Talk:Child psychotherapy

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Expansion of Child psychotherapy article

There has been some discussion on another page about expanding this article to include all therapies aimed at children, a brief description, historical, theoretical and evidence base (or lack of!) use, controversies etc. Therapies that already have their own pages can have brief descriptions and links. It has also been discussed that 'psychotherapy' in the USA tends to mean all therapies, whereas in the UK it tends to mean those deriving from psychoanalysis. This can be covered by redirects. A list of therapies is being compiled. Please add to this. All contributions gratefully recieved!

• LIST

DIR - Stanley Greenspan

PCIA-II/MAP Modifying Attributions of Parents Intervention (is this the right one?) {PCIT, yes} [2] (there seem to be two)

Parent-Child Interaction Therapy (PCIT)

Applied behavior analysis - B. F. Skinner, Ivar Lovaas

MBKT

New Orleans Intervention Zeannah et al

The Bucharest Early Intervention Project Zeannah et al

Minding the Baby (MBT)

Early Childhood Intervention

Early Head Start

intergenerational communication of trauma - Daniel Schechter

Safe Start Initiative - Joy Osofsky

Milieu therapies (e.g/ Bettelheim)

Sensory integration therapy

Autonomous states of mind - Mary Dozier

Attachment and Biobehavioral Catch-Up (ABC)

Watch, wait and wonder' (Cohen et al, 1999)

manipulation of sensitive responsiveness, (van den Boom 1994 and 1995)

modified 'Interaction Guidance' (Benoit et al, 2001)

Preschool Parent Psychotherapy (Toth et al, 2002)

Parent-child Psychotherapy - Alicia Lieberman

Parent-infant psychotherapy ?

Circle of Security - Marvin [[3]][4]

Holding therapy

Theraplay - Jernberg

DDP - Hughes

JeanMercer's suggested format is

• 1. Targeted population (diagnosis or other characteristics like age limits) 2. Related diagnostic methods 3. Description of intervention, including scheduling 4. Training or other characteristics of practitioners 5. Place of treatment-- home, office, residential program 6. Theoretical basis 7. Supportive research 8. Adverse events 9. Professional reviews and published comments 10. Medicaid and private insurance coverage

Fainites ^barley 16:21, 23 September 2007 (UTC

• Should the extensive list at the end of the article be removed if contributors cannot provide at least two peer-reviewed references showing efficacy of the intervention?

Proposed 'Circle of Security' section

This is a parent education and psychotherapy intervention developed by Marvin et al (2002) designed to shift problematic or 'at risk' patterns of attachment–caregiving interactions to a more appropriate developmental pathway. It is stated that it is explicitly based on contemporary attachment and congruent developmental theories. Its core constructs are Ainsworth’s ideas of a Secure Base and a Haven of Safety (Ainsworth et al 1978). The aim of the protocol is to present these ideas to the parents in a ‘userfriendly’, common-sense fashion that they can understand both cognitively and emotionally. This is done by a graphic representation of the childs needs and attachment system in circle form, summarising the childs needs and the safe haven provided by the caregiver. The protocol has so far been aimed at and tested on preschoolers up to the age of 4 years.

The aim of the therapy is:

• 1 to increase the caregivers sensitivity and appropriate responsiveness to the child’s signals relevant to its moving away from to explore, and its moving back for comfort and soothing;
• 2 to increase their ability to reflect on their own and the child’s behavior, thoughts and feelings regarding their attachment–caregiving interactions; and
• 3 to reflect on experiences in their own histories that affect their current caregiving patterns. This latter point aims to address the miscuing defensive strategies of the caregiver.

Its four core principles are; that the quality of the child parent attachment plays a significant role in the life trajectory of the child, that lasting change results from parents changing their caregiving patterns rather than by learning techniques to manage their childs behaviors, that parents relationship capacities are best enhanced if they themselves are operating within a secure base relationship and that interventions designed designed to enhance the quality of child-parent attachments will be especially effective if they are focussed on the caregiver and based on the strengths and difficulties of each caregiver/child dyad.

