Cognitive-Constructivist Psychotherapy with Children and Adolescents

256 Pages·2003·5.24 MB·English

by  Tammie Ronen (auth.)

Cognitive-Constructivist
Psychotherapy with Children
and Adolescents
Cognitive-Constructivist
Psychotherapy with Children
and Adolescents
Tammie Ronen
The Bob Shapell School of Social Work
Tel Aviv University
Tel Aviv, Israel
Springer Science+ Business LLC
Medi~
Library of Congress Cataloging-in-Publication Data
Ronen, Tammie
Cognitive-constructivist psychotherapy with children and adolescents/by Tammie Ronen.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4613-4875-7 ISBN 978-1-4419-9284-0 (eBook)
DOI 10.1007/978-1-4419-9284-0
1. Cognitive therapy for children-Case studies. 2. Cognitive therapy for
teenagers-Case studies. 3. Constructionism (Psychology) 4. Child psychotherapy-Case
studies. 5. Adolescent psychotherapy-Case studies. I. Tide.
[DNLM: 1. Cognitive Therapy-Adolescence-Case Report. 2. Cognitive
Therapy-Child-Case Report. 3. Mental Disorders-therapy-Adolescence-Case Report.
4. Mental Disorders-therapy-Child-Case Report. WS 350.6 R772ca 2002]
Rj505.C63 R658 2002
618.92'89142-dc21
2002028687
ISBN 978-1-4613-4875-7
©2003 Springer Sctence+Business Media New York
Originally published by Kluwer AcademicjPlenum Publishers in 2003
Softcover reprint of the hardcover 1st edition 2003
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted in
any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher, with the
exception of any material supplied specifically Cor the purpose of being entered and
executed on a computer system, Cor exclusive use by the purchaser of the work.
To my husband, Michael Rosenbaum, who brought back
happiness, joy, and creativity into my personal as well as
my professional life, and became a real partner
to each moment and each area of my being.
Foreword
In an ideal training program for mental health professionals, every apprentice
would be asked to spend time with two groups of people: children and dying eld
ers. Both are among our most instructive teachers. The poet Kahlil Gibran liked
to remind us that we should be wary of religions that do not laugh, philosophies
that do not cry, and any perspective that does not bow to the inherent beauty of
the child. There are many ways of conceptualizing therapeutic work with a child,
of course. I believe that the most adequate of these frameworks bespeak a capac
ity to honor each child's current grasp of their worlds and their options within it.
If a therapist knows how to work with a child~how to let go of words as the only
way to communicate, how to trust in an unfolding nowness, how to dance with the
edges of hope and fear~then that therapist is better prepared to work with adults.
The other end of the spectrum~working with dying elders~may seem dis
connected, but I believe that it involves and refines similar skills. It also involves
learning to be genuinely "with" another person, often without words, and to trust
that the being together in and of itself is a gesture of life. Elders have often paid
high and painful prices for lessons about life~lessons that include insights about
what is really important. Hospice workers have noted that the most frequently
voiced regrets on our deathbeds are primarily regrets about paths not taken and
life experiences not risked. Indeed, I think it fair to also say that dying elders often
remind us to honor the child in us at every age.
Some of my most precious memories as a human being~far beneath and
beyond my occasional role as a helping professional~have been formed on play
grounds and in hospices, often with either tiny and young or weathered and old
hands holding my own. I am still learning, of course, but those lessons have con
sistently highlighted the importance of being an engaged participant.
In an ideal training program for mental health professionals, there would be
mentors like Tammie Ronen. She is a rare and precious specimen who sees and
vii
viii FOREWORD
empowers the rarity, the preciousness, and the power of the people with whom
she works. This marvelous book is about helping children. Tammie is one of the
most creative child therapists in the world. This volume is not only a testament to
her work but, more importantly, to the processes of adapting and developing
which she aspires to serve.
When I think of Tammie Ronen, I am reminded of a line once offered by
anthropologist Ashley Montagu. He was speaking about the significance of life
long flexibility, openness to experience, and playfulness. Montagu suggested that
our goal in life should be "to die as young as possible as late as we can." By the
word "young," of course, he meant child-like. His thesis was that our child-like
capacities are our most valuable assets in all adaptation, learning, and develop
ment. Our capacities for playfulness, imagination, and creativity are more than
life phase peculiarities. They are the heart of our "plasticity" -the engines of
human change processes.
This book is a wonderful and welcome illustration of a constructive
approach to the treatment of troubled children. Constructivism is a contempo
rary expression of an appreciation that embraces both ancient and modern
insights into the patterns and processes of human experiencing. Fundamentally
developmental in orientation, constructivism views each individual as a uniquely
unfolding expression of life. Our personal senses of identity develop within con
texts of relationships. Selves cannot be separated from systems or vice-versa. Each
of us (and all others) can be understood only as active participants in the creation
of meaning in our lives. Meaning is, in fact, relational. As Tammie and her clients
so powerfully illustrate, meaning is an ever-unfolding relationship (with oneself,
with one's feelings and thoughts, with other people and the world). We feel and
act and think in an integrative holism of being. Children teach us that, often far
more powerfully than elders.
The unique form of work that Tammie Ronen writes about in this book is a
valuable expression of the wisdom of working simultaneously inside, outside, and
alongside our clients. She combines an appreciation for the subjective world of
the child with respect for environmental contexts, real-life demands, and devel
opmental histories. Moreover, her work with children emphasizes that creativity is
central to adaptation. Using methods that range from movement and drawing to
imagination and play, she shows how children can be helped to find and express
