Counseling Parents and Adolescents Strategies

Counseling for Children

Sometimes children, like adults, can benefit from therapy. Therapy can help children develop problem-solving skills and also teach them the value of seeking help. Therapists can help children and families deal with stress and a variety of emotional and behavioral issues.Counseling Parents and Adolescents Strategies

Therapy can be very effective for families with young children. You can begin to develop an understanding about what’s happening with your child and within your family dynamics.

Your therapist will take a look at what’s going on with your child and within your family. Your therapist will work with you to figure out the root causes of your child’s emotional or behavioral upsets. They can also help you learn how to interact with your child in ways that support long-term, healthy social and emotional development. You can create strategies for strengthening the attachment between you and your child. Developing these approaches now will set the stage for later interactions. It can also help children develop increased resiliency and the social and emotional well being that they’ll carry with them throughout life.

Adolescents

Adolescence is a critical period for mental, social, and emotional well being and development. During this time, the brain will go through significant developmental changes, creating neural pathways and behavior patterns that will last later in life. Because their brains are still developing, adolescents are particularly open to the positive influences of youth development strategies, social and emotional learning, and behavioral modeling. But adolescents’ developing brains, along with hormonal changes, make them more prone to depression and sometimes more likely to engage in risky and thrill-seeking behaviors than either younger children or adults. These and other factors underline the importance of meeting the mental, social, and emotional health needs of this age group.Counseling Parents and Adolescents Strategies

Psychotherapy can help you heal and learn more constructive ways to deal with the problems or issues within your life. It can also be a supportive process when going through a difficult period or when under increased stress, such as starting a new career or going through a divorce.

Generally, psychotherapy is recommended whenever someone is struggling with a life, relationship, or work issue or a specific mental health concern, and these issues are causing the individual a great deal of pain or upset for longer than a few days. Psychotherapy is most successful when the individual enters therapy on their own and has a strong desire to change.

Counseling for Families, Couples, Marital and Divorce Issues

Ideally, we often look to our family members and partners for support, from whom we draw knowledge, strength and feedback, for whom we feel love and concern, and with whom we feel close and comfortable, openly communicating our thoughts and feelings. However, that is not always the case. In all of our lives, it may become difficult when problems arise. We all encounter challenges at different times such as stress, misunderstanding, anger, disconnection, and unmet needs.  These challenges and conflicts may result from unaddressed behavioral and mental health problems in the family. Counseling for families and couples helps to identify and address these events.

Therapy can be important for children whose parents are divorcing. Because parents may often be consumed with their own feelings during a divorce, they might overlook the emotional state of their children, who may be confused by the divorce or feel guilt, loss, pain, or abandonment.

If all members of the family are able to discuss their feelings about any issues that arise as a result of divorce, they may be able to process their emotions more easily and better adjust to the changes. People also sometimes seek therapy to help them decide whether to stay in a marriage or leave. Others may want counseling to make the transition from being married to being single again.  These are goals that can be addressed in individual or couples therapy.

There is little doubt that the relationship between children and parents changes during adolescence. A shift from dependence on parents to increased involvement with peers and others occurs in adolescence, with the timing of change dependent on the cultural expectations of the environment (Christie & Viner, 2005). In this sense, adolescent relationships with parents move to inter-dependence, resulting in reciprocally supportive and connected networks not just with family members, but also friends, partners, colleagues and others (Daniel, Wassell, & Gilligan, 1999).

The role of parents in an adolescent’s life, however, remains important. For example, a growing body of literature indicates that many family-related protective factors – such as providing a secure base (which is discussed further below), caring, connectedness, support and belonging – are linked to positive outcomes (e.g. Luthar, 2006, Rayner & Montague, 2000) The benefits of parental monitoring and limit setting are also emphasised within the literature (Luthar, 2006), with poor parental monitoring clearly linked to negative outcomes in adolescence, such as antisocial behaviour, substance use and sexual risk taking (Hayes, Smart, Toumbourou, & Sanson, 2004). The limits set by parental monitoring, however, may provoke tension as the adolescent negotiates the struggle between developing autonomy and continuing close bonds with parents (Luthar, 2006).

This tension may also be evident in service provision to young people. The balance between parental rights and the rights of minors regarding issues such as protection, competence and a desire to make personal decisions affecting health and wellbeing on their own is important (Larcher, 2005). Decisions such as these are further complicated by the fact that adolescents have developing, yet often immature, cognitive capacities. Brain growth research in recent years has provided new insight into a biological basis for adolescent behaviors (see Patton & Viner, 2007), which is important to consider in developing therapeutic interventions for young people.

