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For As Long As It Takes: Relationship-Based Play Therapy for Children in Foster Care

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For As Long As It Takes: Relationship-Based Play Therapy for Children in Foster Care

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The trauma of child abuse is magnified for children placed in foster care. The disruption, disorganization, and discontinuity experienced in foster care further extend the trauma of abuse. Effective treatment of foster youth must prioritize the basic need for children to experience continuity, stability, and permanency in attachment to a healthy adult(s). Short-term, symptom-focused interventions are inappropriate for this population of ethnically diverse, socioeconomically disadvantaged, underserved, multiply traumatized youths with complex psychiatric comorbidity. We describe a long-term, psychoanalytically oriented, relational play therapy intervention for foster youth and present initial empirical results describing the impact of this approach.
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Psychoanalytic Social Work,19:4353,2012
Copyright © Taylor & Francis Group, LLC
ISSN: 1522-8878 print / 1522-9033 online
DOI: 10.1080/15228878.2012.666481
For As Long As It Takes: Relationship-Based
Play Therapy for Children in Foster Care
JUNE MADSEN CLAUSEN
Psychology, University of San Francisco; San Francisco, California, USA; and A Home
Within, San Francisco, California, USA
SARALYN C. RUFF
Human Development and Family Studies, Purdue University, West Lafayette, Indiana, USA;
and A Home Within, San Francisco, California, USA
WENDY VON WIEDERHOLD
AHomeWithin,SanFrancisco,California,USA
TONI V. HEINEMAN
AHomeWithin,SanFrancisco,California,USA;andPsychiatry,UniversityofCalifornia,
San Francisco, California, USA
The trauma of child abuse is magnified for children placed in
foster care. The disruption, disorganization, and discontinuity ex-
perienced in foster care further extend the trauma of abuse. Ef-
fective treatment of foster youth must prioritize the basic need for
children to experience continuity, stability, and permanency in at-
tachment to a healthy adult(s). Short-term, symptom-focused inter-
ventions are inappropriate for this population of ethnic ally diverse,
socioeconomically disadvantaged, underserved, multiply trauma-
tized youths with complex psychiatric comorbidity. We describe
a long-term, psychoanalytically oriented, relational play therapy
intervention for foster youth and p resent initial empirical results
describing the impact of this approach.
KEYWORDS foster children, psychoanalytic, play therapy
BACKGROUND
Child maltreatment remains a major societal problem with vast negative
consequences for many children and youth in our world today (Mennen,
Address correspondence to June Madsen Clausen, Ph.D., Department of Psychol-
ogy, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117. E-mail:
clausenj@usfca.edu
43
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44 J. Madsen Clausen et al.
Kim, Sang, & Trickett, 2010). The short- and long-term consequences of
abuse and neglect span the physical, social, educational, and mental health
dimensions of development (Zielinsks, 2009). For many of the children who
are identified as maltreated, the removal from home and placement into
out-of-home care serves as a secondary trauma (Putney, Sieta, & Unrau,
2008); over the past 10 years, the number of children placed into foster
care has increased exponentially (Hanson, Mawjee, Barton, Metcalf, & Joye,
2004). The experience of disruption, disorganization, and discontinuity is
magnified even further for many children in foster care by multiple placement
changes and by the lack of permanence and security that characterizes their
dependency status (Connell et al., 2006; Ryan & Testa, 2005). Specifically,
many foster children, particularly those with significant mental health issues,
experience numerous changes in placement with consequent changes in
foster parents, neighborhoods and schools, social workers, and health and
mental health care providers (Kerker & Dore, 2006; Nittoli, 2003). An effective
response to the problem of abuse and neglect must prioritize the basic
need for children to experience continuity, stability, and permanency in
attachment to a healthy adult or group of adults who can provide nurturing
care and help the child to make sense of their life experience.
Our current system of care typically attempts to protect these trauma-
tized children from further experiences of maltreatment and, for most chil-
dren, does nothing more. Comprehensive medical, educational, and mental
health assessments for children in foster care are infrequently administered
and, when they take place, the recommendations for treatment and inter-
vention are rarely delivered (Levitt, 2009; Marx, Benoit, & Kamradt, 2003;
Pecora, Jensen, Romanelli, Jackson, & Ortiz, 2009; Unrau & Wells, 2005).
