Child Therapists Research Articles

Predictors of child–therapist alliance in cognitive–behavioral treatment of children referred for oppositional and antisocial behavior.

We examined the therapeutic alliance in evidence-based treatment for children (N=97, 24 girls and 73 boys, ages 6-13 years) referred clinically for oppositional, aggressive, and antisocial behavior. We predicted that the quality of the child-therapist alliance would be related to therapeutic improvements in the children at the end of treatment and that the alliance would be predicted by alliance-relevant child characteristics (intellectual and social competencies) assessed before treatment. Multiple perspectives were obtained to evaluate child characteristics before treatment, alliance during the course of treatment, and therapeutic change at the end of treatment. The main findings were as follows: (1) the child-therapist alliance was related to therapeutic change at the end of treatment. The better the quality of the therapeutic alliance during treatment, the greater the therapeutic change among the children; (2) intellectual and social competencies of the child before treatment predicted the quality of the therapeutic alliance. Children higher in intellectual and social competencies formed a better child-therapist alliance; and (3) intellectual and social competencies did not account for or explain the connection of alliance and therapeutic change. The findings could not easily be attributed to the influence of other domains (socioeconomic disadvantage, parent psychopathology and stress, and severity and scope of child dysfunction) that plausibly might contribute to alliance and therapeutic change or to rater effects (common rater variance) among predictors and outcome criteria. We propose that the next steps for child-alliance research is to better describe factors that contribute to alliance and to explain precisely what mechanisms might be involved that connect alliance during treatment with changes in individual functioning.

Inconsistencies in Mothers’ and Group Therapists’ Evaluations of Resilience in Preschool Children who Live in Households with Intimate Partner Violence

The association between mother-reported child adjustment problems and group therapists’ ratings of resilience was evaluated in preschool-aged children who reside in homes where intimate partner violence (IPV) is present. Multiple reporters’ evaluations of resilience were assessed to determine how young children display resilience at home and in treatment. Reporters were mothers and child therapists who evaluated resilience in 52 preschoolers who lived in households where IPV occurs. Group therapists’ ratings of resilience were negatively correlated with children’s externalizing behavior problems. Findings indicated poor rater agreement between mothers and group therapists on some aspects of resilience. Evaluations differed based on demographic factors, with the most variability in resilience by child age. Given the lack of research on this topic and the common practice of only one informant supplying most of the data used in studies of child functioning, the current study provides unique information by comparing multiple reports across settings.

Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5-13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children's therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents' perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.

Ghostbusting Discussion: Reply to Commentaries

There is much texture one can bring to the subject of ghosts in middle childhood. Dr. Coates and Dr. Schlesinger elucidate aspects of the intergenerational relational struggles that inform child and adult therapists alike. Dissociated past trauma transmitted between parents and children implicitly creates secondary disorganizing interferences to the relationship and the child's development. The play therapist is in a unique position to create collaborative dialogues for the purposes of bringing systemic change.

What the Children Said: Children's Narrative Constructions of the Events of 9/11 in Psychotherapy

This article is based on a study of children's narrative constructions of the events of September 11 as told to their psychotherapists. Twenty psychoanalytically oriented child therapists were interviewed for case vignettes illustrating how children narrated their responses to the attacks on the World Trade Center. The therapists presented 45 different cases, some of which are discussed here. The narratives included accounts that were verbal or utilized symbolic play content or enactments and, drawings as part of play therapy. The vignettes are discussed utilizing narrative theories, narratology, and psychoanalytic and trauma perspectives. These cases reflected children who lost a parent, relative, or friend; were forced to relocate; children who witnessed the attacks personally or on television; and children who became symptomatic after the attacks. Therapists interviewed worked in school settings, clinics, or in private practice.

Factor Structure and Validity of the Therapy Process Observational Coding System for Child Psychotherapy–Alliance Scale

The aim of this study was to examine the factor structure and psychometric properties of an observer-rated youth alliance measure, the Therapy Process Observational Coding System for Child Psychotherapy–Alliance scale (TPOCS–A). The sample was 52 youth diagnosed with anxiety disorders (M age = 12.43, SD = 2.23, range = 8–15; 56% boys; 98% Caucasian) drawn from a randomized controlled trial. Participants received a manualized individual cognitive behavioral treatment, the FRIENDS for life program, in public community clinics in Norway. Diagnostic status, treatment motivation, and perceived treatment credibility were assessed at pretreatment. Using the TPOCS–A, independent observers rated child–therapist alliance from the third therapy session. Child- and therapist-reported alliance measures were collected from the same session. An exploratory factor analysis supported a one-factor solution, which is consistent with previous studies of self- and observer-rated youth alliance scales. Psychometric analyses supported the interrater reliability, internal consistency, and convergent/divergent validity of the TPOCS–A. Accumulating psychometric evidence indicate that the TPOCS–A has the potential to fill a measurement gap in the youth psychotherapy field. In youth psychotherapy, alliance may be unidimensional, so establishing a strong bond and engaging the child in therapeutic activities may both be instrumental to establishing good alliance early in treatment. However, it is important to be cautious when interpreting the factor analytic findings, because the sample size may have been too small to identify additional factors. Future research can build upon these findings by examining the factor structure of youth alliance measures with larger, more diverse samples.

