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Learning Disorders and Disorders of the Self in Children and AdolescentsReview - Learning Disorders and Disorders of the Self in Children and Adolescents
by Joseph Palombo
WW Norton, 2001
Review by Dan L. Rose, Psy.D.
Jul 8th 2003 (Volume 7, Issue 28)

To the practicing clinician dealing with individuals labeled learning disabled or attention deficited, there often seems only two roads one can take.  If the diagnosis is suspect, one works to understand other, possibly more neurotic causalities. This route is less accepted, being seen more as "blaming the victim." The second is blind acceptance of the diagnosis and the biological constraints of the disorder. The individual is, as she or he is, because of the neuropsychological dysfunction. This route leaves the clinician with an over-simplistic picture of the individual, almost as if one were dealing with an organism of the single celled variety and not the complexity of the more human kind.

Joseph Palombo takes a less traveled path in his text Learning Disorders and Disorders of the Self, one that attempts a space between the aforementioned two. Palombo makes no attempt to argue against the various diagnostic criteria of learning disorders and instead focuses on the ways in which these varieties of neurological dysfunction challenge and often derail personality development. Taking a solid self psychological stance (a variant of contemporary psychoanalytic thought based on the writings of Heinz Kohut and focused on the ways individuals develop and maintain a sense of self esteem), Palombo uses theoretical constructs to map this third trail and guide the clinician who navigates it.

The text begins with an explanation of Palombo's decision to undertake the writing of this book through a history of his training and a very brief history of psychoanalytic theory in its relation to child development. Palombo makes a useful sketch of past psychoanalytic work with the learning disordered and a discussion of the history of the disorders in general. Palombo then moves to the first of the three major sections of his work: the ways in which disorders of the self occur in the development of the child with a learning disability. Focusing on the context of development, particularly the ways in which parental and/or social factors assist the child in developing a self narrative (this being the implicit way the child organizes his fantasies and expectations of his or her place in the world), Palombo outlines the necessity of a coherent self narrative, the consequences of an incoherent self narrative and the loss of self cohesion (usually resulting in anxiety or depression) that results from disruptions in narrative. The relevance of these concepts to learning disabilities is illustrated by a variety of clinical examples.

Palombo's second section deals with the major varieties of learning disorders and developmental difficulties. Each chapter is organized along characteristics of the disorder, expected developmental history, varieties of possible self disorders and recommended intervention. Beginning with Dyslexia, Palombo moves from least problematic to most debilitating developmental disorders. Along the way, he summarizes relevant data and ties this together, through his clinical experience, with self psychological constructs and clinical illustration.

The final section deals exclusively with the role of psychotherapy with children suffering from learning disabilities. Beginning from a place of caution (therapy must be indicated and often may be unnecessary or even harmful), Palombo outlines the role of the therapist, expectations of change, course of treatment and expected pitfalls (called moments of disjunction by Palombo). He spends considerable time outlining the ways parents and family could be incorporated in the treatment.

Palombo's text has a plethora of strengths. His years of experience shine through, especially in the excellent clinical examples. He writes in a clear, concise manner that verges on the lyrical. The book is well organized, to be practical and used by the clinician. Palombo also does an admirable job bridging psychoanalytic theory with neuropsychological assessment. He does not shy from offering criticism of either camp and, time and again, his empathy for the children in his care drive him to criticize anything that complicates their betterment.

The weaknesses are really only quibbles, though one does bear mentioning. Palombo relies almost exclusively on a self psychological construct (almost is correct, since he does mention several other relevant constructs) and, as a result, succumbs to the weaknesses inherent in the theory. Though an accommodating environment is certainly important in developing and maintaining self narratives and self cohesion, it would have been interesting for Palombo to bring his considerable expertise to bear more on the negative consequences of conflictual adaptation, to have him address the self sabotage and self loathing that can disrupt development.

In conclusion, this is a remarkable book and highly recommended to the practicing clinician or any interested party. I suspect it would enrich the understanding and practice of both the seasoned and novice clinician. Furthermore, it is written from a place of compassion and a desire to heal.

 

© 2003 Dan L. Rose 

Dan L. Rose, Psy.D. is a Clinical Psychologist involved in direct clinical work and training at Columbus State University and in private practice. His interests include psychoanalysis, neuroscience, religion and literature.


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