MA Programme in Clinical Counseling Psychology
PSY691-Professional Case Seminar
Spring, 2012
Study Case by Tonya Alexandri
‘Meet kids on their own terms; follow their agendas and interests’ (Straus, 1999)
Description of client
Christine is a 14 year old White teenager, who is currently a high school student. Although both her biological parents are alive she has been living in the orphanage since 2009. In her free time she loves using a computer, dancing, singing and reading. She is a fairly good student but has the potential to do much better, according to, both her own accounts of her previous school performance and grades and the information provided by the people at the site.
Presenting problems
Initially, I was informed by the staff that Christine was dealing with anger and guilt issues, impulsive irritable behaviour and changes in mood, authority issues and reactivity and decreased school performance. I was also told that she was extremely narcissistic, untidy and disorganized and would be reluctant to work with me, and that I would further have difficulty building rapport with her. However, during our first encounter Christine was friendly, articulate, coherent and not particularly ‘resistant’. She demonstrated coherent thought processes and made references to her family of origin and feelings and talked about her friends, herself and her strengths. During sessions she sometimes appeared edgy and emotional and seemed to lack self-esteem because she was pre-occupied with her weight or attractiveness or capacity to engage in artistic activities, but simultaneously she was aware of her strengths, quite competitive, very determined and willing to do new activities and set goals. Moreover, Christine was dealing with abandonment and rejection issues as a result of the abusive and inconsistent parenting she had received.
Comments on assessment
To begin with, it was assumed that the assessment had been conducted by staff, who briefed me about the children. Secondly, apart from information provided by them I also read Christine’s file. Therefore, within the particular setting formal diagnostic tools were not used and a strict diagnostic approach was not adopted. Furthermore, I believe that assessment should be an on-going and open to change process that occurs throughout counseling and the clients’ problems and symptoms should be contextualized to avoid over-anthologizing. Moreover, I kept in mind that children’s troubled behaviour is often a reflection of emotional pain. Finally, I would like to add that from a more constructivist approach a client’s perception and interpretation of their experience/s changes and is dynamically re/constructed within each new encounter and context.
More specifically, I initially allowed Christine unstructured time to freely talk about her life and daily routine. I adopted a more person-centred oriented approach, in terms of assessment, to allow Christine to have more choice and a more directive influence on the process. I did not use a structured list for the reasons mentioned above, but also because I did not want to intimidate her, trigger ‘resistance’ or hinder trust building. This more respectful, of her boundaries and readiness, approach proved effective because I was able to build a caring and trusting relationship and also empower her and encourage her to engage with many techniques and activities. We discussed confidentiality issues, which was very important for all these girls and which resurfaced during sessions. I asked some closed but mostly open questions concerning friends, hobbies, school, favourite and worst school subjects and did not over focus on family and other more difficult topics-initially-to avoid triggering difficult or painful material or ‘resistance’. I also bore in mind throughout the whole process that desirability bias could confound Christine’s responses and reports. Finally, within another setting I could have engaged in school and peer observations, had access to her developmental history and used projective techniques (Straus, 1999) and tools like TAT or CAT (Leopald & Sonya Bellak, 1949).
Psychosocial history
a) Family history and early years
As far as I can know from Christine’s disclosures and reports and her file she spent the first 5 or 6 years with her grandfather and then lived with her father and more recently, at the father’s request, has been living in the orphanage for about three years. Also, according to the staff she was sexually abused by her father when she was six; however, this was not included in her file, where the father was depicted as non abusive and unemployed with financial difficulties. Her parents had never married and there was a big age gap (42-14). Her mother, who had abandoned the family, had been a teenager when she had given birth to Christine and had been abused herself and is currently pregnant. Finally, both parents are currently living with other partners.