Specifically, research indicates that only a small minority of foster children
receive mental health services, and those who are ethnic minorities (who
are overrepresented in the foster care system) and who were removed for
reasons of neglect (the most common reason for removal from home) are
the least likely to receive mental health services (Blumberg, Landsverk, Ellis-
MacLeod, Ganger, & Culver, 1996; dosRios, Zito, Safer, & Soeken, 2001;
Garland & Besinger, 1997).
Despite the fact that mental health problems in foster children are diag-
nostically complex and require long-term intervention, it is a rare foster child
who sees the same therapist for multiple treatment sessions over a period of
several months. In actuality, most foster youth are not seen by licensed men-
tal health providers, but by case managers in the child welfare system that
are heavily burdened by and thus focused on administrative agendas and
requirements, not with developing relationships or with addressing mental
health issues. This lack of consistent, long-term, therapeutic intervention not
only leads to inconsistent care that impedes progress, but also serves to
confirm the youths’ expectations that relationships are temporary.
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For As Long As It Takes 45
In order to appropriately assist foster youth and address the complexity
of their mental health challenges, mental health treatment must be of suffi-
cient intensity and duration to allow for the development of a trusting thera-
peutic relationship in which the depth of experienced trauma and ambiguous
loss can be explored and the breadth of consequent psychiatric symptoms
can be identified and addressed. Although an evidence base has developed
that documents the effectiveness of brief behavioral or cognitive-behavioral
interventions targeted at specific symptoms or diagnoses (e.g., post-traumatic
stress disorder [PTSD], attention deficit/hyperactivity disorder [ADHD], con-
duct disorder, depression), experts note that such interventions are “more
effective when a caregiver is involved” and that youths with “complex com-
binations of mental health conditions” will benefit from “intensive home- and
community-based services” (Landsverk, Burns, Stambaugh, & Reutz, 2009,
p. 53). Children in foster care only rarely have an involved caregiver and are
often burdened by complex combinations of mental health symptoms. Thus,
effective mental health treatment must involve a relationship with an experi-
enced therapist that provides the safety, stability, and containment required
by these troubled youth to work through their traumatic history and address
their current physical health, mental health, educational, and adaptive prob-
lems. Approaches that support the complexity of these youths’ presenting
problems include psychoanalytic psychotherapy and play therapy.
Psychoanalytically Oriented Psychotherapy
with Children in Foster Care
Psychoanalytic approaches offer a way of understanding the multitude of
factors that go into the development of a person’s personality, or the pat-
terned way he or she thinks, feels, acts, and experiences oneself and others
over time. By examining these factors, psychoanalytic psychotherapy pro-
vides a way to understand the individual’s attempts to protect, or defend, the
integrity of the self when exposed to external and internal triggers. More-
over, psychoanalytic psychotherapy offers a way to understand unresolved
needs and desires as a means to facilitate healthy development.
Psychoanalytic psychotherapy pays close attention to childhood expe-
riences and the ways in which these early experiences influence psycho-
logical development. In particular, these approaches focus on the impact of
traumatic experiences in childhood, and their lasting influence on the in-
dividual. Psychoanalytic theory, not to mention simple observation, tells us
that children are compelled to avoid emotions and situations that they can-
not tolerate, that growth involves learning to tolerate difficult emotions, and
that all humans have ongoing challenges associated with our earliest experi-
ences. Reviewing and revisiting, in and through relationships, the remnants
of the past, embedded in the psyche, can provide opportunities for finding
new ways of understanding feelings, thoughts, and actions. The specifics of
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46 J. Madsen Clausen et al.
a child’s earliest relationships, and the nature and quality of a child’s attach-
ment during these years, shapes the character of relationships throughout
life (Bowlby, 1969/1982). Psychoanalytic treatment can revisit, re-create, and
even reshape early attachment experiences.
