Psychotherapy with Children in Switzerland

Psychotherapy with Children in Switzerland (In: The Japanese Journal of Play Therapy, 2012, Vol. 11, No. 1, p. 110-112)

«The reason why I immigrated into this country was the way psychotherapy was done with children!» a well established American Psychotherapist told me years ago, when I asked him what had motivated him to move to Switzerland. As native from Salt Lake City, Utah he read books written by Hans Zullinger, as Swiss psychologist living in Ittingen near Bern. Zullinger proposed a then revolutionary approach. Instead of instructing children what they should do, he suggested that we let them play. He was convinced, that children express their emotions, desires, wishes and complexes when they play. In play they express their soul. Zullinger was also certain, that play has a healing effect. By playing the child would mend emotional difficulties and problems. According to Zullinger our duty as psychotherapist is to establish a place and time, where they feel save and comfortable, so they can engage in playing. Their actions, their behaviour and decisions would reveal deeper emotions and help us understand them. According to him playing was not just a mean to decipher what was going on in the child, but also the key to resources. By playing a child would discover his or her potential and be able to develop new insights. Playing was a way to start a healing process. When playing the child would become more confident and gain a new perspective. Our role as psychotherapist was to encourage child to play and give the occasional input, in order to understand what was going. The psychotherapist functioned as facilitator and interpreter of a psychotherapeutic process.

The days of Zullinger are long gone. Most child psychotherapists don’t realize, that in his days Zulliger was a worldwide acknowledged psychotherapist. Since these days child psychotherapy in Switzerland has gone trough many changes. In the years after Zullinger’s death his psychotherapeutic approach was more and more criticised. The psychoanalytical jargon and interpretations were frowned upon and often considered to far fetch by some. How could a stick be a phallus-symbol or a pond of water a reminiscences of a possible child oedipal drama. The interpretations, which Zulliger offered, were considered too rigid. His postulation that free play therapy was a method, which enabled the child to unearth hidden potentials and energy survived though. Although one did not concentrate on play therapy the way Zullinger devised it, the use of play on therapy become accepted.

Among the child psychotherapeutic community in German speaking Switzerland the focus moved to the family. The family was perceived as a system, with distinct roles, expectations and dynamics. Systems strive for equilibrium, cohesiveness and continuity. Problems of children should be understood in the context of the family. The child enacts a complex or problem, which he or she unconsciously detects in the family. Neurosis, fears and compulsions of children were viewed as possible results of pathological family dynamics. Maladaptation or aggressive behaviour was considered a family symptom. The child might abide the unsolved issue of the parents. According to this approach the unconsciousness was not an autonomous power and in the centre of attention of the psychotherapist. Instead the psychotherapist tried to untangle problematic family relations, diffuse explosive links to parents or siblings. Often every one of the family were asked to be present during sessions and psychotherapist took up the role as mentor or coach. Children and adolescents were understood to be dependent on the family unit. The behaviours and emotions of the patient depended on the dynamic, role and complexes in the family. The child’s behaviour was considered as a symptom for deficiencies within the family system. Family therapy is still very popular in Switzerland, but has passed its peak. Fewer therapist rely on this approach.

In the late Eighties of the last century the focus changed again. Sandplay got known and practiced as one important approach in individual therapy. Children and adolescents were now also contextualized more and more their peer. The colleagues and friends were perceived as influential on the behaviour of a child or adolescents. The fads, trends and idols of the youth culture were now considered a major factor in the development of children and adolescents. The duty of therapist was now to understand a child and in respect to the culture he participated in. Violence, drug abuse, disobedience and addictions were now perceived as being influenced by the youth culture. When a child or adolescent is acting aggressively in school, then television or video games were blamed. When a child lost interest in school, then it was seen as a result of bad peer influence. Because of this focus approaches were favoured, which allowed the psychotherapist to emerge and understand the culture young people admired. This perception was at the origin of group therapy. Face to face settings and long individual therapies with children or adolescents were and are still being widely practised, but group approaches were beginning to get more and more attractive. The basic rationale being, that in order to understand a child or adolescent one had to provide vessels, were the young people could present themselves they way they are. Group therapy was considered appropriate, because the child or juveniles would act more genuine and reveal his or her secrets, fantasies and goals. In the individual therapy there was always the problem of adaption.

Groups were organized and offered by various educational centres, out-patient units and therapist working privately. Various approaches were practised: behavioural training groups, cognitive approaches, and play therapy group. It became clear, that the therapy groups needed some structure and rules, so they would not turn out to be too chaotic, but at the same time the session could not be too strict. If the children had to abide many rules, then the session looses their function as a vessel for the children. The sessions become educational and don’t differ a lot from normal schooling. If the session were conducted too openly, then chaos might be impending and the group would get out of control. Therapist tried to provide children and adolescents with a vessel, where they would reveal their fantasies, worries and wishes, but at the same time they had to prevent the group sessions ending in disarray.

This was the moment Mythodrama was invented. In Mythodrama a semi-structured approach was offered, which allowed the therapist to keep some order, but at the same time made it possible for the children to express their fantasies, believes and emotions: Greetings, warm-up, story, imagination, enactment, transfer round and concrete change. Mythodrama integrated several approaches. Play therapy, group therapy and some elements of behavioural therapy. By choosing this structure or routine, the therapist has a certain control of what is going on in the group and at the same time spontaneous actions are allowed. The fantasies, fear and anger of the children can come to the surface and help the therapist understand what was or is going on inside the child. In Mythodrama one works with stories, which encapsulate the experiences of the children or adolescent. The stories are specially selected according to what the therapist perceive are the issue of the group member. They reflect on a symbolic level the challenge the group members have to cope with. The stories contain images and figures, which help the group member to understand themselves and create a mental ease in order to cope with their challenges and problems. Mythdrama groups usually consist of 4 to 10 children or adolescents and last between usually two hours. Mythodrama as group approach is widely practised in Switzerland, Austria and Germany. The method originated in the department of group therapy for children and adolescents at the educational counselling centre of the state of Bern.

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