Therapies for Children and Adolescents

1. Therapies for Children and Adolescents

2. Play therapy-what is it? No comprehensive definition exists but variously described as: • a mechanism for problem solving and competence skills (White) • a process that allows children to ‘mentally digest’ experiences and situations (Piaget) • an emotional laboratory in which children learn to cope with their environment (Erikson) • a way that the child talks using toys for words (Ginott)

3. What is the theory behind play therapy? • Different theoretical perspectives • Humanistic strong influence, non-directive play therapy • Optimum conditions for healthy development= meeting child’s needs for warmth, empathy and acceptance • Unconditional positive regard

4. What are the principles of play therapy? • Focus on feelings • Reflection of feelings child works with in play • Non judgemental acceptance • Child not therapist driven-respect that the child knows what work she/he needs to do

5. What does play therapy work best for? • Difficult to evaluate, no systematic evaluation but Rogerian therapist qualities found effective adults • Approach of choice young children, can be used up to adolescence • Especially indicated for abused children, PTSD, internalising problems, adjustment problems

6. What are behavioural therapies? • Behavioural therapies are based on the principles of learning and the idea that any observable behaviour can be changed through the manipulation of environmental factors. • Behaviour therapy includes working with children/adolescents to change a ‘maladadptive’ behaviour as well as working with parents to manage and /or modify children’s behaviours

7. What are the theories behind behaviour therapy? • Classical conditioning (systematic desensitisation) • Operant conditioning (contingency therapies)- remember baby Albert?, positive & negative reinforcement, positive and negative punishment • Modelling- peers and parents

8. What are the principles of behaviour therapy? • Objective • If it’s observable it can be changed • Here and now • Baseline behaviours • Ongoing measures-evaluation • Can be applied to families (behavioural family therapy)

9. What behaviour therapies work best for which problems? • Parent training a component of therapy for child physical abuse • Parent training a component of therapy for ADHD • Intensive behavioural parent training a component of therapy for CD • Desensitisation for specific phobia and PTSD • Cognitive behaviour therapy for depression

10. Adam: A case study

11. What is family therapy? • Family therapy focuses on how the whole family system is involved in a child or young person’s problems • Different schools of family therapy, each with its own specific approach • Family structure and family communication key aspects of change

12. What is the theory behind family therapy? • General systems theory (from biology)-every system part of a larger system • Cybernetics (from mathematics)- positive and negative feedback loops • Family life cycle (from psychology)-transition points and the changes they bring

13. What are the principles of family therapy? • “Changing a family changes the life of each of its members” (Nichols & Schwartz) • Problems are an indicator that something is awry in the family • Referred child/young person acts as a family scapegoat • Focusing on the problem means underlying issues don’t need to be addressed-’homeostasis’ • Transform interactions-transform problems

14. What problems respond best to family therapy? • Anorexia-younger adolescents • Component of therapy for Conduct Disorder • Component of therapy for ADHD

15. What is narrative therapy? • Described as a ‘therapy of curiosity’ (Smith & Nylund) • Narrative in the sense that it is the client/family’s story that matters and that to make changes the client/family needs to construct a new version of their story • A strengths approach, not deficits

16. What is the theory behind narrative therapy? • Social constructionism/ postmodernism • Notions of what constitutes psychological problems are socially constructed and reflect dominant views or views of those who have ‘power’ about what is or is not a problem • Challenge to ‘objectivity’ of science-“pathology exists in the domain of human intentions and values” (Smith & Nyland) • All knowledge is perspectival

17. Principles of narrative therapy • shared power-collaborative • exploratory • changing the story • externalising the problem

18. What problems respond best to narrative therapy? • Not included in metanalytic reviews • Approach used for many different kinds of ‘problems’ e.g. Smith & Nylund book chapters include substance misuse, depresssin, ADHD, sexual abuse, problems with anger

19. ‘Sneaky Poo’: A narrative approach to encopresis

20. The ‘ideal’ child/adolescent therapist