Psychoanalytic treatments require time and ongoing commitment to sup-
port the exploration of the complex individual, and the cumulative impact of
his or her experiences. These approaches also require the establishment of
enduring therapeutic relationships to support the individual’s trust and en-
gagement in the healing process. The therapeutic relationship, both real and
transferential, can offer a second chance for foster children who have expe-
rienced ruptured and malignant attachments. The natural tendency, deeply
ingrained in the individual, is to respond to certain situations in unique,
predetermined ways. These tendencies are predetermined by much earlier,
formative experiences—usually within the context of the primary attachment
relationship—and arise in a psychoanalytic treatment in relationship to the
therapist.
To support the development of a strong therapeutic alliance and allow
the therapist to “know” the foster child through exploration of his or her
experiences, it is imperative that treatment be offered “for as long as it
takes.” Specifically, because these youth have often experienced multiple
traumas resulting in deep-seated beliefs about themselves and others, they
require, and deserve, ongoing treatment focused on their growth and healing.
Perhaps the most important aspect of “for as long as it takes” is the way in
which the therapist holds the child and treatment in mind. Even before
the first meeting, the therapist has opened the psychic space to hold the
child for an indefinite time. When child and therapist actually meet for the
first time, the child encounters someone who understands that it is only
through the “meeting of minds” (Fonagy & Target, 1997) that deep and
profound psychological change happens. By approaching therapy without
time constraints or preconceived aims, the therapist signals an interest in a
mutually created relationship and goals. It is the openness of the therapist’s
mind that invites the full participation of the child in the treatment.
Use of Play Therapy with Young Foster Youth
When exploring the impact of a young child’s experiences, play therapy is
an efficacious and developmentally responsive intervention (Bratton, Ray,
Rhine, & Jones, 2005). Most children are not developmentally capable of
experiencing abstract thoughts or of expressing complex emotions. Instead,
children use play as their standard mode of learning, developing, and ex-
pressing feelings. Play diminishes feelings of stress and offers psychological
distance from problems. It also helps the child regulate emotions, affords him
or her the opportunity to practice skills and roles, stimulates creative problem
solving, and communicates psychological interests (Landreth, 2002). While
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For As Long As It Takes 47
an older child might say, “I want to talk about why I worry so much about
people leaving me,” a young child, with the same concerns, might repeat-
edly engage adults in games of hide-and-seek. These children are conveying
the same message, but doing so in their own unique and developmentally
appropriate way.
Play therapy is a theoretically based therapeutic approach that allows
children the opportunity to express themselves through the use of play in the
presence of an interpreting other. Specifically, psychoanalytic play therapy
utilizes the benefits of play and provides children with meaningful opportu-
nities to symbolically share and process their feelings and thoughts. Similar
to psychoanalytic approaches, play therapy has the potential to offer a nu-
anced understanding of the past and a corrective emotional experience to
encourage healing (Landreth, 2002). The therapist facilitates safe exploration
in a nurturing and stimulating environment so that the child can commu-
nicate through his or her play. The acceptance of the child and his or her
expression allows that child to develop insight about and resolution of inner
conflicts (Reddy, Files-Hall, & Schaefer, 2005). Play therapy is a particularly
impactful treatment modality with children who have experienced trauma
(Ogawa, 2004). Play therapy has the potential to assist traumatized chil-
dren to explore thoughts and feelings in a forum that is safe and contained,
conducive to creative expression, and rich with opportunities for repara-
tive experience. Simply, play allows the child to make the unmanageable,
manageable (Landreth, 2002).
“A Home Within” Relationship-Based Intervention
We know that the experience of being “known” is profoundly important. It is
difficult to imagine either a psychic or functional realm in which this does not
apply. Children from intact families typically have one or both parents who
are acutely aware of their likes and dislikes, fears and traumas. Foster children
who have been placed in multiple homes, experienced a revolving door of
social workers, attorneys, and therapists, and endured ruptured relationship
after ruptured relationship after ruptured relationship are certain to have a
fractured history with no one person who “knows” them.
