Helping parents by working with their children in individual child therapy

The paper describes a small scale pilot process and outcome study that was undertaken at the University of York. The study is based on accounts of treatment interventions with children conducted by trainee play therapists studying on the University's programme in non‐directive play therapy. These are being used to develop a methodology for evaluating the effectiveness of non‐directive play therapy as an intervention for distressed and maltreated children. The focus of this paper is on one finding of the study, namely that play therapy undertaken with individual children, in addition to bringing about improvements in the children's problems, may improve their parents’ parenting behaviour if they are appropriately involved in the therapy. The paper describes the cases and their outcomes at a 6‐month follow‐up. It illustrates the finding of changes in parenting behaviour through three case studies, and discusses the kinds of changes, possible reasons for them, and necessary practice requirements if these changes are to take place. The paper concludes that engaging parents in a broadly collaborative effort may be facilitated by a primary initial focus on their children.     

Local therapy facilitators working with children with developmental delay in rural and remote areas of western New South Wales,Australia: the ‘Outback’ service delivery model

Australia's dispersed population in rural areas contributes to poor access to therapy services and the inability of the existing rural therapy workforce to meet demand. As a result, rural children with a developmental delay wait a long time for therapy. This paper describes participant perceptions of a therapy facilitation service model that has worked to improve access to therapy for children in these circumstances. The model, given the pseudonym ‘Outback’, operates in rural and remote areas of western New South Wales. ‘Outback’ employs local people to work under the guidance of therapists based in larger centres to provide preschool children with developmental delays with access to therapy interventions they might not otherwise receive. A two‐stage case study design involving focus groups and interviews with the director, four therapy facilitators, nine therapists, and seven carers was used. Three themes were identified as central to the service model: 1) being part of the local community; 2) developing therapy facilitator knowledge and skills; 3) improving access to therapy intervention for children in rural and remote areas. The ‘Outback’ model demonstrates that appropriately supported, local therapy facilitators provide a flexible workforce adjunct that expands the reach of therapists into rural and remote communities and enhances service access for children and their families.     

Sexual Appetite

Abstract

This paper describes the sensual feeding exercise, a powerful therapeutic technique that reveals unconscious feelings operating within people's relationships. The exercise acts as a surrogate to sexual interaction, eliminating the pressure of genital sexual performance and thereby richly illuminating the emotional impediments to intimacy. Using this technique, the therapist instructs the members of a couple to feed one another, in a time and place of their choosing between therapy sessions. The couple has a spontaneous response to the exercise, different from the response elicited in discussing their sexual problem. The parallel between the process of feeding and the act of sex allows patients to learn a great deal about sexuality through non-threatening playful interaction. The paper reports on two treatment processes which led to greater emotional openness and expression in the couples' relationship, without improving sexual satisfaction. The sensual feeding exercise helpfully addressed the issue of sexual satisfaction by revealing the unconscious impediments to sexual expression.     

Filial Therapy: Helping Children and New Carers to Form Secure Attachment Relationships

This article discusses a method of combined play therapy/familytherapy for looked after and late adopted children and theircarers, namely Filial Therapy. Recently introduced into theUK, Filial Therapy’s well-developed practice base andgrowing body of research findings in North American are presentedhere. The rationale for employing the method of non-directiveplay therapy, on which Filial Therapy is based, with childrenwho have been maltreated is outlined. Case vignettes are usedto demonstrate that Filial Therapy is suitable for using withchildren who have multiple problems, since it is attachmentoriented as well as able to help children address their traumatic,abusive memories and emotional defences through play. FilialTherapy also helps carers develop stronger and more adaptiverelationships with their children, reducing their stress levelsand heightening their care-giving responses. Filial Therapyseems highly viable as a robust, cost-effective, treatment strategyto strengthen new and troubled placements. However, there remainimportant questions to be addressed via future research in theUK.     

Preliminary support for the use of narrative exposure therapy in a child protection context: Collective case-study narratives

The present paper attempts to provide preliminary support for the use of narrative exposure therapy (NET) in a child protection context. The prevalence of violence, abuse and neglect (VAN) within New South Wales is outlined as well as the current perspectives in trauma definition and symptomology, and the prevalence of trauma symptomology among birthparents and young people within child protection services. NET is introduced including its theoretical background, methodology, applications and research. Four applications of NET within a child protection context are presented, including lifelines and narrative excerpts. Specific themes presented included experiences of physical abuse, domestic and family violence, parental drug use, suicidal ideation and child removal. Statistical analysis including reliable change, clinical and statistical significance of pre- and post-PCL-5 outcomes measures are presented to infer preliminary support for NET within a child protection context. Limitations and future considerations for future research are discussed.     

Adventure therapy and its impact on the functioning of youth in a community setting

The purpose of this article is to explore the impact of one type of activity-based group work, adventure therapy (AT) group practice, on youth in a community-based mental health setting. Using data collected from Adventure Works, a nonprofit outdoor behavioral healthcare and adventure therapy counseling center, this article explores treatment outcomes to identify the effectiveness of adventure therapy group interventions. AT has been identified as an effective intervention within wilderness and residential settings, but little research exists focusing on adventure therapy in a community setting. Data collected shows positive outcomes for youth participating in adventure-based group therapy. Research and practice implications are discussed.     

