Child psychotherapy

Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist.[1] The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.[1]

The term, "psychotherapy" includes the implementation of educational and psychoanalytic support for the client and is effective in problem-solving, emotional regulation, and encouraging pro-social behaviors as children develop positive changes to their current mindsets.[1] Terms describing child-focused treatments may vary from one part of the world to another, with particular differences in the use of such terms, as "therapy", "child psychotherapy" or "child analysis"."

Evolution of child psychotherapy

Child Psychotherapy has developed varied approaches over the last century.[2] Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one through the Child Guidance Movement, the other stemming from adult psychiatry or psychological medicine, which evolved a separate child psychiatry specialism.[3]

The separation of child and adult psychology

The attempt to create a unified method of child mental health care led to the increase of child guidance clinics in England throughout the mid-twentieth century.[2] The spread of clinics across Europe coincided with the absence of hospital care as the lack of distinction between child and adult psychiatry prevented further analysis of child diagnosis and treatment.[2] The first Chair of Child Psychiatry officially coined the term, Child and Adolescent Psychiatry in 1973, but it was not until the DSM-III where a full list of distinct child psychiatric disorders were mentioned.

Psychoanalytic child psychotherapy

Psychoanalytic psychotherapy with infants, children and adolescents is mainly delivered by people qualified specifically in psychoanalytic child psychotherapy, or by trainees under supervision from a specialist in child-focused treatment. Recent evidence,[4] covering 34 research papers (nine of which were randomized controlled trials) showed psychoanalytic psychotherapy to be particularly effective for children with the following conditions:

  • depression
  • anxiety and behavior disorders
  • personality disorders
  • learning difficulties
  • eating disorders
  • developmental issues

Furthermore, follow-up research[5] shows that in psychoanalytic psychotherapy, therapeutic improvements continue well beyond the termination of the therapy itself. This has been termed a, "sleeper effect."

In the UK, psychoanalytic psychotherapy is recommended by NICE as an evidence-based treatment for trauma from sexual abuse[6] and severe depression in adolescents[7] following the IMPACT study[8]

Evidence-based child and adolescent psychiatry

There are various therapeutic assessments to address mental health concerns among children and adolescents. Some approaches are backed by strong scientific evidence, while some are not.[9] Some research suggests that it is the quality of the relationship with the therapist, rather than the particular form of therapeutic intervention, that is the strongest factor in helping change develop.[10]

Parent–infant psychotherapy

If the normal course of secure attachment between parent and infant is disrupted, parent–infant psychotherapy is a catch-all term to describe psychotherapies that either aim to restore this bond or to work with vulnerable parents to overcome disruption and prevent further occurrence. Examples of this kind of therapy include, "Watch, Wait, Wonder," and psychoanalytic parent-infant psychotherapy. Many of these techniques require a three-way relationship between the parent, child, and therapist. During therapy sessions, the parent may express his or her thoughts and feelings which are based on a combination of factors including:

  1. The parent's experiences as a child
  2. The parent's expectations and hopes for the child's future
  3. The relationships the parent has with other people

The therapist's role is as an observer and an interpreter of the interaction between the infant and the parent. He might share some of his thoughts about the behavior of the child with the parent and by doing so offering the parent an alternative way of experiencing the child. This technique helps the parent to resolve issues with his or her own infancy-experiences in order to restore secure attachment with the infant. And it helps lower the risk for psychopathological developments of the child in the future.[11][12]

Group art therapy

Group art therapy gives the child a safe environment to access their emotions through a creative medium in the presence of a therapist.[13] This nonverbal therapeutic practice alleviates the stress that a child may feel when trying to find the words to express themselves; thus it helps rebuild social skills and gain trust in others. Studies have also found that this practice can alleviate self-harm engagement. This method of psychotherapy has been found particularly helpful for children who exhibit any of the following:[13]

  • Autism
  • Asperger's
  • Anxiety and behavior disorders

Group art therapy has eight subcategories of specific mechanisms of change. Among them are:[14]