A Home Within therapists often provide these displaced youths with
their first experience of being “known.” Through local chapters in counties
across 25 states, this national nonprofit organization focused on the emo-
tional needs of foster youth offers pro bono, long-term, psychoanalytically
oriented psychotherapy including play therapy to current and former foster
youth “for as long as it takes.”
RESULTS
Results of the first 20 completed treatments of children who were 5 to
10 years old at the start of treatment are presented. Therapists completed the
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48 J. Madsen Clausen et al.
“Initial Telephone Questionnaire for Therapists” (ITQT), a semi-structured,
telephone-administered survey about the start of treatment that includes
44 questions about therapist demographics, foster child patient demograph-
ics, and the foster child’s mental health status. Later, therapists completed the
“Exit Telephone Questionnaire for Therapists,” a semi-structured, telephone-
administered survey that follows the same basic format as the ITQT and
includes 45 questions about the conclusion of treatment including parame-
ters of treatment and the foster child’s mental health status.
Therapists (N = 20), each of whom had provided pro bono psychother-
apy to one young foster child through A Home Within, were predominantly
female (70%), White (90%), and middle-aged (mean = 47.50 years; SD =
10.10 years). The majority of participants were licensed psychologists (55%)
or licensed marriage and family therapists (30%), worked 21 to 30 hours
per week in clinical practice (50%), and described their general approach to
psychotherapy as “Psychoanalytic” and/or “Psychodynamic” (Figure 1). On
average, participants had 7.13 years of clinical experience as a licensed men-
tal health professional (range = 0 months to 17 years; 2 of the 20 therapists
were not yet licensed, but were working as psychological assistants under
the supervision of a licensed psychologist).
The sample of young foster children who had completed treatment
with the therapists just described were predominantly male (70%), ethni-
cally diverse (35% African-American, 30% White, 30% multiple ethnicities),
and ranged in age from 5 to 10.69 years at the start of treatment. Aver-
age length of treatment for these youths was 3.37 years (range = .34 to
7.38 years, SD = 2.16). Comparison of therapist reports of their patient’s men-
tal health status at the start and end of treatment indicated clinically significant
reductions in many areas of psychological dysfunction. Specifically, patients
FIGURE 1 Therapists’ approach to treatment.
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For As Long As It Takes 49
TABLE 1 AHomeWithinTherapistRatingofChildPatientSymptoms
Start of Treatment End of Treatment
Sig.
Symptoms N Mean SD N Mean SD Value
Peer Relationship Problems 20 3.05 0.94 20 2.10 0.85 0.000
Anxiety 20 3.65 0.59 20 2.85 0.88 0.000
Sleep Problems 20 2.50 1.28 20 1.55 0.89 0.002
Dissociative Symptoms 20 2.20 1.24 20 1.45 0.60 0.003
Aggression/Violence 20 2.35 1.31 20 1.60 1.09 0.003
Depression 20 3.30 0.86 20 2.25 1.12 0.003
School Problems 20 2.70 1.30 20 2.05 1.19 0.033
Conduct Problems 20 2.80 1.44 20 2.15 1.09 0.061
Sexual Behaviors 19 1.74 1.19 19 1.12 .71 0.086
Enuresis 14 1.36 0.93 14 1.21 0.58 0.165
Substance Abuse 19 1.00 0.00 19 1.26 0.81 0.172
Anger 5 3.00 1.23 5 2.20 0.45 0.178
Problems with Family of Origin 19 3.42 1.26 19 3.00 1.33 0.249
Psychotic Thoughts/Behaviors 20 1.10 0.31 20 1.15 0.50 0.330
Hoarding 5 1.40 0.89 5 1.20 0.45 0.374
Eating Problems 20 1.85 1.04 20 1.65 1.04 0.551
Problems with Current Family 18 2.
50 1.20 18 2.33 1.14 0.579
Self-Injurious Behavior 20 1.30 0.66 20 1.20 0.52 0.606
Learning Problems 20 1.85 1.18 20 1.75 1.11 0.681
Suicidality 20 1.25 0.55 20 1.25 0.64 1.000
Encopresis 14 1.00 0.00 14 1.00 0.00
p < .05.
demonstrated marked and statistically significant improvements in peer rela-
tionships, anxiety, sleep, dissociation, aggression/violence, depression, and
school functioning (Table 1).
