Making sense in conversations about learning disabilities

This article describes an integrative, multisystem clinical approach to the psychological and relational problems that develop around learning disabilities. Positioned in relationships with children, families, and schools, the therapist addresses the emotions, interpersonal conflicts, and problematic beliefs that contribute to problems. Using clinical skills to contain and relieve painful emotions, the therapist soothes "inflammation at the boundaries" of relationships among children, families, and schools, depolarizing conflicts within and between systems. Familiar with developmental and educational psychology and developmental neurobiology, the therapist makes this specialized knowledge intelligible to children, families, and teachers. This article describes two specific methods, the chart of strengths and weaknesses and the map of learning functions, which facilitate communication of specialized knowledge about children with learning disabilities. The therapist uses expert knowledge to help members of the treatment system transform blaming, helpless, or hopeless interpretations of the problem into more hopeful constructions, which support healthy development.     

Treatment of Sexually Abused Children: Interview Technique,Disclosure, and Progress in Therapy

ABSTRACT

The closed records of 50 children referred for treatment following sexual abuse were analyzed to determine the relationships between therapist structure for disclosure of the abuse, whether the child disclosed, clinical improvement, and several other variables. Ten children revealed details of their abuse in response to introductory structure by the therapist, while 19 children required ongoing structure to disclose such details. Five children did not respond to therapist structure with a disclosure. In contrast, only 1 out of 11 cases disclosed when the therapist did not structure for disclosure. Six of the children who disclosed took five or more treatment sessions to do so. Those who disclosed showed rates of clinical improvement similar to those who did not disclose. Neither maternal support nor foster home placement was related to disclosure or to clinical improvement.     

Relationships,Reconciliation and Children: Giving Young People a Say

I have realised how central my therapy background and skills have been in my current job. Without being conscious of it, I use much of my background as a therapist in my role as Commissioner for Children and Young People. I probably spend more of my time advocating for children and young people as a group because they are excluded or disregarded on the basis of their status as children.     

Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy

Children with histories of maltreatment are at significant risk of developing severe psychiatric problems. Treatment of such children is difficult and there are no empirical studies evaluating the effectiveness of outpatient treatment for children with trauma-attachment disorders. The present study examines the effectiveness of Dyadic Developmental Therapy, a treatment based on attachment theory, provided by one therapist in an outpatient setting. The 64 subjects all had trauma-attachment disorders, met the DSM-IV criteria for Reactive Attachment Disorder, and had histories of serious maltreatment. The 34 children in the treatment group were treated in weekly outpatient therapy at The Center For Family Development with Dyadic Developmental Psychotherapy. The 30 children in the control group were evaluated but did not received Dyadic Developmental Psychotherapy and received treatment from other providers at other clinics. Eligible subjects were children between the ages of five and seventeen years whose case had been closed in 2000 or 2001. All children had significant past histories of abuse, neglect, or orphanage care. Findings for children in the treatment group, as measured by the Achenback and Randolph Attachment Disorder Questionnaire, were significant decreases (p<.01) in symptoms of attachment disorder, withdrawn behaviors, anxiety and depression, social problems, thought problems, attention problems, rule-breaking behaviors, and aggressive behaviors. The findings for children in the control group showed no changes in the variables measured. Dyadic Developmental Psychotherapy appears to be an effective treatment for children with trauma-attachment disorders.The author would like to gratefully acknowledge Ms. Geraldine Gallucci, a master’s level social work intern, who was placed with The Center For Family Development. Ms. Gallucci ensured that the follow-up questionnaires were mailed to the families and returned to the agency.Arthur Becker-Weidmann is affiliated with Center for Family Development, Williamsville, USA.     

Issues of autonomy in the psychotherapy of children with learning problems

For certain children, learning and performance represent a major battleground in their struggles for autonomy. In treatment these children try to get the therapist to do something to them. This poses serious clinical problems since interpretations may be perceived as an attempt at control by the therapist. Such children can use interpretations only after treatment has proceeded in such a way that they have come to feel more autonomous. The psychotherapy of a latency-aged girl with severe learning problems is described and discussed. The authors' approach suggests implications for educational practice.     

Exploring trends: tracking evaluations data over several months by therapists and parents of children with cerebral palsy

A pilot study was conducted at the outpatient rehabilitation unit of a children's hospital to explore the overall performance trends of children in daily life as perceived by their parents, compared to the evaluations of therapists. A performance goal was set for each child by his/her therapist and parent at an initial consultation. Over a six-month period, data were collected from the parents of children with cerebral palsy (N = 53), and therapists assessed children at each therapy session as well. The evaluations of both parents and therapists showed statistically significant upward trends in performance over several months.     

The role of the family therapist in supportive services to families with handicapped children

The family therapist can play a critical role in assisting families of handicapped children develop positive functioning patterns. In this paper the author identifies a number of typical interactional difficulties found in these families together with the unique challenges they place before the family therapist and strategies that she has found to be effective in working with them on their relationship problems.     

Group therapy with sexually abused boys: Notes toward managing behavior

This article examines the gender-specific defense mechanisms of sexually abused boys as they emerge in group therapy, using Finkelhor's model of traumagenic dynamics. Concrete interventions address the acting out behavious that are typical for this population, connecting the acting out behaviors to the boys' common background of sexual abuse. Without these concrete interventions to address the unsafe, aggressive behaviours of sexually abused boys, their problems and experiences cannot be shared, nor can the group therapist address the issues outlined in a curriculum for group therapy for sexually abused children.     