There is an initial assessment which utilises the 'Strange Situation' procedure, (Ainsworth 1978), observations, a videotaped interview using the Parent Development Interview (Aber et al 1989) and the Adult Attachment Interview (George et al 1984) and caregiver questionnaires regarding the child. The childs attachment pattern is classified using either Ainsworth or the PAC (Preschool Attachment Classification System). The therapy is then 'individualized' according to each dyads attachment/caregiver pattern. The programme, which takes place weekly over 20 weeks, consists of group sessions, video feedback vignettes and psycho-educational and therapeutic discussions. Caregivers learn, understand and then practice observational and inferential skills regarding their childrens attachment behaviors and their own caregiving responses.

Circle of Security is being field tested within the 'Head Start'/'Early Head Start' programme in the USA. According to the developers the goal of the project is to develop a theory- and evidence-based intervention protocol that can be used in a partnership between professionals trained in scientifically based attachment procedures, and appropriately trained community-based practitioners. It is reported that preliminary results of data analysis of 75 dyads suggest a significant shift from disordered to ordered patterns, and increases in classifications of secure attachment. The process of validation is not yet completed.

(The refs I've added are marvin et als paper from 2002 and Prior and Glaser from 2006. Also a chapter by Marvin et al in 'Enhancing early Attachments' 2005)

Fainites ^barley 13:51, 23 September 2007 (UTC)

Jean Mercers checklist

1. Targeted population (diagnosis or other characteristics like age limits) Yes

2. Related diagnostic methods Yes

3. Description of intervention, including scheduling Yes

4. Training or other characteristics of practitioners

5. Place of treatment-- home, office, residential program Yes

6. Theoretical basis Yes

7. Supportive research Yes

8. Adverse events

9. Professional reviews and published comments

10. Medicaid and private insurance coverage

Fainites ^barley 16:39, 6 October 2007 (UTC)

References

Proposed Attachment and Biobehavioral Catch-Up (ABC) section

(Dozier,D., Dozier M, and Manni,M. (2002))

This an intervention programme aimed at infants who have experienced early adverse care and disruptions in care. It aims to provide specialized help for foster carers in recognition of the fact that a young child placed in foster care has to deal with the loss of attachment figures at a time when when maintaining contact with attachment figures is vital. It targets key issues: providing nurturance for infants when the carers are not comfortable providing nurturance, overriding tendancies to respond in kind to infant behaviors and providing a predictable interpersonal environment.

It is essentially a training programme for surrogate caregivers. It has four main components based on four propositions:

• "Providing nurturance when it does not come naturally". Based on findings that foster childrens attachments are disproportionately likely to be disorganized and foster mothers with an unresolved or dismissing state of mind were likely to have children with disorganized attachments, the interpretaion of Dozier et al is that foster children have difficulty organizing their attachment systems unless they have nurturing foster carers. The goal is to help foster parents provide nurturing care even if they are non-autonomous with regard to their own attachment status.
• "Infants in foster care often fail to elicit nurturance". Foster carers tend to respond 'in kind' to infants behavior. (Stovall and Dozier 2000). If foster infants behave in an avoidant or resistant manner, foster carers may act as if the infant does not need them. The goal is to train foster carers to act in a nurturing manner even in the absence of cues from the infant.
• "Infants in foster care are often dysregulated at physiological, behavioral and emotional levels". (Dozier et al 2004) Foster children often show an atypical production of the stress hormone cortisol. It is not established whether this is significant for increased risk for later disorders, but very low or very high levels are associated with types of psychopathology in adults. The goal here is to help foster parents follow the childs lead and become more responsive social partners.
• "Infants in foster care often experience threatening conditions". One of the functions of parents is to protect children from real or perceived dangers. This has often broken down for foster children, and worse, the caregiver may have served as a threat themselves. Prime examples are threats contingent upon behavior to have the child removed or taken away. Children experiencing frightening conditions have a limited range of responses and often 'dissociate' as a way of coping. Possible evidence for this may be the disproportionate number of disorganized attachment patterns in foster children. The aim is to reduce threatening behavior among foster parents by helping them understand the impact on the child.

