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Editors

Kirsi-MariaHaapasalo-Pesu

Psychotherapeutic Forms of Treatment for Children and Adolescents

Essentials

  • The patient is helped to
    • come to terms with his/her anxiety and problems, and the development into a healthy, balanced and age-relevant direction is supported
    • find new alternatives to cope with problems concerning interaction in the relations with both adults and peers
    • adopt a clearer and more positive concept of oneself and one's relationships with other people.

Prerequisites for treatment

  • Prerequisites for the initiation of treatment include a thorough examination of the patient, comprehensive diagnostics as well as objectives for the treatment that are set together with the child/adolescent and with his/her family.
  • The younger the patient is, the more important for a successful psychotherapy it is to achieve the parents' support, acceptance and participation.
  • Psychotherapy is not suitable for adolescents who are not motivated and/or who think that all the problems are caused by external factors. Negative attitude of the parents may also pose a hindrance for the use of psychotherapy.
  • With older adolescents the agreement of the therapy is done more clearly with the adolescent.
  • The settings for psychotherapy should be clearly restricted. Sessions for individual therapy last 45-60 minutes, whereas sessions for family and group therapy are longer.
  • Individual therapy is given at least once a week, whereas family and group therapy may be organized at longer intervals.
  • Some of the therapies applied to adolescents are time-limited and based on handbooks. These therapies usually last for 15-20 weeks. A long therapy may last for 1-3 years.
  • Child psychotherapy requires also working with the parents. In adolescents, the amount of parent participation is influenced by the age of the patient and by the nature of the problems.
  • The need for other treatments is considered individually.
  • Find out about locally available services and their reimbursement.

Psychodynamic individual therapy

  • The psychodynamic theory has a certain background influence on several forms of psychotherapy, and psychodynamic therapy is still one of the most common forms of psychotherapy.
  • The objective is to
    • enable progress in the psychic development of the child or adolescent and to heal the jams that prevent it
    • help to experience and endure different emotions
    • fortify psychic structures and support coping methods
    • build communication skills
    • build self-esteem
    • increase the ability to cope with disappointments
    • reduce anxiety and psychic discomfort.
  • The results of psychodynamic psychotherapy are better in anxiety and depressive disorders than in the treatment of conduct disorders.
  • Psychodynamic individual therapy is based on the psychoanalytic framework. A trained therapist shares the experiences of the child's or adolescent's inner world. He/she takes into account the individuality of the patient and the nature of the problems when regulating his/her own ways in acting as a psychotherapist.
  • According to the background theory, the relationship to the therapist replicates the young patient's earlier important emotional relationships and also the conflicts involved in these relationships. This process starts to repeat the developmental area where the adolescent has become stuck.

Cognitive psychotherapies

  • Cognitive and cognitive-behavioural psychotherapies Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents are becoming increasingly common in the treatment of adults as well as children and adolescents.
  • Cognitive psychotherapy focuses on distortions in the cognitive development, in ways of experiencing or in actions of a child or adolescent. According to behavioural and learning theories, the disorders are based on learning, on conditioning process of learned models of behaviour or reactions and on detrimental thinking patterns.
  • The objectives are that
    • the child or adolescent recognizes and names his or her feelings
    • the child changes his or her negative and distorted ideas of him/herself, others and environment
    • social and communication skills improve.
  • The therapist represents an important human relationship but also a partnership for the child.
  • Cognitive therapy requires a certain level of maturity in cognitive skills. Therefore the therapy is primarily used for school-age children only.
  • Cognitive and cognitive-behavioural therapy can be used to treat depression, anorexia nervosa, different fears, anxiety and compulsive disorders, post-traumatic stress disorder, adolescents who are psychotic or at risk of psychosis, and attention, conduct and oppositional defiant disorders.
  • Therapy is given once a week either for a defined period of time or as a long-term therapy often required by child or adolescent patients.

Dialectical behavior therapy

  • The therapy has been developed for patients who suffer from borderline personality disorder and are chronically self-destructive. There are development-sensitive applications of the therapy for children and adolescent.
  • The therapy is based on the biosocial theory, according to which both biological susceptibility and destructive developmental environments predispose to emotional dysregulation.
  • The therapeutic programme combines individual therapy, skills training in groups, counselling over the phone, and a consultation team of the therapists.
  • The need for behavioral change as well as self-acceptance are emphasized in the therapy.
  • In order to achieve the change, skills and self-acceptance are trained in groups.

