This conclusion presents some closing thoughts on key concepts discussed in the preceding chapters of this book. The book attempts to contribute to improving children’s lives by providing a comprehensive and effective treatment protocol. To enhance treatment efficacy and improve the trajectory for children’s lives, case conceptualization in child psychotherapy must integrate developmental theory, neuroscience, and best practice models into clinical practice. The book reviews some of the latest research on attachment and neuroscience that impacts case conceptualization in child psychotherapy. In 1989, Shapiro proposed a new treatment approach she entitled eye movement desensitization (EMD) and, later, eye movement desensitization reprocessing (EMDR) to treat trauma. After reviewing the major theories of attachment and Schore’s current rendition that he labels self-regulation theory, the book offers a foundation for therapists to use develop-mentally grounded theory through the lens of adaptive information processing (AIP) to treat attachment issues in clients of all ages.
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This chapter provides information for therapists to integrate theories of neuroscience into the practice of child psychotherapy. Neuroscientists have described how the brain develops, documented the impact of external experiences on the developing brain, and integrated theories of neurodevelopment and neuroplasticity into our understanding of the impact of our interpersonal relationships on our brain. The chapter focuses on developmental trauma disorder and the research on the impact of trauma on children. The majority of the research on trauma in children has focused on the assessment and diagnosis of Post traumatic stress disorder (PTSD); however, there are a limited number of studies that have documented the efficacy of the treatment of PTSD in children. The chapter reviews diagnoses specific to neurodevelopment, including autistic spectrum disorders (ASD) and sensory processing disorders (SPD).
This chapter discusses some of the more obvious choices therapists make in providing professional services to children, as well as reviews other decisions that therapists don’t learn in graduate school but often encounter in reality. It delves into the pragmatics of providing child psychotherapy with considerations for therapists who are in the trenches every day. In developmentally grounded child psychotherapy, the therapist is exploring the child’s symptoms within a developmental framework while gathering data to assist with diagnosis, treatment planning, and psychotherapy. Parents are important sources about the child’s symptoms and treatment goals and may also participate in the child’s psychotherapy. The therapist may need to teach the parent about using behavioral management skills with the child. Referring a parent to parenting classes can reinforce the parent’s feelings of importance and create a therapeutic alliance with the therapist.
- Go to chapter: From Bonding and Attachment to Self-Regulation Theory: How Relationships Impact Human Development and Psychotherapy
From Bonding and Attachment to Self-Regulation Theory: How Relationships Impact Human Development and Psychotherapy
This chapter reviews theories that speculate how love and our earliest relationships impact health and well-being. From the theories of attachment and bonding described by Anna Freud, Melanie Klein, John Bowlby, Harry Harlow, Mary Ainsworth, Mary Main, and T. Barry Brazelton, to the more recent theories of developmental neuroscience described by Allen Schore, Daniel Seigel, and Bruce Perry, the chapter explores why that first relationship is essential in every aspect of healthy development. Even though bonding and attachment have been explored in the literature on human development and psychotherapy for over 100 years, it is only in the last 2 decades that these theories have been considered integral aspects of psychotherapy. The clinical relationship and therapeutic process can address early childhood relationship damage. The chapter concludes with a brief discussion of how the therapeutic relationship impacts the efficacy of child psychotherapy.
- Go to chapter: A Developmentally Grounded and Integrative Clinical Approach for Treating Complex Trauma and Dissociative Disorders in Children
A Developmentally Grounded and Integrative Clinical Approach for Treating Complex Trauma and Dissociative Disorders in Children
Children are exposed to distress, violence, and trauma even before they are born. In-utero and early childhood exposure can contribute to severe medical and psychological consequences. Children who have been exposed to such traumatic events often arrive at the psychotherapist’s office with emotional and behavioral symptoms suggestive of reactive attachment disorder (RAD), post-traumatic stress disorder (PTSD), and dissociation. This chapter reviews relevant theories of dissociation integrated with theories of development to provide a summary of how attachment impacts dissociation. With a developmentally grounded theory of dissociation, the chapter describes clinical interventions for treating the dissociative sequelae of attachment trauma in children. This theoretical framework offers a developmentally grounded and integrative framework for working with children with complex trauma and dissociation. Symptoms of dissociation are common with PTSD, but an extreme response to trauma can be dissociation and dissociative disorders.
Child psychotherapy is different than any other type of adult-child relationship. A trained mental health professional is using clinical skills to help a child find the answers to the problems he or she has encountered. This chapter outlines the most common symptoms in child psychotherapy. Anxiety is one of the most common symptoms of childhood, but the etiology and manifestation of anxiety varies. Anxiety is a symptom of many other disorders, including generalized anxiety disorder (GAD), separation anxiety, obsessive-compulsive disorder, panic disorder, social phobia and other specific phobias, selective mutism, mood disorders, and post-traumatic stress disorder. Gifted children tend to have higher levels of anxiety because they can think about things they are not yet emotionally prepared to manage. The chapter discusses clinical interventions for common issues of childhood, along with resources for children, directions for parents, and references for parents, caregivers, educators, and therapists alike.
