child and adolescent counseling chapter 19

Chapter 19 Counseling Children with Special Concerns I have found the paradox that if I love until it hurts, then there is no hurt, but only more love Mother Teresa © 2011 Brooks/Cole, A Chapter Objectives After reading this chapter, you should be able to: • • • • • Define child maltreatment, its causes, and protective factors Explain interventions for child maltreatment Discuss the difficulties of children of substance-abusing parents Outline treatment for children and parents in alcoholic families Explain children’s reactions to death and interventions for their grief • Talk about depression and suicide and responses • Describe concerns of children in families and treatment options • Discuss children with violent tendencies and ways to work with them © 2011 Brooks/Cole, A Special Concerns First Items • A child may be in counseling a while before you learn of these items • All of them are under reported • Duty to report o For abuse you only have to believe it was possible o It’s not for you to decide o Call Child Protective Services or equivalent © 2011 Brooks/Cole, A Categories • Child Maltreatment • Substance Abuse in the Family • Death and bereavement • Depression and suicide • Divorce and separation • Children and violence © 2011 Brooks/Cole, A Child Maltreatment • Physical abuse o Beating, striking with an object, burning, biting • Physical neglect o Failure to provide basic needs: food, medical, protection • Sexual abuse o Using a child for sexual gratification: range from watching a child undress to rape • Psychological abuse o Chronic denigration of child, isolation, terrorizing, excessive demands, parental violence and drug use • Emotional neglect o Failure to provide affection; failure to thrive © 2011 Brooks/Cole, A Physical, Psychological Abuse • Physical o Long term effects not well understood o 25% have serious MH issues: anxiety, depression o Overwhelming school problems, academic failure • Psychological o Destructive effects have been documented  Multiple behavioral and MH problems o Enlist the school in responding to the problem © 2011 Brooks/Cole, A Child Sexual Abuse General counseling strategies • Counselor must prepare for total involvement • Expect repeated testing of their caring • Relaxation and visualization may help self attitude • Encourage good physical appearance and self confident body language © 2011 Brooks/Cole, A Child Sexual Abuse • Children are often guilt ridden o o o o o o It is their fault that it happened (the abuser may tell them this) They feel they should have prevented it Someone is in jail because they “told” They may have had to tell the story too many times Talking about the event may be its own trauma Being removed from the home is traumatic • Needs o o o Education on what is appropriate Reassurance Balance protective measures with trust in the world © 2011 Brooks/Cole, A Child Sexual Abuse Child’s memory of abuse • • • • • • • • • • Children’s memories are susceptible to manipulation You are not trained to interrogate for sexual abuse but you must report suspicions Do not jump to conclusions Do not ask leading questions (child will try to come up with “correct” answer Get external corroboration Pay attention to body language Let the child tell her story Be empathic but neutral (do not get upset) Use clarification and summary skills Use child's language © 2011 Brooks/Cole, A Children in Chemically Dependent Families • 8.3 million children in Americans live in an alcoholic family • Often left out of the parent’s treatment • Compared with other children have significant risks for mental illness, physical health difficulties and learning problems • Both physical and psychological needs have not been met • Child’s environment has been unpredictable © 2011 Brooks/Cole, A Depression and Suicide Strategies • • • • • • • • • • Tell parents to find a psychiatrist Consult an expert Do not ignore threats or insinuations Listen in detail Give them permission to call any time Confront the child Allow the child to talk about recent problems Ask about their plan: a well thought out plan is serious Use projective techniques: stories, pictures Watch for a long time after initial threat • A sudden recovery may be a danger signal © 2011 Brooks/Cole, A Depression and Suicide Question checklist • • • • • • • Have you had a problem with feeling sad, trouble sleeping, not eating? Has anything happened recently that particularly upset you? Did you ever feel so upset you wished you were dead? Did you ever something so dangerous you knew you could get killed? Did you ever tell anyone you wanted to die? What would it be like if you died? How did it feel when you thought about killing yourself? © 2011 Brooks/Cole, A Interventions for Suicide • Trust your suspicions • Never ignore threat, hints or comments • Tell the young person you are worried • Ask direct, specific questions • If they admit thoughts, ask about their plan • Do not debate • Do not promise to keep secret © 2011 Brooks/Cole, A Interventions for Suicide • Do not leave child alone • Remain actively involved with the youngster • Confirm with parents • Use available resources • Assure child something is being done • Enhance self-esteem • Listen carefully and non-judgmentally © 2011 Brooks/Cole, A Interventions for Suicide • Allow them to have phone numbers for people to call if they are in distress • Talk with parents • Talk with children about their lives • Ask them about their fantasies and dreams • Be aware they may not understand the finality of death • Be cautious for the months after the threat © 2011 Brooks/Cole, A Family structure Children of divorce • The most important item is parental support • Tasks children must work through o Acknowledging the reality of the marriage breakup o Disengaging from parental conflict o Resolution of loss o Resolving anger and self blame o Accepting the permanence of divorce o Achieving realistic hope regarding relationships the child may be afraid of developing new relationships © 2011 Brooks/Cole, A Family Structure • Children in step families o Primary task is attachment between step kin o Counselors can help people work out their roles • Stages in stepfamily development o Early stages: fantasy, immersion, awareness o Middle stages: mobilization, action o Later stages: contact, resolution © 2011 Brooks/Cole, A Family Structure Children in single parent homes • Twenty-three percent of children in U.S being raised in mother-only families • Single mothers vulnerable economically because earnings are low and many not receive child support • Single mothers and fathers identify parenting skills, family management and good communication as their personal strengths • Emphasis on family education is necessary • Counseling strategies similar to many described for children of divorce and in stepfamilies © 2011 Brooks/Cole, A Family Structure Homeless children - Counseling tasks • Case management • Help child build trust • Be alert for possible abuse and neglect • Educational assessment • Insure remedial work including social skills • Advocate for the child © 2011 Brooks/Cole, A Children and Violence Most common antisocial behaviors of young people: • Aggression and coercive misbehaviors in the family • Problems in school that often lead to a diagnosis of conduct disorder • Community and school problems such as fighting and property destruction • Minor criminal activity such as vandalism, substance use and running away • Major criminal activity such as theft, robbery and larceny • Violence and gang membership © 2011 Brooks/Cole, A Children and Violence • Violence in schools due to poor parenting, disenfranchised students, lack of role models, hate crimes, bullying, media violence • Risk-taking behaviors, criminal activities and violence toward other people • Poor parent-child relationship, little supervision or discipline, having neglectful parents, poor school performance and attitude © 2011 Brooks/Cole, A Children and Violence Effects on children • Young children effected even without verbalizing • More likely to respond nonverbally o Behavioral problems o Adjustment problems • School age children o Anxiety o Sleep disturbance o ADHD like symptoms o Constrained play © 2011 Brooks/Cole, A Children and Violence What we • Therapists o Provide children with freedom to talk o Requires specialized training © 2011 Brooks/Cole, A Children and Violence Teach this: Step 1: What am I supposed to do? Step 2: I have to look at all my possibilities Step 3: I had better concentrate and focus Step 4: I need to make a choice Step 5: I did a good job or I made a mistake © 2011 Brooks/Cole, A Children and Violence Role of schools o From the National School Safety Center • Establish clear behavior standards • Provide adequate adult supervision • Enforce rules consistently • Supervise closely and sanction consistently • Cultivate parental support • Control campus access • Create partnerships with outside agencies • Believe they can make a difference © 2011 Brooks/Cole, A [...]... strategies similar to many described for children of divorce and in stepfamilies © 2011 Brooks/Cole, A Family Structure Homeless children - Counseling tasks • Case management • Help child build trust • Be alert for possible abuse and neglect • Educational assessment • Insure remedial work including social skills • Advocate for the child © 2011 Brooks/Cole, A Children and Violence Most common antisocial... Aggression and coercive misbehaviors in the family • Problems in school that often lead to a diagnosis of conduct disorder • Community and school problems such as fighting and property destruction • Minor criminal activity such as vandalism, substance use and running away • Major criminal activity such as theft, robbery and larceny • Violence and gang membership © 2011 Brooks/Cole, A Children and Violence... criminal activities and violence toward other people • Poor parent -child relationship, little supervision or discipline, having neglectful parents, poor school performance and attitude © 2011 Brooks/Cole, A Children and Violence Effects on children • Young children effected even without verbalizing • More likely to respond nonverbally o Behavioral problems o Adjustment problems • School age children o Anxiety... Structure Children in single parent homes • Twenty-three percent of children in U.S being raised in mother-only families • Single mothers vulnerable economically because earnings are low and many do not receive child support • Single mothers and fathers identify parenting skills, family management and good communication as their personal strengths • Emphasis on family education is necessary • Counseling. .. memorialize her © 2011 Brooks/Cole, A Death and Bereavement Three immediate needs of children • Having their emotions validated • Being given accurate information • Reassurance about the future © 2011 Brooks/Cole, A Death and Bereavement Counseling strategies • Listen carefully and respond clearly • Allow children to express their grief • Help with understanding – talk about a plant or animal dying... about being the cause of the problem • Help children focus on their own behavior • Help children learn to cope with possible situations • Reduce children’s isolation © 2011 Brooks/Cole, A Death and Bereavement • How a child reacts is a function of o Developmental level o How parents deal with life normally o How family deals with a specific death • Death is normal and bereavement should not be an issue... o How much did the child have to enable • Children need to learn to love their parents without loving the behavior • Time and patience required to overcome their learned behaviors © 2011 Brooks/Cole, A Children in Chemically Dependent Families Treatment Goals: • Give emotional support to the children • Provide accurate, nonjudgmental information about chemical dependency • Correct child s misperceptions... like symptoms o Constrained play © 2011 Brooks/Cole, A Children and Violence What do we do • Therapists o Provide children with freedom to talk o Requires specialized training © 2011 Brooks/Cole, A Children and Violence Teach this: Step 1: What am I supposed to do? Step 2: I have to look at all my possibilities Step 3: I had better concentrate and focus Step 4: I need to make a choice Step 5: I did... fantasies and dreams • Be aware they may not understand the finality of death • Be cautious for the months after the threat © 2011 Brooks/Cole, A Family structure Children of divorce • The most important item is parental support • Tasks children must work through o Acknowledging the reality of the marriage breakup o Disengaging from parental conflict o Resolution of loss o Resolving anger and self blame... that I too may die of an illness or fatal accident © 2011 Brooks/Cole, A Death and Bereavement Themes • It is my fault that the person died so I should die • I loved and lost the person who died and now I must carry on without them while cherishing their memory © 2011 Brooks/Cole, A Death and Bereavement Four tasks for children • Accepting the reality of the loss • Experiencing the pain of the loss ... grief • Talk about depression and suicide and responses • Describe concerns of children in families and treatment options • Discuss children with violent tendencies and ways to work with them ©... for children of divorce and in stepfamilies © 2011 Brooks/Cole, A Family Structure Homeless children - Counseling tasks • Case management • Help child build trust • Be alert for possible abuse and. . .Chapter Objectives After reading this chapter, you should be able to: • • • • • Define child maltreatment, its causes, and protective factors Explain interventions for child maltreatment