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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
Conduct disorders are among the most common problems for which children are brought for treatment, and they pose a formidable challenge for psychotherapists. These youngsters have a minimal capacity for insight into their problems, and their motivation to work on their difficulties is often very low. Many insight-oriented and expressive therapies fail to help these youngsters, particularly those treatments that are unstructured. Children with conduct disorders need structure and limits and tend to do better with therapists who are a bit obsessive in their personal style. The goal of treatment is to help the patient deal with the fundamental problems and conflicts of life. For children with conduct disorders, this entails learning a series of psychological skills. These include awareness and appropriate expression of feelings (especially anger and sadness), self-assertion, ability to delay gratification, anticipation of consequences of injudicious behavioral choices, and ability to generate healthier options when internal or external conflicts arise. For children who are incapable of, or unreceptive to, the development of conscious insight (as is the case for conduct-disordered youngsters), these skills are best taught symbolically and allegorically through stories, metaphors, parables, and discussions of third parties. Concrete examples are preferred over abstractions and generalizations. Dr. Gardner finds that being transparently honest and judiciously self-disclosing, particularly of experiences that relate to the youth's present struggles (e.g., the consequences of my periodic inability to delay gratification as a child), helps to build the therapeutic relationship. In the context of this relationship, the child is able to tolerate the anxiety and pain inherent in experiencing his or her core issues (e.g., abandonment, loss, abuse), of which Dr. Gardner speaks openly and directly. Among the psychotherapeutic techniques that are most useful for engaging such youngsters is The Talking, Feeling, and Doing Game. In this board game, both therapist and patient move playing pawns around a curved path, which results in selecting talking cards, feeling cards, and doing cards. Responding to the card's question or instruction enables the player to receive a reward chip. Examples of questions include the following:
These questions give the therapist the opportunity to speak directly or metaphorically about the child's problems and give the child the opportunity to self-disclose at a safe distance. The last question, for example, gives the therapist a platform for describing the social consequences of behaviors such as lying, stealing, and bullying; identifying the feelings of sadness and anger that accompany being excluded from a group; and suggesting alternative ways of behaving that will have more rewarding consequences for the child. This game has proven successful for drawing many (but certainly not all) resistant youngsters into meaningful psychotherapeutic endeavors. Dr. Gardner uses games and stories in his work with children and adolescents. What does this lead you to expect about his work? Will he be active or passive? Will the session be structured or unstructured? Directive or nondirective? Will it focus on the past or on the present? Will the session focus on behaviors, on thoughts, or on feelings? What do you expect to be the relative balance between attention to technique versus the interpersonal interaction? Return to Psychotherapy of Children With Conduct Disorders Using Games and Stories |
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