In Praise of Wordless Comfort

Abstract

This paper explores the author's experience as a cancer patient. She explains why she did not seek talk therapy after learning of her diagnosis. Instead, art therapy provided access to her unconscious and helped her process bodily changes after surgery. It facilitated communication of her experience to others and expanded her self-definition. She describes the importance of other avenues of non-verbal communication, including touch, and concludes that many different modalities may provide support and comfort during critical life crises.     

Play therapy: the children's views

This paper describes my efforts, as a practising play therapist, to listen to children’s opinions about the play therapy experience. There has been ongoing interaction between this project and my clinical work. Previous research has attended to adult agendas, and I have tried to give children a voice. There have been methodological challenges. However, data from the children confirm the overriding importance of the relationship, providing the context for the therapeutic experience. Within the playroom, children distinguish between talking and playing, and both have a role. However, while therapists ascribe meaning to play, most children see it as ‘just fun’. For some children having fun, in the context of a thoughtful and sustaining relationship, was the most significant aspect of the therapeutic process. Others were able to reflect more deeply and recognize the value of having difficult feelings thought about and understood.     

'Everyone Started Shouting': Making Connections between the Process of Family Group Conferences and Family Therapy Practice

This article presents findings from a qualitative study of familygroup conferences (FGCs) in Wales, UK. The study examined theprocess of seventeen FGCs involving twenty-five young people,using semi-structured interviews, analysis of documents andcollection of data on welfare outcomes. Young people were re-interviewedafter six months. The article focuses on the data concerningreported communications between family members during the familymeetings. These data are discussed in relation to similaritiesand differences between FGCs and family therapy sessions. Theauthors conclude that each method of intervention presents potentiallessons and challenges to the other. FGC co-ordinators mightwish to reflect on how to manage and prepare family membersfor the potential for expressions of emotion and disclosuresof confidential information that might arise in a family meeting.Family therapy has a long history of successfully working withsuch processes. Additionally, family therapists may wish toreflect on the successful management of intra-familiar conflictand disclosure by many families acting without a therapist orother professional present in a FGC.     

Pentimento

Abstract

When asked to consider writing a personal essay about a transformational moment in the development of myself as a clinician, this unfolding of events immediately came to mind. This moment captures a story about my development as a clinical social worker through my personal psychoanalysis. Sometimes, when one can contain his/her anxiety about receiving, a spontaneous and wonderful gift may present itself for the opening. This is my offering-a gift to students of clinical process.     

The challenges presented by parental mental illness and the potential of a whole‐family intervention to improve outcomes for families

Parental mental illness (PMI) can negatively affect the lives of all family members, and there is acknowledged need to work with family and social contexts to promote recovery. However, programmes undertaking such work remain rare and knowledge concerning mechanisms through which PMI impacts families and through which recovery might be achieved is underdeveloped. This paper outlines a new family intervention programme and presents evidence from focus groups with 16 professionals into their experiences of work with families with PMI. Evidence suggests that interactional effects of PMI, family communication and family relationships are key to understanding its impacts, but professionals are liable to struggle to engage with these due to concerns over stigma, lack of skills and low confidence. Positive impacts on practice were achieved through raising awareness of the whole‐family context in relation to PMI, building confidence to raise and engage with PMI and the provision of structured tools for use with families. Positive impacts on the lives of family members were then achieved by professionals in relation to symptoms for the ill parent, the burden on children and overall family well‐being, strongly mediated through improved family communication, understanding and relationships. Implications for policy and practice are considered.     

Exploration of Racial Enactments in an Interracial Therapeutic Dyad to Foster the Strengthening of Voice and Identity in African American Male Adolescents

The purpose of this paper is to examine the impact of systemic racism on an interracial therapeutic dyad between a white therapist and an African American adolescent male. Leary (2000 Leary, K. (2000). Racial enactments in dynamic treatment. Psychoanalytic Dialogues, 10(4), 639–653. doi:10.1080/10481881009348573[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]) operationalized the term “racial enactments” and made the important point that its “most common” manifestation “has been our relative silence about racial issues” (p. 647). It is the premise of this paper that the youth of color’s subjective experience of racial microaggressions and assaults experienced on a daily basis must be validated and explored prior to a meaningful intersubjective exploration in the clinical encounter. The emphasis in this paper is on the racial enactment that precedes the clinical encounter. A treatment vignette is used to highlight the intersection of social and psychic spheres of human experience and how an awareness of unconscious bias in the therapist can facilitate a more meaningful dialogue in which priority is given to the emergence of a powerful client narrative voice.     

