Who is This Child? From Observation to Formulation and Therapy Goals

Clinical observation is constantly used in our work: during assessment, when a specific question or need arises, and in fact, during each and every therapeutic hour. When observing a child, whether in natural setting or in the therapy room, on preliminary assessment or during an ongoing psychotherapy, two basic questions need to be related to: “Who is this child?” and- “How may we help him?” In the following paper, characteristics and phases of developmental-psychodynamic noninterventive observation are described. It is then demonstrated by two clinical vignettes, how such observation may afford at least preliminary replies to these questions, and provide meaningful, useful leads to therapists, care-takers, and educational teams to explore and to move forward. Observation is a process of hypothesizing, confirming or refuting our hypotheses, and finally of integration, as we face the creative challenge of translating nonverbal, emotional experience into verbal, concise professional language. The end product of observation is formulation: relating to specific, unique child and family, connected to emotional experience and preserving its truth and authenticity, and at the same time useful and practical in defining and formulating therapeutic goals.