  1. As a form of expression to reveal what's inside
  2. As a way of becoming aware of oneself
  3. a way to form a narrative of life
  4. integrative activation of the brain through experience
  5. a form of exploration and/or reflection
  6. the specifics of the art materials/techniques offered in art therapy
  7. as a form to practice and/or learn skills
  8. art therapy as an easily accessible, positive and safe intervention by the use of art materials

By bundling together these specific groups, the general groups are as follows:

  • art therapy as a form of group process
  • the therapeutic alliance in art therapy

Within this approach, three types of behaviors can be exhibited by the therapist; non-directive, directive, and eclectic.[14] Non-directive refers to a following behavior in which the therapist takes on an attitude of observing self-exploration of emotions rather than facilitation or interpretation. Directive attitudes however follow a facilitative pattern by asking specific questions to guide the clients artwork. With these two processes in mind, eclectic combines them to create a facilitative and lenient approach simultaneously and often utilizes emotion check-in's at the start of sessions, and emotion check-outs at the end of sessions.

This approach adopts various psychological elements such as psycho-educational, mindfulness, psychoanalysis, and cognitive analytic theories. This article sought to analyze this methods effectiveness on a broad spectrum, including the following:[15]

  • traumatic events (PTSD)
  • who have educational needs or disabilities
  • children with medical conditions
  • children with none of the former
  • juvenile offenders

Art therapy can be implemented as a holistic therapeutic practice for child cancer patients as well (effecting 1 in 285 children in the US; 15,980 children each year).[16] Given the alleviating effects that are addressed by this method, children were better able to discuss their needs and emotions to their family members and healthcare team. The results of this study conveyed that art therapy lead to improved emotional and mental well-being and improved communication skills.

Parent–child interaction therapy (PCIT)

Parent–child interaction therapy is meant to assist parents whom have children ages 2–7 years old who are prone to disruptive behaviors and emotional difficulties.[17] Parent–child therapy utilizing two stages, each possessing their own goals and characteristics to create this approach. Beginning with child-directed interaction (CDI), parents learn skills such as praise, verbal reflection, imitation, behavioral description, and enjoyment, to achieve the goal of warm and secure parenting styles. Parent-Directed interaction (PDI), the second phase, seeks to decrease the original disruptive behaviors exhibited by the child. Both phases are designed to be coached by the therapist via another room while the parent interacts with their child. This review found that certain cultural values may impede or contribute to the progress of this approach.

Challenges of child psychotherapy

Disregarding suppressed behaviors

Therapeutic interventions among children and adolescents are subject to specific challenges, many of which stem from the reliance of family members as a result of the clients lack of independency at the current stage in their lives. Unlike adult psychotherapy, it is rare for a client to seek treatment themselves in child psychotherapy.[18] The involvement of parents in treatment referral often leads to the frequent disregard suppressed behavioral or emotional problems such as anxiety and depression with the majority of referrals relating to disruptive behaviors.[18]

Lack of motivation

The child-parent dynamic in psychotherapy also has the tendency to increase disagreements regarding treatment processes.[1] Children may be hesitant to accept the idea of undergoing psychotherapy if they were forced into it by a third party. This reluctancy to abide by a psychotherapeutic schedule contributes to the challenge of retaining clients in treatment as 40%-60% of children and adolescents end up dropping out due to demotivation.[18]

Problems of reporting styles

Many challenges associated with child psychotherapy derive from inefficient reports of client symptoms.[1] The methods provided for obtaining information of symptoms typically involve questionnaires and interviews that may affect how the client will answer.[18] Important characteristics of symptoms such as duration and intensity may not be reliable if the client omits crucial information out of fear or risk of embarrassment.[1]