b) Educational history and adolescence……
According to the site reports Christine’s school performance had decreased since the previous year and she was having problems concentrating. She was aware of her current underachievement and unfulfilled potential and she talked to me about how she could learn and recite information, but did not seem to be able to recall all the information at school; however, often traumatized kids appear to have attention deficits (Straus, 1999) or their memory is impacted by stress or trauma. She was also in conflict with a teacher at the orphanage and had decided to give up her English lessons. It was initially arranged for me to help the girls with their English at a voluntarily basis so I had planned to help Christine and others with their English, and in particular, help her separate the process of learning English and the language itself from the negative representation she held of the teacher. One approach might be to view Christine’s stance as a rebellious attitude towards authority figures but this alone would involve viewing her experience out of context and literature suggests that opposition and indifference may be the result of feeling trapped or an attempt to gain control of one’s life. Literature also suggests that she might be using irritability as a coping mechanism, which might, on the one hand, be impacting her problems, but on the other hand, her ‘anti-authoritarian stance’ could be viewed as a positive response which protects her and gives her some sense of control.
c) Medical history
I did not have access to Christine’s or the family’s medical history. However, her health seemed good; I was not informed of any medical conditions and she did not complain about physical ailments.
d) Support system
Christine discussed the importance of having friends at school and in the orphanage and sometimes brought issues concerning these relationships. She did not perceive her parents as part of her support system; however, she included me and some of her teachers and friends. There was an instance when she visited her mother with the director and returned determined not to be like her mother. Christine further mentioned her grandmother and at times expressed her desire to leave the orphanage and live with her. She had stayed with her grandmother and may have internalized positive emotional aspects of her sense of self or a sense of safety, and this may further suggest that Christine is open to receiving support, help and love from others, which could explain her openness to me as well.
e) Diagnostic concerns and comments
As mentioned above for various reasons I did not adopt a diagnostic approach; however, Christine presented with irritability, impulsivity and feelings of unhappiness. She also referred to feelings of guilt and self-blame and she further struggled with issues of low self-esteem and self-worth. She was quite emotional but was able to talk about her feelings. All these symptoms could suggest depression, but Christine also made some reference to frightening dreams and some sleep disturbances, as well as, concentration problems, irritability and memory issues, which point to hyperarousal symptoms. Taking the information about her past experiences of emotional and sexual abuse (which most likely generated feelings of hopelessness) and the absence of a stable, nurturing environment into consideration one could also suggest that she might fulfill criteria for PTSD, especially if we view disorders on a continuum. Concerning early traumatic experiences she also reported an extremely upsetting and disturbing memory/ incident, which in itself alone could have caused PTSD. She also often denied that she cared anymore about her parents or anything that happened in the past, which could imply avoidance of thoughts and feelings. One reliable tool that could have been used, under more ideal circumstances, could have been the UCLA PTSD Index for DSM-IV (Pynoos, Rodriguez, et al., 1998, cited in Cohen et al., 2006), but it would have required the presence of a licensed mental health professional (Cohen, Kelleher and Mannarino, 2008). However, I was familiar with the areas that the children’s version of the UCLA PTSD Index for DSM-IV explores. In any case a multimodal approach for assessment is always preferable, especially, for children/adolescents.
Furthermore, the simultaneous presence of PTSD and depressive feelings is highly possible because PTSD has a high comorbidity with mood disorders, GAD (for children one symptom is required only) and anxiety, which in children can take the form of restlessness and irritability, and is further present in all AXIS I Disorders (Morrison, 2006). High rates of comorbidity have also been documented in youth exposed to traumas (Kilpatrick et al., 2003, cited in Hawkins and Radcliffe, 2006). In addition, Cohen et al (2006) claim that even if symptoms do not meet criteria for PTSD or depressive and anxiety disorders, they still have a negative impact on the child. Also, if a formal diagnostic approach had been adopted perhaps Oppositional Defiant Disorder might have been explored; however, within the particular context I did not become aware of Chrisitne fulfilling the necessary DSM-IV criteria.
Behavioural observations
Christine could maintain good eye-contact and was coherent even when distressed or angry. She seemed a bright kid, smiled a lot and had a sense of humor. Christine expressed her willingness to engage in activities, to do homework and borrow books. She often confirmed that she trusted me even though she admitted having trust issues and often wanted to cancel her after school lessons to have a ‘lesson’ with me. Despite her issues with promptness and tidiness she was almost always on time and I gave the girls material like coloured pencils, stickers, coloured paper and files, etc, which helped her (and the others) engage in organizing their/her work.
