Counseling Children and Adolescents

Working in School and Clinical Mental Health Settings

Jolie Ziomek-Daigle, Jolie Ziomek-Daigle

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781315466712
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Counseling Children and Adolescents gives students the information they need to prepare for work in both school and clinical mental health settings (two CACREP—Council for Accreditation of Counseling and Related Educational Programs—specialty areas). This text includes not only content related to developmental and counseling theories but also information on evidence-based practices across the continuum of care, diagnosis and treatment of youth, and current trends such as integrated care, mindfulness, and neuroscience. Unique to this book are sections on both the instructional and behavioral Response to Intervention (RtI) model and PBIS, examples of evidence-based practices used across settings such as Student Success Skills, Check & Connect, and trauma-focused CBT, and a review of common mental health-related disorders most often seen in youth and treatment recommendations. Ethical and legal implications are infused throughout the book, as are CACREP learning outcomes. Instructors using this textbook can also turn to its companion website to access test questions for each chapter. Expansive and practical, Counseling Children and Adolescents fills a gap in counselor preparation programs and provides an important resource that can be used across specialty areas and coursework.

Part I
Introduction and Developmental Considerations Pertaining to Counseling Children and Adolescents in School and Clinical Mental Health Settings

Chapter 1
Introduction to Counseling Children and Adolescents

Christopher T. Belser

We worry about what a child will become tomorrow, yet we forget that he is someone today.

Stacia Tauscher

Chapter Objectives

After reading this chapter, you will be able to:

• define childhood and adolescence
• recognize how counseling children and adolescents differs from counseling adults
• understand various models of child and adolescent development
• apply developmental models to counseling scenarios

Introduction

Welcome to the exciting world of child and adolescent counseling. Whether you are reading this textbook for a graduate class or for your practice as a counselor, you yourself were once a child and then an adolescent, and, as you will discover throughout this chapter and throughout the book, there are distinct developmental reasons why you are reading this text at this stage of your life and not when you were a child or adolescent.

Who Are Children and Adolescents?

Childhood and adolescence are distinct periods within the lifespan, although exact age ranges can vary slightly based on the source. Childhood is often divided into at least three sub-stages. The infant/toddler years (ages 0–3) are marked by significant physical and cognitive development as well as dependence on caregivers (American Academy of Pediatrics [AAP], 2016). These trends continue during the preschool years (ages 3–5) as children develop more independence and start preschool. The school-age years (ages 6–12), also called middle childhood, are signified by increases in independence, cognitive development, physical growth, social engagement, and maturation. Sometimes, the school-age years are broken into two smaller stages known as middle childhood (ages 6–8) and late childhood (ages 9–11) to help clarify developmental tasks (Centers for Disease Control and Prevention [CDCP], 2016).

Adolescence, also known as the teenage years, is a time of raging hormones, increased social and romantic interests, marked desire for independence and autonomy, and preparation to leave the family of origin (AAP, 2016). The age range for adolescence also varies based on the source of information. The World Health Organization (WHO, 2016) generally considers adolescence to include ages 10–19, but has also noted that age may be more related to the biological changes occurring during adolescence than the social and emotional changes. The CDCP defines adolescence as the time between ages 12 and 17 and divides the period into two groups: Young teens (ages 12–14) and teens (ages 15–17). Siegel (2013) noted that the brain development processes occurring during this timeframe continue until around age 24, which makes a case for adolescence encompassing more than just the teenage years. The developmental models described later in this chapter will help provide context for other processes that are happening within childhood and adolescence.

How Does Counseling a Child Differ from Counseling an Adult?

Johnson, Rasbury, and Siegel (1997) posited that levels of development account for the differences between children and adults. These developmental differences will influence the content and focus of counseling sessions as well as the modality of counseling delivery. Unlike adults, who can actively comprehend and verbally engage with a counselor, children are often limited in their ability to adequately communicate, comprehend, and make meaning of their experiences (Landreth, 2012; Piaget, 1962). As you will see in the case study below, a child will likely make sense of an experience, such as a traumatic event, in a quite different way from an adolescent or an adult. For example, a child may not fully understand the death of a loved one as a permanent event, and, instead, may not be able to differentiate it from that person leaving for work or for a long trip.

Similarly, children may not emotionally know how to respond to a situation and may not have the emotional vocabulary with which to process their experiences (Landreth, 2002). As such, counselors will need to tailor their counseling approach to the developmental needs of the child. Landreth (2012) described play as children's natural means of communicating with other children and adults. Because play provides an avenue for children to express themselves, it is commonly used as a therapeutic method with children (Bratton, Ray, Edwards, and Landreth, 2009; Kottman, 2011; Landreth, 2012; Taylor and Bratton, 2014). Incorporating play into counseling or engaging in formal play therapy allows the counselor to meet the child's needs while being sensitive to developmental abilities.

