Magical Moments of Change: How Psychotherapy Turns Kids Around

Lenore Terr

Overview – Contents & Contributors – Excerpt

From Magical Moments of Change

From my perspective, a key moment may occur as a child and I venture together through some sort of child-initiated test. Or when a preschooler’s toy does something atrocious to my toy, requiring a quick-witted response on my part (or my toy’s part). An adolescent might challenge me to just dare to treat him. What am I to do? Almost without thinking I ordinarily say or do something apt. Later, and only rarely—by watching the patient—can I grasp what really happened during our tiny instance of crisis or of mutual understanding. It has represented a moment of change, a turning point in the child’s young life.

I have also recently become aware of another kind of therapeutic moment with children that is more evident in retrospect than at the time it occurs. I often belatedly realize that a very difficult youngster has dramatically turned around in psychotherapy. Perhaps she suddenly plunged into treatment after resisting for a while. Perhaps she reframed a better self-image. Sometimes I recognize a sudden rapid rate of improvement in a traumatized kid, one who had just been slogging along before. What led to such a complete turnabout? Was it related to therapy? There have been times—not many, just a few—when I found my answer. In these cases, as in the cases where a young person’s treatment has come to a crisis or to an instance of muutt understanding the solution lay in something I had said or done, the office atmosphere I created, a gesture, a new way we played together, an inside joke between us. Interestingly enough, I sometimes also caught wind of how long the change had come to last—years later, a parent, or even a child, now all grown up, might say something.

. . . There must be more to dramatic instances of childhood change than “real” moments with therapists, however. I asked my peers—once again—to send me their cases.? Over the past three years, 34 psychiatrists (including myself) have written up 48 vignettes (including six of my own) in answer to the question? Have you ever seen a moment of dramatic change in a child or adolescent during psychotherapy? Describe it and explain its meaning in 500 words. When the cases arrived from this wide array of colleagues, the analysis of childhood change began to fall into well-delineated patterns. These categories represented what psychiatrists working in all sorts of settings—offices, hospitals, juvenile institutions—think dramatically works with kids . . . I then found myself considering putting them all together. With a book, the process of childhood change would become clearer and, in a way, more compact. One doctor’s perspective on what had caused a momentous turnabout could be put side by side with other doctors’ perspectives. We practitioners could learn from each others’ change moments with children, whether the turnabouts happened during evaluations, brief therapies, family therapies, or more standard individual psychotherapies. Other professionals working with kids in medical, social, or educational settings might benefit from a collection of such cases, too. In fact, parents, struggling with difficult children, might find a collection like this, and its explanations, useful as well . . .These moments are rare. But by pooling them together, or by looking at how they develop over a long period of time in a single individual, we will be able to achieve further understanding of the process of change in child and adolescent psychotherapy.

About the Author

Lenore Terr, M.D., is Clinical Professor of Psychiatry at the Langley Porter Psychiatric Institute at UCLA, San Francisco. She lives in San Francisco, California.

ISBN 10: 0-393-70530-7
ISBN 13: 978-0-393-70530-0
304 pages pages / hardcover
November 2007