Monday, September 15, 2014

9/16/14 Kaslow, Smith, and Croft

9/16/14 Kaslow, Smith, and Croft

Families with Young Children: A Developmental-Family Systems Perspective

Intro: 
  • Children are intuitive guides to the shared unconscious of the family.  They are honest, direct and their presence enhances the process of family therapy.
  • Many therapist don't include the children in family therapy, especially the younger ones.  And when they are included, developmentally appropriate adjustments aren't made so the children's voices aren't heard.
  • Family therapy with children requires that therapist know about child and family development, developmental psychopathology, systems theory.
Demographics and Descriptive Statistics
  • There are lots of children in America, of all different races and nationalities.  22% of them live in poverty.  And they live in all kinds of families, parents together, step parents, single parents, divorced families.  
  • Therapist must develop expertise in working with multiple family constellations
Child Development
  • Infancy and toddlerhood
    • Infants are completely dependent on their parents. Consistency and responsiveness in caregiving are required for the development of secure attachments.
    • Toddler hood is marked by burgeoning independence, learning to walk, start to communicate their needs, wants, and preferences through 
  • Preschoolers
    • Language acquisition, use words to communicate.
    • Still view events in an egocentric manner, the world is magical and animistic.  Imaginative play becomes increasingly complex.
  • Middle Childhood
    • Marked by a shift from egocentrism to perspective taking.
    • exhibit increased mastery of their bodies, channel self-expression through involvement in sports, the arts, and other hobbies.  Peer relationships become more prominent.
Family Development
  • Common tasks for families with young children
    • With the arrival of children, parents now have to change their role definitions.  Who works, who cleans, having adult relationships, etc.
    • Caregivers must learn to provide consistent nurturance without themselves becoming depleted, and find new forms of emotional gratification in the act of caregiving. 
    • As children get older, the family must be flexible, and parents take responsibility by setting limits and exerting authority.
  • Dynamics for different family constellations (how adding children changes things)
    • Intact families
      • two parent families
      • the couple has to find ways to maintain "couplehood"
      • renegotiation of family roles and responsibilities
    • Single-Parent Families
      • the demands of caring for a child or children by oneself can be overwhelming, both pragmatically and emotionally.
      • Extended family members often play a vital role in care of young children.
    • Extended Family
      • Extended family members can serve as caregivers, often grandmothers.
      • more common among certain ethnic groups.
    • Divorced, Step, and Remarried Families
      • lots of stresses: single parenthood, complexities of coparenting, custody and visitation, remarriages which bring there own challenges.
    • Adoptive and Foster Families
      • bonding, age of the adoption, forming a family  story about the adoption, divided loyalties, managing the child's curiosity about their biological family.
      • Foster families deal with similar issues in addition to uncertainty of the length of placement.
    • Gay and Lesbian Families
      • Blended families, how did the child come, surrogacy, adoptions, a biological parent is out there.  These couples experience intense societal prejudices. 
Common Presenting Issues In Families With Young Children
  • Child Problems
    • Behavioral Problems
      • ADD, ADHD, ODD, tantrums, overactivity, destruction of property
      • Remember, disruptive behavior frequently reflects underlying emotional distress a a reaction to environmental stresses.
    • Emotional problems
      • Depression and anxiety are most common.
      • signs: social isolation, limited peer involvement, fears, withdrawal from activities, low self-esteem, low appetite, and sleep disturbance.
    • School and Learning problems
      • Behavioral and emotional problems may contribute to learning and academic performance problems.
      • Learning disabilities often lead to low self-esteem and disruptive peer, teacher, and family relationships, contributing to the development of behavioral and emotional difficulties.
    • Developmental Disabilities
      • Mental Retardation and pervasive developmental disorders
    • Physical Symptoms and Medical Problems
      • Children are often referred from doctors due to physical complaints, symptoms, and disorders.
      • Can run the gamut, somatic complaints, to coping with chronic medical conditions
    • Links Between Child Problems and Family Dysfunction
      • Children can create problems or children take on stress of the family and become problems.
  • Family Problems
    • Parental Relationship Discord and Conflict
      • High correlation between child maladjustment and marital discord, particularly for boys.
    • Separation and Divorce
      • Psychological difficulties in children postdivorce are predicted by levels of interparental conflict.  A lot depends on the childs contact with both parents, the child's anger, their ability to support their parents for help with emotional regulation.
      • lower parent hostility and parental rejection combined with consistent and appropriate disciplinary practices equal better outcomes for the children, they adapt reasonably well.
    • Remarriage
    • Parenting Problems
    • Family Violence
    • Neglect
      • Often child problems are because of child maltreatment, significant emotional, physical educational, or medical neglect.
    • Parental Psychopathology
      • Parents with psychopathology, their children are at a higher risk for various forms of maladjustment.
    • Illness or Death of a family member
    • Siblings Problems
Family Interventions For Young Children
  • Family Therapy: The Treatment of Choice?
    • Traditionally its been family therapy, but we are adding more modalities to this.
    • When the child has sufficient ego strength, they can speak up, then family therapy might work.
    • You may need to do individual and family therapy when:
      • child manifest significant symptoms and the parents exhibit considerable psychopathology or marital dysfunction contributing to impaired parenting
      • the parents are able to help their children with some but not all, aspects of their development
      • the family engages in maladaptive interactions in response to the child's individual pathology
      • the family exhibits inadequate role function and poor communication patterns
  • Play in Family Therapy
    • Focusing family therapy around play helps the family relax
    • everyone of all ages can participate
    • play lowers everyone's resistance to sharing and change.
    • Ideas: Board Games, Family Puppet Interviews, Family art therapy, telling stories, family sculpting
  • Child-centered Family Therapy
    • short-term, developmentally focused, structural dynamic treatment intervention, uses a family-initiated model of system change.
    • 5 structured activities: 
      • family notebook, family photographs, family network drawing, living sculpture, and family role play
  • Parenting Training
    • Helping parents become better equipped to deal with child's problematic behaviors
    • usually focuses on 1. behavior modification and 2. relationship enhancement
  • Parent-Child Therapy
    • Do therapy helping the child and parent play together
    • Two phases: 
      • child directed interaction
      • parent directed interaction
    • You help them learn how to interact, communicate, etc.
  • Filial Therapy
    • Therapy is a relationship enhancement intervention approach that incorporates client centered play therapy techniques.
    • Basically you are help the parents become the play therapist.
  • Infant-Parent Psychotherapy
    • used primarily with high risk infants
    • Three elements: 1. psychotherapy, 2. nondidactic developmental guidance, 3. concrete support.
Conclusion
  • Although it is largely agreed upon that bringing children to therapy is beneficial, but therapist often don't include children. 

No comments:

Post a Comment