Psychology often talks about childhood as the foundational years of our development. However, when there are issues in childhood which remain unresolved it can cause further difficulties for the individual later in life. Psychotherapy has been traditionally seen as for adults given their cognitive maturity and comprehension abilities. Psychological interventions are designed for different age groups throughout the developmental period taking into consideration the challenges the individual is facing.
Also Check >> Types of Art Therapy
In working with children there may be many problems that are visible across the developmental period and are thus termed as neuro-developmental disorders. There are some behaviours which can be seen as an exaggeration of normal levels of the same behaviour such as anxiety, hyperactivity, aggression. However only the group of children with a psychiatric diagnosis are not the only group requiring psychological interventions. However, there are clients who might not warrant a diagnosis but still require psychological support. Further during the adolescence period there are many behaviours which may be seen as “at risk” behaviours such as experimenting with substances, skipping school, truancy, etc also need support.
Amongst the various disorders they have been primarily classified into internalizing disorders where emotional experiences are directed towards inner experiences such as depression, anxiety, withdrawal. On the other hand, there are externalizing disorders where emotional experiences are directed towards the environment/ others such as aggression, defiance, hyperactivity, etc. Research suggests that often externalizing problems are identified and referred for treatment whereas internalizing problems are often overlooked. Often though they may be identified they are often seen as a phase in the child’s life and the stigma associated with therapy holds back parents and schools from referring children to therapy. Further Keeler (1954) also mentions that depression has a different presentation amongst children and adults. In children, symptoms such as acute anger, rebellion along with impulsive tendencies maybe few of the red signs unlike symptoms of changes in sleep, appetite and a loss of motivation unlike adults. Similarly, anxiety in children may manifest as school refusal, reduced social participation and other symptoms of withdrawal. Hence due to the difference in presentation of symptoms children need interventions particularly tailored to cater to those symptoms.
Common Issues in Child Therapy
It has been found that children/adolescents themselves may not consider their problems to be important enough. They might not understand what they are going through or may not even be able to open up leading to a lack of involvement in the therapy process. Thus, the challenge is to involve the child in treatment and to work towards a change that the child may not see as necessary or even useful. Further the structure of child therapy is very different from a typical adult therapy structure wherein the parents, caregiver have to play a major role in helping the child apply the therapy skills and also to modify behaviour. As a result of parental dependence, the child is likely to be affected by multiple factors beyond their control such as parental discord, family problems, etc which may impact the involvement of family members. In such cases of lack of involvement of the parents/ families the child/adolescent may drop out soon from therapy.
Psychotherapeutic Interventions for Children
1. Cognitive Behaviour therapy
Research suggests the effectiveness of cognitive behaviour therapy for children. It is primarily used for treating anxiety disorders. For children it has been modified using techniques such as use of stories, worksheets. With children the goal is not to work with core beliefs but to help the child express his thoughts, emotions and help them deal with challenging situations effectively. Additionally, use of relaxation is used often for children and adolescents to help children manage the physiological tension manifested by anxiety.
2. Play Therapy
Play is a medium through which children form interpersonal relations with their peers. It is often used as a means to understand the world through the child’s lens. Additionally, it also helps shed light on the psychosocial difficulties the family might be facing at home. The child uses toys as a medium of communicating their feelings, experiences. Play therapy also creates a safe environment for the child which allows him/her to engage in something bad, unacceptable otherwise. It is also used to identify patterns which can also be modified by teaching alternative adaptive behaviours (Koukourikos,2021)
3. Behaviour Modification
It is a form of behaviour therapy which aims to change/altar behaviour patterns. It applies principles of reinforcement in which the consequences of a certain behaviour determine if the behaviour will be repeated or not. The therapy conducts a preliminary assessment of the child’s current behaviours using a visual analogue scale. The therapist also assesses the severity and intensity of the behaviours. Techniques such as chaining, shaping are used where a goal behaviour/ desired behaviour is decided. The therapist helps the client attain the desired behaviour sequentially in smaller steps and after attaining each step a reinforcement is provided. A reinforcement could be anything from physical reinforcement such as gifts, chocolates; verbal such as a praise or non-verbal such as a smile. Additionally in situations where the child engages in undesirable behaviour s/he may be punished to avoid repeating such behaviours (Smith,1972).
Hence early identification, evaluation and treatment can pave the path to recovery. In the process of getting the best help for our children the responsibility lies with adults to observe and look for red flags. To notice changes in behaviour, general levels of functioning and then to make sure that the child is provided with help and support in the best possible way.
References
Glaser, K. (1967). Masked Depression in Children and Adolescents. American Journal of Psychotherapy, 21(3), 565–574.doi:10.1176/appi.psychotherapy.1967.21.3.565
Kazdin, A. E. (2003). Psychotherapy for Children and Adolescents. Annual Review of Psychology, 54(1), 253–276.
Koukourikos, K., Tsaloglidou, A., Tzeha, L., Iliadis, C., Frantzana, A., Katsimbeli, A., & Kourkouta, L. (2021). An Overview of Play Therapy. Materia socio-medica, 33(4), 293–297.
Smith, Janice. (1972). Behaviour Modification with Children. Journal of the Australian College of Speech Therapists, 22(2), 43–47