Abstract
The first consultation sessions are challenging moments for any psychoanalytic work, yet they are the making of any succesful intervention. In her book, Dina Vallino offers the result of twenty-five years of work with children and parents in addressing the problem of how to establish a therapeutic partnership during a consultation.
In the first part of the book the author introduces her unique consulting model, making reference to her years in London studying and doing infant observation, as well as articles and experiences that have inspired and guided her work through the years.
The touching, lively, well-described clinical vignettes immediately immerse the reader in moving clinical situations, seen through the model of “consultazione partecipata” (participatory consultation). This model calls for four or five meetings, of which the first and the last are usually with the parents alone; the others are with parents and child togther. Vallino begins by inviting the family into the consultation room and asking the parents to participate in their child’s activies as they would do at home. We meet Andrea (seventeen months), who expresses his discomfort with a delay in walking; Dan (thirteen months), who struggles to differentiate herself from her mother’s eating problem; Ludovico (four months), whose mother reacts to his physical deformity with a narcissistic injury/fantasy of having a “broken child”; and many more whose stories cannot be summarized here. The analyst observes the emotional vibes of the family relationship, identifying the disconnections and misunderstandings in their communications. With her great ability to modulate feelings, Vallino shows how to regard the suffering of children and parents and how the analyst can enhance the understanding of the participants, restoring hope and confidence.
Both delicate and profound in her interventions, she explains that the main goal of the first meeting is to identify what kind of crisis brings the family to the consultation. She makes a distinction between inner crises of motherhood or parenting and family crises for which family members need to take responsibility. She illustrates with moving vignettes the subtle but fundamental differences such distinctions elicit in her answers and interventions.
By carefully documenting her interpretations of the child’s communication (verbal, emotional, and behavioral) with respectful, skilled attunement to the family’s emotional ambience, she introduces a new and effective way of working with children. Her vignettes show beautifully how parents move from talking “about” their child to talking “with” the child; see particularly the clinical descriptions of Alice (five years old), whose parents are getting divorced, and Corrado (eight years), who struggles with aggression, anger, and tantrums.
With infants and toddlers the participatory consultation can be extended over the first four to five meetings and can become a treatment of choice. The book explains, indirectly but unmistakably, when and why this preventive intervention is recommended. An example is the intervention with Sofia, a girl of about two, and her parents, who came to consultation for toilet problems. Vallino shows us how, by observing the child’s play, she was able to introduce the girl and her mother to the idea that the family’s difficulty throwing things away was linked to the girl’s withholding symptom. Following the girl’s lead, Vallino helped the mother understand her daughter’s curiosity about bodily functions and with simple remarks gently encouraged the mother to explain to the girl the difference between throwing things away and the fantasy of throwing pieces of the self away.
The author’s descriptions of how she uses participatory consultation with older children stand out in a chapter in which we witness the use and interpretation of dreams. Vallino begins by describing her work with an angry girl and her mother. Her attentive, sensitive work in containing feelings slowly unfolds and shows the girl making a drawing and telling the story of her nightmare. Vallino continues with the dream’s interpretation, for which child and mother contribute factual and emotional content. The analyst integrates this content so that new meaning can emerge. With this “choral” interpretation, girl, mother, and analyst bring to light the desire for emotional relationship hidden in the violence of the girl’s nigthmare.
The book’s second part offers essays and articles that allow readers to trace the development of Vallino’s thought over her extensive clinical career. In the last chapter, Vallino reports her conversation with Marco Macchia (a philosopher with whom she has collaborated on several articles and books) on the meaning and direction of clinical research and observation.
Although the book contains references to psychoanalytic theory and a particularly enjoyable application of Bion’s concepts, the author prefers to use marginal comments and brief summaries to provide the necessary theoretical and technical notions; these are never redundant and always illuminating. This brilliant stylistic choice supports a moving, fluent narrative able to communicate difficult concepts in an easy way.
Among the many theoretical and technical thoughts here, some stand out for a note of orginality in their use and application in the participatory consultation. Special place is given to the concept of luogo immaginario (the imaginary place). This concept, dear to the current Italian psychoanalytic culture, finds its theoretical roots in Freud’s idea of fantasy and creativity being an expression of unconscious contents, and in the Winnicottian notion of the transitional object. These ideas have been elaborated in a more contemporary frame by authors like Nino Ferro, with his emphasis on the narrative as a moment in which we can recognize emotion and affects.
On the assumption that children’s play represents the main avenue for accessing their thoughts, child analysts identify the imaginary place as a safe place in which the child can share, play, and create a narrative including his most secret and/or unconscious affects, thereby allowing the analytic process to take place. In Vallino’s model, children find their imaginary place in the participatory consultation setting. It is a safe place because the analyst places the child at the center of his world, a world of which parents are an essential part.
A very interesting chapter discusses the solidarity of siblings. Vallino shows us not only how to modulate feelings of jealousy and exclusion, but how to override cultural biases that impose a preconceived vision of what really happens between siblings. The clinical consultation with two sisters, four and eight years old, shows how their feelings about the parents’ divorce and the complex family dynamics are voiced by the younger sibling’s tantrum toward the older sister.
Vallino has accomplished the difficult goal of writing a book that can be read, understood, and used by any mental health professional. By describing what the analyst feels and thinks, and why she intervenes or remains silent at any moment of the consultation, Vallino teaches professionals how to use their own sensitivity without losing their boundaries. By providing the necessary theoretical frame, she offers an additional setting worth being considered by child analysts. In addition, parents who read this book and its moving clinical vignettes can feel less alone in their daily struggles with parenting.
With great skill, Vallino illustrates her unique way of helping parents and children get in touch with the suffering and difficulties for which they are seeking help. Opening the door of the consulting room, she reveals something about psychoanalytic work with children and parents that was never intended to be the secret it has been for too long a time.