The Practice of Child Therapy

Richard J. Morris, Thomas R. Kratochwill, Richard J. Morris, Thomas R. Kratochwill, Richard J. Morris, Thomas R. Kratochwill

• Publisher: Routledge
• Year: 2007
• ISBN:
  9781136749001
• Edition: 4
• Topic: Education
• Subtopic: Education Counseling

Consistent with previous editions, this book assembles in a single volume summaries of the treatment literature and treatment procedures of the most common childhood behavior disorders facing persons who practice in applied settings clinics, schools, counseling centers, psychiatric hospitals, and residential treatment centers.Its 16 chapters cover

1

Historical Context of Child Therapy

Richard J. Morris and Thomas R. Kratochwill

Although there is increasing interest in the understanding, care, and treatment of children having emotional and behavior disorders, this is a relatively recent event within the history of the mental health field. Unlike the adult treatment literature—which can be traced back to ancient civilizations, with reliance on such practices as trephining and exorcism—the child mental health treatment literature can be traced with any clarity only to the early 20th century (Achenbach, 1974; Kanner, 1948). The one notable exception is the literature on children who were diagnosed as having mental retardation or intellectual disability.

Concern for the systematic and organized care of children with mental retardation or intellectual disability can be traced to Jean Itard and his attempts, beginning in 1799, to educate the “Wild Boy of Aveyron.” These initial treatment approaches were continued by Edward Seguin in the mid-1800s, with research focusing on the causes, nature, and treatment of mental retardation (Achenbach, 1974). This work was followed by the building of residential schools for persons with mental retardation—the first in Massachusetts in 1848 and the second in New York in 1851. These facilities were initially established on an experimental basis as educational institutions, almost like boarding schools, rather than as custodial asylums. The assumption was that after receiving training to assist them in their functioning in society, these children would be returned to their homes. This assumption, however, was found to lack empirical support since few residents actually returned home. By the end of the 19th century, the state residential “educational” institution, although still typically called a “state school” for people having mental retardation (or, as the children were referred to then, as mentally deficient, or as idiots and feebleminded), had become a custodial treatment institution.

Other notable developments in the early 20th century that contributed to the concern with the treatment of children having emotional and behavior problems were: the mental hygiene movement, the establishment of child guidance clinics, and the introduction of dynamic psychiatry. Within the mental hygiene movement, Clifford Beers is credited with changing the direction of the treatment of mentally ill persons in America. Beers, a law student at Yale University, had become clinically depressed and suicidal and was hospitalized. Following his hospitalization, Beers published A Mind That Found Itself (1908), describing the mistreatment that he and others received while they were patients at a state mental hospital. The book gained considerable popularity and raised the level of public awareness of the terrible conditions in the state hospitals and the inadequate treatment received by mental patients. With the help of a number of prominent professionals (for example, psychiatrist Adolph Meyer and psychologist William James), Beers formed the Connecticut Society for Mental Hygiene (1908) and the National Committee for Mental Hygiene (1909) to inform the public of the conditions in state hospitals, to promote the establishment of better treatment methods, and to sponsor research on the prevention and treatment of mental illness. These events led to the development of the child guidance movement and the establishment of mental hygiene programs in the schools (Kauffman, 1981).

Although Beers’s book was instrumental in advancing the child guidance movement, the first Psychological Clinic in the United States was actually established more than 10 years prior to the publication of his book. Specifically, in 1896, Lightner Witmer started the Psychological Clinic at the University of Pennsylvania, where the first case involved a 14 year-old boy, Charles Gilman (pseudonym), who had difficulty learning and was a “chronic bad speller” (Witmer, 1907/1996, p. 249). During the clinic’s first year of operation, McReynolds (1996) reports that Witmer and his students saw a total of 24 children between the ages of 3 and 16 years, who had such presenting problems as “learning difficulties, speech problems, and possibly chorea, hydrocephalus, and hyperactivity” (p. 238). Over the next several years, the clinic gained a good deal of attention among professionals and, in 1907, Witmer published the professional journal, The Psychological Clinic, in which he and the other contributing journal authors discussed various case studies and presented descriptions of programs (Routh, 1996).

In addition to Witmer’s psychological clinic and journal, as well as the publication of Beers’s book, another development contributed to the emergence of the child guidance movement, namely, the establishment in 1909 of the Cook County Juvenile Psychopathic Institute in Chicago, Illinois, under the leadership of William Healy. The institute staff worked directly with juvenile offenders and stressed an interdisciplinary approach to studying them. Psychiatrists, psychologists, and social workers worked together on particular cases, emphasizing the multiple contributing factors to any given child’s behavior disorder(s). Aided by Beers’s National Committee for Mental Hygiene, numerous child guidance clinics developed across the country over the next several decades, addressing a broad range of children’s behavior and learning disorders. In fact, Kanner (1948) reports that by 1930, there were about 500 child guidance clinics in the United States.

