Exploring the factors affecting child and adolescent psychotherapists' and counsellors' decision‐making in clinical work with parents

This study examined interventions with parents/carers in child and adolescent counselling and psychotherapy (CAP). The aim was to investigate clinicians' rationale behind their decision to work with parents and what types of interventions they use. Furthermore, the nature of clinicians' core training with regard to interventions with parents was investigated. The study used both quantitative data and qualitative textual data from an online survey of 110 CAP clinicians. There was significant agreement, regardless of previous training or level of experience, that clinical work with parents in CAP is beneficial, but little consensus for a rationale or model for best practice. There was a relationship between training, theoretical orientation and whether CAPs felt competent to work with parents. Unexpectedly, a significant number (83%) of integrative practitioners said that there had been ‘little’ to ‘none at all’ focus on working with parents on their core training course. Other unforeseen findings were in the domain of working outside generally accepted boundaries for CAP, with a notable number of clinicians making home visits—24.1% with parents alone and 38.9% with parent and child together—along with 47.2% using phone calls and/or email for coaching and support with parents. Many clinicians were candid about their sense of a lack of competence in working with parents, even though at least half were senior, experienced clinicians. A number of these practitioners made specific reference to the wish for further specialist training, with many asking for signposting to where further training could be obtained.     

The advantages and disadvantages of a brief intervention strategy in a community counseling service

Abstract

The Isis Centre, a long-established NHS open-access counselling facility in Oxford, experienced excessive demand for service. This placed strain on the capacity to deliver, and an unacceptably long waiting list resulted. A brief intervention strategy limited to four counselling sessions was shown to reduce the waiting time. This outcome study tests the hypothesis that the strategy was sufficiently clinically effective to warrant its continuing availability to those who wished to be seen more quickly, rather than waiting for an open-ended contract. Counsellors assessed outcome on clinical parameters and clients were retrospectively asked their views on the acceptability of the method and its usefulness.

There was a high level of correlation between clients' and counsellors' assessment. One-quarter of the study group had an experience classified as ‘useful and sufficient’. However, half felt the experience ‘useful but insufficient’, although this group also thought the intervention provided more than temporary relief. For one quarter, the experience was not helpful, but for some of these it prevented a long, unnecessary time on the waiting list.

While a brief intervention appears to be an effective strategy in delivering a counselling service, further work is necessary to target those most likely to benefit and those for whom a longer-term option should be sought from the start.     

Adapting Parent–Child Interaction Therapy for Deaf Families That Communicate via American Sign Language: A Formal Adaptation Approach

While our field has made positive strides in adapting psychotherapeutic interventions for diverse groups of people, considerable work is still needed in this area. We present our formal adaptation procedure for parent–child interaction therapy (PCIT) with Deaf persons. This includes a review of the cultural adaptation process for psychological interventions, including PCIT, as well as an introduction to Deaf culture. Details regarding the specific adaptation of PCIT for Deaf persons are outlined. We found that the utilization of a clear framework to guide the cultural adaptation process facilitated careful consideration of the numerous linguistic and cultural variables involved, while maintaining integrity of the treatment model. While the current focus was on adapting PCIT for Deaf families who communicate via American Sign Language, this framework can also be applied to other populations and/or interventions.     

Parent Management of Attendance and Adherence in Child and Adolescent Therapy: A Conceptual and Empirical Review

There have been impressive, recent advances in the development of efficacious treatments for child and adolescent behavior problems. However, specific methods for delivering these treatments in a way that amplifies their efficacy have not been well articulated. Although many factors may be involved, attendance and adherence to treatment are arguably the most basic necessities for effective treatment delivery. We provide a conceptual and empirical review of past research on attendance and adherence to child and adolescent therapy, with a special focus on the importance of parents/guardians in managing treatment participation. Our review demonstrates that attendance and adherence are associated with a range of significant methodological, clinical, and financial outcomes. Several pretreatment predictors of attendance and adherence have been identified; however, to date only 12 controlled, clinical trials have evaluated strategies for enhancing attendance and adherence to child therapy. We conclude with an agenda for advancing research on the prediction and enhancement of attendance and adherence to child therapy as a means of improving the efficiency and effectiveness of child treatments.     

The 1-2-3 Magic Program: Implementation Outcomes of an Australian Pilot Evaluation With School-Aged Children

No abstract available for this article.     