- Go to chapter: Integrating Theories of Developmental Psychology Into the Enactment of Child Psychotherapy
Child psychotherapy requires case conceptualization through the lens of developmental psychology in a multimodal approach to assessment, diagnosis, treatment planning, and clinical interventions. This chapter outlines a blueprint for therapists to provide treatment for children by integrating these fundamental principles while collaborating with the other people in the child’s life. The chapter guides the therapist through case conceptualization that integrates the most efficacious treatment interventions into the eight-phase template of eye movement desensitization and reprocessing (EMDR). Adaptive information processing (AIP) theory drives treatment with EMDR throughout the eight phases of that protocol and provides a template for case conceptualization and treatment planning. The use of the EMDR approach to psychotherapy is well documented and approved as evidence-based practice in Substance Abuse and Mental Health Administration (SAMHSA) and California Evidence-Based Clearinghouse for Child Welfare (CEBC).
- Go to chapter: Assessment, Diagnosis, and Treatment Planning in Psychotherapy With Children and Adolescents
This chapter reviews the types of assessment tools that cover all phases of development, including emotional, social, developmental, educational, and psychological. In developmentally grounded psychotherapy, a multimodal approach to assessment is necessary. A multimodal approach covers direct interviews of parents and children, interviews of parents and other caregivers, observations in the office and in the child’s natural environment, and the implementation of standardized measures. Child and adolescent personality assessment tools are more likely than adult tools to look at emotional, social, and behavioral functioning because personality disorders are not diagnosed until at least age 18, when children reach adulthood. Ultimately, assessment tools are used to verify the therapist’s clinical impressions to guide diagnosis and treatment planning. The diagnosis only benefits the clinical process because it guides treatment planning and clinical interventions.
- Go to chapter: In Search of Mental Health and Resiliency: The Need to Integrate Developmental Theory Into Clinical Practice
In Search of Mental Health and Resiliency: The Need to Integrate Developmental Theory Into Clinical Practice
This introduction presents an overview of key concepts discussed in the subsequent chapters of this book. The book illustrates how child therapists can arrange clinical practice by exploring considerations for ethical issues and the unique forensic challenges that arise from practicing child psychotherapy. The practice of child psychotherapy has often been extrapolated from adult treatment models, with practice regularly focused on the treatment of a specific mental health diagnosis such as attention deficit hyperactivity disorder (ADHD), phobia, or other disorders of childhood. The book provides an overview of theories of human development, personality development, attachment and bonding, and psychotherapy. It organizes phased treatment of child psychotherapy through the eight phases of the eye movement desensitization and reprocessing (EMDR) integrative treatment protocol proposed by Shapiro exploring developmental challenges, and the impact of attachment, and trauma on symptom presentation and case conceptualization.
- Go to chapter: Integrating Theories of Developmental Psychology to Form a Comprehensive Approach to Treatment
This chapter explores theories of human development, also referred to as developmental psychology, as a knowledge base for professionals to integrate theory into case conceptualization in child psychotherapy. It provides a brief overview of the significant contributions of developmental psychology to the field of child psychotherapy that impact case conceptualization in the clinical treatment of children. Many theorists have shaped the study of human development, including Buford Jeanette Johnson, Anna Freud, Jean Piaget, Lev Vygotsky, Urie Bronfenbrenner, Erik Erikson, Jerome Kagan, John B. Watson, B. F. Skinner, Albert Bandura, Lawrence Kohlberg, Jerome Brunner, Robert J. Havighurst, and Emmy Werner. Collectively, their theories propose explanations of all aspects of human development, including psychosexual, cognitive, social, psychosocial, behavioral, and neurological development, along with memory, information processing theories, and resilience. The chapter includes educational theory in order to understand how children are challenged to learn not only internally, but also externally, as well.
The work directed toward increasing the child’s ability to tolerate and regulate affect, so that the processing of traumatic material can be achieved, is initiated during the preparation phase. The process of providing the neural stimulation to improve the child’s capacity to bond, regulate, explore, and play should begin during the early phases of eye movement desensitization and reprocessing (EMDR) therapy. The Polyvagal theory presents a hierarchical model of the autonomic system. In complexly traumatized children, the development of this system has been compromised due to the early dysregulated and traumatizing interactions with their environments and caregivers. When describing the various forms of bilateral stimulation (BLS), go over the different options and practice with the child. If the child went through the calm-safe place protocol successfully, motivating the child to actually use it when facing environmental triggers is an important goal.
During the installation phase, the child can experience a felt positive belief about himself or herself in association with the memory being reprocessed. Children with history of early and chronic trauma have difficulty tolerating positive affect. Enhancing and amplifying their ability to tolerate and experience positive emotions and to hold positive views of the self are pivotal aspects of eye movement desensitization reprocessing (EMDR) therapy. This chapter shows a script that may be used with children during the body scan phase. Assisting children in achieving emotional and psychological equilibrium after each reprocessing session as well as ensuring their overall stability are fundamental goals of the closure phase of EMDR therapy. The reevaluation phase of EMDR therapy ensures that adequate integration and assimilation of maladaptive material has been made. The future template of the EMDR three-pronged protocol is a pivotal aspect of EMDR therapy.
