#Eating and evacuation disorders in children present one of the most frequent reasons for referral to pediatric and infant mental health clinics. For example, lower intakes of food than expected for their age, lack of appetite/food-searching behaviours, difficulty with fluids or with foodstuffs, reluctance or refusal to eat as well as child’s regulation difficulties during feedings, eating only in fixed conditions, and/or being an extremely picky eater, are some of the reasons why parents address to medical help.
25 to 40% of infants in Western countries are referred for under-eating problems. Constipation, encopresis and soiling are evacuation disorders that usually arise in the period of toilet training. Constipation is characterized by low-frequency bowel movements leading to encopresis and/or soiling unusually large amounts of stool, restrictive posturing, and frequently painful voiding. The prevalence of child constipation ranges from 0.7 to 29.6% worldwide, whereas encopresis ranges from 1.5 to 9.8%. Evacuation disorders tend to persist into adulthood with serious physical damage and medical problems if not treated in childhood.
It is believed that parent-child relationships affect a child's eating behaviours. Parent-child relationship problems may occur and they are usually expressed through difficulties concerning eating and evacuation behaviours in children.
Therefore there are needed effective interventions for children. For example, the “Focal Play Therapy with children and parents” is a psychodynamic model of intervention. It is specifically designed for a child’s eating and evacuation disorders in which parents are actively involved in the play and a special emphasis is given to the early building of the parent-therapist alliance. The Focal Play Therapy with children and parents consists of weekly alternate play sessions with the child and his/her parents together, and sessions with parents only.
This intervention refers to the therapeutic alliance with parents that is a crucial component of a successful child assessment and intervention process. A high parent-therapist alliance correlates with low drop-out rates, decreased youth symptomatology, and improved parenting practices and family functioning. The focal play therapy helps to re-establish the natural valence of food and corporal contents for children while supporting adults to reevaluate their parental abilities.
Chirico et al., 2019 addressed the quality of the parent-therapist alliance during the first phase. The results showed that high levels of parent-therapist alliance were promoted and maintained throughout the “Focal Play Therapy with children and parents”. Parents were highly motivated and in need of help for their child’s problems and, since the beginning of the intervention, they trusted in the therapist’s ability to help them.
As a result, positive parent-therapist alliance were developed and maintained throughout the first 6 sessions of “Focal Play Therapy with children and parents” and there was a slight initial decrease in the parental levels of stress and a small increase in the quality of adult-child relationships.
Source: The Focal Play Therapy: A Clinical Approach to Promote Child Health and Family Well-being.
Chirico et al. 2019