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The Quiet Child · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello, this is Kim Lee, Child and Adolescent Psychotherapist.
• 0:04
  SPEAKER_00: This is the first episode in the new series from Insign the Consulting Room.
• 0:12
  SPEAKER_00: I'm going to introduce you to a number of children throughout this series.
• 0:18
  SPEAKER_00: I'm going to talk about why they come to me, why the families are concerned, schools and sometimes courts and other agencies.
• 0:29
  SPEAKER_00: And I'm going to talk to you about how I understand these things, how I understand what's happened, how I go about trying to help families to find a way through.
• 0:43
  SPEAKER_00: Some of the stories may be a bit uncomfortable.
• 0:47
  SPEAKER_00: They may include things which are distressing.
• 0:54
  SPEAKER_00: But I communicate them because it's the real world.
• 0:58
  SPEAKER_00: And the more we understand these things, the more we can help.
• 1:03
  SPEAKER_00: Now in this first episode, I want to talk about the child who seems fine but isn't.
• 1:10
  SPEAKER_00: And this is because there are some children who never really cause concern.
• 1:17
  SPEAKER_00: They manage, they cope, and they get on with things.
• 1:22
  SPEAKER_00: And they seemingly slip under the radar because they're not making a fuss.
• 1:29
  SPEAKER_00: And so far as everyone can ascertain, there is nothing to be concerned about.
• 1:38
  SPEAKER_00: Sometimes they're described as easy or no trouble at all, or very mature for their age.
• 1:46
  SPEAKER_00: When I hear that, I always think, oh dear.
• 1:50
  SPEAKER_00: And because of that, no one really looks too closely.
• 1:55
  SPEAKER_00: So in this episode, we begin a series on the child who seems fine but isn't.
• 2:05
  SPEAKER_00: In clinical work, it is often not the child who shouts loudest, who shouts the most and who concerns us the most.
• 2:18
  SPEAKER_00: It's the child who makes no noise at all.
• 2:21
  SPEAKER_00: Because absence of disturbance can sometimes reflect an absence of connection to the child's own internal world.
• 2:32
  SPEAKER_00: Now, from a psychodynamic perspective, that's the theoretical clinical framework, we might begin to think about this as a kind of adaptation.
• 2:45
  SPEAKER_00: Somehow the child has learned to adapt, but at a cost.
• 2:52
  SPEAKER_00: A famous child psychiatrist Donald Winnicott spoke about the false self.
• 3:00
  SPEAKER_00: That's a way of being that kind of develops when a child begins to organize themselves around what is expected or their experience of what is expected rather than what is truly felt by them.
• 3:16
  SPEAKER_00: It's not conscious and it's not deliberate, it's a reaction to the environment.
• 3:25
  SPEAKER_00: They have learned to become the way they are because the environment implicitly tells them that is the way to survive.
• 3:37
  SPEAKER_00: I remember sitting with a child who had never ever been a problem, good at school, polite and thoughtful.
• 3:47
  SPEAKER_00: She came into the room and sat down carefully and smiled, not warmly, but correctly.
• 3:55
  SPEAKER_00: And when I asked her how she was, she paused for longer than you might expect and then said I don't really know.
• 4:08
  SPEAKER_00: Now that moment tells us something important because to say I don't know how I feel is often not so much a lack of language, although that can be true as well, not having the words to describe the internal world, but it's a lack of access.
• 4:30
  SPEAKER_00: From an attachment perspective, this comes from the work of John Bowlby.
• 4:37
  SPEAKER_00: A child develops an internal working model, a kind of template, which is based on how their emotional experiences are received and made sense of.
• 4:50
  SPEAKER_00: So if the expression of feelings is welcomed, understood, or held, then the child develops a sense that my internal world not only is real, but it matters.
• 5:04
  SPEAKER_00: But if feelings are overlooked too much, or just quietly unacknowledged, the child may begin to organize themselves differently.
• 5:13
  SPEAKER_00: Now there are lots of reasons why that might be the case.
• 5:17
  SPEAKER_00: There are lots of reasons why the recognition and understanding of a child's needs may be unacknowledged.
• 5:26
  SPEAKER_00: We'll come on to more of that.
• 5:30
  SPEAKER_00: Somebody called Wilfred Beon, another famous psychoanalyst, described the importance of containment.
• 5:36
  SPEAKER_00: What he was describing was emotional containment.
• 5:40
  SPEAKER_00: And that is the process by which a caregiver recognizes the emotional experience of the child, is able to make a kind of sense of it, and then is able to respond and return it in a way that can be tolerated.
• 5:58
  SPEAKER_00: Now, when this is limited in any way, the child might not learn how to think about their feelings.
