For this edition of the Bulletin, I spoke with Ann Marie Sacramone (USA), who co-chairs the committee with Susi Federici (Italy), as part of an effort to give our membership a closer look at IARPP’s various committees.

Matt: At the moment we are speaking, Ann Marie, we are several weeks into the coronavirus pandemic. Clinicians worldwide have rapidly shifted to providing remote therapy. The challenges, and the occasional new opportunities, have been much on our minds, including in our just-concluded online forum, “Working During the Coronavirus Health Crisis.” 

One area of this adjustment that came up only glancingly in this forum is how the cessation of in-person treatment is impacting clinical work with children. So many adolescents live immersively with their screens, which has its pros and cons in the transition to so-called telehealth therapy. But I imagine the transition to remote treatment may be more problematic and disjunctive for analysts working with children, perhaps especially if the modality is play therapy.

What’s your sense, from your own experience and from what you’re hearing from colleagues, as to how things have been playing out in these initial weeks for child and adolescent treatments?

Ann Marie: At first, many play therapists did not feel confident in playwork with children online. We are used to moving in space with children. We are used to how it feels to share a three-dimensional space and to the resonances of our mirror neurons, physiologies, and movements together. Clinicians have grappled with how they can continue to provide a sense of security, companioning, and ‘staying with’ their clients while they are so far apart.

Many clinicians and children of all ages (I am doing parent/infant treatment online) have adapted their abilities to use technology to sustain treatments well. New doors open with a different modality. We learn what home is like for our child clients, and what home means to them in a new way. We learn a lot about what it means to be apart from important relationships. We have an opportunity to work with parents in ways we didn’t have before. We find strategies to communicate, from a distance, that we are still here and close. We are surprised at what we can engage in from a distance.

Because child therapists play, we tend to be resourceful and creative. Many of us have shared ideas with each other about games and materials that can be used online with our clients.

And what of tougher situations?

The same inequalities that plague our world, plague children in treatment. Those that do not have access to technology are sometimes left without treatment or education – even food and safe housing. Others who are lucky and resourceful or who have supportive, talented and resourceful schools and/or parents sometimes find ways to access the internet and continue, with great, great effort. Some therapists’ hearts break when therapeutic relationships with parent and child clients without resources just stop.

So resourcefulness fosters continuity, but there is intense loss as well. I’m glad to know that you and your colleagues are finding ways to proceed with treatment during this period of intense dislocation with its potential for intense traumatization and retraumatization.  

Let me switch gears. This conversation is part of the Bulletin’s project of learning about the purpose, philosophy and workings of all of IARPP’s committees. In that spirit, I’ve been curious to know about your committee’s recent decision to add “& Parent” to its title (i.e., The Child, Adolescent & Parent Committee). How did the thinking around this decision evolve?

From the beginning of the child interest group, founded by Neil Altman (USA) and Esther Bamberger (Israel) in 2009, the focus was on working with children in their relational systems. When the interest group became a committee, we immediately felt we needed to acknowledge the systemic nature of our work with children even in the committee’s title. A major concern of our committee is the intergenerational transmission of trauma, where the relationship of parents and children is central, creating the conditions in which children develop. In fact, since adults and children are always in relation to each other in some critical way (representationally, intergenerationally, in neighborhoods, schools, communities, parents raising children, etc.), perhaps a better question is, “Why does it occur to us that we might have a committee that focuses on child therapy without including parents?” I think this question leads us toward an essential consideration of the depth and complexity of our human and environmental interrelatedness, and why we might not keep that in mind.

In fact, Laurel Silber, whose 2012 papers on “Ghostbusting” anchored our last webinar, commented that before the relatedness of work with parents and children was acknowledged in the title of our committee, she had left IARPP. “That decision,” she said, “was the result of feeling that IARPP was continuing in the hierarchical structure of the classical model, that work with children and adolescents was relegated to an interest group. The work with children was still kept in a separate camp within the association, with the power residing with the adult relational analysts. In other words, relational between adult analyst and their adult patients didn’t feel comprehensive enough in my view.”

“The relational turn occurred in part,” Laurel continued, “in recognition of the influence of the parent – the inclusion of maternal subjectivity – to the interaction. The committee’s inclusion of ‘parent’ in the title signaled to me that the relational turn might be becoming more authentic within IARPP. I reapplied for membership with this hopeful sign.”

This brings me to my next question. What can you tell us about that webinar, entitled “Relational Child Therapy and the Intergenerational Transmission of Traumatic Experience,” which Laurel Silber led in December 2019?