Clinical work with children, adolescents and adults is a vital part of my life. I view psychiatric work as a partnership between individuals and myself, the provider. This partnership can occur with a child, adolescent or adult and often with a family. A key aspect of this relationship are the reasons that prompt an individual or family to seek treatment and, equally important, the particular meaning that treatment has for them. In my clinical work I strive to integrate several therapeutic perspectives. My assessment includes a careful consideration of the importance of fluctuating mental states and key relationships in a person’s life, as well as family and cultural patterns. I strive to develop an understanding of the interconnection of an individual’s biology and body and their psychology. I join with patients to help them discover meaning and purpose in their struggles. I am also pragmatic and pay attention to behavior. How do our actions reflect our psychology and conversely how is our psychology affected by our actions? Lastly, I believe all therapy occurs in a developmental frame whether we are children, adolescents or adults.
Underlying my therapeutic perspectives is my strong belief that people can change and, more specifically, are constantly changing as we adapt to life. Understanding this is key. I believe that therapeutic partnerships aid us in this process.
Psychotherapy with children and adolescents is complex and benefits from an open non-dogmatic approach. Embedded in an overall developmental framework, the following perspectives are essential to consider psychotherapy with children and adolescents:
This perspective combines traditional dynamic principles of psychotherapy, including consideration of therapeutic alliance, attachment, conflict, transference, counter-transference and negotiation of boundaries with recent relational advances in technique. The newer relational advances emphasize greater equality between therapist and patient and utilize techniques such as self-disclosure by the therapist and therapeutic enactments. This therapeutic perspective is currently used by many who work with children and adolescents and is both complex and powerful in its abilities to address a large number of the problems that children and adolescents are struggling with.
- Family and Cultural Perspectives
One of the unfortunate schisms in psychotherapy has been the separation of individual from family work. This divide is particularly unfortunate in working with children and adolescents. I believe that it is essential to address key family issues in psychotherapeutic work not only with children and adolescents but with many adult patients even if we do not see them in a family context with other members of their family. This type of work is especially important in our psychotherapeutic work with children and adolescents as they usually live, struggle, and are supported, both emotionally and financially, by their parents. Integrating family perspectives into our work with children and adolescents may include seeing the referred child or adolescent with their entire family or seeing the child or adolescent individually and meeting with other family members or working with the child and adolescent individually but being aware and knowledgeable regarding the family issues, and integrating this perspective into the work.
- Cognitive Behavioral and Symptom-based Perspectives
Approximately a third of all psychotherapists primarily utilize a cognitive-behavioral therapeutic perspective. These perspectives remind us of the importance of looking at a child or adolescent’s behavior and setting discrete treatment goals. They often emphasize the importance of thoughts, particularly false beliefs in maintaining children’s problems and offers strategies to address these problems. This perspective integrates well with other perspectives. Dialectical Behavioral Therapy (DBT) is an integration of cognitive behavioral therapy with a perspective that underscores the importance of meaning in therapy – the dialectic.
- Perspectives of Meaning
This perspective includes philosophical existential spectrum, but also considers other approaches to discovering meaning in life. For example, a child or adolescent may find their meaning in personal or cultural myth and primarily use their senses rather than cognitive processes to understand their world. The importance of meaning has been ignored in psychotherapeutic work with children and adolescents, but it is vital to address it. For example, children and adolescents always wonder why they are being taken to therapy. Children and adolescents who have suffered trauma or serious medical or psychiatric illnesses often ask why these events have happened to them. Many blame themselves. Knowing that a search for understanding and meaning is a crucial part of what a child or adolescent wants from psychotherapy is key.
- Biological Perspectives
Centuries ago, Descartes introduced the concept of mind body dualism in the Western world. One of the consequences of his work and the work of many who followed him was to divide the mind from the body and not understand the importance of considering these parts as a complete whole. Over the past centuries scientific knowledge has contributed much to our understanding of the body and the mind, but it too has often participated in a false division. In the last decades, biological perspectives have become more integrative and add such to our psychotherapeutic work with children and adolescents. Children with complex medical illnesses and psychological problems can be more completely addressed. Many psychiatric illnesses are in some stage of being understood from a medical perspective. Many serious issues for children related to attachment, trauma and impulsivity can benefit from understanding within a biological frame. Finding better ways to understand and explain these complex problems to children and their families is key.