Current findings are limited by a methodology that queries therapists
about the progress of their own patients; such reports are potentially bi-
ased and therefore reductions in symptoms may overestimate true changes.
There is also no comparison group and thus it is not known whether these
20 foster youths would have demonstrated similar reductions in symptoma-
tology without the play therapy intervention. However, given the small sam-
ple size, findings are statistically remarkable and provide initial evidence
that this relationship-based, play therapy intervention is an effective ap-
proach to working with diagnostically complex, multiply traumatized, young
foster children. Future research should include reports from foster parents,
caseworkers, and/or foster youth themselves, and optimally should include
a comparison group of demographically comparable foster youth who do
not receive the intervention.
DISCUSSION
Initial results of long-term, relationship-based psychoanalytic play ther-
apy with young children in foster care indicate statistically and clinically
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50 J. Madsen Clausen et al.
significant reductions in mental health symptoms across a variety of domains.
Findings validate the clinical and theoretical premise that the provision of
a continuously and consistently available supportive adult in the otherwise
discontinuous and unstable lives of these vulnerable youth promotes positive
change and growth. Specifically, results show that patients who work with a
therapist “for as long as it takes” experience decreased anxiety, depression,
dissociative symptoms, aggression, and sleep disturbances over the course of
treatment. Moreover, these findings occurred despite nonsignificant changes
in the patients’ relationships with their family. This highlig hts the potential
impact of the therapeutic relationship in forwarding a child’s therapeutic
progress, despite external limitations.
Results also show that children who completed A Home Within’s
relationship-based treatment experienced improved peer relationships. This
finding is of particular importance for foster youth. Specifically, due to expe-
riences associated with being maltreated, foster children are at high risk for
developing relational mental representations and behavioral patterns that un-
dermine peer relationships (Bolger, Patterson, & Kupersmidt, 1998; Cicchetti
& Lynch, 1995; Coleman, 2003). The improvements in peer relationships ex-
perienced for A Home Within patients suggest that patients’ representations
of relationships were healthier at the conclusion of treatment. Moreover, this
finding offers hope for potential cumulative gain; specifically, peer relation-
ships in early and middle childhood have immense developmental impor-
tance, influencing an individual’s long-term development in areas including,
but not limited to, self-esteem, internalizing and externalizing behaviors, and
risky behavior (Bolger et al., 1998; Criss, Pettit, Bates, Dodge, & Lapp, 2002;
Goldstein, Davis-Kean, & Eccles, 2005). Thus, these 20 foster children, who
began treatment before puberty, finished treatment better equipped to expe-
rience adolescent and adult relationships and consequently possess higher
self-esteem and fewer psychiatric symptoms later in life.
Another significant finding with the likelihood of long-term impact is that
of decreased school problems. Of all the difficulties foster children experi-
ence, school problems may have the most serious long-term consequences
(Finkelstein, Wamsley, & Miranda, 2002; Goddard, 2000). Foster children,
in comparison with non-foster children, are more likely to have behavioral
problems, experience inconsistencies in their education, be in special educa-
tion, and not graduate high school (Blome, 1997). However, once they age
out of the foster care system, academic performance largely determines fos-
ter children’s futures (Finkelstein et al., 2002). Thus, the benefit of long-term,
relationship-based treatment in decreasing school problems has potentially
immeasurable impact.
While these initial results suggest a model of treatment that is potentially
effective with a highly vulnerable group of youths who are very different
from those included in most evidence-based treatment studies, the treatment
is of much longer duration than what is currently provided by under-funded
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For As Long As It Takes 51
public mental health and child welfare systems tasked with caring for these
children. Yet, foster children who do not receive mental health treatment
or who are treated with short-term strategies delivered by a series of rotat-
ing mental health providers suffer greatly in our system of care and grow
to be adolescents and young adults burdened by a variety of preventable
outcomes. Current findings suggest that the investment in three to four years
of weekly psychotherapy during early childhood likely dramatically reduces
the overall cost of caring for these vulnerable youths. Investment in effec-
tive, long-term mental health treatment likely reduces later costs of more
restrictive care (e.g., residential treatment, juvenile and adult incarceration,
inpatient mental health, and substance abuse treatment).
