Linguistics in the practice of child psychotherapy: challenges for clinical practice.
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It is known that both child psychologists and psychiatrists have little training in linguistics, which undoubtedly has great relevance in children’s mental health. A greater specialization in the evolutionary aspects of children’s language could improve the effectiveness in psychotherapy, enhancing the techniques classically used in setting, such as games and artistic activities. Thus, with greater knowledge in psycholinguistics and pragmatics, mental health professionals could increase their battery of practical tools for effective moment-by-moment communication with the patient. This would expand the use of child psycholinguistics not only for the diagnosis of language disorders, but also contribute to converge theoretical and practical knowledge achieving a more effective communication between the adult and the child.
Key words: language development, psycholinguistics, child psychotherapy.
One of the fundamental characteristics of the human species, related to our evolution, is language. It seems to be a multiform ability that is conducted by universal principles that exist in the ways we communicate. These are the manifestations of language(1) that take shape through speech, writing or other expressive forms. Language cannot exist without socialization(2), since human beings are immersed in settings that include interaction and meanings. Cultural evolution would have led to a brain modification, allowing an evolutionary leap, at a biological, cognitive, and social level, which differentiated us from other animals, making language essential for cultural transmission and our evolution.(3)
Language has been studied since ancient times(4), but the development of children’s linguistics is recent. It began during the second half of the 19th century and the beginning of the 20th, mainly in Germany, France, England and the United States(2). Among the pioneers of the study of thought and language in childhood, Granville Stanley Hall (1844-1924) stands out. He was a psychologist who studied the evolution of the mind, language and physiological psychology, inspiring later language development and child thought scholars.(5)
Another of the main contributors was Piaget (18961980), who proposed the theory of cognitive development, identifying child behavior through the observation of the stages of cognitive development, and specifying that mental processes in different moments of the vital continuum correspond to a progressive reorganization, as a consequence of biological maturity and interaction with the environment. He named the Sensory-motor Stage, which ranges from birth to the acquisition of first words and is characterized by the fact that infants interact primarily through their senses and contact with objects. Progressively, infants learn to differentiate themselves from the environment and to develop a capacity to symbolize at a primary level. Then, during the Preoperational Stage, they gradually acquire the ability to put themselves in the
place of others. However, egocentric thinking tends to prevail, as well as the tendency to guess based on fantasies (magical thinking). Subsequently, the stage of Concrete Operations, involves school age children. It is a period in which thinking acquires greater complexity, managing to categorize and draw conclusions from specific stimuli. Finally, the Formal Operations stage covers the years from preadolescence to all adult life and increases the ability to use logical-deductive thinking, progressing in abstraction and symbolization capacities.
Thus, language and its manifestations have certain particularities during childhood, a period characterized by high sensitivity towards the environment which is relevant for the child’s biopsychosocial development.
Regarding the neurophysiological aspects of language, it has been observed that an abundance of mirror neurons would be found in brain centers associated with language, such as Broca’s Area and Left Inferior Parietal Lobe(3), which could be related to the relevance of language in empathy. This makes even more sense if we think of language as our main means of daily communication, and as a transmission of culture and knowledge.
Following this line, the theory of the mind seems to be exclusive to the human being; that is, that ability to understand the world from someone else’s point of view allows building a mental model of apparent intentions and predicting behavior(3). This means that, canonical neurons which respond to the visual perception of objects in our environment(6) and that activate possible actions towards objects and subjects, and organize action and perception in a new and unified representational format(6), would be linked. We not only passively observe or imitate, but we create possibilities for action by virtue of our relationship with the environment.
This neuropsychological evolution of language and its relationship with other mental functions, such as empathy and theory of mind, should also be considered when carrying out psychosocial interventions with children, considering that,
during this period, the synapse and myelination processes are highly active and sensitive to environmental stimulation.(7)
Therefore, it is important to reflect on the practical implications of understanding children’s language regarding the psychotherapeutic setting with children, proposing the need for greater technical capacity in mental health professionals in psycholinguistics.(2,8)
This article analyzes the relevance of childhood psychologists and mental health professionals viewing psycholinguistics as a theoretical-practical tool that enhances communication efficiency in child therapy. Understanding the development of language in childhood could favor the development of more efficient and concrete communication strategies, both in the therapeutic process and in the construction of the patient-therapist bond and in the establishment of timely psychodiagnoses.
