RATIONALE FOR OUR APPROACH
The ‘We Need to Talk Report’ was produced in 2010 by a coalition of mental health charities, professional organisations, Royal Colleges and service providers who all believed in the effectiveness of psychological therapy. The coalition’s research has shown that in some areas IAPT has led to a reduction in choice of therapy, particularly those unsuitable for the programme. One of their recommendations is that
'Commissioners should commission more support for early intervention and specialist non-IAPT services, particularly those for children and adolescents, to ensure that capacity meets local need and demand.'
Cognitive Behavioural Therapy (CBT) has been shown to be effective for adults with mild to moderate depression. Many children and young people require a different intervention.
There is a general consensus among psychodynamic/integrative therapists that people suffer from stress and emotional problems either because they are dealing with difficult life events and/or they have been emotionally affected by their relationship with their early care givers. How lovable we feel arises from how our parents treat us. Rejection and hurtful responses as well as neglect lead to depression and, in some cases, a sense of not wanting to exist, because the person has not internalised a loving experience. The result can be a vulnerable of sense of self, a feeling that life is empty and meaningless, no sense of motivation, and difficulty in making good relationships.
Psychotherapeutic theory was developed as a way of trying to understand and address these things. During the last ten years neuroscience research has backed up this theory. This research shows that the most significant influence on the development of the brain is the quality of early relationships. Some people might have a genetic pre-disposition to certain behaviours, e.g. interpreting things in a negative way or poor control of aggression, but early experiences can influence whether certain genes are expressed or not. If caregivers are insensitive to their infants needs it is more likely that these genes will be expressed.
This means that a good attachment figure can result in a child with a brain which is more resilient against harm – both in terms of genetic predisposition and in managing difficult life events. Research has shown that loving care builds up a neuronal capacity in the neocortex. This is the area responsible for the capacity for empathy, feeling that you exist, being able to think your own thoughts and understand the thoughts and feelings of others.
Lack of love and care can inhibit neuronal development in the neocortex. In addition, neglect or emotional hurt can have an impact on an individual’s ability to modulate emotion (self-regulate) which takes place in the limbic system.
Children and young people can present with problems such as aggressive and anti-social behaviour, depression, anxiety, self-harm, low self-esteem, believing they are unloveable (feeling that they are rubbish) and feeling that life is not worth living.
As well as the impact on brain function, children who have experienced ongoing trauma suffer from the effects of stress hormones and changes in body chemistry as well. When frightened (e.g. in a domestic violence situation), the adrenal gland releases stress hormones triggering the 'fight or flight' response. Some scientists believe that the release of stress hormones at the same time as an experience of trauma ‘freezes’ the experience in the limbic system. This experience can then be triggered by something in the present, which sets off the fight or flight response: for example, a child who feels humiliated by a teacher may react aggressively and end up being suspended. Young people can present as paranoid, thinking people are against them and cannot settle or concentrate and may have behavioural issues at home or at school.
The good news is that brains have neuro-plasticity and are able to construct themselves continuously using human relationships. Adolescent brains don’t settle until the age of 25, so therapy can be even more effective than with adults.
Phoenix counsellors see children and young people who are anywhere on the continuum, from individuals who have loving parenting but are going through something difficult in their lives, through to those who have suffered significant abuse and neglect. We offer a more cognitive-behavioural problem-solving approach to the former group. The chance to talk through things with a counsellor might be all young people need at this end of the continuum.
Those individuals who have suffered significant feelings of rejection, or who have suffered abuse or neglect need a different approach. The therapeutic relationship between the counsellor and young person is paramount in the healing process. It cannot replicate or replace a parental relationship, but what the counsellor can offer is positive, non-judgemental attention, empathy, focused interest in the young person and a desire to act in their best interests. What this can bring about for the young person is a sense of being ‘seen’, understood and valued. This helps them have an increased sense of self-esteem, a feeling that life is worth living, and a developing capacity to think about themselves and others.
Through this special attention and help in identifying what lies behind their difficulties, people can start to find ways to build up resilience and an ability to work out ways of dealing with problems. We use a psychodynamic/integrative approach, but over the years we have adapted the way we work, learning from experience what works best with this client group. We have analysed numbers of clients seen and clinical outcomes for reports and shared knowledge and learning with each other through peer supervision and regular seminars. It is important to note that working with some young people who have a high degree of emotional distress takes time and six sessions are usually not enough. Some individuals, however, have less than six sessions, bringing the average down.
For young children talking therapy would not be appropriate and we offer therapeutic play to help children express and work through their feelings.