Interview with Child Psychologist Marisol Cortés in Madrid

Madrid based child psychologist opened her private practice, Essentia Integral, in 2013.  for child psychology and play therapy. She has a master’s degree in Psycho-oncology and later trained in Gestalt Therapy and Play Therapy. Both formations have given me tools to support children, adolescents and their families today.

English Speaking Child Psychologist

What nationality are you and what languages do you speak?

I was born in Mexico City where I lived for 24 years. My family emigrated from Spain to Mexico. Therefore I have Spanish heritage. Spanish is my native language and I also speak English.

What professional qualifications do you have?

I acquired a Bachelors degree in Psychology from Universidad Iberoamericana de Mexico, a Masters degree in Psycho-oncology from Universidad Complutense de Madrid, and I specialised in Gestalt Therapy and in Play Therapy.

What are the most common behavioural and emotional problems you treat in children?

The most common behavioural problems I treat are conduct disorders (CD), attention deficit hyperactivity disorder (ADHD) and bullying. The emotional disorders that are most common are enuresis, excessive fears, low self-esteem, anxiety, aggression and anger, depression, divorce and grief.

How do the problems of adolescents differ?

Adolescence is a period that occurs from puberty to adulthood, a stage where physical, emotional, psychological and social transitions occur. It provides the opportunity for development, not just in the physical aspect but also in cognitive and social competency, autonomy, self-esteem and intimacy.

Adolescents want to be adults but still feel like children. They are vulnerable and immature. Anxiety is one of their faithful companions throughout this developmental stage. Panic attacks, decision taking, fears for the future, emotional and economic independence and anger outbursts are some problems adolescents have to deal with daily. Eating disorders start to manifest at this stage. The physical aspect gains importance. Caring about their looks and others opinions will influence their behaviour and the search for their own identity. Social life and peer groups are their priority; meanwhile, they distance themselves from adults.

Discussions and fights will increase at home. They fight for what they think they deserve and believe. The difficulties from their actual developmental stage can increase and they can feel lost, without control in their own life.

What are some of the more unusual problems you treat?

Some “unusual” problems that I treat are children with painful or frightening medical procedures or long hospitalisations. These problems are actually with children with acute and chronic diseases. Cancer patients are the ones that attend the most therapy. I had one case with selected mutism. The child only talked to her nanny. Through play, she could share with me what was wrong and then start to talk to me.  Distress, anxiety, sadness, anger and frustration are reduced and liberated in both situations.

Are any of these problems more prevalent in Expat children due to them adjusting to life in another country / multiple languages, moving away from friends and family etc?

The impact of moving on children depends a lot on their personality, but moving can be very disorienting to a young child. They rely on predictability and attachment to carers to generate a sense of security.

Older children can also feel insecure and disoriented. Saying farewell to their peers, extended family, house, school, pets, toys, food and places that are significant to them can provoke a number of internal concerns. There is very little empirical research on transcultural individuals. Some studies found that separation, unresolved grief, rootlessness and insecurity are the major issues that these children are challenged to deal with. All these trigger self-defence mechanisms such as avoiding long-term relationships.

The most common difficulties they present include denial, anger, anxiety, bargaining, depression, rebellion, withdrawal, vicarious grief, delayed grief and attachment difficulties. Children that move a lot can often have angry and anxious behaviour in school and at home. Parents don’t know what causes it and the child cannot tell why this behaviour is happening. This anxiety can increase when they don’t feel they belong to a place, where they need to learn a new language and struggle to make new friends. The support received from family and teachers can also determine the prevalence of emotional, social and educational problems in Expat children.

Does being bilingual yourself help you when you are working with children whose problems stem from coping with different languages?

Of course, it helps. Personally experiencing what the children are going through helps me understand them better. I had the necessities and frustrations they have. I know they may feel angry, sad, disappointed, or even have the feeling of not being enough. With this experience, I can make them feel understood through empathy. It’ll help the child feel secure to express his feelings and internal difficulties.

Do you feel children suffer both emotionally and educationally when they enter into a schooling environment that is not in their native tongue?

They will struggle a lot and maybe suffer. Changes are difficult for everyone, personality and coping strategies will determine if the child will suffer or not. It won’t be easy for them, especially if they don’t know the language. They can fall behind educationally because educational programs differ in each country. There will be subjects and lessons they will not know and will need to study from the beginning.  Sometimes an extra personal effort will be necessary for them to succeed. Studying pressure may affect them and increase their levels of distress.

How do you know if your child has a behavioural problem or if they are just going through a difficult phase?

A difficult phase may be a natural reaction. Nowadays we are getting a lot of information about emotional intelligence and know-how to pursue happiness. “Negative” feelings are prohibited in our society and we need to eliminate them as fast as we can. The problem with all this information is that negative feelings are as natural and necessary in our lives, as happiness. Feelings are just feelings. What’s happening, actually, is that when a child gets mad, sad, energetic, we tend to try and change immediately that feeling to a “positive” one. We, as adults, do the same thing.  And we interpret this behaviour as unusual. It’s normal that kids feel frustrated, sad, angry, etc.

When they are going through a difficult phase the behavioural problem is present in the most trustful and supportive environment. What I recommend to parents is to talk to their child and try to understand and support what’s going on with them. Maybe they just had a bad day at school. Their behaviour can be caused by something in particular.

