Counseling and Psychotherapy with Children and Adolescents

Theory and Practice for School and Clinical Settings

H. Thompson Prout, Alicia L. Fedewa

• Publisher: Wiley
• Year: 2014
• ISBN:
  9781118772690
• Edition: 5
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

A comprehensive, theory-based approach to working with young clients in both school and clinical settings

Counseling and Psychotherapy with Children and Adolescents, Fifth Edition provides mental health professionals and students with state-of-the-art theory and practical guidance for major contemporary psychotherapeutic schools of thought. Children and adolescents are not just small adults; they have their own needs, requirements, and desires, on top of the issues presented by still-developing brains and limited life perspective. Providing care for young clients requires a deep understanding of the interventions and approaches that work alongside growing brains, and the practical skill to change course to align with evolving personalities. The thoroughly revised fifth edition is a comprehensive reference, complete with expert insight.

Organized around theory, this book covers both clinical and school settings in the fields of psychology, counseling, and social work. Coverage of the latest thinking and practice includes Cognitive Behavioral, Rational-Emotive, Reality Therapy, Solution Focused, Family Systems, and Play Therapy, providing a complete resource for any mental health expert who works with young people.

• Understand the major approaches to counseling and psychotherapeutic interventions
• Discover the ethical and legal implications of working with children and adolescents
• Learn how to employ culturally responsive counseling with younger clients
• Examine interventions for children and adolescents with disabilities and health care needs

This updated edition includes a stronger emphasis on the clinical application of theory to specific disorders of childhood and adolescence, and new coverage of the legal and ethical issues related to social media. Chapters include a case studies and online resources that make it ideal for classroom use, and new chapters on Solution-Focused Therapy and Play Therapy enhance usefulness to practicing therapists. Expert guidance covers techniques for working with individuals, groups, and parents, and explores the efficacy of the theories under discussion.

Chapter 1
Counseling and Psychotherapy with Children and Adolescents
Historical, Developmental, Integrative, and Effectiveness Perspectives

H. Thompson Prout and Alicia L. Fedewa

The psychological treatment of children's problems is the focus of several professions and is carried out in many settings and situations. Although theoretical viewpoints are wide-ranging and essentially rooted in adult-based theories, the child or adolescent presents a unique challenge to the child mental health worker. Children are not simply little adults. Their treatment cannot be viewed as scaled-down adult therapy; their developmental stages, environments, reasons for entering therapy, and other relevant factors necessitate a different, if not creative, approach to therapy. The child/adolescent therapist must have an expanded knowledge base of the human condition and a different perspective of what constitutes therapy or counseling.

This book is about psychotherapy and mental health counseling with children and adolescents. It brings together in a comparative format the major theoretical views of psychological treatment of children and highlights major issues in the area. A number of concerns, however, cut across the theories and are relevant to any provision of mental health services to children. This introductory chapter describes some of these issues: Historical perspectives, the mental health needs of children and adolescents and the need for services, developmental issues, the unique aspects of child and adolescent therapy, a multimodal research/efficacy issues and evidence-based approaches. Throughout this chapter, the terms counseling and psychotherapy are used interchangeably.

Historical Perspectives on the Mental Health Needs of Children and Adolescents

Many major advances in clinical mental health work can, in some way, be traced to Freud. Mental health work with children is no exception. Freud's classic case study of “Little Hans” in 1909 is generally viewed as the first reported attempt to psychologically explain and treat a childhood disorder (S. Freud, 1955). Although Freud did not directly treat Little Hans's phobia, he offered a psychoanalytic explanation of the problems and guided the father in the treatment of Hans. This case study is recognized as providing the base for Freud's theories on the stages of psychosexual development. Freud's interest in childhood disorders apparently waned at this point, and it was not until 1926 that his daughter, Anna, presented a series of lectures entitled “Introduction to the Technique of Psycho-analysis of Children” to the Vienna Institute of Psychoanalysis. These lectures generated considerable interest and established Anna Freud as a pioneer in child psychotherapy. Shortly thereafter, Melanie Klein (1932), emphasizing the symbolic importance of children's play, introduced free play with children as a substitute for the free association technique used with adults, thus inventing play therapy. Although these two camps disagreed on many issues, they have remained the dominant voices in the child psychoanalytic field, with most analytic work being a spin-off of either A. Freud or Klein.

At approximately the same time (the early 20th century), other forces were beginning to put more emphasis on work with children. In France in 1905, Alfred Binet completed initial work on his intelligence test, which was used for making educational placement decisions in the Paris schools. This work provided the base for the psychometric study of individuals and had great impact on child study and applied psychology. At the University of Pennsylvania in the United States, Witmer had established a clinic for children in 1896 that focused on school adjustment and in 1909 Healy founded what is now the Institute for Juvenile Research in Chicago. These events provided the base for the child guidance movement, emphasizing a multidisciplinary team approach to the diagnosis and treatment of children's adjustment and psychological difficulties. The child guidance model involved treating both the children and their parents. The increased interest in clinical and research work on children's problems led to the founding of the American Orthopsychiatric Association in 1924, an organization of psychologists, social workers, and psychiatrists concerned with the mental health problems of children.

Through the 1940s and into the 1950s, psychoanalytic psychotherapies were used almost exclusively in the treatment of children. In 1947, Virginia Axline published Play Therapy, describing a nondirective mode of treatment utilizing play. Nondirective play therapy was, in effect, a child version of Carl Rogers's adult-oriented client-centered therapy. Both nondirective play therapy and client-centered therapy represented the first major departures from psychoanalytic thought, differing in conceptualization of the therapeutic process and content in the role of the therapist. Rogers's impact on adult psychotherapy was paralleled and followed by Axline's impact on child therapy. The next major movement in psychotherapy was the rise of the behaviorally based approaches to treatment. Although the principles and potential applications of behavioral psychology were long known, it was not until the 1960s that behavior modification and therapy began to be used frequently in clinical work with children. In recent years, cognitive-behavioral approaches have become prominent as a treatment modality.