Solution-focused therapy

  • A stepwise programme to solve specified problems of children or adolescents provides a clear structure for the therapeutic work proceeding in stages.
  • The focus from the start is on skills, not on problems.
  • The emphasis is on the future.
  • May be used in individual therapy but also in couples, family and group therapy.
  • Suitable for the treatment of anxiety and mood disorders as well as addictions.

Family therapy

  • Family therapy is directed at interpersonal relationships and the whole family in a greater extent than other therapy forms.
  • Family therapy is used when the psychological disorder of the child or adolescent is an essential part of an intrafamilial interaction disorder.
  • The therapy for an adolescent may include individual therapy and family therapy either concurrently or one after the other.
  • The aim of the therapy is to find, together with the family, new understanding and new ways of interacting in such a manner that the individual growth and development of the family members is possible.
  • There are often two or three therapists carrying out the therapy with one family.
  • In addition to actual family therapy, the family is involved in any treatment of psychic problems in a child: the parents are assisted in understanding their child and the backgrounds of his/her symptoms and behaviours, and thus the interaction between the parents and the child is supported.
  • Psychoeducative family therapy is essential when the goal is to help an adolescent with psychosis and his/her family to adapt to the disease.
  • Multi-dimensional family therapy (MDFT) is an adaptation of family therapy for the treatment of substance abuse and conduct disorders in an adolescent.

Interpersonal psychotherapy

  • A structured form of psychotherapy limited in 12-16 visits for the treatment of depression; nowadays, the method is also used for other non-psychotic disorders.
  • A separate adaptation for the treatment of adolescents has been developed. The therapist also meets the parents.
  • Together with the adolescent, a focus for the therapy is chosen; it may be related to grief, conflicts in human relations, changes in life circumstances or loneliness.
  • The goal is to improve social skills and actual interaction relationships in order to support the growth of the adolescent.
  • The effectiveness of the method has been proven in several studies.

Trauma therapyPsychological Therapies for Children and Adolescents Exposed to Trauma

  • The traumatic event may be a single incident or a repeated situation. The story of the trauma is often fragmentary. Through parallel processing of the cognitive, emotional and physical memories and sensations, the details of the incident are integrated to form a more solid story.
  • Trauma psychotherapy, trauma-focused cognitive behavioral therapy or EMDR (eye movement desensitization and reprocessing) are recommended for the treatment of trauma.
  • For children and adolescents in immigrating refugee families, narrative exposure therapy (NET) is recommended.
  • Playing is often used in children's psychotherapy and trauma therapy. The child can express his/her feelings and thoughts through play. Playing is a typical way for children to express themselves, and they handle different experiences through it. Playing itself can be therapeutic.
  • In play therapy the toys are either standardized or otherwise chosen so that the child can express different situations and emotions through play. For school-aged children, games fill the role that toys have for small children.

Therapy directed to the early interaction

  • The therapy is often implemented as mother-infant or mother-father-infant therapy.
  • The therapy may be used, e.g., for problems of eating, sleeping or interaction.
  • Mother-infant therapy has an important role in the treatment of postpartum depression. In addition to supporting the interaction, it promotes the mother's recovery as she gets positive experiences of motherhood.
  • Therapy of small children is an emerging therapy form that also has problem-preventing effects.
  • The therapy is often carried out by directly supporting the interaction between the parent and the child, but psychodynamic implementation applying guided imagery of the parent is also possible.

Art therapy

  • Art therapy combines artistic expression and the therapeutic process. The therapy concentrates on both the patient's artistic expression and the contact made through it with another person. The therapist acts as a receiver and an interpreter of the patient's inner images and helps the patient to face difficulties, fears and conflicts when they hinder the therapeutic process.
  • Group art therapy treats the patient through a group process Group Treatment of Children and Adolescent. The process works between all group members, their pictures and the therapist.

Riding therapy

  • Riding therapy is used to treat and rehabilitate children and adolescents who are either physically handicapped or sick or who have behavioural or emotional disorders.
  • The movement of the horse during riding and the contact with it can activate the communication skills of an inhibited or distressed patient. Emotional contact with the horse is often important.
  • Riding therapy reaches the patient through many senses: it normalizes and improves not only physical reactions but also perception, function of the senses and speech development. It also improves concentration ability, self-control and social skills. The psychological objectives are to enable the children and adolescents to experience pleasure, feel success and trust their own skills. It is also meant to develop higher self-esteem through positive experiences.
  • The therapy can be used to treat
    • conduct disorders and attention and eating disorders
    • disturbances in interactive relationships
    • autism.

