The Viola’s case: an “insolent and cheeky” girl. A multimodal psychotherapy between the work with the child and the intervention on parenting

Abstract

Viola is a 7 years old girl with behavioral problems. Even if the symptoms are not severe, as a matter of facts they do not suit the diagnosis of Oppositional Defiant Disorder, they interfere with the family atmosphere and compromise her school functioning.
There is a second topic, initially not made pathological explicit by the parents, that concerns nocturnal enuresis; this problem limits the possibilities of explore the extra-family world and it is precisely when the possibility of making experiences with peers emerges that it becomes necessary to include it among the therapeutic objectives.
In a cognitive-evolutionary and constructivist perspective, during the assessment it is a priority to understand the internal meaning of the symptom and disclose the relational function. In Viola’s case, it emerged that the provocative behaviors were the attempt to coercively control the caregivers and enuresis the means to ensure the proximity of the parent.
The clinical work was supported by an excellent collaboration by the parenting couple and a large part of the therapy focused on them.
Thanks to the reconstruction of behavioral ABCs throughout the sessions and the gradual addition of cognitive and emotional details, the parents were able to identify the relational function of symptoms and get closer to the emotional world of their daughter.
The intervention on the child, carried out simultaneously, was aimed at a better management of her own emotions and at a third person mentalization based treatment work, with the purpose to raise awareness of other mental states.