The Handbook of Child and Adolescent Clinical Psychology

A Contextual Approach

Alan Carr

• Publisher: Routledge
• Year: 2015
• Print ISBN: 9781138806009
• eBook ISBN: 9781317591504
• Edition: 3
• Topic: Medicine
• Subtopic: Developmental Psychology

The third edition of the hugely successful Handbook of Child and Adolescent Clinical Psychology incorporates important advances in the field to provide a reliable and accessible resource for clinical psychologists. Beginning with a set of general conceptual frameworks for practice, the book gives specific guidance on the management of problems commonly encountered in clinical work with children and adolescents drawing on the best practice in the fields of clinical psychology and family therapy. In six sections thorough and comprehensive coverage of the following areas is provided:

Frameworks for practice

Problems of infancy and early childhood

Problems of middle childhood

Problems of adolescence

Child abuse

Adjustment to major life transitions

Thoroughly updated throughout, each chapter dealing with specific clinical problems includes cases examples and detailed discussion of diagnosis, classification, epidemiology and clinical features. New material includes the latest advances in: child and adolescent clinical psychology; developmental psychology and developmental psychopathology; assessment and treatment programmes. This book is invaluable as both a reference work for experienced practitioners and as an up-to-date, evidence-based practice manual for clinical psychologists in training.

The Handbook of Child and Adolescent Clinical Psychology is one of a set of 3 books published by Routledge which includes The Handbook of Adult Clinical Psychology: An Evidence Based Practice Approach, Second Edition (Edited by Carr & McNulty) and The Handbook of Intellectual Disability and Clinical Psychology Practice (Edited by Alan Carr, Christine Linehan, Gary O'Reilly, Patricia Noonan Walsh and John McEvoy).

Section 1

Frameworks for practice

Chapter 1

Normal development

This book is primarily concerned with psychological problems that occur during the first 18 years of life. The first 18 years is a period during which the most profound changes occur in physical, cognitive and social development. A summary of important normative findings from the fields of developmental psychology and psychopathology will be presented in this chapter. However, the development of the individual child is primarily a social process and the family is the central social context within which this development occurs. We will therefore begin with a consideration of the family lifecycle.

The family lifecycle

Families are unique social systems insofar as membership is based on combinations of biological, legal, affectional, geographic and historical ties. In contrast to other social systems, entry into family systems is through birth, adoption, fostering or marriage and members can leave only by death. Severing all family connections is never possible. Furthermore, while family members fulfil certain roles which entail specific definable tasks such as the provision of food and shelter, it is the relationships within families which are primary and irreplaceable.

With single-parenthood, divorce, separation and re-marriage as common events, a narrow and traditional definition of the family is no longer useful for the practicing clinical psychologist (Walsh, 2012). It is more expedient to think of the child’s family as a network of people in the child’s immediate psychosocial field. This may include members of the child’s household and others who, while not members of the household, play a significant role in the child’s life. For example, a separated parent and spouse living elsewhere with whom the child has regular contact, foster parents who provide respite care periodically, a grandmother who provides informal day care and so forth. In clinical practice the primary concern is the extent to which this network meets the child’s developmental needs.

Having noted the limitations of a traditional model of the family structure, paradoxically, the most useful available models of the family lifecycle are based upon the norm of the traditional nuclear family, with other family forms being conceptualized as deviations from this norm (McGoldrick et al., 2011). One such model is presented in Table 1.1. This model delineates the main emotional transition processes and tasks to be completed by the family at each stage of development.

Table 1.1 Stages of the family lifecycle

Stage	Emotional transition processes	Tasks essential for developmental progression
Leaving home	Developing emotional and financial autonomy	• Differentiating from family of origin and developing adult-to-adult relationship with parents • Developing intimate peer relationships • Beginning a career and moving towards financial independence • Establishing the self in community and society
Forming a couple	Committing to a long-term relationship	• Selecting a partner and deciding to form a long-term relationship • Developing a way to live together based on reality rather than mutual projection • Realigning couple’s relationships with families of origin and peers to include partners
Families with young children	Accepting new children into the family system	• Adjusting couple system to make space for children • Arranging childrearing, financial and housekeeping responsibilities within the couple • Realigning relationships with families of origin to include parenting and grandparenting roles • Realigning family relationships with community and society to accommodate new family structure
Families with adolescents	Increasing flexibility of family boundaries to accommodate adolescents’ growing independence and grandparents’ increasing constraints	• Adjusting parent–child relationships to allow adolescents more autonomy • Adjusting family relationships as couple take on responsibility of caring for aging parents • Realigning family relationships with community and society to accommodate adolescents’ increasing autonomy and grandparents’ increasing constraints
Launching children and moving into midlife	Accepting many exits from and entries into the family system	• Adjusting to living as a couple again • Addressing couple’s midlife issues and possibilities of new interests and projects • Parents and grown children negotiating adult-to-adult relationships • Adjusting to include in-laws and grandchildren within the family circle
		• Dealing with disabilities and death of couple’s aging parents • Realigning family relationships with community and society to accommodate new family structure and relationships
Families with parents in late middle age	Accepting new generational roles	• Maintaining couple’s functioning and interests, and exploring new family and social roles while coping with physiological decline • Adjusting to children taking a more central role in family maintenance • Making room for the wisdom and experience of the aging couple • Supporting the older generation to live as independently as possible within the constraints of aging • Realigning family relationships with community and society to accommodate new family structure and relationships
Families with parents nearing the end of life	Accepting the constraints of aging and the reality of death	• Dealing with loss of partner, siblings and peers • Preparing for death through life review and integration • Adjusting to reversal of roles where children care for parents • Realigning family relationships with community and society to accommodate changing family relationships

Note: Adapted from McGoldrick et al. (2011).