Music therapy

  • Music affects human beings in many different ways, from the lower levels of brain function (autonomic nervous system) to the higher levels.
  • Music therapy has a positive effect on children with
    • difficulties in making contact
    • multiple disabilities
    • mutistic, psychotic or aggressive conduct.
  • Music therapy can be useful in situations when the child or adolescent is not able to verbally process his/her concerns. Music therapy is commonly provided as a supportive measure for children and adolescent who are clients of the child protection services.
  • Music therapy can involve receiving, producing or performing. It can also be combined with art and psychomotor therapy. Because music makes people feel better and increases wellbeing, it also increases the effectiveness of other treatments.

Occupational therapy

  • Supports the holistic functioning of a distorted child or adolescent. The objective is to improve the ability of the child or adolescent to express him/herself, to offer successful experiences and to develop learning abilities. Occupational therapy includes such creative activities as drama, music, and art or physical exercises.
  • The intention is to use sensory integration to affect the way the brain processes, combines and uses the sensations sent by different senses.
  • In occupational therapy patients also practice the activities needed in everyday life to increase independence. The objective of the treatment is to guide children and adolescents into recreational activities that would bring them joy and pleasure once the therapy has ceased.

Group therapy

  • Group therapy Group Treatment of Children and Adolescent involves psychotherapeutic methods, and the primary objective is to encourage the members of the group to create mutual and healing means of communication.
  • Group therapy helps especially children with disturbances in their relations with their peers.
  • For children, group therapy involves mainly playing and other activities; with adolescents the therapy may include activities (exercise, adventures, experiences) or discussion. The task of the therapist or therapists is to guide the activities or discussions into constructive communication between the members of the group.
  • A therapy group can consist of 3-5 children or adolescents at a time. Two therapists are needed to guide a bigger group. Group therapy generally lasts for 1-1.5 hours, and the group meets 1-2 times a week.
  • Sometimes children's therapy sessions are combined with the sessions of their parents. These sessions deal with the behavioural problems of the children or adolescents and the means with which parents handle the problems. The objective is to find new ways to solve problems.
  • ART (aggression replacement training) programme is used in group therapy of adolescents with conduct disorders. The reinforcement of accepted behaviour is pursued through active exercises. The goal is to develop moral thinking in the adolescent and to learn better self-control, new social skills and ways to control feelings of anger in order to cope better in everyday life.

Telehealth and internet

  • Nowadays, supplemental telehealth services are often provided for children and adolescents. Telehealth services may be available for chilren, adolescents and families. It is also a method for organizing guidance for parents. The child's or adolescent's networks may also be invited to join more widely.
  • Find out about local availability of such services and referral policies.

Cooperation with parents

  • The behaviour of a child or adolescent is generally a result of many factors. Therefore many methods are needed for treatment. The success of all treatment requires working with the parents.
  • For certain disorders the emphasis of the treatment is on the family. Parent training, family therapy and multisystemic therapy Multisystemic Therapy for Social, Emotional, and Behavioral Problems in Youth are generally more effective than individual therapy in the treatment of conduct disorders of children and adolescents.
  • Sometimes it is also necessary to assess the parents' own need for psychotherapy and to refer them for treatment.
  • The child psychotherapist may also meet the child's parents, but often someone other than the therapist of the adolescent deals with the adolescent's parents. The meetings with parents are aimed at informing them of the psychological development in childhood and adolescence as well as of the backgrounds of the child's disorders and, in this way, increase the parents' own understanding. The child's therapist gets also information from the parents about life events which the child may not inform about, but which are important and help the therapist to understand the child better. The aim of the discussions is to create a cooperative relationship with the parents so that they have a sense of acting together with the therapist for the best of the child.
  • It is possible to go through the child's or adolescent's problems during the meetings, to search for new ways of reacting to situations at home and to support the work the parents do in bringing up their child or adolescent. They should also be informed of the effects the therapy has on the development of the child or adolescent.

Evidence Summaries ⬆