Family risk and protective factors

There has been an increased understanding of the role of family-based risk and protective factors for adolescent risk behaviors. For example, there is extensive research that highlights the link between family environment and adolescent depression (Micucci, 2009), including physical and sexual abuse, neglect, attachment problems, parental mental illness and family conflict, stress and breakdown (Larner, 2009). Research on youth homelessness also indicates that characteristics of family environments can lead to homelessness, such as family breakdown, conflict, poor communication, lack of emotional warmth, abuse and neglect (Hyde, 2005; Suk-Ching Liu, 2005; Thompson & Pillai, 2006). Chamberlain and McKenzie (2004) talked about “critical junctures”, which are defining moments such as bitter family disputes or violence, on the “career path” of youth homelessness.Counseling Parents and Adolescents Strategies

In contrast, close relationships with parents can be a protective factor against poor outcomes. Part of this protective relationship is the “secure base” function that parents continue to play in the adolescent years (Daniel et al., 1999; particularly mothers – see Markiewicz et al., 2006). Five elements of a secure parent- or caregiver-adolescent attachment have been described in the literature (Schofield & Beek, 2009):

• availability – helping young people to trust;
• sensitivity – helping young people to manage feelings and behaviors;
• acceptance – building the self-esteem of the young person;
• co-operation – helping young people to feel effective; and
• family membership – helping young people belong.

While the secure base serves a physical and psychological role in early childhood, the emotional and psychological support offered via a warm and communicative child-parent relationship plays an even more important role in adolescence (Allen et al., 2003; Schofield & Beek, 2009). Gilligan (2006) termed this a “scaffolding” role, that is, support is provided when needed and withheld when not. While parents are ideal to play this role, other significant adults can also play a part (Rayner & Montague, 2000).

Positive relationships between parents and young people continue into early adulthood. Vassallo, Smart, and Price-Robertson (2009) found that parents continued to play the role of adviser and supporter to young adult children, while moving away from the more tangible and practical support offered in childhood. Interestingly, parents often underestimated the level of support they actually provided to young adult children, which is highly valued by the young people themselves. As such, contrary to popular beliefs around the diminishing role of parents in late adolescence/early adulthood, a view that many parents held themselves in this study, parents continue to be a vital presence in young people’s lives.

ORDER A FREE PAPER HERE

Family also remains important for young people who are removed from the family home. Being an adolescent doesn’t necessarily diminish a desire for young people in care to be adopted or to have a permanent family connection (Charles & Nelson, 2000). These young people need the same family connections as other young people. This is supported by research on young people who leave care, which shows that contact with non-abusive family members can assist successful transition out of care (Maunders, Liddell, Liddell, & Green, 1999). Dwyer and Miller (2006) likewise suggested that family relationships remain an enormous source of pain for young people who have run away or been removed from family, and the desire for connection remains deeply held. Physical separation over many years, they suggested, rarely equates to emotional separation.Counseling Parents and Adolescents Strategies

Family involvement in interventions for adolescents

If there are risk factors within the family that influence outcomes for adolescents, it makes sense that family should be seen as part of any intervention addressing adolescent problems. While parents and families are seen as vital to successful early childhood interventions, far fewer programs focus on families when late childhood and beyond is reached (Ryan, 2003). For example, Dwyer and Miller (2006) argued that while fewer and fewer services are mandated to work with young people and families together, family work is essential to assisting recovery from trauma.

Youth services are often focused on young people’s rights to individuation, autonomy and confidentiality to the extent that family factors known to be important in healthy development are overlooked (Robinson & Pryor, 2006). Garfat (2003) suggested that youth work has traditionally cast the family as irrelevant, then relevant in a negative sense, such as the cause of the problem or the “enemy”. This may be potentially detrimental where workers are only involved in young people’s lives for a limited time without working on more enduring connections. As such, including or at the very least working with an awareness of family and/or other significant adults, would seem essential (Robinson & Pryor, 2006). In the case of psychiatric treatment, it has been suggested that as a minimum, good clinical practice would include the involvement of family, especially to contain suicide risk (Bickerton, Hense, Benstock, Ward, & Wallace, 2007).

What works?

If we adopt the view that working jointly with families and adolescents is a logical response to the outcomes of recent research, what do we know about what works? As a starting point, evidence presented in Cochrane Reviews¹ are mixed in their endorsement of family therapy/interventions, with most areas examined needing further research. The strongest evidence exists for the effectiveness of family and parenting interventions in reducing time spent by juvenile delinquents in institutions (Woolfenden, Williams, & Peat, 2001). Family therapy for depression in general also shows promise (Henken, Huibers, Churchill, Restifo, & Roelofs, 2007), although young people are not specified in the review. It would appear that the effectiveness of family-based interventions for problems in adolescence is an area of research that is comparatively in its infancy, and caution needs to be adopted in embracing any particular approach. It is worth considering, however, that most of the Cochran e Reviews in the area of family interventions for adolescent problems were written in 2006 or earlier. Subsequent research has added to the evidence base for family-based interventions, as outlined below.Counseling Parents and Adolescents Strategies

