Paradoxical intervention using a polarization model of cotherapy in the treatment of elective mutism: A case study

A case history is presented of a four and-a-half year-old electively mute child who was successfully treated by the authors. The treatment approach involved paradoxical interventions in the context of a polarization model of cotherapy in combination with behavioral techniques in a family therapy framework.     

Concurrent individual and family therapy in a case of elective mutism

In this paper, following a literature review a family containing a child who had been electively mute for four years is described. A concurrent programme of individual and family therapy and the systemic hypothesis which guided these interventions is then presented in detail. Behavioural and psychometric data are presented to illustrate the dramatic improvement which the identified patient showed over the course of treatment. Finally, the probable mechanisms underpinning the child's improvement, and how these differed from our initial expectations, are discussed.     

Behavioral Family Interventions for Improving Child-rearing: A Review of the Literature for Clinicians and Policy Makers

This paper reviews evidence that behavioral family interventions are effective at improving child-rearing in distressed families and families with children exhibiting disruptive behavior. Essential therapeutic strategies offered within a collaborative therapeutic process are identified. Exemplary materials for parents and clinicians are identified. Differences between behavioral family interventions and two popular press parenting approaches are highlighted, including the lack of empirical support for these widely used programs and the advice they offer which runs counter to behavioral approaches. Recommendations are offered for combining behavioral family interventions with other empirically supported approaches, promoting more widespread use of empirically supported treatments, such as behavioral family interventions, and the need for a public health perspective on family functioning, involving collaboration among clinicians, policy makers, and researchers.     

Detriangulation of Absent Fathers in Single-Parent Black Families: Techniques of Imagery

The projection of the mother's unresolved feelings about an absent father onto one or more of her children-often the eldest son expected to assume the role of parental child-is an obstacle frequently encountered in therapy with single-parent Black families. Acknowledgment and resolution of these feelings by the mother is an important step toward reestablishing generational boundaries and improving communication between mother and children. It is suggested that the empty chair procedure and the use of family photographs are two interventions that can be used within the context of structural and/or transgenerational family therapies to help the mother separate her feelings about the absent father from her feelings about her children. Models for the use of both approaches and the potential benefits of each is presented. The successful outcome of either technique may depend, however, on variables in the family's history and the stage of therapy during which the techniques are introduced.     

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

Behavioral-systems marital and family therapy: Integration and clinical application

Abstract

This paper describes our integration of two of the more prevalent approaches to marital and family therapy: the behavioral (social learning) and the family systems (communication theory) approaches. A discussion of the development of family rules from a behavioral point of view is presented as an example of conceptual integration. However, the major intent of the paper is to present a rather detailed explication of the authors' multivaried strategies for intervention, which are designed to integrate and innovate upon the major behavioral and family systems treatment techniques.     

A Family Systems Approach to Behavioral Training with Parents of Autistic Children

This paper reviews briefly the use of behavioral procedures and parent training techniques with parents of autistic children. Potential hazards that may arise when the clinician fails to be sensitive to the family context are examined. Behavioral clinicians are urged to undertake behavioral parent training from a family systems context and thereby enhance the likelihood of more enduring changes for the autistic child and the family as a whole. Case illustrations are provided.     

The efficacy of stimulus fading and contingency management in the treatment of elective mutism: a case study

Stimulus fading techniques were compared to those of contingency management in the treatment of a 6-yr-old, electively mute girl. Experimental periods consisted of the mother rewarding the child for verbal and motor responses to scheduled tasks, while a stranger slowly entered the room and then gradually administered the task items as mother left the room. A timeout contingency for non-response to task items was also employed. Control periods consisted of a stranger administering the same tasks to the child under the same contingencies but without the presence of the mother or the use of stimulus fading. Experimental and control periods were alternated during each treatment hour. The stimulus fading procedure was found to be a necessary component of the treatment process. While the timeout contingency for non-response was found to facilitate treatment if combined with stimulus fading, it was completely ineffective without the stimulus fading.     