Ghostbusting Transgenerational Processes

Transgenerational processes contribute to organizing and disorganizing attachment. The past (in all its forms and potentialities) lives on in the present, influencing the affective field of the parent–child intersubjective matrix. In a child's construction of self, he or she may run up against the confounding presence of ghosts: the dissociated, and thereby unreflected upon past of their parents. This implicitly felt, yet explicitly unknown transmission interferes in the processing of emergent experience and impedes the child's development. Attachment theory, informed by psychoanalysis, and nonlinear dynamic systems theory, is the main theoretical underpinning of this paper's examination of the mechanisms involved in the transfer of dissociated dynamics from parent to child. The child's symptoms grow out of an incoherent affective field that defies representational mapping into a flexible usable theory of mind. Through play a child therapist finds openings to enter the attachment system, reflecting on how a child's experience is being felt, yet unthought about by both child and parents. A parent's recognition process, thereby making what was implicitly felt explicit and consequently more coherent, supports the child in his or her efforts to reorganize aspects of the attachment relationship. Both clinical experience and quotations from literary works are woven into this paper in an attempt to convey the texture, emotional depth, and universality of the subject under discussion.

Child analysis in a changing world. In the face of a paradigm shift from the mind to the brain: Can we meet the challenge?

Child analysts and child therapists are now practicing in a new environment where an increased emphasis is made on identifying the symptoms and finding the shortest possible way to get rid of them, from the knowledge of brain functioning. From that perspective, the history of the symptom, of the child who owns it, and of the family in which this child is being raised are not emphasized as strongly. Searching for a specific meaning of such symptoms seems to be of no more interest. How can such a heavy trend be met? Major changes also have occurred within the psychoanalytic milieu. Advances from the observational world, from Spitz (1945) to Bowlby's (1987) attachment theory, provide essential knowledge to the field of early child-parent interactions. Longitudinal research in recent decades has shown close ties between early development and future outcomes. Such new knowledge is inspiring child analysis with very young children as well as with severely disturbed, older children. Early intervention with disadvantaged populations is showing the importance of the nonspecific aspects of the therapeutic relationship as a factor of change. In light of recent neurobiologic research on the influence of a specific environment-attachment experiences-on early development of the brain, it is now possible to speak of the social brain (Cozolino, 2006).

Perspectives of Child Therapists as Revealed Through Therapist Drawings

This report describes a qualitative study of the perceptions of child mental health practitioners about their own profession, as revealed through their drawings (N = 66). Thirty-three therapists participated in a developmental play therapy training workshop and drew “a picture of a child therapist” pre- and post-training. A content analysis generated 6 categories that were used to rate the drawings: the perceived age of the therapist figure, its body posture, the position of the figure to the ground line, its attentiveness toward the child figure, its differentiation from the child figure, and the placement of play and art materials depicted in the picture. Post-training drawings suggested that participant perceptions had changed. Although the figures representing therapists did not appear as adults in most of the drawings, there were a greater number of child images pictured with the therapist in the post-training drawings, and play and art materials were placed more peripherally. Overall findings provided insight into participants’ perspectives about the essential characteristics of therapists who work with children.

Caracterização do perfil comunicativo de crianças com distúrbios do espectro autístico com diferentes interlocutores

OBJETIVO: caracterizar e comparar o perfil comunicativo de crianças com distúrbios do espectro autístico com dois diferentes interlocutores. MÉTODO: participaram da pesquisa nove sujeitos, sendo quatro crianças do gênero masculino, com faixa etária variando entre cinco anos e oito meses e onze anos, com distúrbios do espectro autístico e cinco terapeutas de linguagem. Foram realizadas análises do perfil comunicativo dessas crianças com os dois diferentes interlocutores (terapeuta de linguagem da própria criança e terapeuta desconhecida). Para análise dos dados foi empregado o Protocolo de Pragmática e tratamento estatístico dos resultados (p < 0,05; Teste dos Postos Sinalizados de Wilcoxon). RESULTADOS: foram levantados o número de atos comunicativos, o meio pelo qual esses atos foram expressos (vocal, verbal e gestual) e as funções comunicativas. Em média, o número de atos comunicativos expressos pelos sujeitos tanto com os terapeutas das próprias crianças (5,10 atos/min) como com a terapeuta desconhecida (4,93 atos/min) não foi estatisticamente significante. Observou-se na situação de interação com o próprio terapeuta que a média do percentual da ocorrência do meio comunicativo verbal (31,50%) e a média de funções mais interativas (33,25%) são maiores do que com terapeuta desconhecida. CONCLUSÃO: os diferentes interlocutores, estudados nesta pesquisa, não tiveram uma influência no perfil comunicativo destas crianças. Deste modo, sugerem-se novos estudos, com inclusão de outros interlocutores, a fim de estabelecer quais variáveis interacionais interferem estatisticamente no perfil comunicativo de crianças do espectro autístico, com o intuito de contribuir para a elaboração de melhores propostas terapêuticas para esta população.

