Bardenstein Karen K. - Child and Adolescent Therapy Science and Art

Contents

Copyright 2006 by John Wiley & Sons, Inc. All rights reserved.

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Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data:

Shapiro, Jeremy P.

Child and adolescent therapy : science and art / by Jeremy P. Shapiro, Robert D. Friedberg, Karen K. Bardenstein.

p. cm.

Includes bibliographical references.

ISBN-13 978-0-471-38637-7 (cloth)

ISBN-10 0-471-38637-5 (cloth)

1. Child psychotheraphy. 2. Adolescent psychotherapy. I. Friedberg, Robert D., 1955 II. Bardenstein, Karen K. III. Title.

RJ504.S516 2005

618.928914dc

2005047032

Preface

Preface The Therapists Challenge

The purpose of this book is to equip readers with the skills and knowledge they need to provide effective psychotherapy to children and adolescents. We aim to provide an understanding of the major theoretical approaches, knowledge about the findings of outcome research, a feeling for what counseling is like, and training in a variety of therapeutic techniques. This is an academic text and, also, a how-to book. We view intellectual rigor and practical application as equally important and complementary objectives. Thus, the book is about theory, etiology, change agents, technique, meta-analysisand what to say to the client.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ( DSM-IV-TR; American Psychiatric Association, 2000) defines mental disorders as behavioral or psychological syndromes involving either significant distress (e.g., symptoms such as anxiety and depression) or significant functional impairment in life areas such as work, school, relationships, and compliance with social norms. Mental health problems involve behavior, emotions, relationships, and the cognitions and skills involved in these dimensions of functioning. Developmental issues are often important considerations in the diagnosis and treatment of young people.

Emotional and behavioral problems are not uncommon in youth. Approximately one child in five has a significant mental health problem (U.S. Public Health Service, 2001). This prevalence rate is quite consistent across a range of countries and cultures (World Health Organization, 2001). However, most youth who need treatment do not receive it; in the United States, only 6% of young peopleless than one-third of those who need servicesreceive mental health care each year (Sturm et al., 2000).

Weisz (2004, p. 5) defined psychotherapy as, an array of nonmedical interventions designed to relieve psychological distress, reduce maladaptive behavior, or enhance adaptive functioning through counseling, structured or unstructured interactions, training programs, or specific environmental changes. The common element linking these activities is this: Psychotherapy relies on talking as a method of ameliorating problems. Therapy is not alone in its purposeful use of conversation, and people have sought help by talking to trusted relatives, friends, and clergy for far longer than counseling has existed. But therapy is also a professional service and, to justify the remuneration they receive, counselors should be able to provide forms of help that laypeople cannot reliably offer. There needs to be something different about our talk.

Therapy fulfills a distinctive and rather remarkable function in our society. When something goes wrong with our cars, we go to automobile mechanics to fix the problem. When something goes wrong with our bodies, we go to physicians for treatment. When something goes wrong with our emotions or behavior, society recognizes psychotherapists as the people to call for help with these central aspects of self.

Given the deeply personal nature of the problems for which counseling is sought, clients and parents are in a position involving considerable vulnerability and trust. They are generally willing, just moments after meeting a stranger, to describe important, painful, and, perhaps, embarrassing aspects of their lives. Therapy is about issues that people do not usually discuss with full openness, such as love, rejection, anger, sex, happiness, unhappiness, and so forth. Clients and parents may be willing to disclose information and feelings they have never told anyone before just because the stranger sitting in front of them has a license indicating her commitment and ability to respond helpfully to this type of disclosure.

The trust that parents demonstrate by bringing their children to therapists imposes an important responsibility on these professionals. This responsibility may result in a feeling of pressure, which can be beneficial if it impels us to do our best for clients. It is an honor and a privilege to work with people on the deepest, most personal aspects of their lives and, in order to be worthy of this trust, we must do our best not to let our clients down.