I think he is still inside me: Mother/child psychotherapy and sandplay with a kosovar woman and her infant son

Abstract

A world where broken spirits abound and surround us with their silent cries and unspoken loneliness Wilson (2004, p. 109) The psychotherapeutic process of a Kosovar adolescent asylum-seeker mother exposed to violent traumatizing experiences is described and discussed in this chapter. The effects of these experiences, especially in the vulnerable period while she was pregnant with her first child, resulted in severe consequences in the mother/child interaction and brought extra complexity to the case. The description of this psychotherapeutic process was enriched in the text by theoretical elements relating clinic to theory. In the therapeutic process of the client here described, conducted in a center for child and adolescent mental health care in the Netherlands, we made two different modalities of psychotherapeutic interventions with Sara, the adolescent mother: the first intervention, after the beginning phase (in which her partner was also present), was an individual psychodynamic psychotherapy, while the second intervention was a mother/child psychotherapy, with Sara and Denis, her one-and-a-half-yearold child. During both psychotherapies, the Sandplay method was eventually used to help the client to project and elaborate her inner world and conflicts. Considering the fact that asylum-seekers, refugees and immigrants are high risk populations for psychiatric disorders, the Reinier van Arkel Groep, in 's-Hertogenbosch, in the Netherlands, developed the Transcultural Problems Program - BTP, a specialized service for these infants, children, adolescents and their families. Since January 2007 this service was integrated with the service for adults in the new Psychotraumacentrum Zuid Nederland - PTZN, International Centre for Victims of War, Trauma and Political Violence. The PTZN consists of a multidisciplinary team which includes psychiatrists, psychotherapists, health psychologists, system therapists, physicians, social-psychiatry nurses, creative therapists and others. In addition to the outpatient treatment, the PTZN provides, if necessary, in-patient treatment (in a short-term closed setting) and a dayhospital treatment. The children and adolescents whose mental conditions do not allow them to attend a regular school, may attend a special school affiliated with the clinic, while participating in the clinical or day-hospital treatment. The diagnosis and treatment process for infants, children and adolescents in the Transcultural Problems Program - BTP (Wiese & Burhost, 2004, 2007) and recently in the PTZN starts with an initial interview with the child and his/her parents, and results in an individual treatment plan, established by the multidisciplinary team. The treatment plan may include medical and/or psychiatric assessment, psychological assessment, system assessment, anamnesis, play therapy, individual group or family psychotherapy (including ethopsychotherapy), art therapy, parent counseling etc. After three months the assessment and treatment evaluations take place, followed by further three-monthly follow-up evaluations. I work as a psycho-dynamically oriented psychotherapist and treatment coordinator at the PTZN, with children and adolescents, as well as with babies and infants (in parents/child psychotherapy). Love brought me to the Netherlands and my life changed suddenly when I married a Dutchman. Prior to this, I was a psychologist, born in Rio de Janeiro, with extensive professional clinical experience, who was for many years a lecturer in the Clinical Psychology Department of the Institute of Psychology of the University of Sao Paulo, in Brazil. My knowledge of languages and my experiences of living abroad in different countries during various periods of my life also help me with the challenges of my clinical work in the Netherlands. The fact that I am not Dutch myself, but from South America, makes it easier for many clients to identify themselves with me (also a foreigner) and this identification seems to help them to develop a positive transference and a therapeutic bond. For the asylum-seeking clients in particular, the fact that I am a foreigner helps them to regard me as someone who is disconnected from the very strict asylum policy of the Dutch government. It was in this context that I saw Sara for the first time. She was referred to me by a BTP colleague, because of my experience in parents/child psychotherapy (Batista Pinto, 2000, 2004; Wiese, 2004). © 2007 Springer Science + Business Media, LLC. All rights reserved.