Hypothesized mechanisms and precipitating factors of Christine’s symptoms and problems
Drawing on the more integrative Schema Therapy Model (STM) one could suggest that the basic predisposing factors of all problems and disorders are the presence of early maladaptive schemas (EMS) about the self, the world and others (Young, 1990; 1999; cited in Barlow, 2008). Schemas can occur outside our awareness and can influence our perception of events and meaning making of experience/s, and they exist on a continuum of activation, from a dormant to a hypervalent condition. Hypervalent schemas can lead to cognitive distortions and intense negative emotions. Therefore, the exploration of Christine’s cognitive distortions helped identify her underlying EMS. For instance, Christine seemed to have a self-defeating EMS, which might have been the result of both her temperament and early experience/s because it is in childhood that we learn to construct reality through our experiences and interaction with the environment and also start to engage in different coping styles to decrease distress (Young and Klosko, 1994). She may have learnt for instance to both avoid and block out pain but also to fight back and to use anger as a means to deal with fear, insecurity, pain and helplessness. Additionally, Christine might have a defectiveness/shame schema in operation, which might explain her sensitivity to rejection; her self-consciousness and her comparing herself with others. She may, for instance, have internalized critical comments and representations of unpredictable or hurtful relationships. As in many cases of abuse and unstable early environment she might also have a vulnerability to harm EMS, which suggests that others are viewed as aggressive, critical, rejecting and the self as powerless (Young and Klosko, 1994). It also might involve inability to trust others and take a stable environment for granted.
More generally, Christine’s troubled attachment history may explain her mild difficulty in regulating emotions (Straus, 1999). This along with her early traumatic experiences concerning neglect, abuse and poor parenting and current environmental stressors may have all activated her underlying schemas and have caused her current symptoms (depressive symptoms, anxiety, irritability, sleep disturbances, difficulty in regulating emotions, etc). Summarily, her presenting problems may be the result of the dynamic interaction of her past traumatic experiences and current context. Moreover, some of her behaviours might be the result of early modelling. Also, according to the cognitive aspect of the STM, Christine is probably selecting and encoding information that maintain/reinforce her schemas. In addition, there is evidence that violence and trauma can cause dissociation, depersonalization, self-blame, anxiety, depression, (self) destructiveness, aggressiveness, clinginess, etc (Straus, 1999). More specifically, there is a lot of evidence that suggests that trauma impacts physiology and neurochemistry in children, which ‘can throw Piaget’s timeline into complete disarray’ (Straus, 1999). Finally, from a developmental perspective identity formation issues should also be considered when working with teenagers because Erikson, MacKinnon Marcia and others claim that teenagers’ prior experiences are crucial for the formation of identity in this stage.
Treatment Plan
1. Introductory notes
Firstly, I have adopted an integrated approach throughout both at a treatment level and in terms of causality. Secondly, I strived to contextualize the techniques and interventions I used to suit Christine’s needs…………………………………………………….
A great part of our work involved psychoeducation and activities to boost self-esteem, understanding of behaviour/s and improvement of daily functioning. I further tried to tailor the treatment plan to address some of the problem domains summarized by Cohen et al (2006; p. 23) by the acronym CRAFTS (cognitive: maladaptive thinking patterns; relationship: trust, self-blame, etc; affective: sadness, anxiety, anger, etc; family problems; abuse, neglect, etc; traumatic behaviour: avoidance, hyperarousal, aggression, oppositional behaviour, etc and somatic symptoms: sleep, tension, headaches, etc). It is also important to mention that I adopted a wellness approach and focused on Christine’s strengths and talents throughout and also on developing a more positive and hopeful outlook on life and on helping her nurture hope. Furthermore, talking about problems with children may intensify them, and therefore, focusing on competencies is vital because every child has ‘islands of competence’ (Straus, 1999). I also tried to adopt a systemic perspective of viewing her experience and problems, but it was not feasible to also adopt a systemic approach in terms of the therapeutic and intervention part because the family was absent and the particular context allowed no contact with teachers. Most importantly, I was cautious not to trigger painful memories or re-traumatize Christine through insensitive questioning. Moreover, I tried to socialize Christine to the activities and the agenda was jointly re/constructed.