Another series of events that substantially contributed to the development of our current emphasis on treatment services for children and adolescents involved the introduction of dynamic psychiatry and psychoanalysis during the early 20th century. Specifically, Sigmund Freud, in Vienna, Austria, and Adolph Meyer, in the United States, are often credited with introducing the dynamic psychiatry approach. Individuals affiliated with this approach maintained that the origins of behavior problems lay in the past experiences (typically, childhood) of the person (Kanner, 1948). With adult patients, these experiences were explored retrospectively by the psychiatrist or psychoanalyst, who attempted to draw causal relationships between these past experiences and the patients’ present behavior. It should be noted, however, that during the early years of the dynamic psychiatry movement children were usually not seen in treatment by psychiatrists. In fact, as Kanner (1948) states, “Even Freud, who so clearly understood the influence of early experiences on emotional development, had his theory of infantile sexuality all worked out and published [in 1905] three years before he even saw one single child professionally” (p. 7).

However, the retrospective search for the relationship between early childhood events and present functioning aroused sufficient interest among professionals that some began to acquaint themselves specifically with the behavior problems of children as well as with the dynamics that contributed to their difficulties. This psychodynamic interest in children was not formally realized in the literature until the publication, in 1909, of Freud’s detailed case of “Little Hans.” Interestingly, although Freud formulated his etiological theory of phobias on the basis of Hans’s symptoms and experiences, he did not treat Hans directly. Hans’s father treated him under Freud’s direction and supervision (Morris & Kratochwill, 1983). Although Hans’s problem was treated successfully, it was not until at least 15 to 20 years later that Freudian psychoanalytic child therapy came into existence. This development was largely due to the contributions and adaptations of Freud’s work for children by Melanie Klein (Freud’s student) and his daughter, Anna Freud, and the subsequent publication beginning in 1945 of Anna Freud’s multi-volume edited book series (with Hans Hartmann and Ernst Kris), The Psychoanalytic Study of the Child. The changes made by these women, as well as the earlier psychoanalytic therapy work with children first initiated by Hermine Hug-Hellmuth (the third woman to join Freud’s Vienna Psychoanalytic Society during the 1900s), made Freud’s therapeutic approach more applicable to children and contributed to its increasing popularity in the 20th century and later influence in the development of many other forms of child and adolescent psychotherapy (Benveniste, 1998; Jones, 1961).

Some of the major methodological changes that were made for children in Freud’s psychoanalysis included the substitution of play activities for the technique of free association and the use of drawings and dreams to understand a child’s problem more completely (Knopf, 1979). For example, through the use of the medium of play, both Klein and Anna Freud discovered that children were able to represent to the child analyst their inner conflicts and perceptions of important relationships in their lives, as well as portray in their play their unique feelings, perceptions and concerns about the various pleasurable and traumatic experiences that they expereinced (Morris, Li, Lizardi-Sanchez, & Morris, 2002; Warshaw, 1997).

These three major developments, as well as the earlier concerns expressed by professionals for the care and welfare of children and adults who had mental retardation, contributed substantially to our present focus on the provision of clinical services to children and adolescents having emotional and behavior disorders. Other developments also contributed to the current focus and should be mentioned briefly. The intelligence testing movement, begun in France by Alfred Binet at the beginning of the 20th century, had a tremendous influence on the study of children. As a result, it became possible to learn the extent to which a particular child differed from the norm in cognitive ability. It also demonstrated clearly the diversity of children in terms of their comprehension of classroom instruction (Kanner, 1948).

The formation of professional associations, in addition to Clifford Beers’s National Committee for Mental Hygiene, also contributed to the increasing emphasis on the treatment of children. The first professional association was the Association of Medical Officers of American Institutions for Idiots and Feeble-minded Persons, founded in 1876, which over the next 130 years evolved into the present-day American Association on Intellectual and Developmental Disorders (formerly, the American Association on Mental Retardation). Its first president was Edward Seguin. In 1892, another professional association was formed, the American Psychological Association, in which Witmer was a charter member. In 1922, the Council for Exceptional Children, was formed. It consisted primarily of educators and other professionals, although parents were members too. The fourth early association was the American Orthopsychiatric Association, founded in 1924 and consisting primarily of psychiatrists, applied psychologists, and social workers, although educators as well as other professionals and parents were also members. Each of these groups encouraged the formulation and conduct of research with children having behavior and learning disorders, as well as the sharing of information regarding effective psychological and/or educational interventions.

In addition, following the emerging changes in the early 20th century in the predominant and very rigid and structured philosophy surrounding the education of students, and in recognition of Alfred Binet’s work, a movement to provide more individualized instruction and special education classes for students who had intellectual, learning and emotional handicaps began. These classes were to be taught by teachers who had studied about particular behavior and learning disorders and developed specific methods for modifying them. As a result, teacher-training programs began to develop, with the earliest appearing in 1914 in the state of Michigan.

