Understanding Child Psycho-Diagnostic Interviews: A Professional Approach
Feeling Parental Images
We can show how a child perceives paternal and maternal figures using test charts and CAT history, illustrating maternal image perception. We also explore how the child identifies with parental roles.
Professional Secrecy and Confidentiality
Testing material and interview content, including verbalizations, drawings, and play, must remain confidential, adhering to professional secrecy standards. Preverbal material requires the same discretion.
Interview Sequence and Anxiety
Structuring the Interview
We recommend starting with less anxiogenic topics and progressing to more anxiety-provoking areas. Usually, less anxiogenic areas indicate healthier aspects, while anxiogenic areas reveal challenges. However, sometimes healthy aspects or repair can be anxiogenic (e.g., parents focusing only on negative aspects). This requires careful handling by the psychologist.
Managing Anxiogenic Content
If the core issues are highly anxiogenic and not initially apparent, the psychologist must gently uncover the true reasons for consultation, addressing any hesitancy or unmentioned concerns. It’s recommended to follow the sequence parents used when presenting their child’s issues, starting with the most challenging if they began that way.
Clear Communication and Summarization
The psychologist must communicate clearly and provide increasingly comprehensive summaries as new data emerges. Repeating information is crucial, especially when anticipating parental resistance, to prevent denial or distortion. The interview’s objective should be stated and reiterated as needed.
Flexibility and Further Interviews
The interview process doesn’t have to be rigidly confined to a single session. Further interviews may be necessary to allow patients or parents to fully express themselves. Both the psychologist and the patient/parent can request additional sessions for clarification, expansion, or correction.
Managing Emotional Dynamics
Polar Emotions and Transference
Psychologists must be prepared for polar emotions, such as envy and jealousy towards the therapist, stemming from guilt or feelings of inadequacy. The psychologist’s role is to differentiate these feelings and ground the patient/parents in reality. They must also address explicit conflicts, sometimes acting as a mediator, while avoiding a decentered focus away from the child.
Envy, Jealousy, and Role Dynamics
Envy, jealousy, and rivalry may emerge within the couple, with each parent attempting to portray themselves as the better parent. This can lead to one parent becoming the scapegoat for the couple’s failures.
Addressing Resistance and Stereotyped Behaviors
When encountering resistance or stereotyped behaviors, it’s essential to focus on the therapeutic relationship rather than just the content. The psychodiagnostic process often mobilizes parental depressive and paranoid anxieties, which depend on their relationship with the child. The psychologist must anticipate and manage these anxieties, acting as a catalyst and container for the complex emotional system. Avoid “peaks” in the interview and be wary of manic trends, as these can indicate difficulty accepting therapeutic help.
Interpersonal Dynamics and Prognosis
Comparing interpersonal dynamics between the initial and follow-up interviews is crucial. Decreased resistance, increased realism, acceptance of latent relationships in behavior, and shifts in roles concerning the psychologist and child indicate a positive prognosis.
Managing Complex Cases
Hidden Symptoms
One of the most challenging situations is when the presenting problem masks a more severe issue (e.g., learning difficulties masking a psychotic crisis). Thorough analysis of materials and initial interviews is necessary to identify breakthrough points and help parents understand what they may not see. These cases can be difficult for the psychologist, who may risk over-identifying with the parents’ distress. It’s crucial to address the reality of the situation, fostering an alliance with the parents’ reparative aspects.
Parental Rage and Countertransference
Parents may direct rage towards the psychologist, who might over-identify with the child and feel compelled to punish or reprimand the parents. This increases parental guilt and hinders communication. The psychologist must strive to present both perspectives and avoid punitive responses.
Persecutory Guilt and Integration
In some patients, persecutory guilt leads to psychopathic defenses. The goal is to integrate healthy and sick aspects, the manifest and the latent.