A Comparison of Methods for Collecting Data on Performance During Discrete Trial Teaching

Therapists of children with autism use a variety of methods for collecting data during discrete-trial teaching. Methods that provide greater precision (e.g., recording the prompt level needed on each instructional trial) are less practical than methods with less precision (e.g., recording the presence or absence of a correct response on the first trial only). However, few studies have compared these methods to determine if less labor-intensive systems would be adequate to make accurate decisions about child progress. In this study, precise data collected by therapists who taught skills to 11 children with autism were reanalyzed several different ways. For most of the children and targeted skills, data collected on just the first trial of each instructional session provided a rough estimate of performance across all instructional trials of the session. However, the first-trial data frequently led to premature indications of skill mastery and were relatively insensitive to initial changes in performance. The sensitivity of these data was improved when the therapist also recorded the prompt level needed to evoke a correct response. Data collected on a larger subset of trials during an instruction session corresponded fairly well with data collected on every trial and revealed similar changes in performance.

Interrater Reliability of Goal Attainment Scaling in Rehabilitation of Children With Cerebral Palsy

Steenbeek D, Ketelaar M, Lindeman E, Galama K, Gorter JW. Interrater reliability of goal attainment scaling in rehabilitation of children with cerebral palsy. Objectives To determine the interrater reliability of Goal Attainment Scaling (GAS) in the routine practice of interdisciplinary rehabilitation of children with cerebral palsy, and to examine the difference in the interrater reliability of the scores between GAS scales constructed by the children's own therapists and the scales constructed by independent therapists. Design Individually tailored GAS scales, based on predetermined criteria, were constructed at the start of a 6-month rehabilitation period. The outcome was rated independently by 2 therapists at the end of the treatment period. Two different data sets were acquired, one consisting of scores on GAS scales constructed by the children's own therapists, the other of scores on GAS scales constructed by matched independent raters of the same profession. Setting A children's unit of a medium-sized rehabilitation center in The Netherlands. Participants Physical therapists (n=8), occupational therapists (n=8), and speech therapists (n=4) participated in pairs. They constructed 2 sets of 64 GAS scales each, for 23 children with cerebral palsy. Interventions A 6-month interdisciplinary pediatric rehabilitation program. Main Outcome Measure Interrater reliability was assessed using linear-weighted Cohen's kappa. Results The scales constructed by the children's therapists had an interrater reliability of .82 (95% confidence interval [CI], .73–.91). The interrater reliability for scales constructed by the independent raters was .64 (95% CI, .49–.79). The main reason for disagreement between raters was discrepancies in the professionals' interpretation of the children's capacities versus their actual performance during assessment. Conclusions The interrater reliability of GAS used under optimal conditions was good, particularly for scales constructed by the children's own therapists.

Factors Influencing the Degree and Pattern of Parental Involvement in Play Therapy for Sexually Abused Children

Although much has been written about the role of therapists in children's recovery from child sexual abuse, relatively little attention has been paid to the role of nonoffending parents. This study investigated the work of a team of therapists who sometimes included such parents in therapy sessions with children. The study sought to understand what factors were influencing the degree and pattern of parental involvement and to understand what effect these patterns of parental involvement were having on the process and outcomes of therapy. The study successfully identified a range of factors influencing the patterns of parental involvement, but more research will be needed to understand the effect on outcomes.

Providing Information to Parents of Children with Mental Health Problems: A Discrete Choice Conjoint Analysis of Professional Preferences

We used discrete choice conjoint analysis to model the ways 645 children's mental health (CMH) professionals preferred to provide information to parents seeking CMH services. Participants completed 20 choice tasks presenting experimentally varied combinations of the study's 14 4-level CMH information transfer attributes. Latent class analysis revealed three segments. Open Access professionals (32.2%) preferred that intake workers automatically provide all parents with CMH information. They preferred information prepared by professional organizations and located at accessible settings such as public schools. They responded favorably to the internet as a source of information for parents. Controlled Access professionals (22.2%) preferred information that was approved and recommended by a child's therapist, prepared by an experienced clinician, and located at hospitals and CMH clinics. Process Sensitive professionals (45.6%) showed a stronger preference for active learning materials with parenting groups and therapist "coaching" calls supporting the knowledge transfer process. Simulations suggested that realizing the benefits of CMH information requires the development of knowledge transfer strategies that align the preferences of professionals with those of the families they serve.