Meeting Them “Where They're At”

Abstract

Child maltreatment is associated with serious psycho-social difficulties and enormous direct and indirect societal costs. As such, it is an area for which new and promising interventions are highly important. The purpose of this exploratory research is to examine intensive school-based psychodynamic therapy for severely maltreated children experiencing significant difficulties, by obtaining perceptions of therapeutic effectiveness by the children's parents, teachers and therapists. Themes include: therapists', parents', and teachers' perceptions of child's changes; parental perceptions of therapy and relationship with the therapist; therapists' perception of relationship with parents; school as the location of therapy; teacher-therapist relationship; and the child's academic status.     

Boundary regulation in family and personal systems: Perceptions of late adolescents

Examination of boundary regulation can provide family therapists with a framework to describe both the functioning of family systems and personal systems (i.e., the intrapsychic functioning of individual family members). In the present study, late adolescents' perceptions of boundary regulation within their family systems (i.e., ratings of family health, communication, leadership, expressiveness, cohesion, and family conflict) were related to regulation of their personal boundaries (i.e., self-reported personal competence, distress, and patterns of defense mechanism use). In addition, personal system variables reliably discriminated between adolescents who described their families as psychologically healthy versus psychologically unhealthy.     

Psychotherapy training in a changing world: A Swedish perspective

The City and Hackney Primary Care Psychotherapy Consultation Service is an innovative, public sector service designed to support GPs in meeting the needs of patients with complex psychological/physical health issues throughout the London Boroughs of Hackney and the City. This paper provides an account of how this new model for the National Health Service (NHS) developed in the context of psychotherapy provision within the NHS, within the national and local context in the UK and gives an overview of some the service's key features and how it differs from other services operating in primary and secondary care. A linked paper, in this journal, explores the reality within which the service functions and describes clinical outcomes, health economic data, the modifications to the original model and prospects for the future.     

Family Reconstruction

Family reconstruction, as described by Virginia Satir, is important for its transformative possibilities. This therapeutic tool can integrate a person into the historical and psychological matrix of his or her family of origin. This article describes how a reconstruction can be accomplished in three hours by using certain steps and principles. A case study is provided illustrating these steps and principles, including the personal reflections of the participant group.     

Keeping It Going: Evidence of Long-Term Improvements After Implementation of the 1-2-3 Magic Parenting Program

This study builds upon a pilot evaluation of the 1-2-3 Magic Program (Bailey, van der Zwan, Phelan, &; Brooks, 2012 Bailey, E. L., van der Zwan, R., Phelan, T. W., &; Brooks, A. (2012). The 1–2-3 Magic Program: Implementation outcomes of an Australian pilot evaluation with school-aged children. Child &; Family Behavior Therapy, 34(1), 53–69. doi:10.1080/07317107.2012.654455[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]), by investigating its long-term efficacy as a brief parenting intervention for families with a school-aged child. Twelve Australian families participated in a randomized controlled trial, assigned either to a wait-listed control group or to one that received immediate training. Consistent with the pilot evaluation, only families who had received training reported significant improvement in child and parenting behavior at an 8-week follow-up assessment. These improvements were maintained for 12-month posttraining, supporting the long-term efficacy of the 1-2-3 Magic Program for Australian families.     

Continued Evolution of Family Therapy: The Last Twenty Years

There have been numerous accounts of the history and major trends and issues in family therapy during the field's first three decades in the literature (see for example: Broderick & Shrader, 1981; Framo, 1972; Guerin, 1976; Kaslow, 1973, 1977, 1980; Nichols, 1986, 1999 for some varied depictions, written from each respective author's unique lens). Viewed as a set, packaged with different, yet interrelated contents, they offer a multihued portrait of the emerging field during its infancy, childhood, and adolescence. Now it is time to move on and look at the adulthood era as it has unfolded.     

Brief therapy in the Israeli kibbutz

Analysis of results of therapy in an unselected sample of 211 kibbutz patients seen over a three year period by the author in his capacity as kibbutz member and psychiatrist indicated that over 70% of the identified patients responded very satisfactorily to brief therapy. About one-third of the clients did not need more than a single comprehensive therapy session to achieve continuous improvement. In a minority of the cases more than 10 sessions were required. The results were significantly better in cases treated by brief therapy than in the sample treated by long-term therapy, where the pre-treatment severity was determined to be greater. The paper describes the unique aspects of brief therapy in the kibbutz setting, giving an outline of the author's model of intervention, using all components of the individual, family, and community ecosystem.     