Caregiver and child behaviors are assessed before and after intervention, as is the childs regulation of neuroendocrine function. The intervention consists of 10 sessions administered in caregivers homes by professional social workers. Sessions are videotaped for feedback and for fidelity. The intervention is currently being assessed in a randomized clinical trial involving 200 foster families, supported by the National Institute of Mental Health. Half the infants are assigned to the Developmental Education for Families programme as a comparison intervention. (DEF:Dozier 2003). The developers themselves point out that they do not test for caregiver commitment although they state this may or may not be a critical ommission as they consider caregiver commitment to be a crucial variable in terms of child outcomes.

A modified version has been introduced for birth parents.which is currently being tested in a small group. Fainites ^barley 21:01, 24 September 2007 (UTC)

Jean Mercers checklist Fainites ^barley 16:40, 6 October 2007 (UTC)

1. Targeted population (diagnosis or other characteristics like age limits) Yes

2. Related diagnostic methods

3. Description of intervention, including scheduling Yes

4. Training or other characteristics of practitioners Yes

5. Place of treatment-- home, office, residential program Yes

6. Theoretical basis Yes

7. Supportive research Yes

8. Adverse events

9. Professional reviews and published comments

10. Medicaid and private insurance coverage

References

Proposed intro explanation

As the term 'child psychotherapy' covers different ranges of therapy in different parts of the world it is proposed that this article cover all therapies aimed at children from behavioural, psychodynamic or other fields.

Proposed DIR section

Intervention: Developmental, Individual-difference, Relationship-based psychotherapy (DIR)

1. Targeted population: DIR is intended to address the needs of children with autistic spectrum disorders, most of them ranging in age from about 4 to about 7 years.

2. Related methods: DIR resembles play therapies, but stresses consideration of individual differences and the need to "follow the child's lead".

3. Description:

4. Training of practitioners: Certification as a DIR specialist involves specific training through Dr. Stanley Greenspan's organization. Most trainees have advanced degrees in psychology, psychiatry, special education, or other relevant areas.

5. Place of treatment: Treatment occurs in the office or clinic, although some DIR-related methods can be used in child care settings or in the home.

6. Theoretical basis: DIR is based on Greenspan's assumption of the simultaneous and interlocking development of intellectual and emotional abilities, in a pattern partly determined by the individual's innate sensory and other characteristics. An essential theme is the idea that social and emotional communication underlies other cognitive abilities like language use. Greenspan's system can be traced back to both Freudian and Piagetian ideas, which Greenspan has been attempting to integrate for decades. It is also notable that Greenspan has been very much influenced by occupational therapists,physical therapists, and speech therapists, and considers team treatment essential for autistic children.

7. Supportive research: So far, research on DIR is entirely descriptive, although clinical trials are said to be in progress. One barrier to more sophisticated outcome research is the fact that children's individual differences dictate specifics of the practitioner's approach.

8. Adverse events: No adverse events appear to have been reported.

9. Professional reviews and published comments:

10. Medicaid and private insurance: In the United States, all forms of insurance cover this treatment to the extent that they accept mental health interventions.

11. Bibliography: —Preceding unsigned comment added by Jean Mercer (talk • contribs) 15:11, 26 September 2007 (UTC) Jean Mercer 15:13, 26 September 2007 (UTC)

Thats interesting. I disambiguated 'DIR' to provide a link but its been removed from the disambiguation page as 'non-notable'. I didn't realise you had to be notable to be disambiguated! I assumed, apparently wrongly, it was about providing easy access to information. Oh well. Fainites ^barley 20:11, 26 September 2007 (UTC)

Should we also say whether these interventions are proprietory or not? Fainites ^barley 20:15, 26 September 2007 (UTC)

PCIT

Just dropping off some more recent research on this

• Chaffin, Silovsky, Funderburk, Valle, Brestan, Balachova, Jackson, Lensgraf, and Bonner (2004) randomly assigned physically abusive parents (N = 110) to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. At a median followup of 850 days, 19 percent of parents assigned to PCIT had a re-report for physical abuse compared with 49 percent of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent–child interactions consistent with the PCIT change model. Hood & Eyberg (2003) examined the long-term maintenance of changes following PCIT for young children with Oppositional Defiant Disorder (ODD) and associated behavior disorders. Three to six years after treatment, 29 of 50 treatment completers were located for this study. Results indicated that the significant changes that mothers reported in their children’s behavior and their own locus of control at the end of treatment were maintained at long-term follow-up. Fainites ^barley 18:00, 26 September 2007 (UTC)

