gathering, about the child and the family, and establishing a relationship with the parents so they can allow the child to be with the therapist as a significant other. The authors suggest that this is likely to stir up parental feelings of guilt or inadequacy, and parents could resent being excluded. They may blame themselves, their child, or someone else in the child’s life, such as teachers or babysitters. And they may press for an instant fix. The therapist’s job in this phase of the treatment is to acknowledge the parents’ good intentions and sincere feelings for the child, establish the frame and confidentiality guidelines, and resist parent pressure for immediate change.

Parent work will be very different at the other end of the treatment, when the child is moving toward termination and the parents simultaneously face losing the therapist. Parents at this stage may feel abandoned and discarded, and they may wish to prolong the treatment or terminate preemptively rather than allow the child and therapist to dictate when and how they stop. The therapist’s job in this phase, the authors suggest, is to address the parents’ feelings of loss and help them in the transformation to life without their child’s therapist.

The Novicks offer ideas for parent work at beginning, middle, pretermination, termination, and even posttermination periods of treatment, for children and adolescents of all ages, and include ideas about parents’ dynamics, defenses, and resistances at each stage as well as instructions for therapists to be effective with each. They address stumbling blocks a therapist might face and provide solutions to potential difficulties.

Some of these suggestions seem a bit pat, as if all one has to do is to follow the book’s instructions and success will always ensue. For example, five-year-old Henry (p. 70-71) had parents who were riddled with guilt and “plagued with lifelong self-doubt.” The therapist told the parents that Henry in fact admired them and wanted to grow up to be just like his father. The information made the parents surprised and touched, led the father to spend more time with Henry, and increased Henry’s ability to stay in his sessions and work with his therapist. This seems to be an incredibly rapid and magical cure. The book is a valuable compilation of ideas and insights, with many useful suggestions for working with parents at all stages of treatment, but I wish it had presented a more layered picture of the many complex challenges in parent treatment.

The second of the Novicks’ basic assumptions is that there are two systems of self-regulation related to self-esteem, a model they have been developing for several years. The Closed system is a pathological system in which parents respond to the child’s needs through power or sadism. Parent and child in this system get locked in a cycle of helplessness, aggression, frustration, and rage, and the result is low self-esteem and pathological symptoms. The Open system is a more adaptive system of response in which parents can absorb their own feelings of ineffectiveness and provide the child with love and joy even in the face of frustration (their own and their child’s); this results in higher self-esteem and growth for both parent and child.

I found this concept to be less useful than the rest of the book. Not that it’s necessarily wrong (who could argue with the idea that it’s better for a parent to be open and accepting rather than devaluing and aggressive?), but that it did not provide additional clarification. It seems reductionistic: real life parents are some combination of Open and Closed, accepting and negating, able to support their children’s autonomous growth and frightened or envious or threatened by it. Real life parents have dimensions to their childrearing in addition to being Open or Closed.

Fortunately, the value of the book does not require one to accept the Open-Closed System construct or to limit one’s repertoire to the Classical analysts. The Novicks have offered us a significant volume that focuses on the under-presented field of work with parents of children in therapy. With or without their two-system model of self-regulation, with or without the fields of relational, object-relations, or self psychology, this book is an important addition to the literature and can be a resource for child therapists at all levels of experience.

References

Altman, N., Briggs, R., Frankel, J., Gensler, D., and Pantone, P. (2002) Relational child psychotherapy. New York: Other Press.
Freud, S, (1909) Analysis of a phobia in a five-year-old boy. Standard Edition, 10, 3-149.
Pantone, P.J. (2000) Treating the parental relationship as the identified patient in child psychotherapy. Journal of Infant, Child, and Adolescent Psychotherapy, 1: 19-37.
Spiegel, S. (1996) An interpersonal approach to child and adolescent psychotherapy. Northvale, NJ: Jason Aronson, Inc.

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