The incorporation of a skill-building phase and eye movement desensitization reprocessing (EMDR) games can greatly enhance and facilitate the utilization of EMDR therapy with children who have a history of complex trauma. Some EMDR games work with cognitive skills, others work with emotional skills, while others work with the body and the language of sensation. The use of positive cognition cards offers a great opportunity to play and use a wide range of card games. This chapter exemplifies how to use negative cognition games. Feeling cubes contain different basic emotions appropriate for children. Clinicians can purchase plain wooden cubes and write different feelings on the cube. A wide range of card games can be used with the feeling cards. The memory wand offers another playful approach to the process of identifying traumatic events with children. The chapter shows a playful way of exploring and identifying parent-child interactions.
The basic goals of phase one are to develop a working relationship and a therapeutic alliance and to determine if the level of expertise of the eye movement desensitization and reprocessing (EMDR) clinician is adequate for the complexity of the case. Other goals are to develop a comprehensive treatment plan and case formulation. EMDR therapy was developed as a form of treatment to ameliorate and heal trauma. Clinicians working with complex trauma must have substantial understanding of the adaptive information processing (AIP) model and the EMDR methodology. During phase one, the clinician works on creating an atmosphere of trust and safety so a therapeutic alliance can be formed with the child and the caregivers. This chapter shows an example of how medical issues can affect the quality of the parent-child communications. The adult attachment interview (AAI) gives us the view of the presence of the experiences in the parent’s life.
Eye movement desensitization and reprocessing (EMDR) therapy was independently designated as a psychotherapy approach, and was validated by twenty randomized controlled clinical trials. Results of meta-analyses show EMDR as an effective and efficacious treatment for posttraumatic stress disorder (PTSD) in adults and children. Childhood complex trauma refers to the exposure of early chronic and multiple traumatic events. The adaptive information processing (AIP) model constitutes the central piece and foundation of EMDR therapy. Affective neuroscience brings up the importance of PLAY as a healing agent. The polyvagal theory emerged out of the work of Stephen Porges on the evolution of the autonomic nervous system (ANS). Interpersonal neurobiology (IPNB) brings a viewpoint that integrates objective realms of scientific findings and subjective realms of human knowing. The structural dissociation theory of the personality is based on Pierre Janet’s view of dissociation as a division among systems that constitute the personality of an individual.
This chapter integrates elements and strategies of internal family systems (IFS) psychotherapy into eye movement desensitization and reprocessing (EMDR) therapy with complexly traumatized children. It shows a description of healing a part using in-sight with a child. In-sight involves having the client look inside to find and work with parts that he or she sees or senses and describes to the therapist. The IFS therapist starts by ensuring the client’s external environment is safe and supportive of the therapy. In a self-led system, polarizations are absent or greatly diminished, leaving more harmony and balance. However, when and how the self is formed may be seen and conceptualized through different lenses in adaptive information processing (AIP)-EMDR and IFS. According to the AIP model, the human brain and biological systems are shaped by the environmental experiences they encounter.
International Society for the Study of Trauma and Dissociation (ISSTD)’s professional training institute offers comprehensive courses on childhood dissociation that are taught internationally and online. This chapter briefly cites some of the theories that have emerged in the dissociative field. One system, the apparently normal personality (ANP) enables an individual to perform necessary functions, such as work. The emotional personality (EP) is action system fixated at the time of the trauma to defend from threats. As with the Adaptive Information Processing Model (AIP) in eye movement desensitization and reprocessing (EMDR), each phase brings reassessment of the client’s ability to move forward to effectively process trauma. There are many overlapping symptoms with Attention Deficit Hyperactive Disorder (ADHD) and dissociation that often mask the dissociation. The rate of diagnosis of pediatric bipolar disorder has increased 40 times in the last ten years.
The inclusion of parents and family caregivers throughout the phases of eye movement desensitization and reprocessing (EMDR) therapy is essential for best treatment outcome with highly traumatized and internally disorganized children. Parental responses that create dysregulation in the child’s system also appear to be related to the parent’s capacity to reflect, represent and give meaning to the child’s internal world. This chapter shows a case that exemplifies how the caregiver’s activation of maladaptive neural systems perpetuates the child’s exposure to multiple and incongruent models of the self and other. Helping parents arrive at a deeper level of understanding of their parental role using the adaptive information processing (AIP) model, attachment theory, regulation theory and interpersonal neurobiology principals will create a solid foundation. The thermostat analogy is designed to assist parents in understanding their role as external psychobiological regulators of the child’s system.
This chapter presents how eye movement desensitization and reprocessing (EMDR) therapy and Theraplay can be used together when treating children with a history of complex trauma. Theraplay focuses on the parent-child relationship as the healing agent that holds within it the potential to cultivate growth and security in the child. The chapter shows some core concepts that help define and illuminate the application of Theraplay. Now that a clear review of basic Theraplay principles has been provided, people need to look at EMDR therapy and the adaptive information processing (AIP) model in conjunction with Theraplay and Theraplay core values. Early in its development, Theraplay integrated parental involvement into its therapeutic model. During the reprocessing phases of EMDR therapy, Theraplay can be very helpful in providing different avenues for emotion regulation and for the repairing of the attachment system.
This chapter focuses on the legal and ethical challenges that arise when providing child psychotherapy. The legal and ethical issues that drive the practice of child psychotherapy are guided by the laws of the community in which the therapist practices and the therapist’s professional organizations. Psychotherapists need to know the code of ethics for his or her respective professional organization. Child psychotherapy can also become forensically complicated when dealing with the child welfare system and family court issues such as divorce, custody, and adoption. This can create a frustrating and stressful process for therapists and clients, alike. The therapist’s compliance with informed consent legal and ethical requirements often requires that a document be provided to the client about what he or she can expect from the therapist and the treatment. Risk assessment documents the therapist’s assessment of the client’s potential for danger to self and others.
This chapter clarifies treatment throughout the similarities as well as the differences between eye movement desensitization reprocessing (EMDR) therapy and sensorimotor psychotherapy in child treatment. Dysregulated arousal and overactive animal defenses biased by traumatic experience are at the root of many symptoms and difficulties observed in traumatized children. Traumatic or adverse experiences are encoded in memory networks in the brain. The adaptive information processing (AIP) looks at different components of the memory network: cognitive, emotional and somatic. EMDR therapy and its phases access not only the cognitive aspects of the memory, but the affective and bodily states. In working with children, microphones may add a playful approach to translating the body’s language. Oscillation techniques are also useful in helping children to shift their focus from dysregulated states to a more resourced experience, which supports flexibility in state shifting and increases awareness of different states.
This chapter presents several strategies, analogies, and metaphors to address dissociation from different angles and perspectives. Clinicians will have a wide range of methods of introducing and explaining dissociation to children. Analogies and stories that help children understand the multiplicity of the self may be presented during the preparation phase of eye movement desensitization and reprocessing (EMDR) therapy. A good way of introducing the concept of dissociation is by using the dissociation kit for kids. Stimulating interoceptive awareness is a fundamental aspect of the work needed during the preparation phase of EMDR therapy with dissociative children. Visceral, proprioceptive, as well as kinesthetic-muscle awareness should be stimulated. The installation of present resolution (IPR) was inspired by an exercise developed by Steele and Raider. In this exercise, the child is asked to draw a picture of the past traumatic event followed by a picture of the child in the present.
This chapter reviews the theories of child psychotherapy and the associated treatment interventions as the next step of integrating theories of developmental psychology into clinical practice. It provides an overview of specific psychotherapies that are significant to the treatment of children; psychodynamic, cognitive behavioral, experiential, family systems, and integrative approaches. The chapter also reviews some of the diagnosis-specific treatment protocols. Trauma-focused cognitive behavioral therapy (TF-CBT) combines cognitive therapy, behavioral therapy, and family therapy in a specific treatment protocol focused on psychotherapy with children who have experienced trauma primarily from abuse. The chapter suggests that case conceptualization in eye movement desensitization and reprocessing (EMDR) with children can include both directive and nondirective roles from the therapist depending on the phase of the EMDR protocol and the individual needs of the child. EMDR is based on adaptive information processing (AIP) theory.
The primary goals of the assessment phase are to access the memory network containing traumatogenic material and to access and activate the cognitive, affective, and somatic aspects of the memory. Since the reprocessing phases of eye movement desensitization and reprocessing (EMDR) therapy follow immediately after the assessment phase, the clinician should have prepared potential interweaves in case the child’s processing of the memory gets blocked. Children with complex trauma histories may already have sensitized sympathetic systems that make them prone to being in fight flight mode even in the face of safety. The chronically traumatized children present with sensitized dorsal vagal systems. Current caregiving and attachment behaviors have the potential for activating the attachment system, and with it past dysfunctional attachment experiences. One of the best adjunct approaches that can be used within a comprehensive EMDR treatment is sandtray therapy.
Desensitization is a complex and important phase of eye movement desensitization reprocessing (EMDR) therapy. This chapter covers child-friendly strategies and interweaves that support and stimulates the social engagement system, maintain dual awareness and kindle children’s integrative capacities. It presents advanced strategies and interweaves that can facilitate the assimilation of memories of trauma and adversity as well as to promote vertical and horizontal integration. Shapiro developed a strategy to jump-start blocked processing that she called ‘the cognitive interweave’. According to Shapiro, clients spontaneously move through the three plateaus of information processing: responsibility, safety, and control/power, to a more adaptive perspective during reprocessing. Most children injured and traumatized in the adult-child relationship carry within the responsibility of the event. Mindful awareness in EMDR is pivotal during the reprocessing phases. The use of nonverbal communication strategies can greatly facilitate the process for children working on memories of events occurring pre-verbally.
This chapter provides a brief overview of the empirical support underscoring the efficacy of problem-solving therapy (PST). It also demonstrates how PST can be flexible in terms of its multiple applications across clinical problems and populations as well as with regard to the methods or venues by which it can be implemented. An example of PST applied in a group format is an outcome study that evaluated the efficacy of PST for adults reliably diagnosed with unipolar depression. Both traditional statistical analyses and an analysis of the clinical significance of the results indicated substantial reductions in depression in the PST group as compared to both the problem-focused therapy (PFT) and waiting-list control (WLC) conditions. Conceptualizing the stress associated with adjusting to cancer and its treatment as a series of problems, PST has been applied as a means of improving the quality of life of adult cancer patients.
After formal training in the four problem-solving toolkits is concluded, multiple sessions should be devoted to guided practice, where clients address various problems they are currently experiencing across various life areas using the overall Stop, Slow Down, Think, and Act (SSTA) approach. The number of practice sessions required after formal training ends is dependent on the competency level that a patient achieves as well as actual improvements in the areas related to the initial reasons for seeking treatment. Therapists are advised to continue evaluating and monitoring patients’ motivation to apply and practice the problem-solving tools. Clients are also directed to engage in future forecasting by predicting any changes in one’s life circumstances, positive or negative, that might occur in the near future as a means of adequately addressing them via problem solving. Any problems with termination should be addressed by the therapist and client as a problem to be solved.
This chapter focuses on Toolkit #4, Planful Problem Solving. This toolkit focuses on teaching individuals four sets of planful problem-solving skills: problem definition, generation of alternatives, decision making, and solution implementation and verification. Two versions for training in these tools includes: “Brief” Planful Problem-Solving Training and “Intensive” Planful Problem-Solving Training. The briefer form of training in this toolkit involved providing individuals with an overview of the four planful problem-solving steps, as well as guided practice applying the “Problem-Solving Worksheet”, which provides for a specific structure to effectively cope with various extant problems. The more intensive training program allows for additional extensive training in any or all of these four tasks. The chapter provides three cases as illustrations of how individuals can use the Problem-Solving Worksheet to help resolve stressful problems based on discussions with, and training by, their therapists.
- Go to chapter: A Problem-Solving Approach to Understanding Psychopathology: A Diathesis-Stress Model
This chapter provides an overview of a conceptual model that explains the role that social problem solving (SPS) plays regarding adaptive versus maladaptive reactions to stressful life events, both major and minor in nature. This model describes the interplay among three related systems, each of which provides for a level of analysis regarding stressful events, problem solving, and health/mental health outcomes. System I is a distal system and represent the first level of analysis that focuses on the relationship between certain genetic factors and early childhood life stress. System II, the proximal system, focuses on later life and the interactions among major negative life events, daily stressors, and various neurobiological systems that are etiologically related to extant distress. The third system, System III, is the more immediate level of analysis and represents a more microanalytic perspective that addresses the interactions among stressful stimuli, various brain components, and emotions.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of the book. The book serves as a basic treatment manual and delineates general intervention strategies of contemporary problem-solving therapy (PST) that are required to effectively conduct this intervention approach. PST has been conceptualized and implemented as both a system of psychotherapy as well as a brief, skills-oriented training program. Problem-solving skills referred to the set of cognitive-behavioral activities by which a person attempts to discover or develop effective solutions or ways of coping with real-life problems. The book distinguishes between the concepts of problem solving and solution implementation. A solution is a situation-specific coping response or response pattern that is the product or outcome of the problem-solving process when it is applied to a specific problem situation.
This chapter addresses a variety of general clinical and therapy issues regarding the effective implementation of problem-solving therapy (PST). It discusses the ideal problem-solving therapist and emphasizes the importance of the therapist-client relationship. The chapter describes a variety of adjunctive therapy strategies and instructional guidelines that can be used by the clinician to enhance a client’s overall problem-solving learning and skill acquisition. It provides a list of ‘do’s and don’ts’ specifically related to the effective implementation of PST. It is important for the PST therapist to be well-versed in the areas of social problem solving, stress, emotional regulation, brain-behavior relationships, and the various details of a variety of health and mental health problems. Similar to many other directive forms of psychotherapy or counseling, particularly those under a cognitive-behavioral umbrella, the success of PST to a large degree depends on the effectiveness of the manner in which it is actually implemented.
This chapter focuses on practical assessment issues related to the effective implementation of problem-solving therapy (PST). When comparing an individual’s Social Problem-Solving Inventory-Revised (SPSI-R) scores with the normative data provided in the manual, raw scores are converted to standard scores such that the total SPSI-R score as well as each of the five major scale and four subscale scores have a mean of 100 with a standard deviation of 15. If the referral problem is specific, or if PST is being provided to a group that was constituted around a common diagnosis, other checklists may exist or can be developed that include common problems related to that diagnosis or group theme. Group treatment can be preferable in those situations where multiple clients are able to serve as sources of feedback to each other regarding both problem-solving skill acquisition and implementation.
- Go to chapter: Overview of the Problem-Solving Therapy Process, Introductory Sessions, and the Case of “Megan”
This chapter presents the therapy manual detailing the specific treatment guidelines encompassing problem-solving therapy (PST). It is important during the initial sessions with a new client to develop a positive therapeutic relationship. Upon obtaining a brief version of the client’s story, it becomes important early in treatment to provide an overview of PST that includes a rationale for why it is relevant to, and potentially effective for, this individual. Problem solving can be thought of as a set of skills or tools that people use to handle, cope with, or resolve difficult situations encountered in daily living. Research has demonstrated that social problem solving is comprised of two major components. The first is called problem orientation. The second major component is one’s problem-solving style. The chapter also presents the case of a 27-year-old woman suffering from multiple concerns, including anxiety, depression, fears of “going crazy”, and prior alcohol abuse.
- Go to chapter: Toolkit #2—The SSTA Method: Overcoming Emotional Dysregulation and Maladaptive Problem Solving Under Stress
Toolkit #2—The SSTA Method: Overcoming Emotional Dysregulation and Maladaptive Problem Solving Under Stress
This chapter focuses on the second Problem-Solving Toolkit the Stop, Slow Down, Think, and Act (SSTA) method of overcoming emotional dysregulation and maladaptive problem solving under stress. The importance of this toolkit is to help individuals prevent strong emotional arousal from escalating, such that effective problem solving becomes extremely difficult to engage in. Encountering emotional stimuli triggers a multitude of neurobiological reactions in the body as well as cognitive interpretations of the source and nature of such stimuli. According to Gross and Thompson, five differing sets or categories of emotion regulation processes or strategies can be identified: situation selection, situation modification, attention deployment, cognitive change, and response modulation. The SSTA toolkit encompasses the following components: becoming more emotionally mindful, identifying unique triggers, and “slowing down”. The chapter presents a case study that provides a series of clinical dialogues illustrating the use of the SSTA approach and the yawning technique.
- Go to chapter: Toolkit #3—Healthy Thinking and Positive Imagery: Overcoming Negative Thinking and Low Motivation
This chapter explains the third toolkit, Healthy Thinking and Positive Imagery, and addresses two significant barriers to effective problem solving: that of negative thinking and feelings of hopelessness. The two activities in this toolkit to help people overcome negative thinking habits include: the “ABC” model of healthy thinking, and reverse advocacy role-plays. The “ABC Model of Healthy Thinking” was introduced as a means by which to better identify one’s negative thinking in order to eventually dispute such inaccuracies with more positive self-statements. A second tool to help individuals overcome their negative thinking involves an in-session role-play procedure and is aimed at helping patients change their maladaptive beliefs and distorted perceptions of external stimuli. Other potential barriers to coping effectively with stressful problems are feelings of hopelessness and poor motivation characteristic of a negative problem orientation.
This chapter described the first Problem-Solving Toolkit, that of Problem-Solving Multitasking. As with the other toolkits, this first one is included in PST in order to help individuals to overcome ubiquitous barriers to effective problem solving. The processing of information becomes increasingly difficult when a person is under stress. Additional tools become necessary to help people cope with problems, particularly if such problems are stressful and engender high levels of negative emotions. PST focuses on teaching individuals three multitasking strategies to address this concern: Externalization, Visualization, and Simplification. Externalization involves the display of information externally as often as possible. Visualization emphasizes the use of visual imagery for a variety of purposes that can positively impact the problem-solving process. Simplification involves attempting to break down or simplify a large or complex problem in order to make it more manageable.
This chapter examines the roles that lifestyle factors and climate change play in the onset and exacerbation of emerging disabilities, and provides examples of chronic illnesses and disabilities linked to lifestyle and climate change that are increasing in the population. It considers the medical, psychosocial, and vocational characteristics of emerging disabilities associated with lifestyle and climate change, and explores characteristics of populations at risk of acquiring disabilities and chronic illnesses associated with lifestyle and climate change. The respective incidences of diabetes, asthma, and heart disease have reached epidemic proportions in the United States. The chapter presents an overview of the health impacts of extreme heat, extreme weather events, air pollution, and vector-borne diseases. Temperature increases, changing precipitation patterns, and extreme weather events have resulted in the increased spread of vector-borne diseases. Health promotions services may be especially beneficial to individuals with lifestyle disabilities to assist them with changing health-related behaviors.
This chapter defines emerging disabilities; explores medical, psychosocial, and vocational implications of emerging disabilities that distinguish them from traditional disabilities; and provides demographic characteristics of individuals who are most vulnerable to acquiring emerging disabilities. It examines some social and environmental trends that have contributed to the development of emerging patterns and types of disabilities including advances in medicine and assistive technology, globalization, climate change, poverty, violence and trauma, the aging American populace, and disability legislation. Psychological and physical trauma from warfare, violent crime, intimate partner violence, and youth violence can result in permanent physical, cognitive, and psychiatric disabilities. Diagnostic uncertainties, misdiagnoses, and skepticism on the part of medical providers are frequently associated with emerging disabilities. Women also represent a population that is at an increased risk of acquiring emerging disabilities and chronic illnesses. Rehabilitation systems are still not fully prepared to address the multifaceted needs of individuals with emerging disabilities.
This chapter examines the medical, psychosocial, and vocational characteristics, challenges, and rehabilitation needs of emerging populations of individuals with psychiatric disabilities, and introduces a recovery-oriented approach to providing responsive services to individuals with psychiatric disabilities. It explores integrated, evidence-based, and emerging practices to facilitate better recovery and rehabilitation outcomes for these populations. The onset of psychiatric disabilities occurs during critical years when major changes are occurring in the areas of identity formation and cognitive, psychosocial, psychosexual, and career development. Many individuals with psychiatric disabilities receive their health care in emergency departments and intensive care units and not until their secondary conditions create medical crises. Substance use disorders (SUDs) often co-occur with psychiatric disabilities. The principles of recovery align with the core values and principles of rehabilitation counseling. Illness management and recovery (IMR) is an evidence-based practice for equipping individuals with the knowledge and skills they need to self-manage their disabilities.
- Go to chapter: Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
This chapter defines neurodevelopmental disorders, and examines the medical, psychosocial, and vocational aspects of two neurodevelopmental disorders that are increasing in the U.S. population: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). It provides populations at risk of being diagnosed with ASD or ADHD, and distinguishes key considerations for outreach, eligibility determination, and rehabilitation assessment and planning. The chapter considers services to be included in the rehabilitation plan to facilitate goal achievement for consumers with ASD or ADHD, and examines evidence-based practices in job development, placement, and retention. Both ASD and ADHD can be accompanied by co-occurring psychiatric disabilities. Counseling and guidance are always individualized to the unique characteristics, rehabilitation needs, and preferences of each rehabilitation consumer. Rehabilitation counselors must also take into consideration the importance of family involvement in the transition and rehabilitation of youths with ASD and ADHD.
This chapter highlights topic areas in which research is needed to more fully understand the nature and needs of people with emerging disabilities, and examines current trends in rehabilitation counseling research and how investigations with people with emerging disabilities are compatible with these trends. It describes types of emerging disabilities for which health care, community living, and vocational experiences should be investigated more thoroughly in future research. The chapter addresses methodological and data analytic strategies that rehabilitation researchers can use to study the complex, multidimensional needs of people with emerging disabilities. Intervention studies that promote evidence-based practices will be increasingly important in future emerging disabilities research. Multivariate data analytic technique that provides opportunities to more effectively model the complexity of the real world in which people with emerging disabilities live is multilevel modeling (MLM), also known as hierarchical linear modeling (HLM).
This chapter describes changes in the age demographic of the American populace that will steadily increase the number of elderly people in the United States for the next 30 years, and examines the relationship among aging, health, and disability. It provides the characteristics and needs of people who have frequently occurring aging-related disabling conditions such as dementia, rheumatoid arthritis, and stroke. The most common chronic health conditions for people over the age of 65 include arthritis, hypertensive disease, heart disease, hearing impairments, musculoskeletal impairments, chronic sinusitis, diabetes, and visual impairments. It is important for rehabilitation counselors to understand the impact that population aging has had and will continue to have on family interaction and socialization, the American economy, and human health care and social service systems. In providing counseling and guidance services to individuals with age-related disabilities, the issue of chronicity is often of paramount concern.
This chapter discusses medical, psychosocial, and vocational issues across emerging disability populations that should be addressed in the rehabilitation process. It also discusses the application of the ecological model developed by Szymanski, Hershenson, Ettinger, and Enright as a framework for assessment and planning with consumers who have emerging disabilities. The chapter examines the role that rehabilitation counselors can play in responding to issues affecting the lives of people with emerging disabilities in each phase of the rehabilitation process. Outreach to administrators, school counselors, mental health counselors who provide school-based services, teachers, school psychologists, parents, and students may be necessary to ensure that these students are made aware of the availability of rehabilitation services. One of the primary goals of counseling and guidance is to facilitate psychosocial adaptation to disability. Rehabilitation counselors can play a pivotal role in assisting consumers with emerging disabilities to develop health literacy skills.
This chapter demonstrates the methodology for formulating cases using the adaptive information processing (AIP) and Indicating Cognitions of Negative Networks (ICoNN) models in conjunction, with clinical case material. ICoNN 4 is the fourth and final category of presentation within the ICoNN model. The psychotic phenomena cause distress and a functional impairment to the person, but the psychological pathogen cannot be identified in the standard way, nor can it be tracked back across an affect bridge. There are no “heard voices” capable of being engaged in dialogue. What can be identified is a Gestalt that relates to psychotic material being presented, which possesses strong, and negatively valenced, emotion. In respect to the second and third targets, the dysfunctional memory network (DMN) could be identified and was reprocessed according to the standard eight-phase, three-pronged protocol of eye movement desensitization and reprocessing (EMDR) therapy.
This chapter demonstrates the methodology for formulating cases using the adaptive information processing (AIP) and Indicating Cognitions of Negative Networks (ICoNN) models in conjunction, with clinical case material. It helps the reader to equip clinicians with the knowledge of how to target eye movement desensitization and reprocessing (EMDR) therapeutic endeavors with people diagnosed with schizophrenia or other psychoses. In the second category of presentations in the ICoNN approach, the psychotic phenomena are evident upon examination and cause distress resulting in a functional impairment. However, the psychological pathogen cannot be identified in the standard way. As a consequence, the dysfunctional memory network (DMN) cannot be understood and acknowledged by the person as the memory system that is driving the psychosis. However, strong emotions, which can be felt, are tracked back across an affect bridge, which allows identification of the DMN. This is then reprocessed in the standard way.
This chapter examines a history of bipolar disorders so that the dramatic differences in the prevalence of this disorder over time will make some sense. It provides the rationale for the addition of the bipolar II category in 1994 to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The chapter discusses the history of the bipolar category, and reviews its neuroscience and genetics. It then reviews current pharmacological treatments and their outcomes. It then provides the case for kindling, because part of the rationale for early treatment of bipolar disorder derives from the kindling hypothesis. The chapter covers alternative, nontraditional treatments. Lithium, anticonvulsant and atypical antipsychotics are used in the treatment of bipolar disorders. Keeping a regular schedule for eating and sleeping improves outcome for both those with bipolar I and II. All of the drugs used to treat bipolar I induce depressive symptoms.
This chapter provides the reader with a working knowledge of the relationship between trauma, schizophrenia, and the other psychoses. Trauma and its consequences have been a part of society for a very long time. The psychological impact of the trauma of war became most widely known as “shell shock” in World War I. Wartime features heavily in the development of the nomenclature of the psychological impact of trauma. Posttraumatic stress disorder (PTSD) is the archetypal response to a traumatic event, and the concept soon expanded from the military to all of society as potential sufferers. The evolution of the diagnosis of schizophrenia was characterized by a move away from a trauma/dissociation model and toward a biological diathesis model, which resulted in schizophrenia’s phenomena being viewed as psychologically incomprehensible. There is no single cause of psychosis, just as there is no single gene.
This chapter discusses various types of violence and their impact on human health, functioning, and onset of physical and psychiatric disabilities, and identifies approaches and programs for treating individuals who have sustained disabilities from violent acts. It examines populations that are most vulnerable to violence, and explores trauma-informed approaches to providing services to these clients in all phases of the rehabilitation counseling process. Military sexual trauma (MST) is heavily confounded by military culture, making the decision to report sexual trauma extremely difficult. The functional limitations associated with disabilities acquired through violence can substantially impair survivor’s ability to achieve and maintain competitive employment. Outreach may be particularly necessary to inform individuals with violence-related disabilities about rehabilitation services. Frain et al. emphasized the importance of training in self-management techniques for veterans because they tend to have poor self-management skills.
This chapter defines chronic pain, types, and causes; describes medical characteristics of two emerging chronic pain conditions namely chronic migraines and fibromyalgia; and discusses symptomology, diagnosis, and treatment issues associated with these conditions. It explores the medical, psychosocial, and vocational aspects of chronic pain, and examines the characteristics of populations most likely to experience chronic pain. The chapter presents recommendations for providing responsive rehabilitation counseling services to the growing numbers of individuals living with chronic pain who are served by rehabilitation counselors across all employment settings. As myths about chronic pain are so prevalent, rehabilitation counselors must carefully examine their own potential biases and misconceptions about chronic pain, its causes, and treatment. Complementary health approaches are often used by people with chronic pain and may include yoga, spinal manipulation, massage therapy, heat and cold applications, meditation, acupuncture, herbal medicines, vitamins, and minerals.
The largest category of psychotic disorders is schizophrenia. In categorizing the classic signs of schizophrenia, symptoms are organized into the categories of positive and negative signs. The risk factors for schizophrenia do influence the development of the fast-spiking gamma-aminobutyric acid (GABA) interneurons. Many of the genetic risk factors for schizophrenia code for proteins involved in the function of the N-methyl-d-aspartate (NMDA) receptor. Antipsychotic drugs are the current mainstay treatment for psychosis. It occupies the D2 receptors. Sarcosine achieved significant reductions in positive and negative symptoms in those with schizophrenia. Nitta et al. conducted a meta-analysis of the studies examining the use of nonsteroidal anti-inflammatories as an adjunct in the treatment of schizophrenia. As the developments in the understanding of the neurological and biochemical mechanisms of schizophrenia have accelerated, philosophic change has also impacted the world of clinical treatment.