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Continuum Concept: A Case Study
Continuum Concept: A Case Study
How the Continuum Concept is Applied Therapeutically
by Jim Giorgi
I have worked with very young children since 1982, as a psychological consultant to preschool programs. My job was to evaluate preschool-age children (between the ages of two and a half to 5 years) who were suspected by their parents, or pediatricians, or other early childhood intervention organizations, of having significant developmental delays.
Based upon the results of my evaluations, I would determine if the child was sufficiently delayed or disrupted in his or her intellectual, emotional or behavioral development to warrant placement in a special education preschool program. When my evaluation was complete, I wrote a report, shared the results with the child’s parents or guardians, and made recommendations as to what types of remedial interventions the child required.
During my years working for public school systems, I also provided psychotherapeutic interventions to those children who required such treatment once they were placed in those preschool programs. In the years since 1997, when I read the book The Continuum Concept by Jean Liedloff, the advice I have given to parents of children with significant emotional and behavioral disorders has derived from that theoretical premise.
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In 2005, I had a job working as a psychological consultant to a private Special Education Preschool program in upstate New York. One day, I was providing feedback to the foster mother of a boy I had just evaluated, who was referred to us by his pediatrician because he was having all sorts of disruptive behavioral problems. “Jordan” (not his real name) was two and a half years old and had a history of consistent neglect, abuse and disruptive elements in his history from birth. His birth mother was a substance abuser with a history of being abused herself, and a history of being in abusive relationships with various men. Without going into detail, to say that this boy’s home environment from birth and the treatment (or lack thereof) that he received from his mother and whatever partner she was with at the time were disastrous to normal development would be an understatement.
According to reports, Jordan was routinely left alone in his crib, unfed, unchanged and without human contact, for long periods of time. Jordan had been removed from his mother’s care by Child Protective Services almost a year prior to my meeting him, and placed in a succession of foster homes. All of the homes that Jordan was placed in previous to that of the current foster mother had requested that Jordan be removed because they were unable to tolerate his disruptive behaviors. “Rose”, (not her real name) the current foster mother reported that Jordan’s behavior in her home was extremely agitated, with many physical and verbal attention-seeking behaviors (which, miraculously, only rarely exhibited overt hostility and aggression), constant motion, and an inability to sleep through the night. She followed this description with an assurance that, despite his behaviors, both she and her husband saw him as a truly lovable boy, and were planning on initiating adoption procedures should the parental rights of the mother be terminated by Family Court, which seemed imminent. I marveled at this woman’s open-heartedness, emotional strength and common sense.
Based upon my knowledge of Continuum principles, I realized immediately that what Jordan needed, and was literally “screaming” for via his behavior, was the extended physical contact with the mother or other adult (father, grandparents, etc.) that he had lacked from birth. One of the situations Rose reported was that Jordan did not sleep well and usually got out of bed and went into the parents bedroom in the middle of the night. They would let him sleep with them for a while and when he was asleep carry him back to his own bed. If he didn’t sleep until morning, he would repeat that process. I suggested to Rose that she just allow him to remain in their bed and sleep with them instead of trying to make him sleep in his own bed . I saw that Jordan was sending a clear message to them which they were not understanding because their responses were based on conventional models of child rearing. I told Rose to just let Jordan know from the outset that from then on, he could sleep with them in their bed, that he would be welcome there whenever he wanted. I assured her that he would sleep more soundly, be more rested, and get the physical contact and emotional reassurance he needed to be able quickly to springboard to higher levels of independence and self-control. I told her that he would probably go back to his own bed of his own volition within about a month, if not less, and be happy to be there because it would be his way of telling them via his behavior that he is truly feeling like a “big boy” now.
I also encouraged Rose to allow Jordan to remain in as close physical proximity to her during the day as often as he wished. This meant, of course, giving and getting hugs and sitting in her lap at appropriate times. But more importantly, I emphasized that Rose should not stop whatever task she happened to be doing for more than a few moments to exchange hugs. Even more critical was just allowing Jordan to stay close to her or to be physically touching her (whenever possible) without her taking her attention off of the task in which she was engaged, whether it was cooking, cleaning, talking on the phone, or any other daily task. I encouraged her to allow Jordan to be a “passive participant” in all of her normal, adult routines, and to be “child friendly” without being “child centered”.