Psycholinguistics to promote a two-way communication between children and adults
Although there are several approaches that attempt to define psychotherapy, the theory of subjective change(9) represents a transtheoretical model that shows that the patient’s emotional improvement occurs in a process of building new ways of interpreting oneself and reality. These changes reflect on behavioral, emotional, affective, and personal value levels. This occurs gradually in the process of patient-therapist interaction(9), with alternative narratives developed to interpret reality becoming relevant. Psychological therapy can be seen as a concrete experience, which favors an alternative interpretation of personal experiences and, like any experience, generates an impact on a physical and psychological level, modifying the brain’s physiognomy through its plastic capacity. Specifically, child psychotherapy involves soft skills and particular techniques that the professional in charge must carry out, for it to be effective and meaningful for the child. It requires the integration of the evolutionary concept, which views patients as changing subjects, influenced by biology and
experience. Understanding the different stages of development and their particularities, helps differentiate between what is expected within the norm and psychopathology.(10)
The establishment of an adequate patient-therapist bond is fundamental(11); it requires an adequate rapport and the patient trusting the professional. There is strong evidence of the impact of bond quality on effectiveness in therapy(12). In child psychotherapy, this aspect is substantial, and requires the therapist to have extensive knowledge about the evolutionary stage of the child, especially about his or her cognitive thought and language development. The therapist must be able to empathize and understand the communicative expressions of their patients. To achieve this, it is necessary to know and understand the child’s mental development and the communicative styles of the evolutionary cycle.
Studying and understanding language should be considered a fundamental aspect in mental health workers, since it is considered the main tool to access the mind and thoughts of human beings(12). Chomsky (2015)(4) described language as an innate and genetically determined human ability that is crucially involved in aspects of thought and interaction. Therefore, communication in its various manifestations, verbal and non-verbal, constitutes an area of experience and becomes language to the extent that the person is exposed to social interaction and experience.
Therefore, the setting establishes a space for an interaction and construction of shared meanings between the patient and the therapist; it is a space that includes concrete experience and should be significant. Thus, we understand language as a human capacity that takes part in many different aspects of life and that constitutes a dynamic tool for socialization and psychic expression. Depending on the child’s’ evolutionary state, we could establish that that he or she is temporarily closer or distant to the initial or pure state that Chomsky (2015) described(4); and that psychotherapy constitutes an opportunity for experience and interaction that could favor the development of
emotional, cognitive and socialization aspects.
Therefore, the use of pragmatics in child psychotherapy could constitute a convergence space for advances in developmental psycholinguistics to provide a practical contribution to benefit clinical effectiveness with children. Based on a better understanding of language development and its manifestation during childhood, practical therapeutic strategies that more adequately connect the ways of communication between children and mental health professionals, could be studied and systematized.
Thus, viewing language as a window to the human mind is also applicable to children’s therapeutic work. For example, there are studies that suggest high comorbidity between language disorders and psychiatric diagnoses in childhood, proposing that developmental language disorders would be associated with lower levels of mental health and that they are underdiagnosed. Furthermore, they conclude that if therapists have a greater technical knowledge of children’s language, mainly in children’s narrative, it will have a significant impact on an adequate diagnosis and psychiatric treatment.(14)
To achieve this, it would be important for professionals to know how to adequately approach the child´s world and mental processes. Comprehending children’s language at the service of psychotherapeutic exercise could be a relevant theoretical-practical tool. Thought, understood as mental processes with representative capacity, are present in children from early childhood, but in an evolutionary state, levels of consciousness and forms of expression, qualitatively and quantitatively differ from the adult world.
However, it seems that, in the clinical practice of psychology and psychiatry, sometimes professionals forget the fact that they are communicating with people in a different evolutionary stage, and that they communicate differently from adults. This could lead to the child attending the session feeling distant or uncomfortable. In contrast, psychotherapy should be a space focused on the child, his or her needs
and well-being, promoting a setting that provides spaces for autonomy and a greater sense of control, so that they can spontaneously express their emotions and thoughts. Pragmatics could contribute to achieving this goal.
