Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 183

Child psychotherapy and adult psychotherapy differ in several ways. First, there are often motivational differences between youths and adults. Most adults refer themselves to therapy; by the time they make the initial appointment, they are at least partially motivated to change their behavior. Indeed, some evidence suggests that the very act of seeking treatment and making an initial appointment is itself therapeutic (Nathan & Gorman, 2016). In contrast, children and adolescents are almost always referred by other people, especially parents and teachers. Youths seldom recognize the severity of their behavioral, emotional, and social problems and they typically show low motivation to change. Most therapists initially try to increase children’s willingness to trust the therapist and participate in treatment (Dean, Britt, Bell, Stanley, & Collings, 2017).

Second, cognitive and social–emotional differences between children and adults can influence the therapeutic process. Most forms of child and adolescent therapy are downward extensions of adult therapeutic techniques. However, by virtue of their youth, children and adolescents often lack many of the cognitive, social, and emotional skills necessary to fully benefit from these techniques. For example, cognitive therapy depends greatly on clients’ ability to engage in metacognition, that is, to think about their own thinking. However, metacognitive skills develop across childhood and adolescence; younger children may find cognitive therapy too abstract and difficult. Similarly, cognitive and psychodynamic therapies often rely on verbal exchanges between client and therapist. Younger children, and youths with limited verbal abilities, may have difficulty participating in these forms of therapy (Kendall, 2018).

Third, the goals of therapy often differ for children compared to adults. In adult psychotherapy, the primary objective is usually symptom reduction. Most therapists and clients consider treatment to be successful when clients return to a previous state of functioning. In therapy with children and adolescents, return to previous functioning is often inadequate. Instead, the goal of child and adolescent therapy is to alleviate symptoms while simultaneously promoting children’s development. For example, a child with ADHD might participate in behavior therapy and take medication to alleviate his hyperactivity and inattention. However, these behavior problems have likely alienated him from classmates. Consequently, the therapist might have an additional goal of helping the child gain acceptance in the classroom and overcome a history of peer rejection.

Fourth, children and adolescents often have less control over their ability to change than do adults. Adults usually have greater autonomy over their behavior and environmental circumstances than do children. For example, a woman who is depressed might decide to exercise more, join a social support group, practice meditation, change jobs, or leave her partner. However, a child who is depressed because of his parents’ marital conflict is less able to alter his environment. Although he might decide to exercise or participate in extracurricular activities, he is unable to leave home or get new parents. Instead, the boy’s social–emotional functioning is closely connected to the behavior of his parents. Consequently, the boy’s capacity to change is directly associated with his parents’ involvement in therapy.

Finally, children and adolescents are more likely to have multiple psychiatric conditions compared to adults. Among youths in the community, approximately 40% who have one disorder also have a second disorder. Among youths referred to clinics, rates of comorbidity range from 50% to 90%, depending on the age of the child and the specific problem. Clinicians who treat children and adolescents must address multiple disorders simultaneously, often without the zealous participation of their young clients (Weisz, 2014).

Review

 Children are often less motivated than adults to participate in therapy and may lack the cognitive or self-regulation skills necessary to participate in many therapies originally designed for adults.

 Whereas adult psychotherapy focuses largely on symptom reduction, child psychotherapy also involves promoting children’s growth and development.

 Children are more likely than adults to experience comorbid problems and less able than adults to alter their life circumstances to improve their functioning.