Therapeutic Interventions, Coursework Example

Write an essay on the concept of reflective functioning; how is it related to attachment? How is it used by child therapists and therapists who work concomitantly with parent and child? What makes it beneficial to children?

The relationship between reflective functioning and attachment plays an integral role in self-organization and the development of the ability to perceive of both one’s own and other people’s mental states. This capacity to envision and internalize behaviors of others in terms of their mental states plays a critical role in an individual’s self-organization. As such, conceptualizing the self has fomented much interest in psychological epistemologies, and understanding mental processes that form various representations of one’s self. Reflective functioning is not an intrinsic trait or ability that comes naturally to parents, as the majority of people must nurture and develop the skill. Reflection refers to the regular examination of one’s own feelings, perceptions, growth, and strengths while discussing on a quotidian basis any concerns, actions, or issues with peers or therapists. Psychoanalyst Peter Fonagy developed the theory of reflective parenting, positing that people can comprehend their own behavior and the behavioral responses of others as a way to communicate various mental states vis-a-vis reflection. The attribution of mental states of others enables children to render people’s behavior both predictable and meaningful. Parents with high reflective functioning retain the capacity to view their child as an autonomous individual that has his or her own separate mind. As a result, the parent attributes certain feelings and, desires, and perceptions to their child and remains cognizant of her own separate feelings, thoughts, desires, and emotions. Research conducted on reflective parenting reveals that parents with high reflective functioning spawns strong parent-child bonds, bolsters mental acuity and cognitive development in a child, and teaches a child both how to comprehend and regulate their behaviors and mental state. Reflective parenting therapies and interventions focus primarily on the development and amplifying of parents’ reflective functioning and thinking by teaching them how to better comprehend and respond to a child’s motives rather than his or her actions. Doing so cultivates far stronger and healthier relationships within the family.

The concept of attachment–postulated within the subfield of psychoanalysis–refers to a trenchant and enduring emotional bond that connects an individual across various temporal and spatial contexts. However, this attachment does not require being reciprocal, as one individual may possess an attachment that is unrequited. Attachment requires specific behaviors usually found in children, which include seeking proximity with a figure when threatened or upset that they are attached to. Adult attachment entails responding appropriately and sensitively to a child’s needs, which traverses all national borders (Howe, 2009). Thus, it is clear that Attachment Theory proffers an explanation for how parent-child relationships development and influence the contours of a child’s relationship. Such “dyadic relational patterns and the intersubjective nature of experience” has gained prominence in how therapists perceive of disturbance and conceptualize intervention, thereby marking a paradigm shift in the role parents play in their progeny’s therapeutic work (Jacobs,. 2010, p. 226).  Psychotherapy that aims at enhancing reflective function create therapies that predict children’s resistance to the interventions Ultimately, the relationship between the concept of reflective functioning and enhancing the secure attachment in a child focuses on preventing mistreatment of a child’s psychopathology beginning at a young age. Outcomes show that children express less depression and a decrease in total problems if they have parents with high reflective functioning.

Imagine that you are a discussant on a panel about child therapy. One of the presenters is a child therapist and argues for the advantages of seeing children in play therapy; the other panelist is a parent therapist and presents ideas about the advantages of seeing parents alone and the pitfalls of child therapy. Discuss the reasoning of each panelist and how you understand their respective approaches.

Play therapy remains a controversial form of therapy and interventions, as some see its therapeutic currency while others believe it is far better to interact with parents alone. Many therapists argue that the mental health modality embraced by mental health professionals known as play therapy makes a significant difference in outcomes for children. Play, Schaefer (1993) argues, is integral to human well-being and happiness in the same way that work and love are. Seminal philosophers such as Plato and Aristotle have opined on the reasons why play is so rudimentary in human lives. To play marks the beginning of mental representation, yet many professionals argue that retains little therapeutic value within the clinical process (Slade, 1994, p. 82). Pro-play therapy professionals contend that play functions as a child’s language and lexicon through actions, and toys become the words of the child. In the less abstract sense, it refers to enjoyable activities that enhances one’s feelings and positive perception life. It amplifies self-efficacy, self-knowledge, and self-expression by relieving negative feelings such as stress while forging relationships amongst individuals in a beneficial manner. In addition, play stimulates exploration and creative thinking while also regulating human emotions. Play therapy focuses on developing learning processes and communication skills in children and retains curative currency in a litany of ways. Play therapy facilitates the efforts of therapists  to understand and propel a child to communicate what troubles them when children lack the lexicon and language to articulate their cognitions and feelings. As such, therapists can help children learn and develop certain behaviors when they are deficient in certain social and emotional skills. As such, play therapy sessions are critical in cultivating a positive and trusting relationship between child and therapist which is a necessary corrective for the efficacy of a child’s healing treatment. In addition, play therapy provides important insight inter the dysfunction or inner conflicts a child experiences while also promoting and enhancing the child’s cognitive development and processes. Research bolsters the efficacy of play therapy for patients who suffer from a vast array of behavioral, social, emotional, and learning problems, especially for those who develop problems related to hospitalization, bereavement, chronic illness, or relocation. Schaefer (1993) acknowledges that, while there are some pitfalls to a theory-based intervention such as play therapy, the benefits outweigh the positives. Play therapy helps children develop self-acceptance and respect for others; become more responsible for their own behaviors and develop better coping strategies; learn new social and emotional skills, especially when dealing with the family; learn how to convey emotion and experience different feelings; and instills empathy in youths and reflect for the feelings and thoughts of others (Schaefer, 1993). A panel member in favor of play therapy would thus underscore these aforementioned benefits.

