Treating Troubled Children and Their Families

Drawing on clinical insights from family systems thinking, psychodynamic play therapy, and cognitive-behavioral approaches, the author brings a thoroughly integrative perspective to bear in her understanding of how parents and children get entangled in patterns that cause grief to both generations. Her approach, called "child-in-family" therapy, is steeped in the systems perspective, yet offers as well a thorough consideration of the unique characteristics of the child in trouble and the specific developmental obstacles he or she faces.

Ellen F. Wachtel, JD, PhD, has taught and supervised individual and family therapy in the doctoral programs at New York University and the City University of New York, as well as at Roosevelt Hospital and the Ackerman Institute for the Family. She maintains a private practice in New York City.

CHAPTER 1. THE CHILD AS AN INDIVIDUAL: AN INTRODUCTION TO CHILD-IN-FAMILY THERAPY

1

(19)

The Exclusion of Children from Family Therapy,

3

(1)

The Child and the System: A Review of Systemic Hypotheses,

4

(3)

Going Beyond Symptom Relief,

7

(5)

An Integrative Approach,

12

(1)

Systems and the Partial Autonomy of Individuals,

12

(1)

The Idea of the "Individual",

13

(2)

Cyclical Psychodynamics,

15

(2)

Borrowing from Other Modalities,

17

(1)

A Preliminary Look at the Integrative Model,

18

(2)

CHAPTER 2. MEETING WITH PARENTS ALONE: UNDERSTANDING THEIR CONCERNS

20

(22)

Building Trust: Establishing a Collaborative Relationship,

22

(1)

Parental Guilt,

23

(1)

Assessing the Attitude toward the Symptom and Its Place in the System,

24

(2)

The Parents' Explanations of the Problem,

26

(4)

Gathering Information for Systemic, Psychodynamic, and Behavioral Hypotheses,

30

(1)

Major Omissions,

30

(2)

Information about Interactions with Teachers, Babysitters, and Other Significant Adults,

32

(2)

Using Questions Regarding Temperament as a Source of Systemic Information,

34

(4)

Attention Deficit Disorder, Hyperactivity, and Learning Disabilities,

38

(1)

Broadening the Focus,

39

(1)

Helping Parents Like Their Children,

39

(1)

Summary,

40

(2)

CHAPTER 3. GETTING THE MOST OUT OF FAMILY MEETINGS

42

(31)

The First Meeting with the Family,

43

(1)

Including Siblings,

44

(1)

The Tone of the First Session,

45

(2)

Activities for Family Sessions,

47

(5)

Observing Systemic Interactions,

52

(6)

Values and Attitudes,

58

(1)

Focusing on the Children's Reactivity, Openness, and Methods of Coping with Stress,

59

(2)

Feedback Meeting with Parents,

61

(3)

Family Meetings as Part of the Ongoing Work,

64

(2)

Using Family Sessions for Problem Solving,

66

(1)

Working on Boundaries and Alliances,

67

(2)

Establishing Rules for Communication when Parents Are Divorced,

69

(1)

Overall Dynamics of the Family System,

70

(3)

CHAPTER 4. KNOWING THE CHILD IN DEPTH: A CLINICAL GUIDE TO EFFECTIVE INDIVIDUAL SESSIONS

73

(35)

The Purpose of Meeting Alone with the Child,

74

(1)

Some Guidelines for Individual Meetings with Children: Differentiating These Meetings from Psychodynamic Play Therapy,

75

(4)

A Word about Confidentiality,

79

(2)

The First Meeting,

81

(2)

Talking: From Facts to Feelings,

83

(4)

When the Child Seems Seriously Depressed or Is Behaving Bizarrely,

87

(4)

Playing, Telling Stories, and Drawing,

91

(1)

"Feeling" Board Games,

92

(3)

Telling Stories,

95

(4)

The Child's Reactions to His Story,

99

(1)

A Word about Telling Stories,

100

(1)

Dramatic Play with Puppets, Dolls, and Toy Figures,

100

(2)

Using Clay,

102

(1)

Drawing,

103

(1)

Understanding the Child's Projective Material: Some General Considerations,

103

(3)

