By: Julia Randle
Book review of Doing Child & Adolescent Psychotherapy: Adapting Psychodynamic Treatment to Contemporary Practice, 2nd ed., by Richard Bromfield. Reviewed by Julia Randle.Bromfield, Richard. (2007). Doing Child & Adolescent Psychotherapy: Adapting Psychodynamic Treatment to Contemporary Practice, 2nd ed. Hoboken, NJ: John Wiley & Sons, Inc. 276 pages, $60 (hardcover).
Doing Child & Adolescent Psychotherapy by Richard Bromfield, Ph.D., is a comprehensive yet coherent guide to counseling youth. This 2nd edition has been updated to address new developments of the last decade, including the conflict between psychodynamic and evidence-based practices. Dr. Bromfield, a Harvard Medical School professor with extensive experience in private clinical practice, does not sugarcoat his portrayal of child therapy; he gives the social work student and current practitioner a realistic view of working with children, aided by case studies and honest discussion of the limitations that managed care, well-meaning parents, and therapeutic intricacies put on practice.
The book is broken down into three parts: “The Essentials,” “Techniques and Tools,” and “The Rest.” In “The Essentials,” he asserts that intervention goes beyond specific techniques; the initial environment created with tone of voice and other non-verbal means of communication (smiles and sincerity) is key in establishing a safe place for the client. This section feels like an introduction to Dr. Bromfield’s theoretical philosophy—a how-to-think rather than a what-to-do. He says, “In order to change, a child has to first notice that a problem exists.... Much of therapists’ intervening is to help children look in the mirror with the lights on and their eyes open.”
Dr. Bromfield gives advice on establishing a therapeutic environment in both a literal and metaphorical sense. He maintains that consistency in location and time, along with freedom of expression, ironically tempered by limits, creates a safe “physical and psychic” space. Along with this, Dr. Bromfield places weight on the common factors essential to a healing relationship: empathy, reflective listening, and acceptance. The creation of the therapist-client dynamic involves finding a shared language and rhythm unique to each child.
In the second part, “Techniques and Tools,” the author supplements his theoretical offerings with specific interventions. He includes puppet play, games, and art. Dr. Bromfield says that puppets and dolls “serve to place conflict and other unwanted psychic stuff outside the child” and help to pinpoint treatment goals. Games and toys create comfort and serve as a blank canvas for endless manifestations of self. Another tool, art, can be used for rapport building and as a means of expression. But he adds that in the end, the clinician must find the balance between play and talk, for it is a conduit to the connection between the inner and outer world. This section concludes with another delicate balance—when to follow the “rules” of practice and when to bend them but not break the therapeutic foundation.
The final section, “The Rest,” is a kitchen-sink chapter that covers everything from family therapy to culture to medication. Its hodge-podge grouping symbolically acknowledges the fact that therapy is complex, ever-changing, and cannot be sectioned into neat categories. Dr. Bromfield appropriately ends his book with a chapter on closure. He candidly shares his own moments of weakness as a therapist, and by doing so, reminds us of the humanness of the process. You don’t have to know everything or possess super-shrink powers; sometimes in the search for answers, you are left only with more questions.
Dr. Bromfield’s passion for respecting the inner world of children is evident, but he also gives credence to social work fundamentals by studying the greater psychosocial world in which the child lives. He imparts 276 pages of valuable tools to the reader, but overall, the practitioner is empowered with the reminder that the most essential tool is simply oneself.
Reviewed by Julia Randle. MSW candidate at the University of Houston specializing in clinical practice; UH Wellness researcher/facilitator of small-group alcohol sessions with high-risk cohorts.