Individual Counseling

Counseling and Psychotherapy refers to a variety of techniques and methods used to help children and adolescents who are experiencing difficulties with their emotions or behavior. Although there are different types of psychotherapy, each relies on communications as the basic tool for bringing about change in a person's feelings and behaviors. Psychotherapy may involve an individual child, a group of children, a family, or multiple families. In children and adolescents, playing, drawing, building, and pretending, as well as talking, are important ways of sharing feelings and resolving problems.

Psychotherapy is often used in combination with other treatments (medication, behavior management, or work with the school). The relationship that develops between the therapist and the patient is very important. The child or adolescent must feel comfortable, safe, and understood. This type of trusting environment makes it much easier for the child to express his/her thoughts and feelings and to use the therapy in a helpful way.

Psychotherapy helps children and adolescents in a variety of ways. They receive emotional support, resolve conflicts with people, understand feelings and problems, and try out new solutions to old problems. Goals for therapy may be specific (change in behavior, improved relations with friends or family), or more general (less anxiety, better self-esteem). The length of psychotherapy depends on the complexity and severity of problems.

For all children, life is a challenging endeavor. Many are constantly experiencing who they are; testing alternative ways to live their lives; and exploring opportunities for love, safety, and joy. Some children are forced to cope with overwhelming experiences, resulting in the loss of all of the best aspects of childhood. It is the counselor’s role, of course, to assist children who may be experiencing a whole host of difficulties through no fault of their own. Among the many complex factors involved in the counseling process, two are crucial: accurately conceptualizing the underlying nature of a child’s struggle and designing an appropriate counseling plan to adequately address the problematic issues at hand. Often, counseling is made all the more difficult because of any

number of limitations associated with early stages of physical, cognitive, and emotional development. ACTS for Kids Counselors and Psychologists that work with and possess the specialized skills and training necessary to conceptualize your child's complex strengths and weaknesses in the scope of their current developmental stage.

At their most basic level, children who present problems can be roughly grouped into two different categories (Halstead, 2007). In the first category are those who present problems resulting from some unexpected event or isolated situation. In these cases, the child usually presents with no remarkable problematic history. In the second category are those children who arrive with difficulties that are more complex in nature. Their issues reflect a larger set of significant patterns of problematic emotions and behaviors that have been in place for some longer period of time. Typically, a child in this second category presents problems that have a historical context and that therefore can be traced back to earlier points of that child’s life and often to the nature of the relational environment in which the child lives. Thinking about these two broad categories can help a counselor establish a framework for understanding a bit better the nature of a child’s presenting problem. It does little, however, to help the Preface viii counselor design effective interventions. Even if the counselor can differentiate the type of presenting problem, without a means of framing what lies at the core of the problem he or she can become stuck and counseling interventions can meet with mixed results. With no framework for understanding the deeper nature of the child’s problem—what we refer to in this book as the child’s core issues—a counselor can often miss the bigger picture of the child’s deeper struggle and the counseling process can falter and stall. The important goal of helping a child either adjust to a one-time situational event (the first category) or change repetitive problematic life patterns (the second category) is achieved more often by happenstance than by design. More important, the larger core issue(s) with which clients struggle but are unable to voice often remain unaddressed and thus are left unresolved, only to become the source of more serious problems in the future.

As a parent, it can be hard to know when your child’s behavior is just a part of growing up or a sign of a bigger issue. There are several things a child and adolescent mental health professional will look at to determine if a child or teen’s behaviors are problematic:

  • Is the behavior more intense than it should be?
  • Does the duration of the behavior continue after the situation has passed?
  • Is the behavior typical for his/her age level?
  • Is the behavior upsetting to your child or other family members?
  • Does the behavior prevent your child from interacting with friends or performing well in school?
  • Is the behavior inappropriate to the situation?
  • Does the behavior happen for no obvious reason?
  • Does your child avoid important social, school or family activities because of the behavior?

All children are different, and even the most typical child or teen may engage in “problematic” behaviors from time to time, especially when they are tired, stressed or sick. However, if your child or teen repeatedly engages in inappropriate or unwanted behaviors, consider meeting with a mental health professional.

Many of the behavioral problems or mental health symptoms that can keep children and adolescents from leading happy, successful lives can be effectively treated with evidence-based therapies. With these treatments, psychologists and other mental health providers help parents and children learn how to work and live better with others, and to build the skills and habits that help them succeed in school and in life.

Not all mental health therapies for young people are effective, and some treatment options do not work the same for all behavioral and mental health disorders.

Outlined below are several therapies that have been proven to work. All of the treatments listed below use techniques that are based on scientific evidence to understand and treat various behavioral and mental health issues in young people.

What is CBT?

