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On the Role of Reparative Processes in Childhood: Pathological Development and Therapeutic Change

This article continues my discussion of the process of therapeutic change in psychodynamic child therapy. In a previous essay (Barish, 2004), I stressed the therapeutic benefit of enhancing the child's positive affects as well as developing his or her capacity to tolerate painful affects. I now propose an extension of these ideas, a perspective on the nature of psychopathology in childhood and the implications of this perspective for our understanding of the therapeutic process, based on the clinical concepts of emotional injury and normal reparative processes. Every emotional injury evokes in the child a complex affective experience, comprised of painful emotions as well as an intensification of the child's instinctive self-protective responses—some form of withdrawal and/or retaliatory response. In normal psychological development, as in healthy biological systems, reparative processes function to heal injuries. Failure of these normal reparative processes sets in motion malignant psychological events in the mind of the child: painful affects and associated fantasies increasingly dominate the child's sense of self and others, leading to prolonged states of withdrawal and demoralization or defiant rage. The therapeutic process, especially the therapist's empathy, intervenes to arrest this malignant development, helping unlock the child's exuberant energies and restore in the child a more confident and joyful participation in life.