Kenneth Barish - How to Be a Better Child Therapist: An Integrative Model for Therapeutic Change

How to Be
a Better
Child Therapist

How to Be
a Better
Child Therapist:

An Integrative Model
for Therapeutic Change

KENNETH BARISH

W. W. Norton & Company

Independent Publishers Since 1923

New York London

A Norton Professional Book

Note to Readers:

Standards of clinical practice and protocol change over time, and no technique or
recommendation is guaranteed to be safe or effective in all circumstances. This volume
is intended as a general information resource for professionals practicing in the field of
psychotherapy and mental health; it is not a substitute for appropriate training, peer review, and/
or clinical supervision. Neither the publisher nor the author can guarantee the complete accuracy,
efficacy, or appropriateness of any particular recommendation in every respect.

Copyright 2018 by Kenneth Barish

All rights reserved
First Edition

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The Library of Congress has cataloged the printed edition as follows:

Names: Barish, Kenneth, author.
Title: How to be a better child therapist : an integrative model for
therapeutic change / Kenneth Barish.

Description: First edition. | New York : W.W. Norton & Company, [2018] | A
Norton Professional Book. | Includes bibliographical references and index.
Identifiers: LCCN 2018001034 | ISBN 9780393712346 (hardcover)
Subjects: LCSH: Child psychotherapy. | EmotionsTherapeutic use.
Classification: LCC RJ504 .B34 2018 | DDC 618.92/8914dc23 LC record
available at https://lccn.loc.gov/2018001034

ISBN 9780393712353 (eBook)

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To my grandchildren, Elliott and Andrew,
hoping that you will live in a world of tolerance,
compassion, and peace.

CONTENTS

Part 1:
An Integrative Model for Child Psychotherapy

I have been fortunate, throughout my professional career, to have had the opportunity to study and exchange ideas with many excellent teachers, colleagues, and students.

In 1979, I arrived as an intern at New York Hospital Westchester Division. In 1984, I began my training in psychoanalysis at the Westchester Center for the Study of Psychoanalysis and Psychotherapy. In 2000, I joined the faculty of the William Alanson White Institute Child and Adolescent Psychotherapy Training Program. I would like to express my appreciation to all of my colleagues and students at these outstanding institutions for years of thoughtful and challenging discussions, and for your friendship and support.

I have also benefited from the encouragement and clinical insights of friends in my study groups: David Aftergood, Laurence Baker, Laura Bartels, Judy Berenson, David Breindel, Diane Caspe, I. Barry Lorinstein, Cynthia Mintz, Martin Mintz, John Turtz, and Arnold Zinman, and from the teaching, for more than a decade, of Arnold Richards.

Recent conversations with Elliot Adler, Breck Borcherding, Barbara Flye, Jo Hariton, Bernie Kimberg, Judi Kimberg, Francheska Perepletchikova, Gary Schlesinger, Jean Schreiber, Tom Schreiber, Matthew Specht, Steven Spitz, Julie Stonis, and Liz Stuntz helped clarify the ideas and recommendations presented in this book.

Thank you also to Marcia Miller and Anne Marie Romano, librarians at New YorkPresbyterian Hospital, Westchester Division, who spent considerable time and effort finding books and articles that I would otherwise still be searching for.

I am indebted to Deborah Malmud for offering me the opportunity to write this book and for her sound guidance along the way. From beginning to end, my team at W. W. Norton has been a pleasure to work with.

As always, my deepest gratitude is to my familymy wife Harriet, my children Rachel and Dan, and my son-in-law Alexfor their constant support and for filling my life with all the love and joy that any husband and father could hope for.

I began my work as a child therapist in a different era. I was trained, circa 1980, in a supportive-expressive psychodynamic approach to child therapy (Kernberg & Chazan, 1991). Our goal was to create a therapeutic relationship, through play and talk, that encouraged children to express feelings that had become a source of conflict and distress; to offer understanding and insight; and to facilitate a childs ego development, with the therapist serving as an auxiliary ego and an object of healthy identification.

At the time, this basic model of child psychotherapy was largely unchallenged, and I was able to help most of the children and families who consulted me. To a great extent, this is still how I work.

But there were limitations and unanswered questions. In the course of therapy with most children, parents asked for help with daily problems. What do I do when my child refuses to do his homework, or go to sleep on time, or stop playing video games; when he wont stop teasing his sister or has a tantrum whenever I say no; when she eats very few foods, or cries when I leave the house, or is late for school every morning?

Often, I was able to provide helpful advice. I offered parents a way of thinking about childrens behavior that focused on a childs frustrations and disappointments, their anxieties and hurt feelings, and their feelings of unfairness. With this new perspective, parents were able to listen more openly and communicate more constructively with their children, with less criticism and anger and with more emotional support. This, too, remains the foundation of how I work.

To help many families, however, I needed to do more. Parents needed more practical advice about how to solve the problems they faced on a daily basis. And I was unprepared.

Then (and now) the most common strategies for helping parents with daily problems were derived from early behaviorist principles and procedures (rewards and time-outs). In some circumstances, these techniques were helpful. However, much of this advice (and certainly its theoretical foundation) was unsatisfying. Then (and now) I could not be a behaviorist. The concepts and language of behaviorismreinforcement, shaping, extinctionwere alien to how I thought about children, and the behaviorism of the time extended these principles well beyond the range of childhood problems for which they might be applicable.

Soon, cognitive-behavioral (CBT) interventions were developed. For some problems, these strategies were also helpful, especially for anxious children. But I could not be a CBT therapist. Although CBT has made significant contributions to child psychotherapy, cognitive-behavioral principles do not address what I believe is most essential in childrens emotional development. Behavioral and cognitive-behavioral models do not offer an adequate account of childrens basic needs and motivations, and of the experiences that are most important to their happiness and success in life. Clearly, for me, an integrative model of both theory and practice was necessary.

The past several decades have seen significant progress in the science of child psychotherapy. Behaviorism has matured (and so have I). Many well-researched therapeutic interventions for children have been developed, most based on cognitive-behavioral principles. There are also hybrid programs that combine play therapy and behavior therapy (Zisser & Eyberg, 2010); attachment theory and cognitive theory (Stark, Streusand, Krumholtz, & Patel, 2010); psychodynamic theory and cognitive theory (Cohen, Mannarino, & Deblinger, 2010); and interventions for children and adolescents based on principles of DBT (Miller, Rathus, & Linehan, 2007; Perepletchikova, 2017; Rathus & Miller, 2015). Child therapists can also make use of strategies from Collaborative Problem Solving (Greene & Ablon, 2006), creative interventions for children with autism spectrum disorders (Greenspan & Wieder, 1998; Smith, Rogers, & Dawson, 1994), and many more. As a result of these efforts, beginning child therapists are now much better prepared than I was to offer help to troubled children and families.