In this way, if the child perceives communicational distance, he will resist the process and it will be less effective, since the patient-therapist bond is weak. Therefore, child mental health professionals with technical and practical knowledge in child linguistics could increase their abilities to understand the specificities of formal language, as well as the expression of its linguistic and paralinguistic content, facilitating a fluid bidirectional dialogue.
According to their evolutionary cycle, children should present the ability to narrate stories related to their daily experiences(14). These stories vary by virtue of their age and possibly, depending on their sociolinguistic context. As expected according to their age, during school stage, cognitive development and thoughts tend to be concrete, having less vocabulary, syntax, and abstraction capacity than adolescents and adults(15). In time, the human being manages to articulate concepts in increasingly complex units of meaning, increasing his capacity for abstraction, generalization and approaching the logical-deductive style of thought(15). Children’s vocabulary reflects their daily life and is unlikely for them to refer to events distant in time or space, or of an abstract nature. First words, such as <hello, mommy>, refer to objects, events, and people in the children’s immediate environment. When they reach school-age, words become increasingly complex and interconnected, and they achieve a new type of knowledge: metalinguistic awareness. This new ability makes it possible for them to think about their language, understand what words are, and even define them(2). Language and communicative intentions in children exist from a very early stage in development. However, they are presented differently from adults, therefore, it is essential that the intervening professional manages to identify child´s linguistic and communicative level, in order to achieve effective communication with him or her.
Therefore, for adequate psychotherapy, it is important not only to understand the development of children’s language and thoughts, but also to apply this knowledge in favor of communication and clinical practice. The therapist should make himself available to the child´s psycholinguistic world and implement communication strategies according to their reality, placing “here” and “now” as the center of the dialogue, and not only viewing the patient as someone in development or looking towards the future. Children have feelings, thoughts, and rights(16). They actively carry thoughts, emotions, and opinions, and require professionals capable of recognizing and responding to this reality in interactive spaces.
Thus, with greater technical knowledge regarding children’s language, psychotherapists will be able to connect to a greater extent with the manifestations and communicational expressions of children in their different age ranges, as well as to identify the existence, or not, of alterations in the development of language and taking action promptly to treat eventual dysfunctions in that area, as well as possible alterations in their mental health expressed through language. In this case, the use of pragmatics can be useful to develop practical intervention techniques in favor of communication. It is essential that the professional manages to make himself available to the child’s evolving reality.
Comparatively, in most adults, language results in speech and speech acts or illocutionary acts, defined by the use of speech for specific communicative purposes. Without denying the presence of verbal communication and illocutionary acts in childhood, language is usually expressed mainly in other ways, since both the phonological, oral, written, and semantic aspects are still immature and, therefore, the levels of complexity of language and its manifestations are in development. Language, as a specialized, complex communication system that surrounds biopsychosocial functions(17), has not reached its full potential in childhood, however, it is still highly active. For example, vocabulary is more limited, so children transmit their experiences, feelings and thoughts with a language that responds to their developmental stage. In this way, professionals who interact with children, should have practical skills that respond specifically to speech acts as to other expressive forms of children’s language.
Consequently, this does not mean that the psychologist cannot use verbal or written language with children, since these forms of language are also present in childhood, particularly after elementary school. Rather, greater knowledge in the pragmatics of children’s language would imply that the therapist should have more resourcefulness to use communication tools related to the development of the child’s language, being able to resort to alternative strategies to communicate with the patient. Thus, not only will the psychologist acquire information from the child, but, the child will probably be able to feel he is communicating and being heard by his therapist.