I adapted and simplified CBT oriented interventions, which are insight focused (Corey, 2009) helping her understand how feelings, thoughts and behaviours are interconnected and how changing one area or aspect can bring about change in another. I tried to help Christine shift her negative thinking pattern to a more functional, hopeful and positive one, which in turn allowed her to interpret her past experiences in new ways, bearing in mind that resilient children have an ‘optimistic bias’ in any case. Within the particular context CBT’s emphasis on the present was convenient and appropriate …………………. since my goal was mostly to increase Christine’s current functioning and well being. In addition, children and teenagers may not recognize, may deny negative feelings or may not be able to distance themselves from their emotional experience, and finally, getting in touch with bad feelings may not always be beneficial with children (Straus, 1999). Moreover, without discussing the problem and by attending to the child with the problem we can often ameliorate the problem (Straus, 1999). However, Christine did bring distressing memories and feelings to sessions and also had an emotional outburst, which required us to focus on release of repressed emotions and do some grief work along with helping her make associations between current problems, feelings, behaviours, thinking and past events. I should also add that Beck suggests that often maladaptive thinking and schemas change when external situations improve or change, but there was no possibility of changing her living circumstances or removing possible current stressors from her life.
Therefore, it becomes evident that an activity oriented approach was appropriate in the particular context. Homework was a favourite part with almost all the girls and it facilitated ‘small and reasonable’ goal setting and continuity from one session to the next and reassured them that I would be there next time… For instance, at the beginning the girls wanted me to leave my stuff behind so that they would be sure that I would return. In addition, there were instances where I gave more advice and was more directive than I would have ideally chosen to because of lack of time and because I judged that certain decisions might prove detrimental for Christine’s future life…… Finally, a goal I achieved was securing a more children friendly space to work in and the decoration of the room became our joint project.
2. Specific interventions and techniques
* Therapeutic relationship as primary technique
The therapeutic relationship is significant and a tool in itself and the presence of a caring adult helps build resilience in children (Straus, ’99). Bronfenbrenneur and Weiss’s ‘curriculum of caring’ also suggests that the best way to teach children to care is by nurturing them (cited in Straus, 1999).
* On a typical day (routines)
One of the early activities involved a picture of daily routines and hobbies as a way to get acquainted mostly and to build rapport and trust. Additionally, it is something that all of the kids felt comfortable talking about initially.
* Mood check
We had initially engaged in creating a coloured mood chart (Osborne, 2008; Gil, 2006), which I often used to conduct a brief and informal mood check at the beginning of each session; however, Christine was sometimes reluctant to talk about her feelings immediately. As mentioned above Straus points out that children and teenagers are not that keen or able to discuss feelings. So instead I allowed her to talk about whatever she wanted initially and she usually naturally referred to how she was feeling at some point during the session and often this occurred during activities that involved drawing or writing.
* Booster messages and creation of a positive self-portrait
Christine, the other girls and I all created a self-portrait of strengths and talents over several sessions, which we stuck on the wall……….
CBT oriented exercises and bibliotherapy helped us explore and diffuse these schemas or beliefs to some extent. We did not go on to list defects (as part of a CBT exercise suggested by Young and Klosko, 1994)) because I wanted to firstly and mostly empower her/them. In addition, Cohen et al (2008) suggest that adolescence counseling/therapy should be ‘resilience based rather than deficit based’.
* Socializing Christine to the concept of cognitive distortions and other mechanisms, in simple language, and accompanying worksheet/s
We also worked on how we may use entrenched distorted ways of thinking to interpret reality or others and Christine filled in a worksheet with her own examples. For instance, she became aware of how she might catasrophize, filter events, personalize, play the comparison game, generalize or how she may project or displace her internalized past anger onto people and things in her current setting. However, I was careful not to decontextualise her experience and to reassure her that being angry can be a legitimate and healthy feeling. Young et al. claim that people should be allowed to express their anger because ‘the schema represents a world gone wrong and anger sets the world right again’ (2003). We also explored how her pessimistic thinking at times may be the result of her distorted thinking without devaluing the significance of her painful experiences or current context because this helped shift the problem from within the individual to the environment and also prevented pathologising her. Normalizing experience was also very important because Christine and the other girls would ask me, for instance, if I ever got angry and how I went about it in my personal life. Although I was aware that children’s questioning may be a defense mechanism, Thompson and Henderson also claim that it is important to remember that children learn through imitation and counselors can be models for behaviour (2010). Finally, the specially written children’s books on feelings (Εκδόσεις Σχήμα και Χρώμα, 1990) were also very useful in normalizing difficult feelings (bibliotherapy).
