Every decade, or so, a major worldwide review of psychotherapy is conducted by leading researchers in their fields and published as ‘Bergin and Garfield’s Handbook of Psychotherapy and Behaviour Change’. The most recent, sixth edition, was published in 2013 and edited by Professor Michael Lambert.
Within Bergin and Garfield’s Handbook, the chapter on psychotherapy for children and adolescents was written by John Weisz and collaborators. Reviewing the evidence these authors found the effect sizes for outcomes with children and adolescents were comparable with those of adults. On average, adults benefit from therapy, and on average children and adolescents find therapy as helpful as adults do.
Yet there are challenges in providing effective therapy for children and adolescents.
Yesterday I attended a training course for ‘Supervising Professionals Who Work With Young People’. The course was put on by Cambridge Supervision Training, with whom I did my Supervision Certificate (2010-11) and Supervision Diploma (2011-12). The course was led by Nick Luxmoore at Thriplow Village Hall.
Amongst many other attributes, Nick Luxmoore is a teacher, counsellor, clinical supervisor, trainer and writer. As an author, Nick has written a number of books including Practical supervision for counsellors who work with young people (2017), Horny and hormonal: Young people, sex and the anxieties of sexuality (2016) and Working with anger and young people (2006).
Nick was keen to stress the importance of defining the therapeutic task in counselling with young people. It can be too easy to resort to platitudes about ‘giving space to talk’ rather than encouraging the counsellor, and in turn their client, the young person, to focus on ‘what difference are we hoping to make’: What are we working to achieve here?
If we’re not clear on what we’re seeking to achieve, we may not achieve it.
Nick points out therapy and therapists need to be held accountable for the resources they are using (time, money and so on) and the outcomes they are achieving.
When I’m working with clients and supervisees my own case formulation approach centres around three questions:
- What is going on here? What problems/ symptoms is the client experiencing.
- What should be going on here? How would the client like their life to be like.
- How are we going to make that change happen? What is it that the client/ counsellor/ supervisor can do to make change happen.
In their 2013 review, Weisz and colleagues pointed out, often it is not the young person themselves who initiates therapy. Even when they do, their concerns may not agree with those of their parents and other adults.
One of my interests in attending the course was because of my work as Group Clinical Supervisor at a therapeutic community where I provide supervision to a group of therapists working with young people who are 15 to 18 years of age. Typically, in this setting, the young people are mandated to receive therapy.
Weisz and colleagues suggested a key challenge with therapy for children and adolescents is that of establishing engagement. If a person is mandated to receive therapy, it is important to build rapport and motivation in order to achieve the goals of therapy.
An area discussed by Nick that I particularly enjoyed was ‘On not being weird’.
Often as part of their training, counsellors will have learnt particular ways of being and behaving that somehow fit the theories they have learnt. Too often these result in the counsellor coming across as someone who is a bit weird. It’s difficult to build rapport with (young) people when you come across as weird.
Nick gave a particular example of ‘being weird’. Not unreasonably a new client asks their counsellor, ‘have you got kids?’.
Rather than simply answering the question, the counsellor replies ‘Hmm… I’m interested that you’re wondering whether or not I’ve got kids?’. This kind of response, while logical to the therapist, is weird! And it puts young people off.
Therapy for children and adolescents can be effective and what helps in being effective is being clear about goals, progression and engagement.
Clinical supervisors play an important role in holding the client’s counsellor to account in terms of ensuring goals have been established and the counsellor is working towards these in ways that maintain the engagement of the young person. Within the context of the scientific literature, the training course delivered by Nick Luxmoore on ‘supervising professionals who work with young people’ made a valuable contribution to my understanding of the importance of the role of the clinical supervisor and how to fulfil that role.
Lambert, M. J. (Ed.). (2013). Bergin and Garfield’s handbook of psychotherapy and behaviour change (6th ed.). Hoboken, NJ: Wiley.
Weisz, J. R., Ng, M. Y., Rutt, C., Lau, N., and Masland, S. (2013). Psychotherapy for children and adolescents. In M. J. Lambert, (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavioural change (6th ed., pp. 343-392). Hoboken, NJ: Wiley.