A decade of randomized clinical trials that included parents in the treatment of child and adolescent psychiatric disorders, reviewed in 2005, concluded that family interventions are effective (Diamond & Josephson, 2005). Carr (2009) argued that family-based therapies are as effective as individual cognitive-behavioral therapy and psycho dynamic therapy in the specific treatment of major adolescent depression. Larner (2009) similarly calls for the integration of family therapy into treatment for adolescent depression, due to “limited, but encouraging” support for a family therapy approach (see also David-Ferdon & Kaslow, 2008). Some of the suggested features of family interventions for depression include:

• improving communication skills;
• promotion of systemic family-based problem solving;
• promotion of attachment and disruption of negative and critical interactions between parents and adolescents; and
• building family resilience and hope and helping families manage depression and contain suicidal risk. (Carr, 2009; Larner, 2009)

Evidence supports the use of family-based therapies to address other adolescent problem behaviors. For example, family-based therapies are considered among the most effective current treatments for adolescent substance abuse (Carr, 2009; Carey & Oxman, 2007; Cottrell & Boston, 2002; Diamond & Josephson, 2005; Hogue & Liddle, 2009). In Australia, evaluations of the BEST-Plus program (a whole-of-family therapy option for families of adolescent drug abusers) indicate that the program is effective in helping families to redevelop positive family environments that encourage recovery from drug abuse. The program has also been shown to have a similar positive impact on other adolescent behaviors, indicating that the behaviors are symptoms, rather than causes, of difficult family relationships (Bamberg, Findley, & Toumbourou, 2006).

Support has also been found for family-based treatment for co-morbid behaviours (e.g., delinquency and drug abuse) and for externalising (e.g., aggression) and internalising (e.g., anxiety) behaviours, although the evidence base is limited (Hogue & Liddle, 2009). Good evidence also exists for the effectiveness of family-based therapies for eating disorders (Cottrell & Boston, 2002) and conduct disorders (Carr, 2009; Cottrell & Boston, 2002). Carr (2009) highlighted family-based interventions as effective for anxiety, school refusal, obsessive-compulsive disorder, grief, bipolar disorder, attempted suicide and somatic problems (e.g., recurrent abdominal pain).Counseling Parents and Adolescents Strategies

Types of therapies

Of all the therapies that include family elements, multi systemic therapy has a particularly supportive evidence base for certain behaviors in adolescence. Multi systemic therapy has the most extensive evidence base for its effectiveness in dealing with conduct disorder, and it is also described as a promising intervention for the treatment of adolescent substance abuse (Carey & Oxman, 2007). It has also been effectively used to address delinquency, with outcomes such as improved family relations, decreased behavioral problems and decreased out-of-home placements (Utting, Monteiro, & Ghate, 2006). In a 4-year follow up of a randomized clinical trial of multi systemic therapy with juvenile offenders who met a formal diagnosis of substance abuse/dependence, there were significant long-term reductions in aggressive criminal behaviour (but not property crimes) (Henggeler, Clingempeel, Brondino, & Pickrel, 2002). The impact on long-term drug use was mixed. The authors also highlighted that even though outcomes were significant, many of the participants still engaged in significant problem behaviors, supporting the view of the chronicity of problems and the likely need for long-term, intensive intervention.

It has been suggested that work in this area is at the point where “implementation science” is needed (Hogue & Liddle, 2009). In other words, there is a growing urgency to work out how to implement favorable findings, given that family-based therapies are not used widely in working with adolescents. There is also a need to determine how to export validated treatments to “real world” clinical settings (Diamond & Josephson, 2005). This includes considering the best methods of delivering empirically supported family therapy in a range of settings, to address a range of problems, and creating clinical/policy guidelines to support this work. Hogue and Liddle (2009) suggested a “core elements” approach, using a small number of overlapping practice elements that clinicians can mix and match to suit client presentation. Similarly, interventions that are delivered using standardized manuals to maintain treatment integrity are supported by the literature (Cottrell & Boston, 2002).Counseling Parents and Adolescents Strategies

Larner (2009) claimed that no particular school of family therapy has a monopoly on effectiveness. He argued that the way the therapies are delivered is important, including the establishment of therapeutic alliance. In contrast, Sells (2004) suggested that in the case of behavior-based problems a good therapeutic alliance is necessary but not sufficient. In addition, Sells argued for the use of structural and strategic approaches to restructure family hierarchy. Parents need to regain authority by intervening strategically, but at the same time the nurturing side of parenting needs to be maintained. Consideration must also be given to the larger environmental system: when parents seek to regain authority, the outside environment can react either positively or negatively and the worker’s job is to try to enhance the wider system’s cooperation and collaboration.Counseling Parents and Adolescents Strategies