Reactions of Adolescents to Their Therapist’s Serious Illness

Few publications exist on the reactions of children and adolescents to the serious illness of their therapist. This paper reviews the literature on the responses of adult patient’s and presents three vignettes of adolescents who were in treatment when their therapist was diagnosed with cancer. We discuss some of the theoretical and clinical issues these cases present and conclude that openly sharing an appropriate amount of information with the adolescents appears to further rather than impede the therapeutic process.     

No Small Change: Process‐Oriented Play Therapy For Children of Separating Parents

This article looks at a process‐oriented play therapy for children adversely affected by parental separation. Process‐oriented play therapy is a therapeutic method that involves the therapist directly entering the ‘world of play’ with the child, by amplifying various modes of expression and helping underlying meaning to emerge, in order to help children access aspects of their life they feel they have no say in. One particular case has been used as an example, involving ‘Jim’ (pseudonym) and his mother, who attended the play therapy session.     

The Bowl of Terror: A Case Study of an Adolescent Perpetrator of Sexual Abuse

This article describes a complex multimodal intervention with a family where inappropriate sexual contact had occurred between Taro and his younger sister Lara, when they were young children. The family presented to clinical services when Lara was brought to hospital with suicidal ideation, traumatic flashbacks and regressed behaviour at 13 years of age. Treatment involved multiple components: family work with all members of the family individual work with Lara, joint work with Lara and Taro, and finally, a brief intervention with Taro. This article focuses primarily on the therapist's work with Taro, the perpetrator of the inappropriate sexual contact. The Adult Attachment interview (AAI), a semi‐structured interview, was used by the therapist to assess Taro's developmental experiences and psychological functioning. Information from the AAI helped the therapist identify both the relationship factors that had contributed to the perpetration of sexual abuse and the self‐protective strategies Taro had come to use in order to elicit maximum comfort and protection from neglectful attachment figures. The therapist used the functional formulation derived from the AAI to structure a time‐limited intervention.     

Family Therapy Following the Death of a Child*

The reactions of the entire family system to the death of a child are examined. The case illustrates therapeutic interventions dealing with changes in family structure, guilt and mourning processes in parents, anxiety and other reactions of children, and the cognitive confusion of both children and adults. The problems for the therapist in working with a family following the death of a child are discussed.     

Risky Business

The author outlines the role and responsibilities of the Human Rights and Equal Opportunity Commission, then considers the ethics and responsibilities of the family therapist, with particular reference to the Rights of children.     

Prescribing the Families Own Dysfunctional Rules as a Therapeutic Strategy*

The use of paradox-strategy in therapy is motivated by the fact that many families request help but at the same time seem to reject all offers of help. The therapist may be drawn into a game in which every effort on his part to act as an agent of change is nullified by the family group. In systemic terms these contradictory attitudes derive from the dynamic equilibrium existing between the tendency toward change, which is implicit in the request for help at one level, and the tendency toward homeostasis which at another level imposes the repetition of the family's habitual rules of interaction. The coexistence of these forces can entangle the therapist in the family's paradoxical logic of “help me to change, but without changing anything.” By accepting the contradiction facing him and by “uniting” himself with this within the family, the therapist puts himself into a position opposite to that which the family expects. His response to the family's paradoxical request is a paradox, or counterparadox, because it creates the contradictory communication typical of rigid family systems. By prescribing its own dysfunctional rules to the family, the therapist can stimulate the tendencies toward change present in the family system.     

Projective Identification: A Request for Relationship

Projective identification is commonly recognized as a primitive defense. In group work with ego-impaired preadolescent boys with significant environmental deficits, projective identification is used to communicate a need for a relationship previously unavailable to them. These boys project unwanted aspects of themselves in order to have them contained by the therapist. They induce feelings in the therapist in order to share their internal experience. As the feelings are modified by the therapist and reintrojected by the boys, the boys receive the parenting they missed and are able to form more stable attachments.     

Training family therapists to work with children and families: a modified Delphi study

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.     

A Solution Focused Approach to Adolescent Groupwork

The use of Solution Focused Therapy in a group setting with adolescents requires the therapist to encourage the young persons to recognise when they are not bullying, what prosocial behaviours they use and how others respond to them. Furthermore it gets bullies to work together in a cooperative and purposeful direction, approaches negative behaviours positively, and allows desired outcomes to be supported. The group setting enables the adolescent to gain support from peers as well as provide support to others. The therapist must be flexible, remain focused on the solution and allow the group to determine the course to a certain extent.     

“Funny Face”: Shareware for Child Counseling and Play Therapy

SUMMARY

“Funny Face,” an off-the-shelf children's computer game, is used in play therapy and counseling with preschool and latency age children by the author/designer, who also serves as the therapist.     

Therapeutic Process as a Means to Navigate Impasse? Reflections on a Complex Case of Crosscultural Adolescent Family Therapy

This article explores the process of family therapy with a Turkish‐speaking single‐parent family with four children in which suicidal behaviour and family violence have become the norm. The following example describes a pivotal experience early within my career as a family therapist. The universality of first, being a beginner family therapist, and second, receiving a referral of a daunting, difficult case has led me to share my experience here. Central to this article is the focus on therapeutic process as a means to navigate beyond impasse. It is my hope that those who read this article will consider taking the risk to prioritise the therapeutic relationship, even when anxiety about ‘doing something’ to fix the problems is high.