Moreover, investment in long-term mental health care offers the possi-
bility of dramatically altering the developmental trajectory for these children.
A healthy, lasting therapeutic relationship lays the foundation for a child
to build other healthy relationships with peers and adults. The capacity to
form and maintain connections are crucial as these young people move into
adolescence and young adulthood and face the challenges and rewards of
school, work, and parenting. Using relationship-based, psychoanalytic play
therapy to change mental health and functional outcomes for individual chil-
dren in foster care has the likely potential to change long-term outcomes for
these children and, ultimately, for the next generation of children who will
be born to these former foster youth.
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... These elements reveal that, in many cases, the various forms of support offered by child protection measures do not improve the conditions of existence of these young subjects, but aggravate them (Clausen et al., 2012). In these circumstances, the characteristics of pliability do not seem to be embodied in any other secondary object of attachment for the child. ...
... The analysis of the ecosystem shows us how considering subjective characteristics at all levels of support given to a child plays a role in the process of individuation, construction or reconstruction. It also shows how shortfalls in child protection within the cross-border context favour the reiteration of ruptures (Clausen et al., 2012). In addition, the notion of pliable medium and its connection to subjectivity shows how children who do not have secure and containing environments cannot build their capacity to think and function psychically. ...
... The Child Protection System suffers from paradoxical aims and applications that can harm children's development and fail to achieve their goal of protection (Berger, 2006;Clausen et al., 2012). The limits of international cooperation between countries are also revealed in the application of child protection measures. ...
Article
This article addresses the issue of ruptures in cross-border contexts in Child Welfare Systems, and their impact on family relationships and organisation. To illustrate some of the challenges and paradoxes, our case study focuses on the situation of a mother and her 10 year old son. The pair received social care as part of a European research programme (EUR&QUA), the goal of which is to create a cross-border zone for child welfare. In such zones, many families receiving social support frequently face different legislative, social and health systems once they move from one country to the other, despite the geographical proximity. This discrepancy in systems complicates continuity in care and may also influence the subjective experience of each family member. It also raises the question of harmonising social work practices beyond border, the aim being to offer better support to vulnerable families with traumatic experiences.
... In response to this evidence, predominantly with children who suffered maltreatment, a number of attachment-based interventions have been developed. These include child-parent psychotherapy (CPP-Lieberman & van Horn, 2011), relationship-based play therapy (Clausen, Ruff, Wiederhold, & Heineman, 2012), attachmentbased family therapy (Diamond, Russon, & Levy, 2016) and theraplay (Booth & Jernberg, 2009). These approaches usually target parentchild and parent-adolescent dyads either posing a risk of attachment disruption or presenting with attachment difficulties or disorders (Clausen et al., 2012). ...
... These include child-parent psychotherapy (CPP-Lieberman & van Horn, 2011), relationship-based play therapy (Clausen, Ruff, Wiederhold, & Heineman, 2012), attachmentbased family therapy (Diamond, Russon, & Levy, 2016) and theraplay (Booth & Jernberg, 2009). These approaches usually target parentchild and parent-adolescent dyads either posing a risk of attachment disruption or presenting with attachment difficulties or disorders (Clausen et al., 2012). Although these modalities are informed by different theoretical frameworks, their broad objective is to enhance the quality of the parent-child attachment relationship by improving parents' (or caregivers') sensitivity towards their children's emotional needs. ...
Preprint
Despite the evidence on the role of parental factors, especially attachment relationships, in mediating complex trauma experienced by refugee children, there is limited evidence on the use of attachment‐based interventions. The aim of this study was to explore the feasibility of adapting such an intervention, group theraplay, for refugee children in Turkey. Fifteen child–parent dyads participated, and completed measures on attachment relationships, child mental health and parenting strategies. Children engaged with the intervention, whilst it proved more difficult to involve parents regularly. There was a significant improvement in children's post‐traumatic stress and other common mental health symptoms, as well as parent‐rated attachment relationship difficulties. Attachment‐based modalities using play, activities and games can be particularly useful for children and families with cultural and language challenges. Therapeutic interventions for refugee children and families should be integrated with other types of support within a multimodal service approach.
