Therapies for Children and Adolescents

Play therapy-what is it?No comprehensive definition exists but variously No comprehensive definition exists but variously

described as:described as: a mechanism for problem solving and a mechanism for problem solving and

competence skills (White)competence skills (White) a process that allows children to ‘mentally a process that allows children to ‘mentally

digest’ experiences and situations (Piaget)digest’ experiences and situations (Piaget) an emotional laboratory in an emotional laboratory in

which children learn to cope which children learn to cope with their environment (Erikson)with their environment (Erikson)

a way that the child talks using a way that the child talks using toys for words (Ginott)toys for words (Ginott)

What is the theory behind play therapy?

Different theoretical perspectivesDifferent theoretical perspectives Humanistic strong influence, non-Humanistic strong influence, non-

directive play therapydirective play therapy Optimum conditions for Optimum conditions for

healthy development= healthy development= meeting child’s needs for meeting child’s needs for warmth, empathy and warmth, empathy and acceptance acceptance

Unconditional positive regardUnconditional positive regard

What are the principles of play therapy?

Focus on feelingsFocus on feelings Reflection of feelings child works Reflection of feelings child works

with in playwith in play Non judgemental acceptanceNon judgemental acceptance Child not therapist driven-respect Child not therapist driven-respect

that the child knows what work that the child knows what work she/he needs to doshe/he needs to do

What does play therapy work best for? Difficult to evaluate, no systematic Difficult to evaluate, no systematic

evaluation but Rogerian therapist qualities evaluation but Rogerian therapist qualities found effective adultsfound effective adults

Approach of choice young children, can be Approach of choice young children, can be used up to adolescenceused up to adolescence

Especially indicated for Especially indicated for abused children, PTSD, abused children, PTSD, internalising problems, internalising problems, adjustment problems adjustment problems

What are behavioural therapies? Behavioural therapies are based on the Behavioural therapies are based on the

principles of learning and the idea that principles of learning and the idea that any observable behaviour can be any observable behaviour can be changed through the manipulation of changed through the manipulation of environmental factors.environmental factors.

Behaviour therapy includes working Behaviour therapy includes working with children/adolescents to change a with children/adolescents to change a ‘maladadptive’ behaviour as well as ‘maladadptive’ behaviour as well as working with parents to manage and /or working with parents to manage and /or modify children’s behavioursmodify children’s behaviours

What are the theories behind behaviour therapy?

Classical conditioning (systematic Classical conditioning (systematic desensitisation)desensitisation)

Operant conditioning (contingency Operant conditioning (contingency therapies)- remember baby therapies)- remember baby Albert?, positive & negative Albert?, positive & negative reinforcement, positive and reinforcement, positive and negative punishmentnegative punishment

Modelling- peers and parentsModelling- peers and parents

What are the principles of behaviour therapy? ObjectiveObjective If it’s observable it can be changedIf it’s observable it can be changed Here and nowHere and now Baseline behavioursBaseline behaviours Ongoing measures-evaluationOngoing measures-evaluation Can be applied to families Can be applied to families

(behavioural family therapy)(behavioural family therapy)

What behaviour therapies work best for which problems? Parent training a component of therapy Parent training a component of therapy

for child physical abusefor child physical abuse Parent training a component of therapy Parent training a component of therapy

for ADHDfor ADHD Intensive behavioural parent training a Intensive behavioural parent training a

component of therapy for CDcomponent of therapy for CD Desensitisation for specific phobia and Desensitisation for specific phobia and

PTSDPTSD Cognitive behaviour therapy for Cognitive behaviour therapy for

depressiondepression

Adam: A case study

What is family therapy?

Family therapy focuses on how the Family therapy focuses on how the whole family system is involved in a whole family system is involved in a child or young person’s problemschild or young person’s problems

Different schools of family therapy, Different schools of family therapy, each with its own specific approacheach with its own specific approach

Family structure and family Family structure and family communication key aspects of communication key aspects of changechange

What is the theory behind family therapy? General systems theory (from General systems theory (from

biology)-every system part of a biology)-every system part of a larger systemlarger system

Cybernetics (from mathematics)- Cybernetics (from mathematics)- positive and negative feedback positive and negative feedback loopsloops

Family life cycle (from Family life cycle (from psychology)-transition points and psychology)-transition points and the changes they bringthe changes they bring

What are the principles of family therapy? ““Changing a family changes the life of Changing a family changes the life of

each of its members” (Nichols & Schwartz)each of its members” (Nichols & Schwartz) Problems are an indicator that something Problems are an indicator that something

is awry in the familyis awry in the family Referred child/young person acts as a Referred child/young person acts as a

family scapegoatfamily scapegoat Focusing on the problem means Focusing on the problem means

underlying issues don’t need to be underlying issues don’t need to be addressed-’homeostasis’addressed-’homeostasis’

Transform interactions-transform problemsTransform interactions-transform problems

What problems respond best to family therapy?

Anorexia-younger adolescentsAnorexia-younger adolescents Component of therapy for Conduct Component of therapy for Conduct

DisorderDisorder Component of therapy for ADHDComponent of therapy for ADHD

What is narrative therapy?

Described as a ‘therapy of Described as a ‘therapy of curiosity’ (Smith & Nylund)curiosity’ (Smith & Nylund)

Narrative in the sense that it is the Narrative in the sense that it is the client/family’s story that matters client/family’s story that matters and that to make changes the and that to make changes the client/family needs to construct a client/family needs to construct a new version of their storynew version of their story

A strengths approach, not deficitsA strengths approach, not deficits

What is the theory behind narrative therapy?

Social constructionism/ postmodernismSocial constructionism/ postmodernism Notions of what constitutes psychological Notions of what constitutes psychological

problems are socially constructed and reflect problems are socially constructed and reflect dominant views or views of those who have dominant views or views of those who have ‘power’ about what is or is not a problem‘power’ about what is or is not a problem

Challenge to ‘objectivity’ of Challenge to ‘objectivity’ of science-“pathology exists in the domain of science-“pathology exists in the domain of human intentions and values” (Smith & human intentions and values” (Smith & Nyland)Nyland)

All knowledge is perspectivalAll knowledge is perspectival

Principles of narrative therapy

shared power-collaborativeshared power-collaborative

exploratoryexploratory

changing the storychanging the story

externalising the problemexternalising the problem

What problems respond best to narrative therapy?

Not included in metanalytic Not included in metanalytic reviewsreviews

Approach used for many different Approach used for many different kinds of ‘problems’ e.g. Smith & kinds of ‘problems’ e.g. Smith & Nylund book chapters include Nylund book chapters include substance misuse, depresssin, substance misuse, depresssin, ADHD, sexual abuse, problems ADHD, sexual abuse, problems with anger with anger

‘Sneaky Poo’: A narrative approach to encopresis

The ‘ideal’ child/adolescent therapist