Enhancing treatment for school-age children who stutter I. Reducing negative reactions through desensitization and cognitive restructuring

This paper describes several treatment strategies that clinicians can use to address negative affective, behavioral, and cognitive reactions that school-age children who stutter may experience as part of their disorder. Specific strategies include desensitization to stuttering, cognitive restructuring, self-acceptance, purposeful self-disclosure, and a combination of both fluency enhancing and stuttering modification approaches. To facilitate clinicians' application of these techniques, the strategies are presented in the context of a case study involving a 9-year-old boy who participated in a comprehensive treatment program for stuttering. Following treatment, the child exhibited improved communication attitudes and a reduced frequency and severity of stuttering, combined with reduced concern about stuttering, as indicated through formal and informal assessments. Findings suggest that clinicians can help children overcome the negative reactions associated with stuttering through a number of treatment strategies that can be applied in a variety of clinical settings. Educational objectives: After reading this article, participants will be able to: (1) define desensitization and cognitive restructuring and provide two arguments in favor of using these strategies in treatment for school-age children who stutter; (2) describe two treatment strategies for helping school-age children achieve desensitization through stuttering therapy; (3) describe two treatment strategies for helping school-age children engage in cognitive restructuring in the context of therapy.     

Family-Focused Treatment for Childhood Depression: Model and Case Illustrations

Although the evidence base for treatment of depressive disorders in adolescents has strengthened in recent years, less is known about the treatment of depression in middle to late childhood. A family-based treatment may be optimal in addressing the interpersonal problems and symptoms frequently evident among depressed children during this developmental phase, particularly given data indicating that attributes of the family environment predict recovery versus continuing depression among depressed children. Family-Focused Treatment for Childhood Depression (FFT-CD) is designed as a 15-session family treatment with both the youth and parents targeting two putative mechanisms involved in recovery: (a) enhancing family support, specifically decreasing criticism and increasing supportive interactions; and (b) strengthening specific cognitive-behavioral skills within a family context that have been central to CBT for depression, specifically behavioral activation, communication, and problem solving. This article describes in detail the FFT-CD protocol and illustrates its implementation with three depressed children and their families. Common themes/challenges in treatment included family stressors, comorbidity, parental mental health challenges, and inclusion/integration of siblings into sessions. These three children experienced positive changes from pre- to posttreatment on assessor-rated depressive symptoms, parent- and child-rated depressive symptoms, and parent-rated internalizing and externalizing symptoms. These changes were maintained at follow-up evaluations 4 and 9 months following treatment completion.     

Concurrent treatment of mother and child in resolution of multigenerational separation and individuation difficulties

This case serves as a paradigm of concurrent treatment of a mother and child, where the central problem was one of separation-individuation. The nature of the child's presenting symptom of night terrors, the overinvolvement of the mother and the child, and the tendency of the child to withdraw from the outside world, all pointed to a child at risk for the more symptomatic development of school refusal and greater psychopathology. Since the treatment took place within a full service community mental health clinic, it was possible to provide psychiatric evaluation and consultation of both mother and child and the use of two therapists working collaboratively. With this method of treatment, the unfolding of both mother's and child's separation-individuation processes could be identified and utilized. Since she was an electively mute child who refused to come into the treatment room, another therapeutic tool became the use of the younger brother as a facilitator.     

Impact des contraintes linguistiques et cognitives sur l’acquisition de l’accord en genre de l’adjectif en français écrit

The aim of this research is to show the impact of linguistic (the feminine inflexion was audible or not) and cognitive (the complexity of the task in which the agreement is realized) factors about the acquisition and the use of adjectival gender inflexions in written French. In this perspective, we compared the production of the mark of the agreement in three tasks not mobilizing the same levels of linguistic treatment: transcribe sentences under dictation, recall sentences presented orally, and produce two sentences ending with an adjective from a syntactical priming. The results show that the systematic application of the adjectival agreement in gender is not totally mastered at the end of primary. Besides, the use of the adjectival gender inflexions is more difficult when the written inflexion is mute. Finally, the children forgot more the gender inflexion in written production task than in a dictate or recall task. These results are interpreted within the framework of a functional approach of language production.     

Metaphors and Stories in Cognitive Behavioral Therapy with Children

Despite the recent proliferation of material on cognitive behavioral approaches with children and adolescents and the call for these approaches to be more child-friendly, there is scant attention paid to the use of metaphors with youngsters. This paper emphasizes the value metaphors add to cognitive behavioral therapy with children and adolescents. The advantages which recommend metaphor use for cognitive behavioral therapy with children are delineated. Further, seven guidelines for clinical practice are outlined. Examples of both clinician-generated and patient-generated metaphors are also presented.     