Behavioural problems occur when the difficult phase becomes repetitive and persistent in all environments (school, park, home), especially with adults and lasts more than 6 months. Parents may be desperate and need help to deal with the situation because it’s out of control. 

How can behavioural problems affect a child’s performance at school?

Research has found that behaviour problems are linked to poor grades. They tend to be very distracted; they won’t pay attention for long periods of time. They usually disturb their classmates or even make them join them in their crazy ideas.

The teachers can’t handle them; they are desperate because they don’t know what to do with them, punishment is their only ally, but most of the time it doesn’t work. They get bored very quickly and can’t accomplish to maintain good friends. There are different degrees of bad behaviour. Sometimes they can be aggressive to others, other times they do not obey the rules and teachers. They get away with everything they do.

What have you found are the main concerns among parents in recent times for school-age children?

The biggest concern I encountered is how to set boundaries at home. Most of their children do not obey them. The reason many parents can’t set limits is that they feel guilt. We work together to help them manage this feeling, so they can start restoring order at their home. I help them deal with very energetic children and tantrums. Communication is also a big concern because they usually do not know what to say or not say in certain situations. I help them deal with difficult adolescents, what to do and what not to do. And I explain to them what’s normal in their child’s developmental stage.

What are the most common anxieties in children? 

The ones I’ve worked with most are to fulfil their parents’ expectations. To be who they want them to be, even though they don’t like it. (For example, they play football because his father loves it and wants him to be the best goalkeeper, but the child doesn’t like football, he likes tennis). Fears, phobias, obsessive-compulsive disorder and post-traumatic stress disorder are also very common.

If left untreated can anxieties in children affect their social and educational development?

Yes. They will also affect their emotional development. The internal problems will increase provoking an increment in their behaviour. It will affect their relationships and their educational achievement. Paying attention will get more difficult for them and their normal development will be affected. That’s why it’s very important to prevent these situations.

It’s very important to give children the space they need to express themselves. Children do not have the cognitive capacity to understand and express their feelings in words. They express themselves through non-directive play.

What treatments are available to treat childhood anxieties?

Medical treatments are the most common in paediatrics. There are also different psychotherapies that can help children cope with anxieties. In Spain, the most prevailing psychotherapy is Cognitive-Behavioural Therapy, but there are also humanistic, psychoanalytical and systemic therapies that can help them.

The ideal treatment is for the child to have a multidisciplinary team that will aid from different specialities and points of views. So that way the problem can be treated and be solved from the origin.

How do you assess which therapy is suitable for a child? 

It depends on the problem and the personality of the child and parents. If it’s an emotional difficulty, humanistic therapies and psychoanalytical therapy can help. Making a decision will depend on the way each professional works and if the parent and child are willing to work with that method.

It’s important before starting the treatment to research the working method of each professional. Some professionals work just with the parents, some with the child through play, others with the child through speech and some with the whole family. So it’s up to the parents to decide what therapy is suitable for them. The professional is ethically obliged to tell the parents if the therapy will help their child or if it won’t help resolve that kind of difficulty.

Two of the therapies you offer are Gestalt Therapy and Play Therapy. Can you explain what they are?

Play Therapy is an approach in which play is used to help a child or adolescent express their emotions, thoughts, wishes and needs. It helps them to understand muddled feelings and upsetting events that they have not had the chance or the skills to sort out properly. Children use play to communicate at their own level and their own pace, without feeling interrogated or threatened. Play is a central ingredient in learning, allowing them to imitate adult behaviours, practice motor skills, process emotional events and learn much about their world.

The playroom is a privileged, confident, intimate and unconditional supporting space. Play therapists have the knowledge to understand and get involved in the child’s play. Creating a confident and trustful relationship, which encourages the expression and management of the child’s internal conflicts, the discharge and understanding of their deepest emotions, recognising and exploring the issues that affect their lives.

It can help children with: depression; hyperactivity; anxiety; shyness; lack of attention; death of relatives or friends; low self-esteem; excessive fears; night terrors; divorce or separation; illness, hospitalisation, painfully or frightening medical procedures; anger; aggression; emotional, physical or psychological abuse; domestic violence; bullying.

Adolescents often have difficulties communicating verbally their concerns and feelings. Physical activity is also important in their development, Play Therapy provides opportunities for movement and discharging excess energy. Play, expressive art activities, games, and other materials are used as a bridge to help them express and to obtain insight into their lifestyle.

Gestalt therapy is an interactive and holistic form of psychotherapy that focuses on the total person, recognising the unity of the mind, body and emotions. It’s a creative and patient approach that is non-authoritarian and non-interpretive. It’s a trustful, privileged space. Where the person can feel the support they require for coping with the dilemmas, concerns and difficulties in their daily lives. Where they will find new alternatives and solutions.

It can help to free energy locked into old, dysfunctional behavioural patterns and re-organise ourselves in a way that allows us to live more fully and effectively, centred in ourselves, yet able to reach out and take in what the world has to offer. It can help the adolescent or adult to be aware of what they do and how they feel. Developing skills for self-acceptation, focusing in the here and now, encouraging self-knowledge. It benefits parents and adolescents with emotional problems, couples and/or familiar adversities and conflicts in their professional environment. It can help anyone who needs support to find new and better psychological means to solve their internal and external struggles.

January 2019