Therapies for Children and Adolescents

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

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

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

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

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. 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 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

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

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

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 child physical abuse Parent training a component of therapy for ADHD Parent training a component of therapy for ADHD Intensive behavioural parent training a component of therapy for CD Intensive behavioural parent training a component of therapy for CD Desensitisation for specific phobia and PTSD Desensitisation for specific phobia and PTSD Cognitive behaviour therapy for depression Cognitive behaviour therapy for depression

Adam: A case study

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

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

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

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

What is narrative therapy? Described as a ‘therapy of curiosity’ (Smith & Nylund) 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 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 A strengths approach, not deficits

What is the theory behind narrative therapy? Social constructionism/ postmodernism 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 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) Challenge to ‘objectivity’ of science- “pathology exists in the domain of human intentions and values” (Smith & Nyland) All knowledge is perspectival All knowledge is perspectival

Principles of narrative therapy  shared power-collaborative  exploratory  changing the story  externalising the problem

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

‘ Sneaky Poo’: A narrative approach to encopresis

The ‘ideal’ child/adolescent therapist