Psychotherapeutic intervention in childhood and adolescence

4046
Philip Kelley
Psychotherapeutic intervention in childhood and adolescence

Contents

  • Common reasons for demand in therapy with children and adolescents
  • Cognitive Psychotherapy
    • Emotional education
    • Cognitive restructuring
  • Personal Construct Psychotherapy (PCP)
  • Narrative Psychotherapy: the externalizing conversation
    • References

Common reasons for demand in therapy with children and adolescents

  • Difficulties in school (learning / relationship)
  • Nightmares and / or night terrors
  • Eating disorders and eating behavior
  • Elimination disorders (enuresis / encopresis)
  • Psychological problems of the child derived from the relationship between the parents and with the parents.
  • Oppositional defiant disorder
  • Attention deficit with hyperactivity (ADHD) or without hyperactivity
  • Sad or irritable mood (sometimes diagnosable as depression)
  • Anxiety disorders (especially separation anxiety, social phobia, and school phobia)

Cognitive Psychotherapy

As in psychotherapy with adult clients, cognitive therapy has proven to be effective in working with children and adolescents, for example in treating depression. Its main objective is to change negative thoughts for more adaptive ones.

Usually the therapeutic procedure is carried out from the following sequence:

Emotional education

  • Teach the child to differentiate between different types of emotions and to recognize that a person can experience two different and / or contradictory emotions simultaneously.
  • Teach the child that different situations provoke different emotions.
  • Teach the child that the intensity of emotions varies depending on the situations.

Cognitive restructuring

  • Teach the child that thoughts are responsible for emotions.
  • Teach the child to identify cognitive distortions and discuss depressive thoughts.
    • Help the child to be more tolerant of his own mistakes.
    • Help the child develop his capacity for social perspective.
    • Help the child acquire more adaptive social behaviors.
    • Help the child to develop enjoyable activities.

As in the case of therapy with adults, to address these objectives in cognitive therapy with children and adolescents, we usually intervene through the use of worksheets and self-records. For this reason, the format and presentation of the worksheets and records is adapted to the developmental level of the child and his personal interests..

Personal Construct Psychotherapy (PCP)

The greatest exponent of work with children and adolescents since PCP is Tom Ravanette (1999), who has worked and researched especially in the field of educational psychology. When George A. Kelly (1955) developed PCP, he started from the philosophical postulate according to which the meaning of experience is a personal construction and is not revealed to us directly by simply observing external reality. In this way, new interpretations of the experience are always possible. Following these premises, the main objectives of working with children and adolescents from PCP would be the following:

  • Evaluate the constructions by which the child makes sense of himself and others.
  • Help the child discover new personal meanings that are more useful and make him feel better.

These objectives are pursued by exploring different aspects of the child's life:

  • Exploring the sense of self
  • Exploring yourself in relationship
  • Exploring the child's problems
  • Elaboration of feelings

Techniques designed to address therapeutic goals are invitations for the child to think about himself and his way of giving meaning to life; They are characterized by having a minimal structure and encouraging maximum freedom of expression. In addition, each exercise contains the possibility of generating new construction alternatives.

Narrative Psychotherapy: the externalizing conversation

From narrative psychotherapy, narrative is considered as the central element in the construction of knowledge. That is, we organize knowledge about ourselves and what we live in stories or narratives. Since there is always more than one way to explain one's story, narrative psychotherapy has two main goals:

  • The child is helped to find more satisfying ways to tell his own story.
  • It is intended that the child's identity is not defined by his problem. As Freeman, Epston and Lobovits (2001, p. 29) state, "the problem is the problem, the person is not the problem." It is in this sense that we speak of externalization of the problem: the problem is given its own entity, reified or personified, and the child and his family are invited to foresee it as something external to themselves. Thus, starting from the knowledge of the abilities and the particular interests of the child, the exceptions to the influence of the problem will be emphasized and the co-creation of new possibilities of functional relationship (solutions) between the child and the problem..

But how do you conduct an outsourcing conversation? Here are some useful types of intervention to outsource the problem:

Relative influence questions (White, 1986): they are useful for the child not to identify with the problem and feel that he has or may have some control over it.

  1. Questions about the influence of the problem on the child's life / relationships, for example: "How does anger make you angry at your mother? What does it make you do?".
  2. Questions that prompt a description of the child's influence on the life of the problem, for example: "What do you do to make the anger disappear?".

Invitational Questions: they are useful to generate experience of preferred relationships with the problem, not only to obtain information:

  1. Questions about interests (hobbies, favorite TV and cartoon characters, favorite games, etc.), special abilities (intuition, imagination, magic games, playing music, being a good athlete, etc.) and other particular characteristics of the child, which you can use to cope with the problem, just as you may have used to overcome other problems.
  2. Questions to generate experience of preferred relationships with the problem: invite consideration of the effect of seeing the problem from several more advantageous points of view, for example: "Can you think of something that worked for you in the past to get something you wanted?".

Use of metaphor: it is useful to describe the relationship between one person (or more) and a problem. Thus, we can talk, for example, about the wall of rage, turn our backs on the problem, tame it, destroy it, throw it away, etc. The metaphor changes as the relationship to the problem changes. It is chosen with the client, using their own language; meaning is always negotiated.

We can also personify the problem to be able to negotiate: for example, ask the child to give it a name, draw it, write letters, etc..

References

Freeman, J., Epston, D., and Lobovits, D. (1997). Narrative therapy for children. Barcelona: Paidós, 2001.

Ezpeleta, L. (2001). The diagnostic interview with children and adolescents. Madrid: Ed. Synthesis (Technical Guides Series).

Mendez, FX (2000). Fears and Fears in Childhood: Helping Children Overcome Them (2nd Ed.). Madrid: Pyramid.

Mendez, FX (2001). The child who does not smile: Strategies to overcome childhood sadness and depression (2nd. Ed.). Madrid: Pyramid.

Pacheco, M. and Botella, L. (2001). Relational constructivism in psychotherapy with children and adolescents: a proposal for the liberation of new dialogic spaces. Journal of Psychotherapy, 44, 5-26.

White, M., and Epston, D. (1993). Narrative means for therapeutic purposes. Barcelona: Paidós.


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