... Exploratory research has indicated that mental health interventions offered through A Home Within are associated with decreases in mental health symptoms of depression, anxiety, dissociation, sleep problems, and school problems among those starting treatment as infants and toddlers (ages 0-5) as well as for those clients starting treatment as school-aged children (ages 5-10) (Clausen et al. 2012;Ruff et al. 2015). Moreover, infants and toddlers experienced additional reductions in self-injurious behaviors, enuresis, conduct problems, sexualized behavior, and aggression (Ruff et al. 2015), and school-aged children experienced additional reductions in peer relational problems and aggression (Clausen et al. 2012). ...
... Exploratory research has indicated that mental health interventions offered through A Home Within are associated with decreases in mental health symptoms of depression, anxiety, dissociation, sleep problems, and school problems among those starting treatment as infants and toddlers (ages 0-5) as well as for those clients starting treatment as school-aged children (ages 5-10) (Clausen et al. 2012;Ruff et al. 2015). Moreover, infants and toddlers experienced additional reductions in self-injurious behaviors, enuresis, conduct problems, sexualized behavior, and aggression (Ruff et al. 2015), and school-aged children experienced additional reductions in peer relational problems and aggression (Clausen et al. 2012). Further, when A Home Within therapists offered care Bfor as long as it takes,^findings indicated that weekly treatment lasted upwards of three years and involved active collaboration with other adults involved in the client's life (e.g., teachers, social workers). ...
Article
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Foster youth experience a complex combination of psychological symptoms associated with the experience of abuse and/or neglect. Among adolescents, psychological challenges can be magnified by an increased likelihood of placement disruption once in foster care, longer stays in the system, and numerous barriers that impede access and use of mainstream psychological intervention. This manuscript relies on two studies to learn more about the experience of adolescent-aged foster youth who utilize long-term mental health services coordinated through A Home Within, a national nonprofit committed to reducing treatment barriers by asking licensed therapists to provide pro bono therapy “for as long as it takes.” Study 1 evaluates 84 therapist interviews about client demographics, trauma history, and mental health symptoms in an effort to learn more about the concerns and experiences of adolescent-aged youth participating in treatment. Study 2 examines 30 pre/post interviews with therapists to understand outcomes associated with treatment completion, as well as to describe treatment practices. Findings support a need for continued investigation of long-term psychotherapeutic services with foster youth focused on the needs of youth accessing care and best treatment practices with this population of vulnerable youth.
... Behavior Therapy, 35, 205-230. Brandl, Y., Bruns, G., Gerlach, A., Hau, S., Janssen, P. L., Kächele, H. et al. (2004) Erstautor (Jahr) Bewertung Apter (1984) mangelhafte Ergebnisdarstellung Clausen (2012) unklare Diagnostik/Krankheitswert Eresund (2007) mangelhafte Ergebnisdarstellung Heede (2009) mangelhafte Ergebnisdarstellung Jordy (1996) mangelhafte Ergebnisdarstellung mangelhafte Ergebnisdarstellung Milrod (2013) möglicher Wirksamkeitsnachweis für Anwendungsbereich 2 Salomonsson (2020) unklare Diagnostik/Krankheitswert Saltzman (2001) nicht psychodynamische Therapie Sugar (2011b) nur 3 Fälle Vilsvik (1990) mangelhafte Ergebnisdarstellung Vorgraft (2007) möglicher Wirksamkeitsnachweis für Anwendungsbereich 13 ...
Article
In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.
... Some studies have focused specifically on children in foster care (e.g., Clausen et al., 2012). Midgley et al. (2019) conducted a feasibility RCT with follow-up at 12 and 24 weeks postrandomization, examining the effectiveness of MBT vs. usual care (UCC) for children in foster care. ...