Dealing with the Child's Hostility,

106

(2)

CHAPTER 5. ANXIETY, ADAPTATIONAL STYLES, AND DEFENSE MECHANISMS

108

(26)

Adaptational Styles,

109

(3)

Defense Mechanisms,

112

(7)

When Defenses and Coping Strategies are Maladaptive,

119

(2)

Understanding the Behavioral and Systemic Reinforcements for Maladaptive Defense and Coping Mechanisms,

121

(3)

Insufficiently Developed Defense Mechanisms,

124

(2)

Understanding the Behavioral and Systemic Components of Insufficiently Developed Defense and Coping Mechanisms,

126

(4)

The Child's Defenses and the Family System,

130

(2)

A Word about an Integrative Perspective and Specificity,

132

(2)

CHAPTER 6. ESSENTIAL PSYCHODYNAMIC CONCEPTS

134

(23)

Frightening or Denied Aspects of the Self,

135

(4)

Deprivation, Frustration, and Abandonment,

139

(3)

Overgratification as a Source of Rage and Feelings of Deprivation,

142

(1)

Understanding Hostile and Aggressive Children,

143

(4)

Overly Anxious and Dependent Children,

147

(4)

The More Seriously Disturbed Child,

151

(3)

Interpersonal Expectancies,

154

(3)

CHAPTER 7. INTERVENTIONS BASED ON PSYCHODYNAMIC FORMULATIONS

157

(41)

Playing Baby,

158

(6)

The Story-Telling Technique,

164

(1)

Real-Life Stories,

165

(1)

Telling Stories as Exposure to Both Parent and Child,

166

(1)

Telling Stories and the Alteration of the Family Structure,

167

(2)

Utilizing Prewritten Stories,

169

(1)

Negative Reminiscing,

169

(2)

Positive Reminiscing,

171

(1)

Using Psychodynamic Understanding to Inform Systemic and Behavioral Interventions,

172

(1)

Limit Setting to Address the Child's Fear of His Own Anger,

173

(1)

Limiting the Expression of Negative Feelings,

174

(1)

Avoiding Overstimulation of Regressive Urges,

175

(3)

The Child's Fears,

178

(2)

Psychodynamically Based Reassurances,

180

(1)

Recognizing a Child's Unarticulated Need for More Attention,

181

(1)

Relaxing with Children,

182

(1)

Understanding the Child's Need to Have Some Control Over the Parent's Availability,

183

(1)

A Word about the Child's Needs for Autonomy and Mastery,

184

(3)

Working Collaboratively with Teachers,

187

(2)

Using Psychodynamic Formulations in Individual Sessions with a Child,

189

(2)

Neutralizing the Discussion of Forbidden Material,

191

(3)

Addressing Unconscious Conflicts and Anxieties through Metaphoric Stories,

194

(4)

CHAPTER 8. INTERVENTIONS BASED ON BEHAVIORAL FORMULATIONS

198

(35)

Understanding what Is Being Taught and Learned in the Family: An Analysis of Reinforcement Contingencies,

202

(8)

Utilizing Principles of Behavior Modification,

210

(8)

Use of Negative Consequences or Punishment versus the Natural Extinction of Undesirable Behavior,

218

(1)

Time Out,

218

(2)

Penalties, Punishment, and Disapproval,

220

(1)

Cognitive-Behavioral Approaches and Social Skills Training,

221

(2)

Utilizing Cognitive Methods, Modeling, and Role Playing,

223

(9)

Summary,

232

(1)

CHAPTER 9. PULLING IT ALL TOGETHER: FIVE ILLUSTRATIVE CASE STUDIES

233

(50)

Jenny: A Depressed Child,

235

(9)

Mathew: A Child Who Hated School,

244

(8)

Johnny: An Encopretic 10-Year-Old,

252

(7)

Sara: A Child Who Hated Herself,

259

(8)

Mickey: A Boy with a Dangerous Temper,

267

(15)

Conclusion,

282

(1)

Notes

283

(4)

References

287

(10)

Index

297

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Treating Troubled Children and Their Families

Summary

Author Biography

Table of Contents

Supplemental Materials