* Coping with anger
I drew an outline of a turtle, which Christine cut out and then wrote the 4 steps of how to go about when feeling angry (Robins et al, 1987, cited in Persons and Tompkins). We combined this with reading ‘Θυμός’ (Anger) (Amos, 1990) for homework and we explored anger as a strength and separated it from ‘acting out’. I had also planned to use more activities from Lohmann’s (2009) anger workbook for teens, but we never got round to it. Additionally, we had discussed the usefulness of writing anger letters because letter writing can be a powerful way to express feelings and resolve relationship issues even though the letter is never sent (Belmont, 2006).
* Guided imagery exercise-Safe place (more in dialogue part)
To help Christine deal with safety issues, anxiety and sleep disturbances (drawing of safe place for homework and discussion; completion or improvement of picture; discussion of coping mechanisms, etc)
* …. Combined with relaxation techniques
Teaching simple muscle relaxation techniques while doing guided imagery work to provide her with a way of relieving fear and stress.
* …. & dream work
Teaching Christine how to ‘step in’ and change the dream or how to create an empowering happy end and brainstorming coping skills concerning sleep problems
* Memory picture (adapted from Cohen et al, 2006)
This activity allowed release of difficult feelings and processing at different levels and at her comfort level. In a nutshell, Christine discussed what she missed about the deceased person, preserved the positive memories, and finally, redefined the relationship with the deceased and made a commitment to her present relationships (Cohen et al., 2006). It also helped her gain insight of how unresolved past issues or repressed feelings may impact her current behaviours, thinking and way of feeling.
* Humor
A sense of humor and laughing in sessions facilitated our work and rapport building and were both recognised as strengths and useful coping mechanisms.
* Train on the wall
A simple paper steam-train on the wall allowed me to very simply depict visually how feelings, thoughts and behaviours and consequences are linked.
* Worksheets
Worksheets were used to supplement other activities; for instance, lists of coping mechanisms and strengths, examples of cognitive distortions, examples of maladaptive thoughts and associated feelings and behaviours, etc.
* Drawing……of safe place, self, favourite animal, routines…….
Drawing can become a background activity while talking, and in any case, talking may not be the most natural way of exchanging information with younger clients (Straus, 1999). Furthermore, drawing or playing and regressing to earlier stages facilitates therapeutic work and can be beneficial and healing (Straus, 1999). Finally, art is a therapeutic process and non-verbal form of communication, which allows one to obtain a sense of pride concerning the end-product, but also facilitates catharsis.
* Colourful genograms (Gil, 2006)
Allowed Christine to release and discuss difficult feelings about family members and issues, such as, separateness, freedom and choice. I found it to be a useful technique to indirectly process shame.
* Tidiness and respect for Christine’s things
We worked on her untidiness and planning capacity and made associations between (self) destructive impulses, her untidiness and lack of respect for her things. It was amazing how she achieved her goal to tidy her room and maintain it clean and the sense of pride she gained from this and it further allowed us to discuss the reasons behind her behaviour and reach some resolutions…..
* Psychoeducation, bibliotherapy and reading competition…
Christine read with the greatest zeal of all and enjoyed the competition. It allowed us to discuss issues like rejection, jealousy, insecurity, anger, (self) acceptance, tolerance and friendship and other issues that she brought. We also discussed kindness, goodness and love. And I think the books opened up her outlook on life and allowed her to see another way of being, doing and perceiving experiences and feelings. She also lent the books to the other girls in the orphanage, who gave me feedback, pictures and asked for more books. We created a list with the books each girl borrowed and decided there would be an award at the end of the year.
While working with these girls I realised that children of the same age are a heterogeneous group with varying developmental and behavioural needs and that teenagers do not always display/have abstract reasoning abilities and logical thinking, and therefore, I brought in a lot of shorter illustrated books for younger children which they thoroughly enjoyed and which spawned discussion. Through reading and engaging in more creative activities Christine and the others were also encouraged to cut down on their watching horror movies**up until late, which I believe might have further impacted sleep disturbances.