The mental health treatment of children and adolescents has also been affected by two policy and legislative mandates. First, the community mental health movement was strongly influenced by the passage in 1963 of the federal program to construct mental health centers in local communities and begin a move away from large institutional treatment. This movement grew not only because it was mandated by a federal program but because it represented a philosophy that mental health interventions are more likely to be successful when carried out in the community where the maladjustment is occurring. The new programs emphasized early intervention and prevention of mental disorders. The second mandate, with a similar philosophical base, involved the provision of special education services to all handicapped children, including emotionally disturbed and behavior-disordered children and adolescents. Exemplified initially by Public Law 94–142 (now the Individuals with Disabilities Education Improvement Act [IDEA]), this movement has not only expanded the role of public education in provision of services to these children but also allowed more children to remain in their home communities. Psychotherapy and mental health treatment, if deemed a part of the total educational program of a child, has become by law and policy an educational service.

In the past 10 to 15 years, child and adolescent treatment has been in the identification of treatments that are evidence based (e.g., Kazdin, 2003; Weisz & Kazdin, 2010). Various terms have been used to describe these treatments including empirically validated or supported treatments, evidence-based practice, or simply treatments that work. Efforts have also been made to quantify the degree and strength of support for the treatments, for example, the number of studies showing evidence of effectiveness. Studies are examined with the specification of treatment (i.e., age, setting, presenting problem), use of treatment manuals or clearly specified intervention procedures, and evaluation of outcome with multiple measures. Procedures must be replicable and independent replication studies are often included in criteria for a treatment to be labeled as evidence based.

Child and Adolescent Mental Health Needs: A Chronic Problem

There are well-documented estimates of large and perhaps increasing numbers of children who are experiencing significant mental health problems. These needs have been apparent for some time. Studies in the 1960s and 1970s clearly showed the pervasiveness of problems at that time. In a study of children in public school, Bower (1969) estimated that at least three students in a typical classroom (i.e., 10% of school-age children and adolescents) suffered from moderate to severe mental health problems; many of these children were disturbed enough to warrant special educational services for the emotionally handicapped. In 1968, Nuffield, citing an estimate of 2.5 to 4.5 million children under the age of 14 in need of psychiatric treatment, found indices of only 300,000 receiving treatment services. This figure represented services to roughly 10% of those in need. Berlin estimated in 1975 that each year there would be 6 million school-age children with emotional problems serious enough to indicate the need for professional intervention. Cowen (1973) noted a smaller group (1.5 million) in need of immediate help but estimated that fewer than 30% of these children were receiving this help.

There has been little change in the reduction of problems. Kazdin and Johnson (1994) noted that incidence studies show between 17% and 22% of youth under the age of 18 have some type of emotional, behavioral, or developmental problem. This represented between 11 and 14 million of the 64 million youth in the United States with significant impairment. They noted that many of those with disorders are not referred for treatment and are not the focus of treatment in the schools. Kazdin and Johnson (1994) also noted that there are high and increasing rates of at-risk behaviors, including antisocial and delinquent behaviors, and substance abuse. Doll (1996), in a synthesis of epidemiology studies, notes a similar rate of 18% to 22% with diagnosable disorders, translating this to the analogy of a school of 1,000 students with 180 to 220 students in the school having a disorder in the clinical ranges. Doll sees the need for broad-based policies at all levels (i.e., school, district, governmental) to address these significant needs. Regardless of the estimate of incidence, it is clear that many children and adolescents with problems are not identified by educational, mental health, and social service institutions as having emotional difficulties and thus are not referred for or provided treatment services.

Reviews (Huang et al., 2005; Tolan & Dodge, 2005) have noted this continued problem despite many government panels formed to address the problem. It is estimated that 1 in 5 children have a diagnosable disorder, with 1 in 10 having a disorder that substantially impacts functioning at home, at school, or in the community. Further, there continues to be limited or difficult access to appropriate mental health services, both for families with financial resources and those with more limited means.

Children and adolescents remain critically underserved populations, despite ample recognition of the problem based on nearly 40 years of research documenting needs. The mental health needs of children present an enormous service delivery shortfall; and with funding problems continuing in the human services, the gap between need and available services is likely to continue. Preventive services may be a cost- and resource-efficient mode for dealing with part of this problem, but the provision of quality counseling and psychotherapeutic services will be a crucial component in the total mental health system. Tolan and Dodge (2005) call for a fundamental policy shift to development of a comprehensive mental health care system for children that includes treatment, support, and prevention.

Huang et al. (2005) have described a “vision for children's mental health” that would address the complex needs of children and adolescents, including:

• Development of comprehensive home- and community-based services and supports.
• Development of family support and partnerships.
• Development of culturally competent care and reducing disparities in access to care.
• Individualization of care.
• Implementation of evidence-based practice.
• Service coordination and designation responsibility.
• Prevention activities for at-risk groups with earlier identification and intervention, including programs for early childhood.
• Expansion of mental health services in the schools.
• The components of this vision are clearly consistent with the theme of this book.

The Centers for Disease Control (2013) released an updated survey of the status of children's mental health. Among the highlights of this report include the increasing rate for internalizing disorders (e.g., depression, anxiety), behavioral disturbance (ADHD, conduct), and autism spectrum disorders. The report noted that up to 1 in 5 children in the United States may experience a mental health disorder in any given year. Adolescent issues included substance use/abuse disorders and suicide. Labeling children's men...