their own powers as active agents in their own lives.
This book offers a new way of conceptualizing therapeutic work with chil
dren. It also offers many examples of new ways of being and working as a thera
pist. I hope that it will inspire many to imagine, explore, and create in their own
ways.
MICHAEL MAHONEY
Acknowledgntents
This book is an outcome of many years of discussions with my dearest friend and
colleague, Michael Mahoney. While seeing each other at conferences and profes
sional meetings, while talking with each other between courses in restaurants, and
even while dancing and joking at parties, we have shared our experiences of the
treatment process and its techniques and strategies. It has taken quite some time
for Michael Mahoney's imploring to sink in: that I should take time out from my
busy schedule of writing about theory and research and should begin writing
about my real work, the unique way in which I view and treat children. I will
always be grateful for his persistence that led to the writing of this volume.
Writing a book is a creative process that consolidates thoughts as well as
emotions, discussions, memories, images, and knowledge based on working for
many years with many people. It is a pleasant obligation to express my apprecia
tion to those who have been instrumental in helping bring this work to fruition.
First of all, my deepest thanks go to my clients, the children and adolescents.
Most of what I do, I have learned from them. They challenged me by asking,
demanding, and proposing techniques and strategies. They taught me to open my
ears and eyes and listen to their wishes, words, and needs.
The case studies in this volume all describe children whom I have been treat
ing at my private clinic during the last few years. The reports of these cases are
true to these remarkable children's own words and the actual events transpiring
during treatment; however, to honor their dignity and their secrets, I made
changes in these youngsters' names, ages, and demographic components.
I am also indebted to my university students, whose inexhaustible curiosity
and unrelenting insistence that I describe in detail the "how to do what" of child
therapy, induced me to record my clinical work via audiotape and videotape and
to document some of the cases for teaching purposes.
To my friends and colleagues at the Bob Shapell School of Social Work, who
enabled me to finance the editing of this book, I am very grateful.
ix
ACKNOWLEDGMENTS
The chapter relating to opposition defiant disorder was supported by grants
to our university research clinic from the Ashalim Organization for Youth at Risk
and their Families and from the Pratt Foundation. The Empowering Children and
Adolescents for Self-Control Research Clinic treats and studies children with aggressive
behavior. I extend my appreciation to them.
And last but not least, I want to thank my editor, Dee B. Ankonina. Dee has
edited all of my professional writing up to now and hopefully will continue to do
so in the future, but also has become a good friend with whom to share, discuss,
and consult.
Contents
INTRODUCTION 1
I: THEORETICAL GROUND FOR COGNITIVE
CONSTRUCTIVIST PSYCHOTHERAPY
WITH CHILDREN AND ADOLESCENTS
1. The Unique Nature of Child Psychotherapy. . . . . . . . . . . . . . 9
The Complexity of Child Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Gender as a Component To Be Considered. . . . . . . . . . . . . . . . . . . . 14-
The Impact of Children's Cognitive Level. . . . . . . . . . . . . . . . . . . . . 15
The Influence of Children's Emotional Stage. . . . . . . . . . . . . . . . . . . 16
Mobilizing the Child's Motivation for Change . . . . . . . . . . . . . . . . . . 17
Personal Style, Interests, and Culture. . . . . . . . . . . . . . . . . . . . . . . . . 18
2. Cognitive-Constructivist Therapy with Children. . . . . . . . . . 21
The Basic Assumptions of Cognitive Theory. . . . . . . . . . . . . . . . . . . 21
The Basics of Constructivist Therapy. . . . . . . . . . . . . . . . . . . . . . . . . 23
The Cognitive-Constructivist View of Therapy. . . . . . . . . . . . . . . . . 24-
Child Development in View of Cognitive-Constructivist
Theories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Adapting Cognitive-Constructivist Psychotherapy to Children. . . . . . 27
Basic Principles in Applying Cognitive-Constructivist
Therapy with Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
xi
xii CONTENTS
3. Creative Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Defining Creativity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
The Creative Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Characteristics of Creative People . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Art as a Creative Intervention ..... . . . . . . . . . . . . . . . . . . . . . . . . . 36
Creative Psychotherapists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Techniques to Facilitate Creativity. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
II: APPLYING AN INTERVENTION MODEL
4. Making Decisions on Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . 41
A Preface: Assessment as an Essential Treatment
Feature from Start to Finish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Phase I: How to Decide If Therapy Is Needed Based on
the Unique Nature of Childhood. . . . . . . . . . . . . . . . . . . . . . . . . . 43
Phase 2: How to Classify Children's Referrals and
Goals for Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Phase 3: How to Decide Who Should Be Treated (Setting)
Based on Developmental Variables and Referral Type . . . . . . . . . . 55
Phase 4: Creative Thinking in Selecting Appropriate
Modes and Techniques for Change .. , . . . . . . . . . . . . . . . . . . . . . 58
Phase 5: How to Evaluate and Maintain Treatment Outcomes. . . . . . 62
5. Self-Control Therapy with Children. . . . . . . . . . . . . . . . . . . . . 69
Imparting Children with Self-Control Skills . . . . . . . . . . . . . . . . . . . . 69
The Efficacy of the Self-Control Intervention Model (SCIM)
with Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Description of the Self-Control Intervention Model (SCIM). . . . . . . . 72
III: CHILDHOOD DISORDERS: REVIEWS AND
CASE STUDIES
Ear(y Childhood
6. Selective MutiSJll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Literature Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Ben's Story of Silence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80