** APA (1993): TV is responsible for 15% of violent behaviour in children, etc
* Snacks
Literature suggests snacks and cooking can facilitate trust building and work with youngsters (Straus, 1999). Moreover, I had personal experience with my past classes of how effective cooking can be in learning and in building competence in children. So even though I did not feel we could use the kitchen in the particular setting after some of the girls started bringing snacks from the kitchen I also stated bringing a whole packet of biscuits or a bag of chocolates instead of a small snack for me and I would leave these on the table and the children would naturally start helping themselves, which increased their trust and comfort levels.
3. Termination
Drawing an animal I identify with (version of activity in Nichols, 2010)
My aim was to help Christine and the other girls to identify strengths and instill hope; however it also generated a lot of talk about my leaving, and many last minute disclosures and functioned mostly as a background activity in the end, which generated pride in her/their end product.
Goodbye gifts, dedications, cards and photos ….
Christine and the rest of the girls received books as gifts and a dedication from me to remind them that I would be thinking of them. My wish was retrieved from the book Ένα Δύσκολο Αντίο (Βούλα Νικολαίδου, 2010). Straus suggests ‘good-bye’ letters, e-mails or answering children’s and adolescents’ journals to let them know that you are thinking of them (1999). Christine and the other girls gave me a book as a gift and cards and photos with dedications.
Song, table ‘graffiti’ and sharing of personal objects
All the girls sang a goodbye song, which was moving and sad, but I felt that our brief encounter and work had to some extent empowered them and that they had internalized a caring respectful mode of relating. They also wrote dedications and wishes on the table we used, and finally, my pencil container, hankies, coloured paper and pencils and markers, were distributed among them.
Sample dialogue from one of the sessions….
This is a fragment, from memory, of a session* that took place because recording it was not an option. The reason for choosing it is that it depicts various interventions mentioned above and provides details of how we went about them and also demonstrates the use of certain microskills and session stages. Concerning evidence of the theoretical model, as already stated, I worked within an integrated approach and tailored interventions/techniques to suit the context, the client and the developmental phase or capacity of each particular child ………………………………… (The dialogue has been omitted for confidentiality reasons)
*Actually, we used the word lesson instead of session because the children preferred it and I think it was encouraged by the staff at the orphanage, as well, which I think also helped prevent pathologising the girls.
Christine’s ego strengths, talents and aspirations about the future & Prognosis
Despite her difficulties Christine had the ability to engage in critical thinking, and was capable of displaying confidence and determination and working towards achieving the goals we set each session so one could suggest that she had the internal resources to gain further insight, to set goals and strive to achieve them. Furthermore, she was healthy, had adaptive skills and aspirations about the future. For instance, she was angry at her parents and mostly at her mother for betraying her and for her many wrong choices, but she was aware of her separateness and the possibility of doing things differently and had reached a resolution not to repeat the mother’s mistakes, not to have a baby at the age of 15, not to live in a dirty and chaotic house, but instead to strive to achieve her goals and be able to make wiser decisions. Her interest in reading and learning could also be considered a strength and a helpful tool in understanding and gaining insight and in learning that there are other ways of being. Moreover, Christine’s anger could also be viewed as a strength because it shows her indignation at not being treated respectfully or lovingly from her parents/others and her ability to discern right from wrong. Finally, it is important to contextualize behaviour and consider whether ‘aggression’ or angry outburst might be a healthy reaction (as already mentioned) or perhaps the only response that can provide her with some sense of control.
Taking all the above into consideration one could suggest that Christine perhaps has a good prognosis; however, research has shown that women who have suffered sexual abuse met criteria for PTSD 17 years later (Kilpatrick et al., 1987, cited in Dalgleish, 2008). Furthermore, she lacks the support of a caring family and a stable home environment. In addition, she is not receiving any therapy, as far as I know concerning past trauma, so it all depends on her levels of resilience and ability to adapt and make healthy choices in the future, but also on her current environment and what will happen in the future. Finally, from a behavioural approach disorders and symptoms are caused and maintained by the absence of positive reinforcement (Ferster, 1973, cited in Persons and Tompkins) so again her living context might to some extent determine the outcome.