Cerebellar mutism

Cerebellar mutism occurs in about 25% of children following posterior fossa tumor surgery. It is usually accompanied by other neurological and behavioral disturbances. Mutism is transient in nature lasting several days to months and is frequently followed by dysarthria. In addition, impairment of language and other neuropsychological functions can be found after long term follow up in the majority of patients. The pathophysiological background of mutism may be higher speech dysfunction mediated by crossed cerebello-cerebral diaschisis which is frequently found during the mute period. Foremost injury to the bilateral dentatothalamocortical tract appears to be critical for the development of cerebello-cerebral diaschisis and subsequent mutism. Direct cerebellar injury is the likely reason for persisting deficits after the mute period. Minimization of injury to the dentatothalamocortical tract during surgery may be promising in the prevention of mutism. While there is no established treatment of mutism, early speech and rehabilitation therapy is recommended.     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

Family treatment of an obsessive-compulsive child: a case report

This paper presents a family therapy approach to the treatment of an obsessive-compulsive child. Psychodynamic, behavioral and family therapy approaches to the etiology and treatment of this dysfunction are described briefly, and a detailed case report of a 15-session treatment utilizing behavioral interventions designed to change the family context is presented. Various procedures for dealing with the obsessive-compulsive behavior have been reported in the literature, including eliminating it directly by interruption or ordeal and modifying it. In this case, the author proceeded by ignoring the compulsive behaviors and concentrating on more functional ones using a paradoxical charting intervention. At one-year follow-up, the child was symptom free. Relationship factors, technical interventions, and stylistic aspects of the therapy are discussed, and the importance of rapid symptom alleviation in these children is underscored.     

ACQUISITION OF EXPRESSIVE SIGNING BY AUTISTIC CHILDREN: AN EVALUATION OF THE RELATIVE EFFECTS OF SIMULTANEOUS COMMUNICATION AND SIGN-ALONE TRAINING

Two methods of training autistic children to use manual signs were compared. Two children, one mute and one capable of some verbal imitation, were taught to use signs as expressive labels for pictures of objects. Using an alternating treatments design, speed of sign acquisition was compared across two training conditions in which signs were presented either accompanied by, or without, the corresponding verbal label. In both conditions, the training procedure incorporated reinforcement, modeling, prompting, fading, and stimulus rotation. The efficacy of training in both treatment conditions was demonstrated by the use of a multiple baseline control across signs, but no clear differences in acquisition speed across conditions were apparent. Posttests conducted to assess stimulus control of signing, and learning of verbal labels when these were present in training, showed that the behavior of the imitative, but not the mute, child was controlled by the verbal stimuli. The implications of the results both for understanding deficits characteristic of autistic children and for developing appropriate language training procedures are discussed.     

Employing the Principles of Positive Behavior Support to Enhance Family Education and Intervention

Positive behavior support (PBS) is an evidence-based approach for supporting adaptive behavior and addressing behavioral challenges. It is critical that families have access to effective evidence-based behavior support practices for both intervention and prevention because they lead to better outcomes for families, and counter-productive family management practices have been shown to further escalate children’s behavioral challenges. PBS has been demonstrated to be effective with individual children with serious behavior challenges in family homes and features of PBS are evident in common family-based intervention approaches. Unfortunately, complete application of PBS in family contexts has not been fully explored or conceptualized. The purpose of this paper is to define the core features of PBS including lifestyle enhancement, assessment-based intervention, and comprehensive support plans (i.e., including strategies for prevention, teaching, and management). Examples of how the features of PBS are currently being employed within the field of PBS and within other evidence-based parent education and support programs are provided. Suggestions for how collaboration, assessment, data-based decision making, comprehensive intervention, and tiered approaches to service delivery may be used to enhance behavioral support for families are offered. Lastly, future directions for research and practice are recommended.     

Social skill assessment and training for children: an evaluative review

Techniques employed in the behavioral assessment and treatment of socially deficient children are reviewed. General definitions and components of assertion and social skill in children are presented. While considerable data attest to the potential efficiency of behavioral approaches with this population, several methodological problems prevent any definitive conclusions from being drawn at this time. Some of these include: (1) lack of an accurate classification system of socially isolated children, (2) need for an empirical determination of skill components, and (3) the paucity of data concerning generalization and maintenance of treatment effects. The utility of incorporating developmental and social psychological methods into behavioral programs also is discussed. Suggestions for future directions of research are offered.     

A modified cognitive-behavioral approach to group therapy with the elderly

Group approaches to treatment subsume a wide variety of techniques. The present article describes a modified cognitive behavioral approach as developed by the author for certain groups of elderly clients. This modified approach incorporates principles of cognitive behavioral therapy in combination with humanistic, and developmental perspectives, while leaving room for addressing psychodynamic issues if desired. It is suggested that such an approach is of value where structured group techniques are called for.