Assessment in Child Psychotherapy

Views: 898
Ratings: (0)

This book describes an approach to children and young people who might be helped by child psychotherapy. Attention is paid to factors within the child's personality, to strengths and impediments in the developmental process, and to the family and wider school and community context. Individual chapters address both clinical methods and a variety of clinical problems, including work with very young children and their parents, severe deprivation and family breakdown, developmental delay, and the more serious psychological illnesses of childhood.Assessment in Child Psychotherapy is a significant contribution to all mental health professionals who need to be able to identify the precise nature of a child, adolescent or family's problems and to offer the most appropriate help. Such a book is long overdue. It spans a range of thinking about how best to reach those whose emotional and behavioural difficulties pose challenging questions as to the most suitable forms of treatment. Through vivid and detailed clinical examples the book shows how the assessment procedure itself can constitute a helpful piece of work, as well as an exploration, which leads to a variety of treatment possibilities. Expert knowledge is made accessible and an elusive process is brought alive.This book will be of great help to child and adolescent mental health professionals and to a wider public interested in the development of children and in how help can be provided when things go wrong.Contributors: Anne Alvarez, Robin Anderson, Beta Copley, Jeanne Magagna, Lisa Miller, Emanuela Quagliata, Maria Rhode, Margaret Rustin, Judith Trowell and Margot Waddell.

List price: $25.99

Your Price: $20.79

You Save: 20%

 

10 Slices

Format Buy Remix

Content

ePub

 

1. Assessing Children with Communication Disorders

ePub

Maria Rhode

The children I shall discuss in this chapter suffer from autistic spectrum disorder, mutism, or a learning disability arising from a pervasive developmental disorder (PDD). I shall not be considering children who stammer, or the psychotic or borderline children discussed by Anne Alvarez (this volume) who may use words in idiosyncratic ways for purposes other than communication. However, some of the points Alvarez makes are highly relevant to the kind of child I shall discuss, such as the importance of assessing the symbolic level at which the child is operating at any moment. This is essential if we are not to misunderstand him, and if we are to be able to phrase our own communications in ways that he can hear.

Autistic spectrum disorder includes children with autism proper and with Asperger’s Syndrome. Children with autism may be completely mute, or may produce language ranging from single words to complete sentences. Sometimes their words are their own; often they are quotations from stories, songs and videos, or they may be echolalic reflections of someone else’s speech (Rhode, 1999). In Asperger’s Syndrome, language is well-developed though it is often used idiosyncratically (see Rustin, 1997; Youell, 1999). According to the criteria of DSM-IV, children with autism must demonstrate Kanner’s (1943) classic triad of impairments: affective, cognitive, and social, which must have been manifest by the age of three. Children with pervasive developmental disorder (PDD) satisfy some of these criteria, but not enough for a diagnosis of autism.

 

2. Borderline Children: Differentiating Disturbance and Deficit

ePub

Anne Alvarez

INTRODUCTION

Before introducing what is the subject of this chapter, it may be important to say something about what it is not. It is not about deciding which borderline psychotic, psychopathic, or psychotic children, are able to ‘use’ psychotherapy. This is, first, because it is extremely difficult to predict degree of improvement. A lesser degree of improvement may have as much to do with our own failure, as the patient’s therapist, to understand the nature of his communications, as with his actual original level of pathology. External factors, too, may intervene for good or ill. I think we are constantly being surprised at how well very damaged children or adolescents do do in treatment: the third assessment session, or, for that matter, the thirty-third treatment session, may be vastly different from the first or second, in terms of revealing new sensitivities in an apparently hardened child. Alternatively, it may reveal new horrifying areas of madness in an apparently only neurotic but slightly odd child, so it is dangerous to predict too much. It may, however, be possible to say something, by the end of a few assessment sessions, about the level and type of illness, by attending to three major areas of functioning i.e. the level of ego development, the nature of the sense of self, and the nature of the ‘internal object’ or ‘representational other’. This may cast some light on where the child is on the neurotic-psychotic continuum (already an oversimplification) and possibly on the degree of overwhelming anxiety, persecution, paranoia, despair, the degree of impulsivity, psychopathy, perversion, addiction, the degree of thought disorder, and perhaps, on the chronicity or acuteness of all or any of these. Such assessment may give some indication of how far the child may have to go to reach normal development; unfortunately it may give little idea of how fast he and his therapist may travel, nor how circuitous the road ahead may have to be.