New Orleans Intervention

This is a foster care intervention devised by J.A.Larrieu and C.H Zeanah in 1998. The program is designed to address the developmental and health needs of children under the age of 5 who have been maltreated and placed in foster care. It is funded by the state government of Louisiana and private funds. It is a multidisciplinary approach involving psychiatrists, psychologists, social workers, paediatricians and paraprofessionals - all with expertise in child development and developmental psychopathology.

The aim of the intervention is to support the building of an attachment relationship between the child and foster carers, even though about half of the children eventually return to their parents after about 12 to 18 months. The designers note Mary Doziers program to foster the development of relationships between children and foster carers (ABC) and her work showing the connection between foster childrens symptomology and foster carers attachment status. Work is based on findings that the qualitative features of a foster parents narrative descriptions of the child and relationship with the child have been strongly associated with with the foster parents behavior with the child and the childs behavior with them. The aim was to develop a programme for designing foster care as an intervention.

The theoretical base is attachment theory. There is a conscious effort to build on recent, although limited, research into the incidence and causes of Reactive attachment disorder and risk factors for RAD and other psychopathologies.

Soon after coming into care the children are intensively assessed, in foster care, and then recieve multi modal treatments. Foster carers are also formally assessed using a structured clinical interview which includes in particular the meaning of the child to the foster parent.. Individualised interventions for each child are devised based on age, clinical presentation and information on the child/foster carer match. The assessment 'team' remains involved in delivering the intervention. Those running the programme maintain regular phone and visit contact and there are support groups for foster parents.

Barriers to attachment are considered to be as follows;

• the disturbed nature of the childs relationship with its parent(s) before their removal by the state. Serious relationship disturbances are considered likely to be important contributors to difficulties in establishing new attachment relationships. Psychiatric and substance abuse histories and other criminal activities are common. Developmental delays in the children are common and there is a considerable range of regulatory, socioemotional and developmental problems. The child may percieve relationships as inconsistant and undependable. Further, despite harsh and inconsistant treatment many of the children remain attached to their parents, complicating the development of new attachment relationships.
• foster parents may also present barriers to forming healthy attachment relationships. Based on Bowlby, the caregiving system is seen as a biobehavioral system in adults that is complementary to the childs attachment system. Not all foster carers have this strong biological disposition as many fear becoming too 'attached' and suffering loss, many are effectively doing it to earn money and some percieve such children as 'damaged goods' and may remain emotionally distant and under involved.

Interventions include supporting foster parents to learn to help the child in regulating emotions, to learn to respond effectively to the childs distress and to understand the childs signals, especially 'miscues' as the signals of such children are often confusing as a consequence of their often frightening, inconsistant and confusing past relationships. Foster carers are taught to recognize what such children actually need rather than what they may appear to signal that they need. Such children often exhibit provocative and oppositional behaviors which may normally trigger feelings of rejection in caregivers. Withdrawn children may be overlooked and seemingly independant, indiscriminate children may be considered to be managing much better than they are. Foster carers are regularly contacted and visited to assess their needs and progress.

As of 2005, 250 children had participated in the programme. Outcome data published in 2001 revealed a 68% reduction in maltreatment recidivism for the same child returning to its parent(s)and a 75% reduction in recidivism for a subsequent child of the same mother. The authors claim the programme not only assists the building of new attachments to foster parents but also has the potential impact a families development long after a returned child is no longer in care. Fainites ^barley 16:12, 1 October 2007 (UTC)

Jean Mercers checklistFainites ^barley 16:40, 6 October 2007 (UTC)

1. Targeted population (diagnosis or other characteristics like age limits) Yes

2. Related diagnostic methods not set out for children

3. Description of intervention, including scheduling Yes - but not much scheduling

4. Training or other characteristics of practitioners Yes

5. Place of treatment-- home, office, residential program Yes

6. Theoretical basis Yes

7. Supportive research Yes

8. Adverse events

9. Professional reviews and published comments

10. Medicaid and private insurance coverage

At this rate the page is going to be much, much too long. We will have to consider a logical way of dividing it. Fainites ^barley 16:22, 1 October 2007 (UTC)