A slow unfolding – at double speed: reflections on ways of working with parents and their young children within the Tavistock clinic's under fives service

This paper describes clinical work carried out as part of the Tavistock Clinic Under Fives Service, which offers brief focused psychoanalytically based interventions to families with young children, as well as longer-term work. It elaborates psychoanalyst Annette Watillon's idea that it is the dramatic way in which children enact their (and their family's) predicament in the consulting room which speeds up the process of change. The author clusters clinical cases into three categories, each cluster representing a different kind of ‘dramatic’ enactment and leading to a different kind of intervention relating to the therapist's role, the structure of the interventions and the ‘ports of entry’ for the work. The categories are defined as: ‘child-led drama’ with the therapist in the role of ‘therapeutic observer’; ‘internal parental drama’ with the therapist in the role of ‘therapeutic consultant’; and ‘external parental drama’ with the therapist in the role of ‘therapeutic modulator’. The author defines these categories, illustrating each category with clinical examples.     

Parent Expectancies for Child Therapy: Assessment and Relation to Participation in Treatment

Two studies examined parents' pre-treatment expectancies for their child's psychotherapy among children (N = 405, ages 2–15) referred for oppositional, aggressive, and antisocial behavior. Study I focused on the development of a measure to assess expectancies. The results indicated that the measure was internally consistent. Moreover, socioeconomic disadvantage and ethnic minority status, severity of child dysfunction, child age, and parental stress and depression were significant predictors of lower parent expectancies for child therapy. Study II examined the relation of parent expectancies and participation in therapy. The results indicated that parent expectancies predicted subsequent barriers to treatment participation, treatment attendance, and premature termination from therapy. Overall, these findings have implications for the study of expectancies for therapy, for identifying families at risk for premature termination from treatment, and for the development of interventions designed to increase parent participation in child therapy.     

Involving the family in the evaluation and treatment of the child patient: A psychodynamic approach

The purpose of this article is to provide psychotherapists with a tool for family evaluation using the basic principles of psychodynamic work; and to introduce a transitional format for therapists who have practiced family evaluations in their training institutions and now need to adapt this model to the private practitioner's office. A case example illustrates: (1) Use of the therapist's unconscious for diagnosis of the child and its family, (2) joining the family's intersubjective space, and (3) use of play and therapist's neutrality as ways that the psychodynamically oriented clinician involves the family in the evaluation and treatment of the child.     

Book Review

This article is based on Ulkuniemi's key-note lecture in the Congress of Photo Therapy and Therapeutic Photography. The lecture dealt mainly with the history of family photography and the uses of family photographs in art education. Here Ulkuniemi has put her ideas in dialogue with some of the themes presented in the Special Issue (11.1) of European Journal of Psychotherapy and Counselling. Thus this article also serves as a commentary to some of the texts in this journal. The main approach of this article is to offer some hints about possibilities for using photographs in therapy by giving practical examples from the field of art education and art – Ulkuniemi's own visual-pedagogical installations. Another aim is to offer a general view of how a family photograph is constructed. Ulkuniemi will ‘break the frames’ by showing the various factors existing outside the frames that have influence on the outcome of the picture.     

Family Functioning in Pediatric Trichotillomania

Little is known about how pediatric trichotillomania (TTM), a clinically significant and functionally impairing disorder, is impacted by, and impacts, family functioning. We explored dimensions of family functioning and parental attitudes in a sample of children and adolescents who participated in an Internet-based survey and satisfied conservative diagnostic criteria for TTM (ages 10–17, n = 133). Analyses reveal trends toward higher levels of dysfunction in families of TTM youth relative to normative samples, although no differences achieved statistical significance. However, scores on the Family Assessment Measure and the Attitudes Toward My Child scales were similar to those in clinical samples of youth with cystic fibrosis, an eating disorder, or an anxiety disorder. While these results indicate that family functioning and parental attitudes in TTM were not generally or extremely problematic, family issues may nevertheless warrant particular clinical evaluation and attention in more severe TTM cases.     

The Efficacy of Child Parent Relationship Therapy for Adoptive Families: A Replication Study

This randomized controlled replication study examined the effectiveness of child parent relationship therapy (CPRT) with 49 adoptive families. Statistically significant improvement and large treatment effects for child behavior problems, parent–child relationship stress, and parents' empathic interactions with their children indicated the effectiveness of CPRT over treatment as usual. Findings confirm Carnes‐Holt and Bratton's ( 2014 ) results and provide strong support for CPRT as a responsive intervention for adoptive families.     

‘And when you were a child?’: how therapists working with parents alongside individual child psychotherapy bring the past into their work

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.