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January 31, 2023

The Formula for Successful Therapy

When Your Child is Involved in Therapy

If your child is involved in therapy, you may wonder about the approach of your child’s therapist, to what extent you’ll be involved in the therapy, and how those decisions are made. This post will shed some light on that process.

Different Approaches to Therapy

Therapists use different therapeutic approaches in the therapy process, such as client-centered (reflective listening) and cognitive-behavioral (CBT). Interestingly, how these approaches are utilized, and how they are implemented, depends on essential factors or aspects of their client. When working with an adult, a therapist may need to deal with some degree is resistance. But there is a general expectation that the adult will arrive for therapy and engage in a back-and-forth exchange. However, when working with children and teens, all bets are off. In that respect, a child therapist will be prepared for a wide range; from a five-year-old child with ADHD to a 15 year who doesn’t want to be in treatment. Of course, in each case, the approach will need to be quite different. This post will highlight the formula I developed that helps therapists navigate through those differences and utilize the correct approach for your child. 

The Steps of The Formula

Step One: Therapy Detective

The formula begins with the therapist acting as a Behavioral Detective to fully understand the specific issues that bring a child or teen into therapy. In that regard, there are dozens of questions that need to be answered to help the practitioner understand the history of the condition and the current behaviors and emotions. The therapist then prioritizes the problematic behaviors to determine which to target in treatment, and in what order. 

In Step One – the therapist must know the specific behaviors/emotions that need to be targeted in treatment. The therapist must be laser-focused on the specific behaviors that led to the child being in therapy in the first place. 

Prior to beginning therapy and before any session with your child, the therapist must have a clear understanding of the specific behavior(s) that needs to be addressed. This could include, for example, the child demonstrating outbursts when asked to do a chore.

Step Two: What’s the Protocol to Treat the Problem?

Once the practitioner fully understands the specific problematic behavior that needs targeting in the session, the next step is to determine the specific 'best-practice' treatment protocol to treat that specific behavior. This usually includes teaching any number of coping skills, improving communication, and helping the parent to implement behavior management. 

Step Three: Rate the Three Primary Factors

Next, your child’s practitioner will determine how to implement that treatment protocol based on three factors: the child's or teens’ level of insight, openness, and attentiveness.

Let’s Look at Each Factor:

Insight denotes the extent to which a child or teen realizes that they have a problem and understand the dynamics of the problem. In that respect, some kids can, for example, explain their tendency to quickly become emotional and understand that their reaction ‘goes way too far’, while other kiddos have a far more difficult time in that respect and tend to only blame others. 

Openness to treatment reflects being ‘open’ and willing to talk and discuss the issue, as opposed to being resistant, guarded, and defensive. You can see that insight and openness overlap to some extent. However, a child can have great insight but not be open to treatment, or have poor insight but be more than willing to participate in treatment.

Attention simply indicates the extent to which the child can pay attention, focus, and remain on-topic for a back-and-forth conversation and explore any given issue. As you would expect, a child with more severe ADHD would struggle with attention.

All children and teens can be rated on these three aspects. Here’s how your therapist uses this process:

The Rating Process

Your child or teen's therapist will score these three factors from 1-10 (1 is low, 10 is high, or well-developed).

  • Insight (1-10)
  • Openness to treatment (1-10)
  • Focused/attentive (1-10)

Plug the score into the scale below, and the scale guides the therapy approach:

The difference in how the therapist will approach a client with a high, medium, and low score
*Note that a high or low score is not ‘bad’ or ‘good’, it simply ‘is what it is’ and guides a therapist on how to implement the protocol.

What Do These Scores Mean?

High Score: Traditional talk therapy - talking "with" the client; give-and-take, reflective listening, back-and-forth dialogue talking about coping skills.

Medium Score: More so talking 'at' the client and psycho-education. Teaching, explaining coping skills, and discussing scenarios that are similar to the client's issues is common. Explaining how other clients overcame a similar problem is sometimes used. This is similar to using a 'social story' but in a more mature context. The therapist may also negotiate with a teen client to elevate them higher on the scale. They may say: "if you are cooperative, we can work on the problem so you don't have to come to therapy anymore..." The therapist will also rely on involving the parent in the sessions to address communication and behavior management. 

Low Score: It’s more common for a younger child to earn a lower score, especially a child with ADHD or autism with poor insight. The child may be open to treatment but can't pay attention. In this instance, an activity-based approach will predominate such as utilizing games and activities, and play-oriented therapy, to directly target and improve attention, frustration tolerance, sharing, turn-taking, and emotional regulation. Social stories and the use of pictures and art is also common to promote attention, interest, and learning skills. Parent involvement and working on behavioral management during sessions are vital.

Combining of Therapy Approaches

A therapist will combine approaches because clients may not fall into any one area and may change in terms of openness from session to session. Moreover, aspects of all the approaches will be relevant for all clients. In addition to utilizing a more traditional talk-therapy approach, therapists will involve parents. They will discuss behavior management, incorporate psycho-education, and use games and activities to work on feelings and coping skills. This formula indicates those approaches that the therapist will predominately rely on during therapy sessions for any given client.

Wrap-Up

I hope this post helps to clarify how your child’s therapist decides on the treatment protocol and how to implement that protocol with your child. At Community Psychiatric Centers, your involvement, as the parent, is always vital and instrumental! We’ll always ensure you’re a large part of the process and understand all aspects of your child’s treatment. If you have any specific questions, feel free to email me at DrCarosso@aol.com. To make an appointment, feel free to call 724-850-7200. God bless you and your family.

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