• 6:07
  SPEAKER_00: So instead, they move away from them.
• 6:11
  SPEAKER_00: Now, because the child who seems fine may simply have learned that their environments do not understand, read, and respond to their emotional states, they just simply learn to not have them.
• 6:30
  SPEAKER_00: It's almost as if what is the point of expressing and allowing yourself to visibly show what you're experiencing if the environment, the family system, is unable to tolerate it, recognize it.
• 6:48
  SPEAKER_00: Now, there are lots of reasons why this can happen.
• 6:52
  SPEAKER_00: There are parents who are, in their own ways, underdeveloped in their capacity to manage emotional states, whether their own or other people's.
• 7:07
  SPEAKER_00: They may be people whose own awareness has been blunted by their experiences.
• 7:14
  SPEAKER_00: It is not that they intentionally ignore, but that they simply can't do it.
• 7:21
  SPEAKER_00: And somehow their own impoverishment in this respect is touched by the child.
• 7:29
  SPEAKER_00: And so the parent may shut down, the parent may override, the parent may dismiss the child's feelings, the child may, the parent may rationalize what the child is expressing.
• 7:42
  SPEAKER_00: It can also be the case that parents have incredibly difficult circumstances to live with in, and as a consequence, they are simply unable to take on anymore.
• 7:59
  SPEAKER_00: I know of a number of cases where one mother in particular was so overwhelmed by her son's behavior, which was aggressive, violent, and delinquent, really incredibly hard to manage, that her attention was paid largely to just simply coping.
• 8:29
  SPEAKER_00: And his younger sister became the compliant, counterbalancing and need-denying member of the family.
• 8:42
  SPEAKER_00: What she was doing was to simply not make things worse.
• 8:49
  SPEAKER_00: She was being quiet, not complaining, not demanding, because she experienced the environment as one in which it would be wrong for her to have her own needs and demands.
• 9:06
  SPEAKER_00: Because were that to happen, she would overwhelm her mother.
• 9:11
  SPEAKER_00: And this is the sort of situation that we see also in families where perhaps there's a sick child, a child who needs frequent hospital trips, a child about whom everybody is concerned, and the needs of that child quite understandably take precedence.
• 9:32
  SPEAKER_00: But what about the remaining children or child?
• 9:36
  SPEAKER_00: What do they do with their needs?
• 9:38
  SPEAKER_00: Well, often what they do is they close down, they become compliant, they become helpful, they become seemingly mature for their years.
• 9:48
  SPEAKER_00: And then what happens is at some point they'll go bang.
• 9:53
  SPEAKER_00: And almost I've heard parents say, Well, I think it will be, you know, we're we're working with with one child, and then uh the other, I've heard this before saying, when will it be my turn to seek him?
• 10:09
  SPEAKER_00: Which is both sort of sweet, but it's also a little worrying, is this child signaling that they too have needs.
• 10:23
  SPEAKER_00: And it's very hard, and it would be this is not about neglect, this isn't about parents neglecting the other, you know, the quiet child.
• 10:31
  SPEAKER_00: You know, in a way, it's almost like what they're trying to do is just just balance and just just you know, just manage things.
• 10:40
  SPEAKER_00: Sometimes when you have children, and again, this is within my experience, but when you have children who have life-threatening illnesses, and you know, those who move into the critical phase, end-of-life care, the experience of the quiet child is one which is not necessarily seen, and the needs of those children are incredible, as of course the sick child and members of the family.
• 11:20
  SPEAKER_00: But it makes me think so often of this notion of just because we can't see something doesn't mean there isn't something there.
• 11:30
  SPEAKER_00: So I suppose, in a sense, what I'm encouraging people to do is to allow the child, encourage the child to talk about them, not necessarily in a deep and detailed kind of way, but almost a sort of it's okay just to say how you are.
• 11:56
  SPEAKER_00: And it's okay to be you.
• 11:59
  SPEAKER_00: It's also important that when we are aware of how we are as parents, when we're struggling, it's really important to say to children, yeah, I'm having a tough time at the moment, but it's okay because I have a grown-up or somebody else who can help me, and it will be okay.
• 12:20
  SPEAKER_00: Otherwise, what we might get into is parentification, where the child abandons them themselves as a child and becomes an adult, and they take care of they take care of the parent.
• 12:36
  SPEAKER_00: So there are lots of different features to this, but we start with the idea that a quiet child is fine.
• 12:50
  SPEAKER_00: I say very often that behavior is not the problem, behavior is the communication.
• 12:58
  SPEAKER_00: Just because a child is quiet doesn't mean they're not communicating.
• 13:03
  SPEAKER_00: Thank you for listening, and I look forward to coming back with the next episode shortly.