Introduction to Abnormal Child and Adolescent Psychology. Robert Weis

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      Psychodynamic Therapy

      Psychodynamic therapy focuses chiefly on unconscious conflict within the self. Psychodynamic therapy is based on the theoretical and clinical work of Sigmund Freud (1923/1961), Anna Freud (1936), and a host of neo-Freudian theorists. Although there are a vast number of psychodynamic approaches to therapy, almost all believe that unconscious thoughts, feelings, dreams, images, or wishes influence our behavior (Barber & Solomonov, 2018).

      Sigmund Freud believed the mind is analogous to a topographical map with different levels of awareness. According to Freud’s topographic theory on mind, two levels influence and direct our thoughts, feelings, and actions. The conscious mind consists of thoughts and feelings that are immediately accessible: the book that you are reading, noises in the background, or transient feelings of hunger. In contrast, the unconscious mind consists of mental processes that are not immediately accessible but can nevertheless affect our behavior: thoughts, feelings, wishes, and images that we cannot admit, even to ourselves. Unconscious mental activity can be influenced by experiences of loss, rejection, fear, or pain. From the psychodynamic perspective, psychological symptoms often reflect these unconscious mental processes (Terr, 2015).

      The primary goal of psychodynamic therapy is to provide insight—that is, to make the person aware of unconscious mental conflict that contributes to his psychological symptoms. Insight is believed to result in symptom alleviation and more adaptive behavior (Barber & Solomonov, 2018).

      One way therapists help clients gain insight is by paying attention to the client’s transference, the attitude and patterns of interaction that the client develops toward the therapist. Transference is believed to reflect the client’s history of interpersonal relationships and unconscious thoughts and feelings projected onto the therapist. For example, an adolescent who has been physically abused or neglected by her parents might express mistrust and hostility toward the therapist. The client might unconsciously expect the therapist to abandon, reject, or mistreat her in a way similar to her abusive parents. The therapist can use transference to help the client gain awareness of these unconscious thoughts and feelings. For example, the therapist might interpret the client’s transference by suggesting, “I notice that whenever we talk about ending treatment, you get very angry and resentful toward me. I wonder if you’re afraid that I’m going to abandon you?” Over the course of therapy, as clients gain greater insight into the causes of their distress, they may experience symptom reduction, develop better means of coping with anxiety, and achieve more satisfying relationships with others (Terr, 2015).

      A psychodynamic therapist might focus on Anna’s transference. Over the course of multiple sessions, the therapist might notice that Anna often acts helpless and childlike during therapy sessions, as if she wants the therapist to tell her what to do. Furthermore, Anna might become frustrated and angry toward the therapist when the therapist remains nondirective and insists that Anna solve problems for herself. The therapist might interpret Anna’s transference as an unconscious desire to remain in a childlike state. The therapist might suggest that as long as Anna remains helpless and childlike, she does not have to assume adult responsibilities that cause her anxiety: getting a part-time job, going to college, or leaving home. The therapist might suggest that Anna’s eating disorder ensures that her parents will care for her and provide her with attention and sympathy, rather than insist that she develop more autonomous, age-appropriate behavior.

       Review

       Behavior therapists focus on children’s overt actions. They try to change problem behavior by modifying its environmental antecedents or consequences.

       Cognitive therapists focus on children’s thoughts about self, others, and the future. They identify and challenge biased or distorted thoughts that lead to maladaptive actions or emotions.

       Interpersonal therapists focus on the quality of children’s relationships with family and friends. They help children cope with disruptions in these relationships or improve their interpersonal skills.

       Family therapists view the entire family system as their client. They believe that improvement in one family member will change all members of the family.

       Psychodynamic therapists focus on unconscious thoughts and feelings that affect children’s functioning. Therapists attend to transference, that is, the client’s feelings and ways of responding toward the therapist based on his or her developmental history.

      What Is Culturally Adapted Treatment?

      Intersectionality

      The American Psychological Association has developed guidelines for adapting therapy to meet the needs of children and families from multicultural backgrounds. In order to provide culturally adapted treatment, psychologists must develop an appreciation for, understanding of, and willingness to learn about clients’ social–cultural histories, identities, and values (APA, 2017b).

      At the heart of the APA multicultural guidelines is the notion that a child’s identity is shaped by multiple ecological systems. Each child views herself as a member of a family, peer group, school, neighborhood, and community. The child’s identity is also formed by her educational background, ethnicity, gender, immigration status, income, religion, sexual identity, and social–cultural values. Identity is constantly changing, depending on the child’s age, experiences, and the broader social–political context in which she lives (Bronfenbrenner, 1979, 2005).

      Psychologists use the term intersectionality to describe the way these social–cultural factors interact to shape children’s identity and either promote or hinder their development (Rosenthal, 2017). Instead of examining each factor individually, psychologists try to understand how identities intersect to affect children’s outcomes in either an adaptive or maladaptive way (Figure 4.6).

      Most research has focused on the manner in which social–cultural dimensions of identity interact to limit children’s access to high-quality mental health care. For example, African American and Latino children with depression are less likely to receive adequate, evidence-based treatment than non-Latino White children. This ethnic disparity in treatment is partially explained by cultural differences in parents’ attitudes toward treatment. On average, ethnic minority parents have greater concerns about stigma or the effectiveness of psychotherapy than non-Latino White parents and are less likely to seek services for their children. Ethnic minority parents may also be reluctant to pursue treatment if they speak a language different than the therapist or if they perceive the therapist as being insensitive to their social–cultural background and experiences (Comas-Diaz & Brown, 2018).

      Ethnic minority children who also live in poverty are even less likely to receive treatment. African American and Latino, low-income families face additional logistical barriers to treatment—barriers that may not limit middle- or high-SES minority families. These barriers include the cost of therapy, finding access to childcare and transportation to attend sessions, securing time off work, and obtaining high-quality mental health services in their community (Cummings, Ji, Lally, & Druss, 2019).

      Figure 4.6 ■ Intersectionality

      ©iStockphoto.com/pijama61

      Note: Intersectionality refers to the way social–cultural factors interact to shape children’s identity СКАЧАТЬ