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Body image, relational psychoanalysis, and the construction of meaning: Implications for treating aggressive children

Published online by Cambridge University Press:  31 October 2008

Sebastiano Santostefano  and
John A. Calicchia
Sebastiano Santostefano*
Affiliation:
McLean Hospital and Harvard Medical School
John A. Calicchia
Affiliation:
Center for the Psychoanalytic Study of Children and Adolescents
*
Address reprint requests to: Sebastiano Santostefano, Ph.D., Director, Department of Child and Adolescent Psychology, Hall-Mercer Center for Children and Adolescents, 115 Mill street, Belmont, MA 02178-3299.
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Abstract

For more than a decade it has been reported that a significant proportion of youth referred for treatment come with aggressive problems that are difficult to treat and resistant to change. Concepts and research findings from the domains of body image, cognitive unconscious, and the new relational perspective in psychoanalysis are integrated to address this issue and construct a treatment model. It is proposed that body image schemas, representing early, interpersonal experiences and prescribing persistent aggressive behaviors, are cast in nonverbal, nonsymbolic forms. On the other hand, meanings of environmental rules are cast in symbolic/verbal forms. Therefore, little or no communication and conflict exist between these meanings. For the same reason, because verbal interpretation and discussions of beliefs and attitudes, emphasized by both cognitive-behavioral and psychodynamic therapies, are cast in symbolic-conceptual forms, they might not effectively influence embodied meanings that prescribe aggression. Accordingly, the goal of the proposed approach is to facilitate the translation of embodied meanings that underly aggression into symbolic form in order to promote communication between these meanings and those of expectations and interpretations. This translation is accomplished as the youth and therapist (paralleling infant-caretaker transactions) interact and negotiate an evolving series of ritualized activities within which the youth projects various unrepaired, developmental interferences (interpersonal dilemmas), and their associated embodied meanings, onto the therapist who enacts the roles of the projected dilemmas, using action symbols as solutions whenever possible. As the youth identifies with and internalizes the therapist's efforts and solutions, the embodied meanings become translated into symbols that communicate with those of rules at higher cognitive levels, resulting in mental conflict available to awareness and discussions. To illustrate the heuristic value of the model, a treatment case is described and new research directions discussed.

Type
Articles
Information
Development and Psychopathology , Volume 4 , Issue 4 , October 1992 , pp. 655 - 678
Copyright
Copyright © Cambridge University Press 1992

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