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A New Therapeutic Model

Research has shown that neither temperament nor personality accounts for differences in resilience as much as power does—the power to access what others make available and accessible, and the power to influence how others perceive us. While Jake could easily be seen as a traumatized child in need of protection, he preferred to see himself as a capable boy with a contribution to make to those he cared about.

To my knowledge, Jake was never again sufficiently at risk to require CPS involvement or another mental health intervention. In fact, I recently heard from Jake’s school social worker that he’d advanced to the next grade and was making academic progress. In my experience with clients like Jake, I’ve learned that if limited, short-term involvement can get them past developmental hurdles without pathologizing them, they often don’t need further mental health intervention. Collaborating with clients in the way I’ve described without seeking some perfect solution or total transformation is helpful to them and means that my work with them is easier, quicker, and less burdensome for everyone concerned.

CASE COMMENTARY
By Janet Sasson Edgette

Michael Ungar’s case study of 13-year-old Jake was a terrific lesson in clinical economy and the impact of a clinician’s bearing on the therapy process. Ungar, a leading researcher in the area of resilience in children, delivered a lean yet unhurried therapy in a case that practically begged for intervention overkill. Imagine how easy it would have been for a therapist to go to town on this one. The boy came gift-wrapped with a cluster of diagnoses, and then, of course, there was the climactic event of finding his father hanging from a hot-water pipe.

However, instead of rushing in with a corresponding index of treatment objectives, Ungar settled into a comfortable back and forth relationship with a boy who, for the time being at least, wanted most of all to keep his father from killing himself. Ungar’s easy-going manner and understated compassion lent the therapy a composed and reassuring feel, and struck me as a fitting match for Jake—much better than the sometimes gushing (and often claustrophobic) empathy expressed to children whose case histories tug at our heartstrings.

Ungar saw Jake as a resilient kid—resilience being defined, in part, as a child’s ability to navigate his way to the psychological, social, cultural, and physical resources that will help him withstand adversity. A second part of resilience has to do with a child’s ability to negotiate for these resources to then be provided and experienced in ways that are most meaningful, which Jake did, most obviously in his successful insistence that he remain involved in his father’s treatment. I loved Ungar’s willingness to take up Jake’s cause, and was taken aback by his ability to broker the deal. I don’t know how often other therapists could make that sort of thing happen, but there’s still a great takeaway here: the importance to children of having a voice in the processes affecting them that’s genuinely taken into consideration.

Ungar’s conceptualization of resilience seems hopeful, emphasizing as it does children’s capitalizing on community resources, rather than having to rely only on their own particular personality or temperament. Nonetheless, I can’t shake off the idea that another 13-year-old boy with a history similar to Jake’s could have reacted quite differently to the same services that Jake was offered. The power to access resources constructively, which Ungar notes is partly what determines resilience, seems to me to be very much a function of personality. For example, Jake’s request to be placed on his father’s treatment team seemed powered by a sense of entitlement—not the entitlement of someone who’s demanding and self-absorbed, but the healthier kind that comes from self-respect and a belief in the authority of one’s voice (a premature, but not unreasonable, adaptation on his part, given his parentification). Figuring out how much of this Jake brought to the table on his own and how much was fostered by his interactions with Ungar, his guidance counselor, and teachers could, I imagine, be tricky stuff.

I appreciated Ungar’s concluding point about letting kids leave therapy easily when enough has been done. It’s a refreshing break from the possessiveness some clinicians show in relation to their clients. There’s always more to do, and in a case like Jake’s, the to-do list could go on indefinitely. I could only hope that I’d have had the chance to position Jake to see around the next corner before his exit from therapy. For instance, how will he know when his dad is safe enough for him to drop his vigil? What does it say about him and his family that he thought he was the only one to do the job? But that’s just me.

Sometimes you can’t do it all at once, and you may not even need to. Besides, the easier we make it for kids like Jake to leave, the easier I think we make it for them to come back when they’re ready to do more.

Michael Ungar, Ph.D., is principal investigator of the Resilience Research Centre and Killam Professor of Social Work at Dalhousie University in Halifax, Canada. His books include Researching Resilience, edited with Linda Liebenberg, and Nurturing Hidden Resilience in Troubled Youth. Contact: Michael.Ungar@dal.ca

Janet Sasson Edgette, Psy.D., is a clinical psychologist practicing in the suburbs of Philadelphia. She’s the author of Adolescent Therapy That Really Works: Helping Kids Who Never Asked for Your Help in the First Place and Stop Negotiating with Your Teen: Strategies for Parenting Your Angry, Manipulative, Moody, or Depressed Adolescent. Contact: janet@janetedgette.com; website: www.janetedgette.com.

Tell us what you think about this article by leaving a comment below or sending an email to letters@psychnetworker.org.

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