Finally, in addition to the work of Anna Freud and Melanie Klein regarding applying Freudian psychoanalysis to children, a second treatment approach emerged which was initially much less popular than psychoanalytic child therapy. This approach was called behaviorism and later became known as the behavior modification or behavior therapy movement (Kazdin, 1994; Morris, 1985). Behavior modification emerged largely from the experimental psychology laboratory rather than from direct interaction with patients, and was based on theories concerning how people and animals learn to behave through stimulus-response learning and conditioning rather than through the conscious or unconscious thinking found in psychoanalytic writings. Perhaps, the two most famous behaviorists associated with this movement were John B. Watson (e.g., Watson, 1913, 1919), often referred to as the “Father of Behaviorism,” and B. F. Skinner (e.g., Skinner, 1938, 1953), the behavioral researcher and theorist who extended Watson’s behavioristic views and developed a learning paradigm that Skinner referred to as “operant conditioning.” The behavior modification and behavior therapy procedures that were derived from various learning theories were largely confined for many years to research settings. In fact, it was not until the mid-1960s to late-1970s that these procedures began being applied on a regular basis in children’s residential treatment settings, regular and special education classrooms, and outpatient mental health settings (Morris, 1985; Morris, Li, Lizardi-Sanchez, & Morris, 2002). As was the case with the advent of child psychoanalysis and the advancement of the child guidance movement several decades earlier, the impact of the child behavior modification movement in the mid-1960s to late-1970s was profound in that it further contributed to society’s thinking that children and adolescents having various behavior and learning disorders could be treated successfully.

In considering all these developments, one begins to realize that concern with the understanding, care and treatment of children and adolescents did not stem from one or two major activities. Rather, many events, occurring over more than 100 years, set the stage for our present-day psychotherapy and intervention services for children and adolescents. The authors of the remaining chapters provide a brief historical perspective on their respective topics and then present a detailed account of various therapeutic methods for helping children and adolescents change their behaviors. The focus of each chapter is on evidence-based treatment procedures that are supported by group and/or single-case experimental research conducted in clinical settings. In addition, where possible, chapter authors have included discussions of school-based and home-based interventions that have empirical support. We hope that readers will find these chapters of great interest and practical value.

REFERENCES

Achenbach, T. M. (1974). Developmental psychopathology. New York: Ronald Press.

Beers, C. (1908). A mind that found itself. New York: Longmans, Green.

Freud, S. (1963, 1909). The analysis of a phobia in a five-year-old boy. Standard edition of the complete psychological works of Sigmund Freud (Vol. 10). London: Hogarth Press.

Jones, E. (1961). The life and work of Sigmund Freud (Abridged by L. Trilling & S. Marcus). NY: Basic Books.

Kanner, L. (1948). Child psychiatry. Springfield, IL: Charles C. Thomas.

Kauffman, J. M. (1981). Characteristics of children’s behavior disorders. Columbus, OH: Merrill.

Kazdin, A. E. (1994). Behavior modification in applied settings (rev. ed.). Homewood, IL: Dorsey Press.

Knopf, I. J. (1979). Childhood psychopathology. Englewood Cliffs, NJ: Prentice-Hall.

McReynolds, P. (1996). Lightner Witmer: A centennial tribute. American Psychologist, 51, 237–240.

Morris, R. J. (1985). Behavior modification with exceptional children: Principles and practices. Glenview, IL: Scott, Foresman and Company.

Morris, R. J., & Kratochwill, T. R. (1983). Treating children’s fears and phobias: A behavioral approach. Elmsford, NY: Pergamon Press.

Morris, R. J., Li, H., Lizardi-Sanchez, P., & Morris, Y. P. (2002). Psychotherapy with children and adolescents. In I. Weiner (Ed.), Comprehensive handbook of psychology: Clinical psychology (pp. 389–405). New York: Wiley.

Routh, D. K. (1996). Ligtner Witmer and the first 100 years of clinical psychology. American Psychologist, 51, 244–247.

Skinner, B. F. (1938). The behavior of organisms. New York: Appleton-Century-Crofts, Inc.

Skinner, B. F. (1953). Science and human behavior. New York: MacMillan.

Warshaw, S. C. (1997). A psychoanalytic approach to intervention. In R. C. D’Amato & B. A. Rothlisberg (Eds.), Psychological perspectives on intervention (pp. 48–68). Prospect Heights, IL: Waveland Press.

Watson, J. B. (1913). Psychology as the behaviorist views it. Psychological Review, 20, 158–177.

Watson, J. B. (1919). Psychology from the standpoint of a behaviorist. Philadelphia: Lippincott.

Witmer, L. (1907/1996). Clinical psychology. American Psychologist, 51, 248–251.

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