Although there are multiple perspectives on the age ranges, childhood usually refers to the period from birth to approximately age 12 and adolescence usually refers to the teenage years. Both periods are marked with physical, cognitive, and social growth, typically increasing in complexity with age. These differences set children and adolescents apart from adults. Counselors must keep these developmental considerations in mind when working with children and adolescents to ensure that interventions are tailored to the client. One such example of this is play therapy, which is often used with children, due to their limited verbal and cognitive abilities. The following case example illustrates some of these differences within the context of family grief.

Case Study: The Knight Family

The Knight family is comprised of James (41-year-old father), Sheri (39-year-old mother), Sam (15-year-old son), and Shay (5-year-old daughter). They are a hardworking, middle-class American family, but their world is turned upside down after the tragic loss of one of the family members. While he was driving home from work one day, James was hit by a driver who ran a red light, and died as a result of the injuries he sustained. All of the other members of the family, devastated by the loss, are left to pick up the pieces and move on.

Sheri is now a widow. At first she is shocked at the sudden loss of her partner and angry at the other driver, but she knows that she has to hold her family together and be there for her children at this time. At night, she cries herself to sleep, and feels empty without James. She is afraid of how her children will handle his death, concerned about whether she will be able to continue to raise them by herself, and worried about taking on the responsibilities of both parents. As time moves on, she must cope with the changes to her social life, as she is no longer a member of a couple.

After hearing the news about his father, Sam does not cry. Instead, he withdraws and becomes very angry. He misses his dad, but does not want to admit it. At the same time, he feels very guilty that the last conversation he had with his dad that morning on the way to school was an argument—James had told Sam he was not ready to get his driver's permit. Instead of saying goodbye that morning after getting out of the car, Sam had just slammed the door and walked away. Sam knows he is the “man of the house” now but cannot get past the anger. He wants to be helpful, but snaps at his mom and sister every time they try to talk with him.

Shay does not really understand what is going on, but knows that everyone is sad. She tells Sheri that she wants her daddy to tuck her in, like he always does. When Sheri says that he will not be able to, Shay asks if it is because she did not pick up her toys, and whether he will come back if she is “good enough.” Over the next few days and nights, she does not want anyone to leave the house for fear that he or she will not come back, and she has nightmares about her mommy leaving too.

Each member of the family has lost the same person, yet each of them is experiencing loss differently. Sheri's grieving process is influenced by her roles as wife and mother; additionally, she is deeply concerned about what will happen long term. Sam and Shay are both concerned about their mother; however, their grief process is more egocentric. For Sam, he feels guilt about the argument he had with his father; Shay believes that if her behavior is good enough her father will come back and be able to tuck her in. Sam knows what happened to his father, but Shay is unable fully to comprehend the concept of death. These differences in the family members' grieving process are the result of their development.

Whereas a family intervention may be warranted for the Knights, we will examine each as an individual client in order to highlight the differences in how a counselor would approach working with each member. Sheri will be able to verbally talk about her feelings, and a counselor would likely work with her on how to cope with her husband's death (i.e. a trauma-focused therapy), how to support her family, and how to move forward with the changes that will be occurring. Sam will likely be resistant to counseling and will need a counselor who is patient and focused on building a rapport before helping him work through his guilt and grief. It will be important for his counselor to recognize the surface-level grief responses (e.g., withdrawal, acting out, vacillating between being irritable and wanting to be helpful) and also explore the underlying feelings. For Shay, a play-based approach to counseling, such as sand tray, puppets, or drawing, may help her process thoughts and feelings she may not even know she has. A counselor working with her would need to have specialized training in utilizing these counseling media with children.

The developmental nuances of each family member shapes his or her grief responses and ultimately how counselors would work with each. But what impacts human development? Are these differences solely explained by stage models related to various aspects of development, or does environment play a factor? The following sections will explore different models related to child and adolescent development. We begin with Bronfenbrenner's Ecological Theory.

Bronfenbrenner's Ecological Theory

Bronfenbrenner (1977) posited that individual biological factors strongly influence a child's development. He also noted that development is shaped by the interactions between these environmental factors and between environmental and biological factors. Bronfenbrenner's Ecological Theory describes the multiple environmental levels that impact human development. These environmental levels are often depicted as a set of concentric circles with the individual in the middle; circles that are smaller and closer to the center are meant to represent the environments that more closely interact with a person on an individual level (Bronfenbrenner, 1977). Table 1.1 provides a description and examples of each level in order of smallest to largest.

More recently, Bronfenbrenner and Evans (2000) discussed societal changes that have resulted in children's varied developmental experiences. These societal factors, such as increases in single-parent households, the prevalence of school violence, and the educational achievement gap, impact children's development at various levels within the bioecological model. Moreover, examining these changes within the context of the various bioecological systems provides another element within more traditional stage models of development (e.g., Piaget, Erikson, Kohlberg). Writing about school counseling, Galassi and Akos (2007) described this as contextual development and noted that...