Thus, psychotherapists resort to various intervention strategies to promote communication with children. Games and art are mostly used. This is due to the capacity for symbolic abstraction that both activities have and because they favor materialization and non-threatening expression of information associated with their vital and emotional experiences, and encourage the development of creativity and the integration of cognitive, motor, emotional and socialization functions. The richness of the symbolic content in playful and artistic activities compensate for the lack of vocabulary and verbalizations in childhood and therefore, brings the adult closer to the child’s language. Following this concept, games and the art therapy are widely recommended in child psychotherapy, because they are able to communicate symbolic content of children’s unconscious emotional states and daily experiences in a non-threatening way, which is in itself, healing. However, in addition to stimulating or interpreting this context, the therapist, must also be able to respond and connect interactively in during the session, and use psycholinguistic expressions as more than a basic tool when diagnosing patients, but instead, as a two-way communication tool that allows them to become the main character.
Therefore, human language can be manifested and expressed in several formats. Manifestation varies according to age as the semantic and phonological capacity begin to strengthen as a consequence of experience and biological development. In childhood, the phonological apparatus and semantics are immature, but growing in capacities. The mental activity of children presents great activity and richness, deploying unconscious and natural strategies to express themselves and condense their mental content. In addition to verbal communication, they can express themselves through games, body language, drawing or other art techniques.
On the other hand, it is important to remember that psychotherapeutic work with children should be approached from a systemic perspective, that is, considering the interrelation with their family and social environment, understanding evolutionary development as a whole and as a multifactorial process. The psycho-emotional world of children is highly impacted by their context as well as parenting and care styles carried through by the adults in charge (18), and it is essential to include them into the intervention process. The child is not an isolated being immune to environmental influences. Consequently, professionals who are mostly trained in child linguistics and pragmatics could pass on certain information as well as assertive and concrete communication strategies to caregivers or adults in charge, so that they can better communicate with children and in this way, will be able to have a positive impact on parenting styles and affective expression, favoring the empowerment of the so-called parenting skills.
Considering this information, adults should favor and provide several resources and activities that support the abstraction and symbolization of children’s thoughts and emotions. This should be especially relevant for child psychotherapists, who must not only interpret and understand the symbolic content expressed in isolation, but must be connected to the interaction and the psychotherapeutic process. The classically used techniques in child therapy could be strategically enhanced through pragmatics, since this would offer a more fluid and efficient communication with the patient, so interventions would become more flexible and include the use of the mentioned tools considering the child’s linguistic expressions during the different moments of the session.
Without basic knowledge of childhood psycholinguistics,itisdifficultforthepsychotherapist to achieve effective communication with the child since it will possibly be difficult to understand and empathize with their internal-subjective world and their expressions. The therapist might use strategies involving games and art, however, the technical and practical knowledge to understand and respond to linguistic expressions on a moment-to-moment basis may be limited or insufficient. Consequently, the communicative styles and the language used by that adult will not respond to the needs of the child in psychotherapy and might increase the risk of using the usual therapeutic techniques in a generalized way and not taking in to account the patient´s particular needs that might be expressed through his language.
In contrast, that professional who comprehends and knows children’s linguistics, will be trained in technique, practice to communicate properly, to make diagnoses, as well as to carry out an effective psychotherapy, based on communication and understanding of speech acts in a setting.
Training child psychologists in psycholinguistics and pragmatics can favor the theoretical-practical convergence of specific communication strategies that result in effective adult-child communication, centered on the needs of the patient, placing the child as the leading figure of their psycho-emotional process, and not as a passive subject that is observed and assessed by the therapist.
Further research on psycholinguistics and pragmatics in the field of developmental psychology and clinical child psychology is necessary. This could contribute to the exercise of psychotherapy being more effective and for therapists to increase their technical and applied skills to respond to communicational expressions during every moment in therapy, considering the individual characteristics and the evolutionary stage of the patient. The systematization of the study of child linguistics and pragmatics could contribute to a better understanding of mental and communicational processes in childhood and, therefore, develop more efficient, concrete psychotherapeutic programs according to the sociolinguistic reality of each child. It could, as well, favor the early identification of language disorders, as well as possible comorbidities in child psychopathology and treat them in a timely manner.Finally, a greater knowledge on the pragmatics of linguistics in childhood, could contribute understanding that language development in children is not focused almost exclusively on the identification of language disorders, but is also a practical tool that favors the promotion of children’s mental health
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