Indirect communication as an insight-oriented technique with the resistant and intellectually limited

A proactive cognitive-behavioral approach that presents interpretative options indirectly to children is introduced as a method to promote insight in psychotherapy. The treatment of a resistant, intellectually limited Hasidic 10-year-old child, with secondary personality disorder features, is described. By "talking to himself and musing out loud, the therapist resorted to vocalized "guesswork" when frequent impasses occurred during sessions. As different options were verbalized in interpreting the child's affect, his reactions were monitored by the therapist and elaborated upon. In an approach akin to shaping in the conditioning literature, dynamics of behavior and acting out were uncovered, allowing social adjustment and promoting adaptive behavioral development. The intervention is conceptualized within the framework of cognitive behaviorism, and informed by insight-oriented dynamics as adapted for the resistant and intellectually limited.