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Child Psychology Blogs

Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, June 2, 2016

What Does Evidence-based Therapy for Children Look Like?

If you’ve never been in psychotherapy, the idea can be a pretty scary one. Revealing ourselves and our problems can seem so intimidating that we may think we’d rather just have the problems. Taking your child to psychotherapy is even scarier--  what will they do when I’m not there? What will they talk about? Will they say the problems are all my fault? Will my child learn to disrespect me? Will the therapist work against our family values? Parents may have to feel pretty desperate before they are ready to face some of the possible answers to these questions!

When people start talking about evidence-based therapies, that can be scary too. The term just means that these treatments have been systematically tested and shown to give good results, but many parents are not sure what’s evidence-based and what isn’t, or how these “scientific” methods look different from any other kind of treatment. (Maybe they even involve electric shock, some may fear.)

Fortunately, you can now have a good look at what happens in some evidence-based treatments for children, thanks to Dr. Cynthia Hartung of the University of Wyoming and her graduate students. They have made  a series of youtube presentations that describe and give examples of treatments for certain childhood problems—I found these not only informative but quite fun to watch. You will enjoy watching them yourselves, but I will give a little summary about each.

1. Cognitive-Behavioral Therapy for Adolescent Depression
by Brooke Merrow & Kendal Binion

This presentation gives an excellent discussion of the basic ideas of cognitive-behavioral therapy (CBT). This treatment is based on the very real links between thoughts, feelings, and behaviors. Changing the way people think about situations or people (including themselves) can change the feelings they have, and that in turn can change their behavior. Or things can work the other way around--  if behavior can be changed, the result can be that people think and feel differently about some aspects of their lives. Depressed behavior (like staying in bed all day) can create negative feelings and subsequent negative thoughts about the world, for example, and changing that behavior can give someone a chance to experience better feelings and more positive thoughts.

2. Coping Cat to Treat Anxiety in Children and Adolescents
by Andrea Slosser & Shira Kern
This presentation discusses treatment for the debilitating anxiety some children and adolescents experience, anxiety that interferes with many of their normal behaviors and experiences. It affects school performance, sports, friendships, and family relationships. An important point is that children’s anxiety may not be shown by restlessness or a fearful expression as we might expect, but instead may show up as irritability. Sleep problems may also occur and are likely to make parents more irritable too, as their sleep is disturbed by the child’s disturbance.  

3. Parent Management Training for Childhood Behavior Problems
by Adam Ripley & Alejandra Reyna

This presentation focuses on way parents can learn to help children whose behavior is hyperactive, oppositional, or aggressive. These children may have been diagnosed as having Oppositional Defiant Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD), or Conduct Disorder. The point of parent management training is not to blame parents or say they have caused a child’s problems, but to call to their attention how they can respond to the child’s behavior in ways that can make “good” behavior more likely.

The basic idea is that under certain circumstances (antecedents), an unwanted behavior may occur. The consequences or results that follow that behavior will help to determine whether the behavior will happen again if the same antecedents are present (for instance, a child being teased or frustrated). To help decrease unwanted behaviors and increase wanted ones, parents need to follow the wanted behaviors by a positive reinforcement. (The video gives an excellent discussion of rewards and punishments.) Methods like time-out try to ensure that children are not accidentally rewarded for unwanted behaviors.

Of course, for any of this to work, the child must be able to do what is wanted, or to stop doing what is unwanted.

4. What is Trauma-Focused CBT for Children & Adolescents?
by Kati Lear & Sarah Steinmetz

This treatment is aimed at reducing the distress and anxiety children and families experience after a child has been exposed to trauma--  an incident in which there is extreme fear and helplessness. A recent example of such a traumatizing event is the experience of the Cincinnatti family whose three-year-old slipped into the gorilla pit at the zoo during the Memorial Day weekend of 2016. A child who experiences a very frightening event may later have “flashback” memories as if re-experiencing the incident, may have family and other relationship problems and emotional outbursts along with difficulty in obeying rules, and these problems may last over some time, with impact on the family members’ states of mind and ability to help the child. The treatment helps child and parents identify and talk about the emotions connected with the event and eventually become able to talk to each other calmly about what happened.

 I hope that readers who are concerned about child emotional problems and who are hoping for effective treatment will look at these videos (thanks, Dr. Hartung and students!) and will also have a look at for further discussion of evidence-based treatments for children. Do note that these treatments are not a matter of interminable psychotherapy--  generally, they involve fewer than 20 sessions, once a week.

1 comment:

  1. Which fits in well with Better Access to Psychology which is usually 10 sessions for adults and adolescents - in the Australian federal context. This is part of Medicare.

    "Taking your child to psychotherapy is even scarier-- what will they do when I’m not there? What will they talk about? Will they say the problems are all my fault? Will my child learn to disrespect me? Will the therapist work against our family values?"

    Especially the last three questions.

    As simple as it seems - trust.

    I do not know that children will generally say "all [their] fault" unless they are pushed into it/genuinely feel it/had the idea from someone else who has an adversarial relationship or ambivalent relationship with the parent/has something to gain from it.

    We will be very interested in Trauma-Focused CBT.

    A good book I have read is M Grace Baron's STRESS AND COPING which was written in the 2000s. There are Grandin's, Jessy Park's and a chapter on bereavement in developmental disability.

    "Hoping for effective treatment". Concern and hope are two powerful motivators.