Helping families when child sexual abuse is suspected but not proven

This paper reports from a project investigating reactions within families when intra‐familial child sexual abuse was suspected, and family members’ responses to a therapeutic approach. Data were obtained from therapeutic sessions and follow‐up interviews with mothers, children and alleged perpetrators. Before treatment the mothers felt uncertain as to how to interpret the children’s unclear signs. The children had severe symptoms, but had seldom disclosed abuse. The alleged perpetrators were often not informed about the suspicions. The families were in a state of crisis and shock, and communication within the family was characterized by uncertainty about what to talk about and whether the suspicions should be shared. In most cases after treatment the conflicts had been reduced, the children had few symptoms, supervised contact had been established, and the clients were satisfied with the treatment. One conclusion is that therapeutic sessions, where family members share information about concerns and take part in the decisions of how to protect children, seem relevant and helpful to the clients in unclear abuse cases.     

Mindfulness-Based Cognitive Therapy With Older Adults: An Exploratory Study

An 8-week mindfulness-based cognitive therapy (MBCT) group for older adults with depression and/or anxiety is described. This article is based on an exploratory study of this therapeutic approach and changes in participants’ symptoms associated with participation. Pre-post data from 5 MBCT groups showed significant improvements in reported anxiety, ruminative thoughts, and sleep problems and a reduction in depressive symptoms. Case examples are presented to illustrate these symptom changes. Findings showed that this nonpharmacological intervention is acceptable to older adults and is associated with positive changes. Suggestions are provided for both practitioners and researchers interested in using MBCT with older adults.     

Towards a second‐order view of child protection placement‐related decision‐making

Child protection workers are tasked with prioritizing and facilitating safe, secure and preferably, long‐term care arrangements for children and adolescents living within the child protection system. Recognizing the complexities associated with this task, this paper will propose that the application of theory – namely attachment theory and family systems theory – may aid in the conceptualization of placement decision‐making within the context of child protection practice. In particular, this paper will describe a framework entitled: Towards a second‐order view of child protection placement‐related decision‐making. This framework assumes the position that the ideals of relationship security and permanency of placement are more accessible in instances in which practitioners are able to locate themselves within temporary, stabilized but ultimately evolving systems. Specifically, the practitioner is encouraged to conceptualize where their individual selves, the broader child protection system and family system are located at any one point in time, whilst also identifying the direction in which these systems should be moving.     

Playing with sound: The therapeutic use of music in direct work with children

Children rarely have the language or the cognitive development to process and convey their experiences solely through words, so spontaneously complement these with symbolic forms of expression and communication, such as play, metaphor and a variety of visual, auditory and kinaesthetic imagery. Consequently, social workers need to supplement verbal methods of assessment and intervention with more symbolic modes of communication and engagement when working directly with children. The play therapy literature has been a key source of guidance and the expressive arts therapies, such as art and drama therapy, are now well represented in the literature and training of social workers in ‘direct work with children’. However, principles and practice from music therapy are under‐represented. The writer, who is a social worker, psychotherapist and musician, shares her reflections on introducing techniques and theoretical approaches from music therapy into her own therapeutically orientated direct work. Suggestions are made as to how other practitioners (both musically trained and not) could develop the use of music as a further ‘tool’ in their direct work with children.     

Adventure Therapy: Nondeliberative Group Work in Action

ABSTRACT

Nondeliberative group work allows group members to generate their own solutions and provides experiential opportunities to transfer learning to life outside of a therapeutic setting. Adventure therapy is explored as a tool for engaging groups in a nondeliberative manner. The theoretical underpinnings of adventure therapy are presented and contextualized within the larger framework of experiential education. Specific methods and models of adventure work are presented and considered in relationship to nondeliberative social work with groups. Two case examples are presented to illustrate the nondeliberative nature of adventure therapy.     

Enriching the professional repertoire of social workers: locus of control as a diagnostic and therapeutic tool

This article examines the locus of control construct and its utility from a social work perspective. For an overview, the background and evolution of the locus of control concept and the characteristics of internally and externally controlled individuals are provided. How this construct is relevant to social work is treated in relation to social work functions, areas of application, as well as relevant social work treatment issues. The article concludes by examining common criticisms of the locus of control construct and argues for a formal inclusion of this concept in the education and treatment process in social work.     

The later social adjustment of a group of borderline defective delinquents trained at the oaks school 1

In Part 1 of this article, the author provides an overview of the history of psychoanalytic treatment of those identifying as homosexual. In Part 2, the author interviews “Rob” to more fully demonstrate the corrosive effects over a lifetime of analytic and psychotherapeutic treatment, as it had once been practiced. Rob, a man primarily attracted to men, spent many years in treatment with different therapists and analysts during the 1950s, 1960s, and 1970s. Now in his early eighties, Rob is married and remains closeted to all but a few close associates. When Rob entered treatment many years ago, he was told that his homosexual attractions were symptoms of an illness and with treatment he could change. Rob's experience is uncannily similar to multiple reports that exist in the professional and lay literature. Rob knows that nothing can undo the damage he suffered, yet it remains his wish that the psychoanalytic community would acknowledge, and even apologize, to all those who were harmed—including the many who took their lives—by theories and practices that were once so central to mainstream psychoanalysis.