How long is too long?Jean Mercer 01:24, 15 November 2007 (UTC)

Anything over 40 kbs of readable text, excluding refs, titles, see alsos etc. Fainites ^barley 17:59, 15 November 2007 (UTC)

Its not too long now. It just will be if we do 6 inches on every therapy aimed at children. Fainites ^barley 23:58, 15 November 2007 (UTC)

How about dividing it into treatments for infants up to age 3, and those for children up to puberty? Another division would be into children treated on their own, versus parent-child therapies. Jean Mercer (talk) 14:41, 17 November 2007 (UTC)

Good idea. Also - psychoanalysis/behavioural/attachment-based divisions. Fainites ^barley 20:24, 17 November 2007 (UTC)

Another way of organizing is to choose the five that have the most supportive evidence, describe them in some detail, then have a descriptive section with briefer material about interventions that have less of an evidence basis.Jean Mercer (talk) 16:40, 18 November 2007 (UTC)

References

Writing citation

Sorry-- i still have to look up how to do the reference-- and writing "citation" reminds me to do it which I SOMETIMES even do.Jean Mercer 01:24, 15 November 2007 (UTC)

instead of writing 'citation' you put a little sideways hat < . Then you write ref. Then you put name="Name". Then a little sideways hat pointing the other way. Then all the info. Then you do the little two hat thing again with /ref inside them. Fainites ^barley 00:00, 16 November 2007 (UTC)

I didn't mean I couldn't find how to do it--- I just mean, each time I do it, i need the model. But I'm doing it, F.! The sideways hats are what i call less-than and greater-than signs--- i wonder if printers have some other name for them.Jean Mercer (talk) 14:38, 17 November 2007 (UTC)

Leave ref here for the moment Lieberman, A.F., & Zeanah, C.H. (1999). Contributions of attachment theory to infant-parent psychotherapy and other interventions with infants and young children. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment theory and research. pp. 555-574. New York:Guilford Press. Fainites ^barley 19:54, 2 March 2008 (UTC)

Tag

I see the articles been tagged. I assume it refers mainly to the MBT and psychotherapy section - which is what the article used to consist of. The author of those parts has never come back and neither area is one I'm familiar with. Are you in a position to do anything about the MBT stuff Jean? Fainites ^barley 23:58, 25 April 2008 (UTC)

Several claims are made in the first 375 words of the article, all unsourced/reffed. It sure needs work. Kaiwhakahaere (talk) 01:12, 26 April 2008 (UTC)

All help gratefully recieved. As I said - the author of the psychotherapy and MBT section appears to have long gone. I've left a useful ref in the section above for when I have a moment.Fainites ^barley 21:42, 5 May 2008 (UTC)

Move

As no interest has been taken in this article other than the over large section on attachment based therapies, I have created a separate article on that topic here. Fainites ^barley 22:05, 7 October 2008 (UTC)

Wiki Education assignment: ENGW3307 Adv Writing for the Sciences

This article was the subject of a Wiki Education Foundation-supported course assignment, between 9 January 2023 and 17 April 2023. Further details are available on the course page. Student editor(s): Treelee26 (article contribs).

— Assignment last updated by Number1PecanHater (talk) 18:47, 31 March 2023 (UTC)

Planned Edits

The main contribution I plan to make for this article includes adding an "evolution of child psychotherapy" section to further expand on the increasing recognition of child mental illness as separate from adult diagnosis and treatment. This can help add to the little information included in the existing introduction of the article. I noticed this article is very list-heavy. If anyone has suggestions on how to improve this format, feel free to add any ideas you might have. Treelee26 (talk) 19:02, 11 April 2023 (UTC)

Autism? Aspergers??

In the 'Group Art' section it lists both Autism and Aspergers. Autism and Aspergers are the same thing, why is it listed seperatly? Is it the severity that makes them listed seperatly? Tvgirl4ever (talk) 13:49, 7 February 2024 (UTC)