Some clinicians, however, deplore play therapy and believe that parents should be treated alone because of the various pitfalls associated with the practice modality. Play therapy requires a long-term commitment and often hurts rather than helps children experiencing from self-harm or Post Traumatic Stress Disorder. Children who are forced to go to therapy   because he or she has a perceived problem often internalize negative perception of themselves and create their identity predicated on such intimations. As such, play therapy interventions are rendered obsolete, which is why many licensed medical professional prefer more traditional interventions and therapies. When a child is playing with toys or acting with dolls, such activities may adversely impact the development of a child. Play therapy does not directly deal with the abuse or troubling behaviors exhibited by a child. Rather, it merely distracts the child from his or her real problems, which renders it ineffective in the long term despite the short-term, positive benefits. The child most likely suppresses his or her abuse or negative behaviors during play therapy, as the child grows and develops, the memories will come back to haunt him or her. This attitude towards play therapy finds currency in interacting with parents alone in therapy because parental relationships are viewed from a dyadic perspective. The parent-centered paradigm is predicated on the notion that children learn behaviors from their parents and internalize them. As such, enhancing the health of parental behaviors and relations would be transposed onto the child’s behaviors and fundamentally alter any disordered behaviors. Such a paradigm shift in children’s therapy continues to gain currency amongst medical professionals.

How does a parent-focused model see children’s problems or symptoms? What is the theoretical underpinning behind this model and how is therapy conducted with this paradigm in mind? What is seen as therapeutic or change producing?

The parent-focused model view children’s problems as a reflection of parenting outcomes, which is why parent-focused therapy finds currency in turning to the parents as the main modality in solving any and all problems in children. The efficacy of working with a parent or parents in therapy and relies on the Attachment Theory as its governing paradigm. Children who suffer from attachment disorder often experience very traumatic childhoods, which manifests in the inability to forge any meaningful social relationships. Attachment theory states that a child possesses a natural inclination or tendency to seek intimacy with another person, especially his or her parent, in order to feel safe and secure. Parental deprivation cultivates depressive behaviors in children, and hostility or conflict between a child and his or her parent diminishes the capacity of a child to forge healthy relationships in adulthood. As such, therapeutic interventions with only the parent represents a paradigm shift in approaches to child therapy yet it enhances a parent’s understanding of a child’s internal experiences (Jacobs, 2010, p. 226). The rationale behind parent-centered work is the argument that children internalize relationship patterns they perceived, which is why the parental relationship is put under the microscope. Relational patterns observed “become the basis for [children’s] interpersonal modalities and character development,” which is why it is critical for parents to alter their behaviors that adversely impact their children’s psychopathologies  (Pantone, 2000, as cited by Jacobs, 2010, p. 227).  Bettering parental relationships induces change in children’s behavior because they internalize more positive notions about relationships and proper behaviors. Psychologists who buy into this paradigm pinpoint parents modeling healthy behaviors and interactions with one another as the change-producing element in this form of therapy

Discuss the fundamental disagreement between Deri and Sapountzis; do you see the difference as stemming from entirely opposing theories or is it a matter of emphasis. What might be the points of agreement or similarity?

Deri and Sapountzis discuss effective therapeutic interventions in early child development and the role parents play in these interventions. Both psychological theorists convey their concern regarding treatments that only focus on neurobiological facets of behavior or on the so-called psychogenic underpinnings of a child’s psychopathology, and they concur with one another that both facets are critical in understanding how a child experiences the world. However, they fundamentally disagree on certain aspects. Deri believe that working with parents in interventions assists them in understanding and ameliorating the behavioral and familial dynamics that affect a child’s development. Such an approach underscores how sensitive children are to their environment and what they observe, which Deri attributes to a neurological etiology.  The behaviors associated with abnormalities based in the brain that cause development problems are responsible for high levels of guilt and anxiety in parents, and it is this anxiety and guilt combined with a child’s own individual anxieties that are responsible for enhancing behavior problems in children. Sapountzis maintained similar concerns regarding the lack of parent-centered therapeutic work within child therapeutic interventions. Parents possess anxieties about the difficulties their child faces, so combined with other anxieties or negative self-concept exacerbates rather than heals a child’s behavioral problem. Sapountzis tries to resolve parental ambivalence or confusions when their “own internal self states interact with the child’s temperamental sensitivities” (Sapountzis, 2006, as cited by Wachs & Jacobs, 2006, p. 155). As such, both theories argue that parents must be more observed and taken into consideration for their child’s therapeutic intervention. The differences within each theorist’s approach merely is point of emphasis rather than theoretical disagreement.

References

Altman, N. (1997). The case of Ronald: Oedipal issues in the treatment of a seven year-old boy.Psychoanalysis Dialogues, 7, 725-739.

Haggerty, J. (2006). Psychodynamic therapy. Psych Central. Retrieved July 20, 2015 from http://psychcentral.com/lib/psychodynamic-therapy/000119

Howe, D. (2009). A brief introduction to social work theory. New York: Palgrave Macmillan.

Jacobs, L. (2006). Parent-centered work: A relationship shift in child treatment Journal of Infant, Child, and Adolescent Psychotherapy, 5(2), 226-239.

Schaefer, C.E. (1993). What is play and why is it therapeutic?, in Children at play: Clinical and developmental approaches to meaning and representation. Oxford: Oxford University Press.

Slade, A. (1994). Making meaning and making believe: Their role in the clinical process, in Children at play: Clinical and developmental approaches to meaning and representation. Oxford: Oxford University Press.

Wachs, C. & Jacobs, L. (2006). Parent-focused child therapy: Attachment, identification, and reflective functions. United States: The Rowman & Littlefield Publishers, Inc.