Magical Moments of Change: How Psychotherapy Turns Kids Around (Book Review)

Author:  Terr, Lenore
Publisher: W.W. Norton
Reviewed By: Saralea Chazan, Winter 2008 (Vol. XXVIII, No. 1) pp. 48-49

This is a book about change, specifically about how kids change in psychotherapy by one of the authorities of our times. Lenore Terr is a familiar name for all of us working in the area of trauma. She is known for both her clinical work and her research. So it is with eager anticipation that I began to read this book and learn from its insightful observations, I was not disappointed.

Dr. Terr begins by telling us about how she came to write this book. She cites those special moments “when something passes from a child to me—or from me to a child…and this ‘something’ impels the child to begin looking at himself differently” (p.2). From this changed perception emerge altered behaviors and the child is changed for the better. I noted immediately the emphasis not only on the immediate moment, but also the element of “togetherness.” Emotional growth and health, the author tells us, are to be found in these moments that draw people together. It is out of this shared togetherness that a moment of change, a turning point in the child’s life, is born.

Dr. Terr’s own sense of “togetherness” is at the forefront of this book. She cites Selma Fraiberg as one of “four great spirits” mentoring her professional growth and development. It was probably with Professor Fraiberg that she observed the value of bringing colleagues together to gain group support and wisdom in understanding a problem. It was also probably from Professor Fraiberg and The Magic Years that she learned about magic. As Dr. Terr confides to us near the end of this book, she is a believer in magic. This volume brings together the wisdom contained in 48 vignettes (including 6 of her own), collected over a period of three years from 34 different psychiatrists (including herself). These are professionals that form part of Dr. Terr’s professional network. She has interacted with them for varying periods of time, in different places; they all share a common commitment to working with children and their families. Their identities and professional workplaces are identified in an appendix. This collected virtual database of important moments (Daniel Stern, 2006) lends credence to the significance of the “meeting of minds and hearts,” those glimpses of mutual understanding, accounting for change in child and adolescent psychotherapy.

This book is divided into four parts. Part One addresses how the professional persona can be used in psychotherapy. Part Two addresses creating the “right” atmosphere for treatment. Part Three addresses how to connect meaningfully with a child. This part describes primarily supportive interventions. Part Four describes how the therapist can react in a timely, “pungent” fashion. This part describes primarily expressive interventions. An extremely enlightening Epilogue deals with the issues of looking back and looking forward, two critical sources of momentum in child treatment. I will not attempt to summarize each of these sections of the book separately. Suffice it to say, each section is full of cogent comments and observations enhanced by a selection of clinical vignettes chosen from the collective databank. The clinical vignettes are well chosen and give much pause for thought. Indeed, I found this book a slow read, as I paused to ponder each of the clinical examples at some length and let my own reverie explore freely the many memories from my own repertoire of clinical experiences.

It is the freedom to conjure and explore that Magical Moments evokes. The book’s message is at no point doctrinaire, although the author certainly voices opinions and makes suggestions. Perhaps it is the collective voices that elicit this openness to think and then to think some more about the nature of human agency and the actions implying change.

I will select three ideas that were of intriguing to me. The first idea to think about is the persona of the child therapist. Of particular interest was the notion of the importance of the “real self.” As Dr. Terr comments, kids almost always feel most comfortable with “real” people. She notes that “real” behavior holds up best on a day-to-day basis, to be supplemented when needed by the roles of “teacher” or “investigator.” In fact, she points out, the “real me” turns up in tiny, tiny doses even when the therapist is not thinking about it. However, at times the real person of the therapist shows up in larger quantities. Dr. Terr quickly qualifies the effect of these exposures as being relative to the timing, the prior relationship, the child’s problems, and immediate issues. However, sometimes these sudden glimpses can shake a child out of longstanding inertia. This statement is then explored, elaborated upon and detailed in four vignettes, each vignette followed by an explication of the meaning of the moment. In sum, Dr. Terr is suggesting that not every psychotherapeutic change comes through insight, new awareness and cognitive reworking. Some comes from the therapeutic relationship itself, a corrective relationship with a fine therapist.

A continuing therapy case of 15 years duration, of a child named Cammie, “more animal-like than human” when brought to Dr. Terr at 29 months, serves as a vehicle for further integrating this book. Cammie had witnessed the murder of her infant sister. The reader follows the thread of Cammie’s treatment that is woven in and out of the volume, alongside the unfolding of the book’s narrative. The spirit of play activity is integral to Dr. Terr’s very unique understanding of how “to be” with children. It is of particular note when 4 year-old Cammie inspects her 3-piece Russian dolls and declares the larger matrushka doll to be “Lil Red Riding Hood.” A raccoon puppet becomes “wolf,” who pounces on an invisible “grandma” and kills her. Next, the wolf falls upon Little Red Riding Hood and eats her up. This becomes a ritualized game for Cammie. The character Grandma is acted upon, but never appears in person. Dr. Terr wonders: “Could this character represent Cammie’s dead infant sister?” Cammie seems to feel no pain for the victims. Rather she develops a capacity to “identify with the aggressor” and “glorifies” in its use. Dr. Terr, an innovator in understanding and giving recognition to the existence of PTSD as reflected in the traumatic play of children, gives an extensive rendition of the unfolding of this aggressive theme over time in her child patient’s play narrative. These extensive descriptions of the function of play activity in facilitating Cammie’s emotional development are another enlightening cameo in this valuable book.

The third idea of particular interest to me in this book was the analysis of the role played by time—present, past and future—in the treatment of children. Here Dr. Terr discusses the meaning of the spontaneous “gesture.” She extends Winnicott’s concept to include all kinds of interactive moments between therapist and patient that prove to be sustaining and meaningful, despite their brevity. She stresses the importance of counterintuitive moments that make a difference, surprises that are blurted out on impulse, that eventuate in shared meaning. At these moments we are getting closer to the “magic” to which this author eludes. In fact, in Dr. Terr’s work with terror and horror, the unimaginable known seems balanced with the presence of magic, an unknown known, the magic that acts to heal and bind the wounds of the unspeakable.

So, in sum, I recommend this book to all readers interested in learning more about the treatment of children and their families. It is written in a style that can be understood by both laypeople and professionals. It is an ideal textbook for a class studying agents of therapeutic change. Moreover, it provides us with much of real interest and much to admire in the magical work of Dr. Lenore Terr.

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