 

3. Severe Eating Difficulties: Attacks on Life Traumatised Children and Their Families

ePub

Jeanne Magagna

‘When I’m thin I’ll be happy. I’m fat and therefore unhappy. My body is huge and disgusting. Nobody tries to understand who I really am. They are only interested in how much I weigh and how they can make me fatter.’ These words, spoken by an anorectic girl after the failure of a treatment programme for anorexia, underline the importance of having an assessment process which enables a child to feel that the whole of her being (feelings, physical condition, body sensations, thoughts) is accepted and understood.

UNDERLYING HYPOTHESIS

My hypothesis is that refusal to eat does not simply refer to refusing to open the mouth to take in food. It might simultaneously mean closing the mind to the emotional experience of oneself and others. ‘I won’t eat’ can in fact signify closing the mind in the face of conflicts or withdrawing from the nurturing emotional link with the mother. The anorectic child’s fear of being fat, as well as being linked to the pressure society exercises on women to become thin, also includes the fear of bodily sensations and intense emotions that overwhelm the child to the point of threatening her sense of identity, her perception of the form and size of her body and her own mental health (Palazzoli, M., 1974).

 

4. What Follows Family Breakdown? Assessing Children who Have Experienced Deprivation, Trauma and Multiple Loss

ePub

Margaret Rustin

Children may lose continuity of care within the family they entered at birth for a variety of reasons. In this chapter, the focus will be on children who have experienced severe losses. Such children are those whose families have been unable to provide an ongoing home and who have entered the system of child-care administered by the state. Either because of requests for help in taking care of a child from overwhelmed families or because of state intervention to remove a child from an abusive home, these children become the responsibility of social work agencies and are in residential homes or foster-placements, and some ultimately in adoptive homes. Within this group, the children referred for psychotherapeutic assessment are not usually those for whom there are hopes and plans for rehabilitation within the family of origin, but those for whom long-term alternative plans are being or have been made. They are the children who have not been helped enough by being offered alternative care, and whose psychological distress is evident either through their own visible unhappiness and difficulties in living, or through the disturbing effect they have on their carers and the wider world.

 

5. Assessing Sexually Abused Children Family Approaches

ePub

Judith Trowell

INTRODUCTION

Child sexual abuse is an event in which an adult is involved and the child is left confused, frightened and ashamed (Kempe, C.H. & Kempe, R., 1984). The child may have been hurt, or be excited, or both. If abuse has occurred over a prolonged period, the child may be flat, withdrawn and apathetic or angry, defiant and difficult. Some children and young people may also express their distress through self harm, or become anorexic, or run away to live on the streets. The emotional impact is what needs to be understood, what has happened in the individual’s mind, if we are to intervene most effectively. Sexual abuse is of a different order from other forms of abuse, because of the linking up of sexuality and aggression. Such violence results in a very primitive destruction of the child’s mind. Irving Kaufman (1989) used the evocative term ‘soul murder’ to describe emotional abuse. In sexual abuse, there is nearly always an element of physical abuse, but there is also serious emotional abuse. At one and the same time, the child’s mind and body are being ‘raped’. The child’s body may recover fairly quickly once the abuse has ceased, but the mind is left profoundly traumatized. While we do not yet fully understand all that happens to the developing mind, the more we struggle to do so, the more damaging sexual abuse is revealed to be (Renvoize, J., 1983; Morris, M., 1982; Baker Miller, 1976).

 

6. An Under Fives' Counselling Service and its Relation to Questions of Assessment

ePub

Lisa Miller

This brief chapter sets out to describe the Under Fives’ Counselling Service at the Tavistock Clinic, to outline some of our practice and its origins, and to link it with assessment, including that kind of assessment which never moves towards long-term treatment but stays at the level of what Winnicott called a ‘therapeutic consultation’. The Under Fives’ Service is a much-used service in our Child and Family Department which was set up to answer the frequent need for brief work with parents and their baby or small child. This service has been running for some years, and we have developed our own way of working. We offer up to five sessions (all five may not be needed or wanted) with one of our team of professionals drawn from all the four department disciplines in psychiatry, social work, child psychotherapy and psychology. This work needs to be undertaken by experienced workers, because in brief work you need to have some resources to draw on, to have some capacity for quick thinking and to have developed some resilience in the face of sudden strong projected anxiety. Nowhere are these qualities more necessary than in work with infants and very young children when one is constantly urged on by the inner awareness that every week counts at a time when development is proceeding at such a pace. Less experienced workers have ample opportunity both for co-work with a senior person and for supervision. Indeed, for all kinds of briefer work, and certainly for assessment too, support and discussion times are not just desirable but essential.