See also

References
  1. Bhide, Ajit; Chakraborty, Kaustav (2020). "General Principles for Psychotherapeutic Interventions in Children and Adolescents". Indian Journal of Psychiatry. 62 (8): S299–S318. doi:10.4103/psychiatry.IndianJPsychiatry_811_19. ISSN 0019-5545. PMC 1347. PMID 32055072.
  2. Barrett, Susan (2019). "From Adult Lunatic Asylums to CAMHS Community Care: the Evolution of Specialist Mental Health Care for Children and Adolescents 1948-2018". Revue Française de Civilisation Britannique, XXIV-3. XXIV (3). doi:10.4000/rfcb.4138.
  3. John Stewart (2012). "The dangerous age of childhood: child guidance in Britain c. 1918–1955". Retrieved 9 January 2020.
  4. Midgely, N.; Kennedy, E. (2011). "Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base". Journal of Child Psychotherapy. 37 (3): 232–260. doi:10.1080/0075417X.2011.614738. S2CID 28367786.
  5. Bateman, A.; Fonagy, P. (2001). "Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up". American Journal of Psychiatry. 158 (1): 36–42. doi:10.1176/appi.ajp.158.1.36. PMID 11136631.
  6. "Therapeutic Interventions after Abuse and Neglect – Guidance 76". National Institute for Health and Care Excellence. HM Government. 9 October 2017.
  7. "Therapeutic Interventions for Moderate to Severe Depression – Guidance 28". National Institute for Health and Care Excellence. HM Government. 26 September 2005.
  8. Goodyer, I. M.; Reynolds, S.; Barrett, B.; Byford, S.; Dubika, B.; Hill, J.; et al. (2017). "Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial". Lancet Psychiatry. 4 (3): 109–119. doi:10.1016/S2215-0366(16)30378-9. PMC 5285447. PMID 27914903.
  9. APA Task Force on Evidence-Based Practice with Children and Adolescents (2008). Disseminating Evidence-Based Practice For Children & Adolescents: a systems approach to enhancing care. Washington, DC: American Psychological Association.
  10. Sutton, S. (2014). Being Taken In: The Framing Relationship. London: Karnac.
  11. Lieberman, AF (1992). "Infant-parent psychotherapy with toddlers". Development and Psychopathology. 4 (4): 559–574. doi:10.1017/s0954579400004879. S2CID 145171277.
  12. Lieberman, AF; Silverman, R; Pawl, JH (2000). "Infant-parent psychotherapy". In Zeanah, CH (ed.). Handbook of infant mental health (2nd ed.). New York: Guilford Press. p. 432. ISBN 1-59385-171-5.
  13. Waller, Diane (April 2006). "Art Therapy for Children: How It Leads to Change". Clinical Child Psychology and Psychiatry. 11 (2): 271–282. doi:10.1177/1359104506061419. ISSN 1359-1045. PMID 17086689. S2CID 8241451.
  14. Bosgraaf, Liesbeth; Spreen, Marinus; Pattiselanno, Kim; Hooren, Susan van (2020). "Art Therapy for Psychosocial Problems in Children and Adolescents: A Systematic Narrative Review on Art Therapeutic Means and Forms of Expression, Therapist Behavior, and Supposed Mechanisms of Change". Frontiers in Psychology. 11: 584685. doi:10.3389/fpsyg.2020.584685. ISSN 1664-1078. PMC 7578380. PMID 33132993.
  15. Cohen-Yatziv, Liat; Regev, Dafna (3 July 2019). "The effectiveness and contribution of art therapy work with children in 2018 -what progress has been made so far? A systematic review". International Journal of Art Therapy. 24 (3): 100–112. doi:10.1080/17454832.2019.1574845. ISSN 1745-4832. S2CID 151138642.
  16. Aguilar, Bree A. (1 September 2017). "The Efficacy of Art Therapy in Pediatric Oncology Patients: An Integrative Literature Review". Journal of Pediatric Nursing. 36: 173–178. doi:10.1016/j.pedn.2017.06.015. ISSN 0882-5963. PMID 28888499. S2CID 1784960.
  17. Lieneman, Corey C.; Brabson, Laurel A.; Highlander, April; Wallace, Nancy M.; McNeil, Cheryl B. (20 July 2017). "Parent–Child Interaction Therapy: current perspectives". Psychology Research and Behavior Management. 10: 239–256. doi:10.2147/prbm.s91200. PMC 5530857. PMID 28790873.
  18. Kazdin, Alan E. (February 2003). "Psychotherapy for Children and Adolescents". Annual Review of Psychology. 54 (1): 253–276. doi:10.1146/annurev.psych.54.101601.145105. ISSN 0066-4308. PMID 12185210.
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