In the first stage, which is marked by young adult children leaving home, the main process is the emergence of young adults’ emotional and financial autonomy. The principal tasks are differentiating from the family of origin and developing adult-to-adult relationships with parents, developing intimate peer relationships, beginning a career and moving towards financial independence, and establishing the self within the community and society.

The second stage is that of couple formation, where the main process is commitment to a long-term relationship. The principal tasks include selecting a partner and deciding to form a long-term relationship, developing a way to live together based on an appreciation of partners’ real strengths and weaknesses rather than mutual projection, and realigning couple’s relationships with families of origin and peers so as to accommodate partners.

The third stage occurs when couples have children, and the main process is accepting new children into the family system. The principal tasks are making space within the couple’s relationship for children; arranging childrearing, financial and housekeeping responsibilities within the couple; realigning relationships with families of origin to include parenting and grandparenting roles; and realigning family relationships with the community and society to accommodate the new family structure. When couples adjust their roles to make space for young children, this involves the development of parenting roles which entail routines for meeting children’s needs for

• safety
• care
• control
• intellectual stimulation.

Developing these routines is a complex process, and often difficulties in doing so lead to a referral for psychological consultation. Routines for meeting children’s needs for safety include protecting children from accidents by, for example, not leaving young children unsupervised and also developing skills for managing frustration and anger that the demands of parenting young children often elicit. Failure to develop such routines may lead to accidental injuries or child abuse. Routines for providing children with food and shelter, attachment, empathy, understanding and emotional support need to be developed to meet children’s needs for care in these various areas. Failure to develop such routines may lead to a variety of emotional difficulties. Children’s need for control are met through routines for setting clear rules and limits, for providing supervision to ensure that children conform to these expectations, and for offering appropriate rewards and sanctions for rule following and rule violations. Conduct problems may occur if such routines are not developed. Parent–child play and communication routines for meeting children’s needs for age-appropriate intellectual stimulation also need to be developed if children are to avoid developmental delays in emotional, language and intellectual development.

The fourth stage of the family lifecycle model occurs when children make the transition to adolescence. At this stage the main developmental process is increasing flexibility of family boundaries to accommodate adolescents’ growing independence and grandparents’ increasing constraints. The principal tasks at this stage are adjusting parent–child relationships to allow adolescents more autonomy, adjusting family relationships as the couple take on responsibility of caring for aging parents, and realigning family relationships with the community and society to accommodate adolescents’ increasing autonomy and grandparents’ increasing constraints. Good parent–child communication and joint problem-solving skills facilitate completion of some of the tasks in this stage of the family lifecycle. Skills deficits in these areas underpin many adolescent referrals for psychological consultation. However, parents in families at this stage of development must contend not only with changes in their relationships with their maturing children, but also with the increased dependency of the grandparents upon them. The demands of grandparental dependency may compromise parents’ abilities to meet their adolescents’ needs for increasing autonomy.

The fifth stage of the family lifecycle is concerned with the transition of young adult children out of the parental home and the parents’ progression into midlife. The main process during this stage is accommodating exits from and new entries into the family system. During this stage a key task is the development of less hierarchical relationships between parents and children. Parents are also faced with the tasks of adjusting to living as a couple again, to dealing with disabilities and death in their families of origin, of adjusting to the expansion of the family if their children procreate, and realigning family relationships with the community and society to accommodate changes in the family structure.

The acceptance of new generational roles arising from aging parents’ physiological decline is the main developmental process in the sixth stage of the family lifecycle. This stage is marked by aging parents moving into late middle life. The principal task for aging parents is to maintain functioning and interests and accept help and support from their adult children. The principal task for adult children is to take a more central role in family maintenance which includes arranging appropriate supports for their aging parents so that they can live as...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Figures
• Tables
• Boxes
• Preface to the third edition
• Acknowledgements
• Frameworks for practice
• Normal development
• Influences on problem development
• Classification, epidemiology and treatment effectiveness
• The consultation process and intake interviews
• Report writing
• Problems of infancy and early childhood
• Sleep problems
• Toileting problems
• Intellectual, learning and communication disabilities and disorders
• Autism spectrum disorders
• Problems of middle childhood
• Conduct problems
• Attention and over-activity problems
• Fear and anxiety problems
• Repetition problems
• Somatic problems
• Problems in Adolescence
• Drug Misuse
• Mood Problems
• Anorexia and Bulimia Nervosa
• Psychosis
• Child Abuse
• Physical Child Abuse
• Emotional Abuse and Neglect
• Sexual Abuse
• Adjustment to major life transitions
• Foster Care
• Separation and divorce
• Grief and Bereavement
• References
• Index