Case Study #4

A Toddler Banging her Head

Samantha (not her real name) brought her 2-year-old daughter, Courtney, to see me. Her daughter had progressed from throwing tantrums to banging her head on the floor. Samantha was upset and genuinely worried that her daughter might be hurting herself but didn’t know what to do. Many people think that therapy is all about talk and this child, while she could talk, was essentially pre verbal. My approach was to interact with Courtney with play and art, at first giving her a lot of room to play and interact with toys in the office. Once I had established rapport with her I began to gradually increase the structure of her experience in the office. I started giving her more direction and expecting her to respond. I also worked with her mother.

Childhood innocenceMy analysis of the situation was that this child wanted and needed more structure so she could feel safe to be the child. The proof is she responded by calming down when given appropriate boundaries. Children need love and acceptance and the opportunity to explore and make choices. But they also need parents to set appropriate limits in order for the child to feel safe. The office is an ideal space for both the child and parent to practice these skills and then to transition to a new mode of interaction at home. Look at the photos of the office and you will see that this is a rich environment for both children and parents to interact. The result of our work was that Courtney visibly calmed down, stopped throwing tantrums and, most importantly, stopped banging her head. And, Samantha learned how to create a safe parenting environment with both openness and limits.

Many children need help in the transition to preschool and kindergarten if the child is not used to appropriate limits. Appropriate intervention at this stage can head off major problems as the child moves into the school setting allowing the child to blossom and experience success rather than frustration.

David Shanks, LCSW