 

7. Family Explorations Adolescents

ePub

INTRODUCTION

I start by thinking about some emotional and functional complexities within family life which influence clinical work. I make use of a traditional model of a family which may need some adjustment according to the actual circumstances of any individual family: what are described as male or female roles may, for example, be shared in various ways, and a degree of parental functioning, following a separation or divorce, may be carried by an adult who is not a biological parent. I go on to discuss indications for initial exploratory work with families, the purposes this can serve, and how it can be carried out. Much of the thinking in this chapter is based on the experience of the Family Workshop in the Adolescent Department of the Tavistock Clinic and is discussed more fully in Box et al. (1981/1994). I am grateful to Mary Boston for personal discussion of exploratory family work which includes younger children.

EMOTIONAL COMPLEXITIES IN DEVELOPING FAMILIES

The Containment of Anxieties and Family Dynamics

 

8. Assessing Adolescents: Finding a Space to Think

ePub

Margot Waddell

Exploring adolescent difficulties with a view to possible therapeutic treatment involves attempting to engage a troubled, and often confused, individual in beginning to think; to think in a very specific and probably unfamiliar way. Beginning to think can itself be a frightening process. It necessitates learning about oneself.’… they all hate learning’, says the psychoanalyst in Bion’s final Memoir ‘it makes them develop swell up’ (1979, p. 8), pregnant, that is, with a new idea, a new birth/thought in the mind.

It is often at adolescence that the issue of different kinds of learning and thinking, and their implications for development, take on some kind of clarity. The emotional ferment stirred up by puberty and its complex aftermath is one which adolescents find themselves alarmingly, and often unexpectedly, caught up in. Inner conflicts and anxieties are aroused which many seek to avoid, if at all possible. Some seem to stop thinking independently altogether, and submerge themselves either in the shared mentality of group-life, and/or in activities which are literally mindless — such as drug, alcohol or substance abuse. At me other extreme, some may try to rely on intelligence itself as a defence against facing and thinking about turbulent and often contradictory feelings as a way of avoiding intimacy and evading engagement with ‘the agitation of inexperience’ (Copley, 1993, p. 57).

 

9. Assessing the Risk of Self Harm in Adolescents: A Psychoanalytical Perspective

ePub

Robin Anderson

INTRODUCTION

The risk of self harm rises dramatically in adolescence. Suicide, attempted suicide, and other forms of self harm are rare in younger children, but once adolescence is reached the rate of deliberate self harm rises steeply. In 1990 the suicide rates per million for 15-19 year olds in England and Wales for males and females were 57 and 14 respectively. This is almost certainly an underestimate because of the reluctance of Coroners’ courts in this country to bring a verdict of suicide for all but the most certain cases. Even so, mortality rates were only higher for accidents. [Of course many fatal teenage accidents may have a suicidal aspect to them as well.] Of great concern at the present time is the increase in the male suicides in this age group. Between 1980 and 1990 the increase was 78%. This is particularly disturbing because the rate for adolescent girls and for all other age groups is falling (Flisher, A. 1999).

Seventy-one per million is of course a very small proportion though even one wasted life would be too many. The effect on others of an adolescent suicide cannot, however, be over-estimated. It is a trauma which is devastating for other family members who frequently suffer for years afterwards. Siblings can have their own development grossly interfered with and are at risk of suicide themselves. It is also deeply upsetting for the surrounding community, especially in schools and on university campuses where it can trigger off waves of suicide attempts or even actual suicides. Where the young person has been receiving help from professionals it is very distressing for them too, giving rise to strong feelings of guilt and distress and loss of a sense of competence. Often the situation is noc helped by the ensuing inquiries which can become dominated by hostile and blaming attitudes, which are at the heart of suicidal behaviour and die response it can evoke.

 



Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781780497600
Isbn
9781780497600
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata