DUE TO NEW COVIDE-19 LEVEL 5 RESTRICTIONS FROM THE 22ND OCTOBER ALL SESSIONS WILL MOVE ONLINE.
Advanced Specialist in Adolescent Psychotherapy
Creative Expressive Methods It is well noted inthescientific literature thattheexternalizingoftroubling experiences, thoughts and feelings is the nature and purpose in all psychotherapeutic approaches (Malchiodi&Perry, 2015). However,adolescentsare not alwaysable to engage in talk therapy (Green&Drews,2014).Developmental maturation, configuration style, andtrauma(Starrs,2019) may be the culpritof suchdifficulties. Some clinicians consider the sole use of dialogic methods inefficientin psychotherapy work with young clients as Green and Drews state “Traditional talk therapy alone is generally unsuccessful when working with children and adolescents, especially within the developmental context of young childhood”(2014, p.2).ForStarrs(2019)an attuned therapist canobservetheadolescentclient shifting to a more remote posture, or completely stopping contact when dialogic methods become difficult for them.Starrscontends that inthesesituationswhen intensity and shame are to be moderated,the use ofcreative methods can be extremely useful (2019).
Working with Parents Field Theory, was postulated by the German psychologist Kurt Lewis and is considered a central tenet of Gestalt Therapy. Lewis posited that understanding a person outside his/her environmental field context is not possible (1952). McConville (1995), a renowned clinical psychologist specialised in adolescent psychotherapy contends that the family is the field from which the child’s behavioural and experiential make up arises and are shaped by, in his view “Adolescents can be understood only as part of the larger fields in which they live, and only when we see and appreciate their very personal, subjective struggles to renegotiate their status within those fields, find meaning and a place for themselves, and, at the heart of that struggle, give birth to an existential self” (1995, p. xxii). Gestalt therapy was adopted by McConville over other forms of psychotherapy because in his experience other approaches where not able to see the whole picture of adolescence, for psychoanalysis gave him understanding about the internal world of the person, but little insight about the systemic context and the practical side of working with adolescents, meanwhile family systems taught him a good deal about childbearing and development, but he saw that it lacked explanations about the inner world of the adolescent (1995). In his view Gestalt is a model that bridges this gap both theoretical and clinical, as this model is interested not only on the inner world but also in the changes occurring in the adolescent’s social and familial world, perhaps focusing more on the construction of experience which brings insight into the adolescent’s inner world and the changes happening between the individual and the social field (1995). Gestalt emphasizes the importance attuned relationship plays in childhood development; the view on human interconnectedness, and how the self/other development is rests on intersubjective and co-constructed experience (Lee, 2017). However, as scientific evidence suggesting that parental involvement is a must for effectiveness and efficiently of clinical treatment of children and adolescents (Haine-Schlagel & Walsh, 2015) started to grow, the development of models utilizing parental inclusion in the treatment of adolescents started to be developed. In psychoanalysis, a study done by Fonagy & Target in 1996 analyzed 763 cases of psychotherapy offered to youth populations, concluding that success in child therapy is simply impossible without changes in family dynamics or parental changes. Oren (2011) argues that the Fonagy and Target study kick-started developing psychoanalytical models that would change from work solely with the individual to include parents in sessions. Dowell & Ogles (2010) meta-analytic review of 48 child psychotherapy studies, in cognitive and non-cognitive approaches, when comparing individual to combined parent-child therapy concluded that “including parents in the psychotherapeutic treatment of children adds benefits beyond the outcomes achieved by individual child therapies” (p.151). This is in agreement with Kazdin view, a renowned name in the CBT field, that if best practice in working with children and adolescents is to be achieved, the inclusion of parents during assessment and periodically throughout treatment is a must (2000). Oren (2011) classify the main way inclusion of parents occurs in therapy as 1) originated in child therapy, the child is at the core of the process and parental inclusion occurs only when meeting parents to update them about therapy and listen to their concerns or feedback; 2) methods centred at parental education and guidance on parenthood; 3) Relationship Therapy where the emphasis is on the family dyadic relationships. Sessions may occur with father-child, mother-child and father-mother or with the specific problematic member in the relationship, the prominence in this therapy is given to child-parent relationships where the parent is invited as a partner to the process; 4) Family therapy which sees parents as part of the treatment, the goal is to help parents succeed in ascertaining their roles as leaders of the system. Orel (2011) recognised the importance of such models of parental inclusion in therapy. Notwithstanding, he spoke about the need for interventions that dealt with parents as main issues to children’s mental health and developed a psychoanalytical model named PPT or Psychodynamic Parenthood Therapy aimed at helping parents with parenthood issues. Studies have shown that parental psychopathology increases risk for children internalised problems (Connell & Goodman, 2002), in fact in a 2013 study, Siddaway, Wood, & Cartwright-Hatton highlighted how parental anxiety negatively affects children’s anxiety levels, and how offering psychoeducation about anxiety to not only the child but to parents and explaining how parental styles negatively influence the child positively impacted on anxiety reduction.
How the adolescent makes contact with themselves and the world Gestalt adolescent development can be explained by utilising Kurt Lewin’s field theory (1939). In his influential work Lewin postulated that “adolescents do not develop in isolation, but that development is an integrative process of biological, psychological and social circumstances which shapes how we construct our experience and move forward in the world” (p. 3). For young persons the family is considered as the background or ground as Gestaltists call it, that organises the effect on the behaviour and emergent personality of the individual or figure, another term used in Gestalt that classifies what we are attending to and aware of in here and now (McConville, 1995). This mutual influencing space of ground and figure has been termed lifespace by Lewin (1939). In this view any part of the system will affect the whole system, hence the work of a therapist is to understand that the whole determines the parts, and how the interplay between ground and figure are affecting the client (Clarkson, 1999). Lewin spoke about how children’s behaviours are moulded by social situations and facts, therefore what determines a child’s morale, ideology, religion and political views is the societal environment the child is part of (1939). To understand the adolescent experience, the therapist is asked to understand the relevant factors in his/her lifespace such as family, socioeconomic position, political views, spiritual belief system, cultural and historical factors, and how this weave into emotional and psychological problems (Gold & Zahm, 2018). The Gestalt view in child and adolescent development is indeed contrary to the most used psychological developmental model that understands development to be a succession of developmental and distinct stages characterized by differences in behaviour (Erikson, 1962; Piaget, 1977), in Gestalt therapy “…no domain of change is prior to another; both of these are expressions of a more comprehensive reorganization of the field, an evolution of the contact functions and boundary processes that define the very meaning of self” (McConville, 1995, p. 7). Gestalt also sees the conflicts between superego and impulse, with the wish to act out those forces and the success or failure in regulating such wants, as part of the intrapsychic and interpersonal field process, rather than a separate individual phenomena (McConville, 1995). The term contact is used in Gestalt (Perls, Hefferline, & Goodman, 1951) to refer to self in touch with what is arising in the here and now. Renowned Gestalt Child and Adolescent therapist Violet Oaklander (2006) refers to contact as the way the individual uses the environment to satisfy a need, adolescents with healthy contact style make contact with the environment by utilising all sensorial and intellectual faculties in a healthy manner in order to satisfy a need, by that she means that the adolescent will have “the ability to be fully present in a particular situation with all of the aspects of the organism-senses, body, emotional expression, intellect-ready and available for use (p. 22), joining and withdrawing from the contactful space appropriately (Oaklander, 1997). This space is termed contact boundaryin Gestalt which Starrs (2019) considers as “the concrete, experiential meeting place of self and other” (p.4). These contact boundaries relates to the point where the individual experience the I to that which is not I, the functions of such contact boundaries is to connect people with others, and simultaneously maintain a separation between them in order for identity to be retained (Blom, 2006). It is in the contact making and withdrawal process that adolescents meet their needs and growth is attained, hence contact boundary rigidity or inflexibility will impede growth leading to a poor sense of self (Blom, 2006). Healthy contact contains “awareness, excitement and the mobilization of energy” on four stages of contact, namely fore-contact, contact, final contact, and post-contact (Gold and Zahm, 2018). For this healthy abilities to contact to be developed the organism needs a supportive environment, if this is lacking the organism will creatively adjust on the basis on his/her “perceptions, experience, creativity, and resources adapting to the situation” (Gold & Zahm, 2018, p. 100). The main issue is that creative adjustment that were once helpful so as to survive, becomes a habit and out of awareness, parts of the self that are not identifiable, ignore or entirely disowned leads to rejection, internal conflicts and negative view of self (Gold & Zahm, 2018) and shame (Starrs, 2019). The later added point on shame has been argued by Starrs who contends that presenting issues are directly related to the level of support adolescents receive from the environment, along with a lifespace situation filled with shame. Shame in this context is a result of yearnings for integrity at a psychological, physiological and interpersonal level (2019).
“They have faith in me, I can have faith in myself and my expanding world” (Starrs, 2019, p.26)
Awareness, accepting and understanding what was then and what is now. Wholeness is integrating what once was disowned, ignored or dormant. Interconnectedness and Interdependence: We get ill if not meeting. We heal through connecting. Not Individuals, but organism in an environmental field.
References Finlay, L. (2016). Relational integrative psychotherapy: Engaging process and theory in practice. Chichester, West Sussex: John Wiley & Sons. Gray, A. E. (2015). Dance/Movement Therapy with Refugee and Survivor Children A Healing Pathway Is a Creative Process (C. Malchiodi & B. Perry, Eds.). In Creative interventions with traumatized children. New York: The Guilford Press. Graves-Alcorn, S & Green, E. J. (2014). The Expressive Arts Therapy Continuum: History and Theory (E. J. Green & A. Drewes, Eds.). In Integrating Expressive Arts and Play Therapy With Children and Adolescents(pp. 1-16). New Jersey: John Wiley & Sons. Green, E. J., & Drewes, A. A. (2014). Integrating expressive arts and play therapy with children and adolescents. Hoboken, NJ: Wiley. Knill, P. J., Levine, E. G., & Levine, S. K. (2005). Principles and practice of expressive arts therapy: Towards a therapeutic aesthetics. Philadelphia, PA: Jessica Kingsley. Malchiodi, C. (2015). Neurobiology, Creative Interventions, and Childhood Trauma. In Creative interventions with traumatized Children(pp. 3-23). New York: The Guilford Press. Malchiodi, C. A., & Perry, B. D. (2015). Creative interventions with traumatized children. New York: The Guilford Press. Norton, C. L. (2011). Innovative interventions in child and adolescent mental health. New York: Routledge. Schreier, H., Ladakakos, C., Morabito, D., Chapman, L., & Knudson, M. M. (2005, 02). Posttraumatic Stress Symptoms in Children after Mild to Moderate Pediatric Trauma: A Longitudinal Examination of Symptom Prevalence, Correlates, and Parent-Child Symptom Reporting. The Journal of Trauma: Injury, Infection, and Critical Care,58(2), 353-363. doi:10.1097/01.ta.0000152537.15672.b7 Starrs, B. (2019). Adolescent psychotherapy: A radical relational approach. Milton Park, Abingdon, Oxon: Routledge. Wiener, D. J. (2001). Beyond talk therapy: Using movement and expressive techniques in clinical practice. Washington: American Psychological Association. Wolfert, R., & Cook, C. (1999). Gestalt Therapy in Action. In Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical Practice. Washington: American Psychological Association. Yalom, I. D. (1989). Love's executioner: And the other tales of psychotherapy. London: Bloomsbury.
References Blom, R. (2006). The handbook of gestalt play therapy: Practical guidelines for child therapists. London: Jessica Kingsley. Clarkson, P. (1999). Gestalt counselling in action(Second ed.). London: Sage. Connell, A. M., & Goodman, S. H. (2002). The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: A meta-analysis.Psychological Bulletin,128(5), 746-773. doi:10.1037//0033-2909.128.5.746 Dowell, K. A., & Ogles, B. M. (2010). The Effects of Parent Participation on Child Psychotherapy Outcome: A Meta-Analytic Review. Journal of Clinical Child & Adolescent Psychology,39(2), 151-162. doi:10.1080/15374410903532585 Erikson, E. H. (1961). Identity and the life cycle: Selected papers. New York. Fonagy, P., & Target, M. (1996). Predictors of Outcome in Child Psychoanalysis: A Retrospective Study of 763 Cases at the Anna Freud Centre. Journal of the American Psychoanalytic Association,44(1), 27-77. doi:10.1177/000306519604400104 Gold, E., & Zahm, S. (2018). Buddhist Psychology and Gestalt Therapy Integrated(Vol. 1). Portland: Metta Press. Haine-Schlagel, R., & Walsh, N. E. (2015). A Review of Parent Participation Engagement in Child and Family Mental Health Treatment. Clinical Child and Family Psychology Review,18(2), 133-150. doi:10.1007/s10567-015-0182-x Hawley, K. M., & Weisz, J. R. (2005). Youth Versus Parent Working Alliance in Usual Clinical Care: Distinctive Associations With Retention, Satisfaction, and Treatment Outcome. Journal of Clinical Child & Adolescent Psychology,34(1), 117-128. doi:10.1207/s15374424jccp3401_11 Hefferline, R. F., Goodman, P., Fritz. P.(1951). Gestalt Therapy: Excitement and Growth in the Human Personality. Goudsboro: Gestalt Journal Press. Kazdin, A. E. (2000). Psychotherapy for Children and Adolescents: Directions for Research and Practice. Oxford University Press. Lee, R. (2017). Shame & Belonging in Childhood. The Interaction Between Relationship and Neurobiological Development in the Early Years of Life. In Relational Child, Relational Brain: Development and Therapy in Childhood and Adolescence(pp. 55-74). Santa Cruz: Gestalt Press. Lewin, K. (1939). Field Theory and Experiment in Social Psychology: Concepts and Methods. American Journal of Sociology,44(6), 868-896. doi:10.1086/218177 Lewin, K. (1952). Field Theory in Social Science: Selected Theoretical Papers. London: Tavistock Publications. Manassis, K., Lee, T. C., Bennett, K., Zhao, X. Y., Mendlowitz, S., Duda, S., . . . Wood, J. J. (2014). Types of parental involvement in CBT with anxious youth: A preliminary meta-analysis.Journal of Consulting and Clinical Psychology,82(6), 1163-1172. doi:10.1037/a0036969 McConville, M. (1995). Adolescence: Psychotherapy and the Emergent Self(First ed.). Oregon: A Gestalt Institute of Cleveland Publications. Oaklander, V. (1997). The Therapeutic Process With Children and Adolescents. Gestalt Review,1(4), 292-317. Oaklander, V. (2006). Hidden treasure: A map to the child's inner self. London: Karnac. Oren, D. (2011). Psychodynamic Parenthood Therapy: A model for therapeutic work with parents and parenthood. Clinical Child Psychology and Psychiatry,17(4), 553-570. doi:10.1177/1359104511426403 Piaget, J. (1977). The essential Piaget. London: Routledge & Kegan. Siddaway, A. P., Wood, A. M., & Cartwright-Hatton, S. (2013). Involving Parents in Cognitive-Behavioral Therapy for Child Anxiety Problems. Clinical Case Studies,13(4), 322-335. doi:10.1177/1534650113510398 Starrs, B. (2019). Adolescent psychotherapy: A radical relational approach. New York: Routledge. Weisz, J. R., & Kazdin, A. E. (2017). Evidence-based psychotherapies for children and adolescents. New York: The Guilford Press.
Joint assessment (Parents and Adolescent) is a must as the therapist is interested in understanding how early years experiences have shaped the brain of the child. Key informations such as pregnancy, birthing, family mental health, transgenerational trauma, amongst others can't be obtained by the adolescent and as such parental assessment with the adolescent is extremely important. Usually assessment takes over two sessions.
"The essential condition for healthy development is the presence of nurturing, non-stressed, non-depressed, attuned parenting caregivers. The architecture of the brain is constructed through an ongoing process that begins before birth, continues into adulthood and establishes either a sturdy or a fragile foundation for all the health, learning, and behaviour that follows. The interaction of genes and experiences literally shapes the circuity of the developing brain, and is critically influenced by the mutual responsiveness of the adult-child relationships, particularly in the early childhood years". (Center on the Developing Child at Harvard University, 2007).
Recommendations: Books For Supporting Parenting The power of showing up - Dan Siegel Hold on to your Kids - Dr. Gabor Mate Parenting from the Inside Out - Dr. Dan Siegel The Hoffman Process - Tim Laurence and The Presence Process - Michael Brown = both for parents own process.
Videos for Supporting Parenting Please watch in order if possible.
FEES Adolescent Psychotherapy Sessions= 80 Euro per 50 minutes in person. 70 Euro online.