Child–therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders

Few studies have examined the link between child-therapist alliance and outcome in manual-guided cognitive behavioral therapy (CBT) for children diagnosed with anxiety disorders. This study sought to clarify the nature and strength of this relation. The Therapy Process Observational Coding System for Child Psychotherapy - Alliance scale (TPOCS-A; McLeod, 2005) was used to assess the quality of the child-therapist alliance. Coders independently rated 123 CBT therapy sessions conducted with 34 children (aged 6-13 years) diagnosed with anxiety disorders. Parents reported on children's symptomatology at pre- mid-, and post-treatment. A stronger child-therapist alliance early in treatment predicted greater improvement in parent-reported outcomes at mid-treatment but not post-treatment. However, improvement in the child-therapist alliance over the course of treatment predicted better post-treatment outcomes. The quality of the child-therapist alliance assessed early in treatment may be differentially associated with symptom reduction at mid- and post-treatment. Results underscore the importance of assessing the relation between alliance and outcome over the course of therapy to clarify the role the child-therapist alliance plays in child psychotherapy.

The role of play therapists in children’s transitions: From residential care to foster care.

The role of play therapists in children’s transitions: From residential care to foster care.

Assessment of Visual Processing Disorders in Children with Other Disabilities

Visual processing disorders are a common hidden problem of children with a more visible disability, which is considered to be the primary disability even if it may affect the development and learning of the child less than his impaired vision. Early diagnosis, early intervention and thorough assessment of visual processing problems require transdisciplinary working of physicians, child's therapists and teachers, orthoptists, vision rehabilitation optometrists, psychologists, and early intervention and rehabilitation teams.

Factors Associated with Time to Therapy Referral and Length of Placement of Children in Foster Care

ABSTRACT Objective: This article explores the association between therapy referral and length of time in care in a clinical foster care population as well as the relationship between these variables and the child's behavioral characteristics. Method: Children referred for therapy at four different foster care offices of a large foster care agency in New York City were assessed on these variables. Information on behavioral characteristics was obtained from the child's foster parent, the child's teacher and the child's therapist at the beginning of therapy and at regular intervals thereafter. Results: A third of the children were discharged from care at some point during their therapy. The longer it took for a child to be referred to therapy the longer the child spent in therapy and the longer it took for the child to be discharged from care. Children that took longer to be referred for therapy were rated by teachers as presenting more somatization difficulties. Foster parents, teachers and therapists rated children that were eventually discharged from care exhibiting fewer behavior problems after 6 months of therapy. Conclusions: The importance of a timely referral to therapy for children placed in foster care is pointed out. It is argued that the therapist's involvement in the case could be an important catalyst with respect to necessary actions by the family court and other players in the foster care system which would expedite the child's return home or to other permanent caregiver. Findings underscore the importance of caseworker training in psychiatric risk assessment and mental health screening at admission to foster care.

Fear of the unknown

While there is considerable public concern over stranger‐perpetrated child sexual abuse (CSA) and abduction, much of the professional debate over this subject is characterised by quite polarised views and a dearth of reliable research‐based knowledge. In order to start addressing this situation, a major questionnaire survey was carried out among almost 2,500 children aged 9‐16 years in 26 primary and secondary schools in four types of area in north‐west England. Approximately seven per cent of children reported an attempted or completed incident. In terms of its broader messages, the research suggests that we should adopt a more balanced approach in our assessments of the seriousness of stranger CSA and abduction. The research highlights practice issues for child safety educators, the police and therapists and counsellors, relating to prevention, disclosure, reporting and re‐victimisation.

Effectiveness of the prevention program for externalizing problem behaviour (PEP) in children with symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder – generalization to the real world

The aim of the present study was to test the effectiveness of the Prevention Program for Externalizing Problem Behaviour (PEP). PEP has already been evaluated as an efficacy study, i.e., with high internal validity. The main concern of the current study was to test the effects of PEP under conditions of high external validity.58 child therapists of 37 local institutions of the public health system held PEP trainings. The intervention was evaluated by a within-subject control group design with three assessment points, two before (pre1 and pre2) and one immediately after (post) the PEP training. Depending on the type of analysis, 198 up to 277 families with children aged 3-10 years were included. Data were collected by questionnaires and comprised symptomatology of the child and the mother as well as parenting. For parenting and child behaviour problems, changes after treatment were greater than changes during the waiting period. PEP produced effect sizes in the small to moderate range. The results suggest that PEP can be delivered under routine care settings without loss of positive treatment effects. As worse results are often obtained in effectiveness trials, these findings have to be regarded as particularly promising.