The following parts of this case study have been omitted or not presented in full.
Ethical/Legal considerations
Referrals
If circumstances had allowed then…….
To begin with, as time went by I became aware that group work with the girls could have proved beneficial because it could have increased their trust levels, their self-acceptance and interpersonal skills and normalized their experience/s (Corey et al., 2010)…….
Concerning the termination phase Straus (1999), the Coreys (2010) and others suggest that taking children out for a meal, having a party or ceremony, where graduation certificates are handed out can be empowering, but again due to contextual limitations I only brought snacks and all the girls gathered in the room towards the end after their individual ‘good-bye’ session.
Also, I did not go ahead with my initial idea of displaying their work for other children at the site to see and instead all the girls took down their work and put them in their files to remind them of our work and to resort to when in need. ……..
Situating myself in the process
I am aware that I might display ‘child bias’ and that being a mother and sensitive to children’s pain could potentially blur my vision so I was cautious about my conclusions and readings of children’s disclosures and tried to stay in the ‘here and now’. I was alert to counter transference processes, and therefore, always did some brief journaling after my work at the site or special exercises about how I felt with the material Christine brought. I tried to evaluate the techniques or exercises we had used and of course I always planned the sessions and often prepared more than we could ever realistically do in an hour. To do this I read books and downloaded relevant material from the internet. Moreover, being in touch with the more childlike parts of myself, my high levels of empathy and my ability to function as an integrated and responsible adult with the children (see more in Straus, 1999), along with, my long teaching experience, definitely helped me build a trusting, caring, working relationship with Christine. Additionally, I was able to display adaptive and creative skills, without compromising my ethical values………………
References
Amos, J. (1990) Συναισθήματα: Θυμός, Εκδόσεις Σχήμα και Χρώμα, Ελλάδα
Barlow, D. (2008) Clinical Handbook of Psychological Disorders, Guilford Press, the USA
Belmont, J. (2006) 86 Treatment Ideas & Practical Strategies for the Therapeutic Toolbox, PESI, the USA
Cohen, J., Mannarino, A. and Deblinger, E. (2006) Treating Trauma and Traumatic Grief in Children and Adolescents’, Guilford Press, the USA
Cohen, J., Kelleher, K. and Mannarino, A. (2006) ‘Identifying, Treating and Referring Traumatized Children: The Role of Pediatric Providers’, American Medical Association, vol. 162, no. 5, Retrieved January 2nd, 2012 from www.archpediatrics
Corey, G. (2009) Theory and Practice of Counseling and Psychotherapy, Thomson-Brooks/Cole, the USA
Corey, M., Corey, G. and Corey, C. (2010) Groups: Processes and Practice, Thomson-Brooks/Cole, the USA
Gil, E., (2006) Helping Abused and Traumatized Children: Integrating Directive and Nondirective Approaches, Guilford Press, the USA
Hawkins, S. and Radcliffe, J. (2006) ‘Current Measures for PTSD for Children and Adolescents’, Oxford Journal of Pediatric Psychology, vol. 31, issue 4, pp. 420-430
Lohmann, R. (2009) The Anger Workbook for Teens, Instant Help Books, the USA
Morrison, J. (2006) DSM-IV Made Easy: the Clinician’s Guide to Diagnosis, Guilford Press, the USA
Nichols, M. (2010) Family Therapy: Concepts and Methods, Pearson, the USA
Νικολαίδου, Β. (2010) Ένα Δύσκολο Αντίο, Εν Πλω, Ελλάδα
Osborne, J. (2008) Sam Feels Better Now! An Interactive Story for Children, Loving Healing Press, the USA
Persons, J. and Tompkins, M., Cognitive-Behavioural Case Conceptualisation, Chapter 10
Straus, M. (1999) No-Talk Therapy for Children and Adolescents, W. W. Norton and Company, the USA
Thompson, D. and Henderson, D. (2010) Counseling Children, Cencage Learning, the USA
Young, J. and Klosko, J. (1994) Reinventing Your Life, Plume, the USA
Young et al. (2003) Schema Therapy and Gestalt Therapy, Retrieved May 17th, 2011 from http://www.g-gel.org/10-1/schematherapy.html,