Re-Framing and de-Pathologizing Behavior in Therapy for Children Diagnosed with Psychosocial Disorders

The increasing number of children diagnosed with psychosocial disorders reflects a trend toward pathologizing behavior that is unusual, challenging or extreme. Although these behaviors may match items on the symptom lists for various disorders, a therapist must first consider the origin and context of those behaviors for an individual child through a non-pathological lens. This paper proposes a framework for understanding the behavior of difficult children based on core issues rather than diagnostic symptoms: arousal/excitability, range of focus, perfectionism, intensity, interpersonal sensitivity, sensory sensitivity, cognitive/perceptual style, perception of time, reaction style, and affiliation/integrity. Each trait is examined from two perspectives: how it can lead to or be interpreted as a problem, and how a therapist can re-frame the trait and build on it to identify effective interventions. This approach affirms children’s strengths and upholds social work values.Barbara Probst, Adjunct Professor is affiliated with Graduate School of Social Service, Fordham University, NY, USA.Address correspondence to Barbara Probst, MSW, LCSW, Graduate School of Social Service, Fordham University, Neperan Road, Tarrytown, NY 10591, USA; e-mail: barbprobst@aol.com