Psychotherapy Health Article

Psychotherapy

The treatment of mental or emotional disorders and adjustment problems through the use of psychological techniques rather than through physical or biological means.

Psychoanalysis, the first modern form of psychotherapy, was called the "talking cure," and the many varieties of therapy practiced today are still characterized by their common dependence on a verbal exchange between the counselor or therapist and the person seeking help. The therapeutic interaction is characterized by mutual trust, with the goal of helping individuals change destructive or unhealthy behaviors, thoughts, and emotions.

For a child, psychotherapy can bolster hope and self-esteem, improve mastery and coping abilities, change maladaptive behavior patterns, and facilitate normal developmental processes. Childhood emotional and behavioral problems that have been treated through psychotherapy include adjustment problems at school; attention deficit/hyperactivity disorder; anxiety and depression; conduct problems; obsessive-compulsive behavior; eating disorders; enuresis; autism; child abuse; and post-traumatic stress disorder. Severe problems that require immediate professional attention include severe, uncontrollable anxiety; hallucinations and other bizarre behavior; dangerous actions such as arson and other forms of violent aggression; and suicidal behavior.

A major distinguishing feature of psychotherapy for children is the role played by the parents, who choose the therapist (in most cases), provide information that aids in the initial assessment, and may be asked to participate in therapy sessions. While therapists generally respect the privacy of children, as they respect that of adult clients, patient confidentiality may be breached if circumstances warrant notifying a parent about activities or feelings that pose a potential danger to the child. Most of the basic therapeutic approaches used with adults are also used with children, but they are adjusted for the child's age, mental and emotional development, and language skills. It is common for experienced therapists to combine several different approaches or techniques. The most effective therapy for a child may be either time-limited (generally six months or less) or long-term, depending on the severity of his or her problems.

Psychodynamic approach

Although Freudian psychoanalysis is rarely used with children, individual, long-term therapy may be based on a psychodynamic treatment approach that shares the Freudian emphasis on uncovering unconscious motivations and breaking down defenses. Therapy sessions may be scheduled once or even twice a week for a year or more. This type of therapy is appropriate when internal conflicts contribute significantly to a child's problems. Play therapy, which has been called "the playing cure," is generally used with young children to help them express their repressed emotions and resolve their inner conflicts. Repressed feelings are allowed to emerge as the child symbolically acts them out using dolls, puppets, games, and storytelling. Infants as young as 15 months of age have responded to play therapy.

Behavioral techniques

In contrast to the psychodynamic approach, behavior-oriented therapy is geared toward helping children see their problems as learned behaviors that can be modified, without looking for unconscious motivations or hidden meanings. According to the theory behind this approach, once behavior is changed, feelings will change as well. Probably the best-known type of behavioral therapy is behavior modification, which focuses on eliminating undesirable habits by providing positive reinforcement for the more desirable behaviors. Timeouts are an example of negative reinforcement; accumulating tokens that can be exchanged for a reward (such as a movie) is an example of positive reinforcement.

Another behavioral technique is systematic desensitization, in which people are deliberately and gradually exposed to a feared object or experience to help them overcome their fears. A child who is afraid of dogs may first be given a toy dog to play with, then be exposed to a real dog seen at a distance, and eventually work up to the point of interacting with dogs at close range. Relaxation training is another popular form of behavior therapy. Through such techniques as deep breathing, visualization, and progressive muscle relaxation, youngsters learn to control fear and anxiety. Relaxation training can be particularly helpful with separation anxiety and sleep problems.