I reassured Rose that every child who feels that he has the physical contact that he really needs, and not what his parents give him as substitutes for that contact, wants to grow up and be more mature. If a child gets stuck at any point along the way of his development, it is because he feels that he hasn’t received all of the contact he really needed at that point to feel secure enough to leave less mature levels for more mature levels. I knew that Jordan, despite the severity of his troubles, was no different.
Sitting with and listening to me during this feedback session with Rose was the program’s special education evaluator, who had performed the academic portion of Jordan’s evaluation, and was poised to make a report on her findings as well. She heard all of my advice, and I could see the tension building up in her face. After I gave the advice about allowing Jordan to sleep in the parents’ bed, she said quietly “we don’t encourage that here”. I felt a flash of annoyance, but shrugged it off. I understood that she, too, just didn’t “get it”. She was about 30 years old, and with perhaps five to eight years of teaching experience. She certainly had been exposed only to the conventional theories of infantile attachment and child development. I made an offhanded remark about “special circumstances” to deflect her concerns. But her comments clearly showed me that there needs to be a massive educational initiative to change this attitude and show people what is really happening to a child when they hear him crying or see behavioral problems, and then mistakenly assume that feeding him, or changing his diapers, or making silly faces, or giving him toys or other distractions will satisfy his true needs.
The session ended after the special education teacher gave her feedback, and Rose left feeling both encouraged and empowered by the advice she received. She was committed to putting it into practice as soon as she got home. I went home that afternoon feeling gratified that the few minutes I spent with Rose might have made a positive difference in the lives of this family, people whom I would probably never see again.
About a week and a half later, I received a call from the preschool agency, asking me if I would consent to their giving my telephone number to the pediatrician who treated Jordan. Apparently the pediatrician had called the center and asked to speak with me. As I worked there only one day a week, I did not have my own extension or voicemail. I readily consented, and within 5 minutes of doing so received a call from the pediatrician, a female physician whose practice was in a town about 15 miles from where I lived. She informed me that she had seen Jordan for a regular checkup the day before and, as she put it, was presented with a “totally different child” than the one she had seen a few months before, during the visit which had initially prompted her to refer Jordan for the preschool evaluation. She went on to say that Jordan was “calm”, “happy”, “relaxed”, “attentive”, and, in short, exhibited none of the problematic behaviors that she had observed in previous meetings.
She was so stunned by this transformation (as she put it) that she asked Rose what could possibly have happened as a result of the evaluation that Jordan had undergone. When Rose described to her the advice that I had given, she felt compelled to contact me. The pediatrician continued, saying that she had always felt that physical contact with newborns was essential for appropriate development, but she had never heard of the Continuum Concept and how this principle confirmed her intuitions in ways that transcended conventional developmental and attachment theory. Most importantly, she affirmed that her “before and after” observations of Jordan’s behavior demonstrated unequivocally to her the validity of the Continuum Concept’s essential elements. She was truly dumbfounded by what she saw, and needed to speak with me personally to reassure herself that Jordan’s improved state was not just the effect of some random factor, or his just “growing out of it”. She mentioned that Rose reported that Jordan was now sleeping in his own bed of his own volition and sleeping peacefully for the entire night.
I spent probably half an hour discussing with the pediatrician both Jordan’s case and the Continuum Concept in general before she needed to end the call to see her next patient. We closed with her thanking me profusely and blessing me for “changing Jordan’s life”. I am still awed by Jordan’s transformation. I also realize that I, personally, did nothing to produce it. It was simply another confirmation of my conviction that no psychotherapist can ever be as effective in making a rapid, positive healing impact on a child’s damaged psyche as a parent who finally gives the child what it has been insatiably craving since infancy...the “full contact parenting” of Continuum treatment.
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