Cognitive behavioral therapy (CBT) for children and adolescents usually are short-term treatments (i.e., often between six and 20 sessions) that focus on teaching youth and/or their parents specific skills. CBT differs from other therapy approaches by focusing on the ways that a child or adolescents thoughts, emotions, and behaviors are interconnected, and how they each affect one another. Because emotions, thoughts, and behaviors are all linked, CBT approaches allow for therapists to intervene at various points in the cycle.

These treatments have been proven to be effective in treating many psychological disorders among children and adolescents, such as anxiety, depression, post-traumatic stress disorder
(PTSD), behavior problems, and substance abuse.

There are differences between cognitive therapies and behavioral therapies for young people.

However, both approaches have much in common, such as:

  • The therapist and child or adolescent develop goals for therapy together, often in close collaboration with parents, and track progress toward goals throughout the course of treatment. 
  • The therapist and client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him-or herself.
  • The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors.
  • Treatment is often short-term. Clients actively participate in treatment in and out of session. Homework assignments often are included in therapy. The skills that are taught in these therapies require practice.
  • Treatment is goal-oriented to resolve present-day problems. Therapy involves working step-by-step to achieve goals.

Types of Cognitive Behavioral Therapy

Individual CBT
Individual cognitive behavioral therapy focuses solely on the child or adolescent and includes one therapist who teaches the child or adolescent the skills needed to overcome his/her challenges. This form of CBT has been proven effective in the treatment of child and adolescent depression and anxiety disorders, as well as substance abuse in adolescents.

CBT with Parents
Cognitive behavioral therapy that includes parents in the treatment process has been shown through research to be effective in treating children and adolescents with anxiety disorders. Specifically, CBT that teaches parents techniques to help care for anxious youth, including psychoeducation, individual therapy, caregiver coping, and parent training techniques are especially helpful. In this form of therapy, the parents are involved directly in the treatment of their children and are essentially trained in ways to help them handle their children’s fears at home.

CBT with Medication
Research has shown that pairing cognitive behavioral therapy with psychotropic medications can be effective in treating a child or adolescent’s anxiety symptoms or depression. A child’s care team will be able to prescribe the right medication if he/she believes it to be necessary in your child’s therapy process.

Trauma-focused CBT
Trauma-focused cognitive behavioral therapy was developed to help children and adolescents affected by trauma. It is effective in treating PTSD but can be effective in treating other trauma-related disorders as well. It is delivered in the same way as cognitive behavioral therapy – usually short-term in six to 20 sessions with the child and his/her parents present. A trauma-focused CBT session addresses several factors related to the child’s traumatic experiences, including behavioral and cognitive issues, and depression or anxiety symptoms, and helps improve parenting skills and parents’ interactions with their children to help support and cope with their children’s struggles.

CBT paired with Motivational Enhancement Therapy
Motivational enhancement therapy (MET) is a type of evidence-based therapy that motivates adolescents internally to change their behavior. When MET is paired with group-based CBT, it is effective in changing an adolescent’s behavior towards drug and alcohol abuse. This therapy uses discussion, coping strategies, and motivational interviewing principles to help the youth initiate a plan to change his/her behavior and motivate the youth to follow through. Throughout the sessions, the therapist will guide the youth through their plan to stop using substances and will continue to motivate and encourage his/her progress. Following MET therapy sessions, the adolescent would participate in group-based CBT to see the best results.

CBT paired with Motivational Enhancement Treatment and Family-based Behavioral Treatment

In family-based behavioral treatment, parents set examples for their children in changing their own behavior to help their children change their behaviors in the long run. An important component of this type of therapy is the training of parents on child management and problem-solving skills. This integrated therapy has been proven effective in treating adolescent substance abuse.
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Graeme Whitfield (2010). Group cognitive-behavioral therapy for anxiety and depression.
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Charmaine K. Higa-McMillan, Sarah E. Francis, Leslie Rith-Najarian, & Bruce F. Chorpita
(2015). Evidence Based Update: 50 Years of Research on Treatment for Children and Adolescent Anxiety. Journal of Clinical Child & Adolescent Psychology. Vol. 45 Issue 2, 91-113.
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Aaron Hogue, Craig E. Henderson, Timothy J. Ozechowski, & Michael S. Robbins (2014).
Evidence Base on Outpatient Behavioral Treatment Adolescent Substance Use: Updates and
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Myra Altman & Denise E. Wilfrey (2014). Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents. Journal of Clinical Child & Adolescent Psychology. Vol. 44 Issue 4, 521-537. http://dx.doi.org/10.1080/15374416.2014.963854

Kendall, P.C. (2016). Child and Adolescent Therapy, Fourth Edition. New York: Guilford.
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