Relational Therapy – Treatment (Goals and Application)

The following are goals to incorporate as one conducts Relational Therapy: I) Develop a therapeutic frame, II) Develop a model of attachment and engagement, III) Development of a repertoire of practical techniques, IV) Develop specific steps in deciding which techniques to use, and V) Application through case consultation

I will now take each goal and explain it in more detail in this and the next four blogs.

Goal I: How to develop a therapeutic frame

As with all our patients, we need to follow guidelines in developing a therapeutic frame and boundaries. With this population, it becomes extremely important to adhere to the following guidelines. Not only are we “keeping the frame,” but we are also modeling behavior that the client cannot do for himself. It is important to remember that these individuals feel boundary- less. Individuals with autism may have strongly or loosely held boundaries. Examples of strongly held boundaries would be the lining up of toys, talking about a subject in a sequenced manner or perseverating on a subject. An example of loosely held boundaries would be the child who “seems” to touch others in an inappropriate manner, walks over people or may be a runner.

The following are some suggestions on specific techniques to keep in mind with the autistic population: 1) Be consistent with everything you do – time and place of the therapy. 2) Be dependable. If you agree to do something, do it. Do not promise something you cannot fulfill. 3) Take the child seriously. The child is doing the best he can to exist. He is not being difficult and different because he wants to be. 4) Take your role as therapist seriously. As with all of one’s clients, we need to understand the importance of ourselves to the client. The autistic individuals development depends on you. Think of them as having had an arrested development and that your role is to “jump start their development.” You do this by becoming the person in their world that understands, validates, recognizes and accepts them. Remember that this population has not developed any trust in others so how you interact with them is going to be pivotal to their development. Most likely they will not be able to show you how important you are to them. This is because they lack the ability to use themselves in relationship to you. 5) Be strong and thoughtful about what you say and do. Your behaviors and tone of voice will help to hold (psychologically) or not hold the child. The child is very good at understanding nonverbal communication. In fact for many that is their primary means of communication and will also be the primary means of communication that they will be using to understand you. You provide a holding environment by the strength of conviction you have with the child/adolescent – you need to communicate caring, understanding and a desire to help. It is also important to communicate to the child that together “we will find a way for you (the child) to function in the world. 6) Take responsibility for your actions. The child needs to become conscious of himself in a relationship to you. One way to demonstrate this is to take responsibility for the part you may play in the disjunctions that occur between the two of you. Demonstrate the “repair” process by taking responsibility for your part. 7) Be flexible. One child may need one kind of boundary and another a different kind of boundary. For example, in working with a runner, you will need to run with the child until they can accept you and the boundaries you provide. 8) Do not give up. Be prepared to experiment with different ways of being with the child as long as you maintain ethical standards.

The next blog will focus on Goal II: Developing a model of attachment and engagement.