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Despite a rich theoretical and clinical history, psychodynamic child and adolescent psychotherapy has been slow to engage in the empirical assessment of its effectiveness. This systematic review aims to provide a narrative synthesis of the evidence base for psychodynamic therapy with children and adolescents. Building on two earlier systematic reviews, which covered the period up to 2017, the current study involved two stages: an updated literature search, covering the period between January 2017 and May 2020, and a narrative synthesis of these new studies with those identified in the earlier reviews. The updated search identified 37 papers (28 distinct studies). When combined with papers identified in the earlier systematic reviews, this resulted in a combined total of 123 papers (82 distinct studies). The narrative synthesis of findings indicates that there is evidence of effectiveness for psychodynamic therapy in treating a wide range of mental health difficulties in children and adolescents. The evidence suggests this approach may be especially effective for internalizing disorders such as depression and anxiety, as well as in the treatment of emerging personality disorders and in the treatment of children who have experience of adversity. Both the quality and quantity of empirical papers in this field has increased over time. However, much of the research demonstrates a range of methodological limitations (small sample sizes, lack of control groups etc.), and only 22 studies were Randomized Controlled Trials. Further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy for children and young people.
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Children and youth in foster care often experience numerous traumas both in and out of the child welfare system, and as a result many need access to mental health support. Researchers report low utilization rates of mental health services among individuals who have lived in foster care, often attributed to barriers to both access and receipt of consistent mental healthcare. A Home Within is a national nonprofit organization that aims to reduce these barriers to mental healthcare for children and youth with past or current involvement in foster care by facilitating their access to consistent pro bono psychotherapy for “as long as it takes.” Eight-five A Home Within therapists completed interviews with trained research assistants at two time points. Interviews included 44 closed- and open-ended questions regarding therapist demographics, client demographics, clients’ presenting concerns and mental health status, and treatment description. Repeated measures analysis of variance (ANOVA) models showed significant decreases in all five outcomes from baseline to termination of treatment. The associated effect sizes for length of time in treatment were medium to large for depression, anxiety, conduct disorder, and perpetrating aggression/violence. There was a small to medium associated effect size for peer relationship problems and the effect of time was not significant for cohabitation relationship problems. Findings provide preliminary support for continued development and evaluation of mental health services facilitated through A Home Within among clients currently or previously in foster care.
Chapter
A play is referred to the language of children through which they express and communicate their feelings, thoughts, and behavior in a playful way. Play therapy enables children to gain an understanding of themselves and the world around them and helps them to overcome behavioral, emotional, social, and various other issues through play activities. The chapter majorly focuses on the effectiveness of play therapy in different neurodevelopmental disorders. Recent trends and studies suggested that play therapy is one of the most favored therapeutic approaches used in the children with various neurodevelopmental disorders.
Article
If we can find ways to hear and understand children, they have a lot to say, tell and teach us, adults. Children who do not have extensive verbal abilities like adults can express themselves through playing. It has been proven by research that the best method by which they can convey their feelings, thoughts and problems is play therapy. At this point, it is important that professionals working with children are equipped with the knowledge of play therapy. Social workers who frequently come into contact with children in their professional lives should be involved in the field as play therapy practitioners. However, when the literature is examined, it is seen that there are very few practices and studies on the subject in Turkey. This study presents the place and importance of play therapy in social work practice with children in the light of the researches and applications in the literature, and highlights the importance of the use of play therapy as a method by social workers working with children. It has been observed that play therapy needs a wider coverage in social work practice and research. Suggestions have been made for popularizing play therapy in the relevant social work education, research and practices. Extended English summary is in the end of Full Text PDF (TURKISH) file. Özet Çocukları duymaya, anlamaya ilişkin yollar bulanabilirse, onların yetişkinlere söyleyecekleri, anlatacakları, öğretecekleri çok şey vardır. Yetişkinler gibi geniş sözel yeteneklere sahip olmayan çocuklar kendilerini oyun yoluyla ifade edebilmektedirler. Onların duygularını, düşüncelerini, sorunlarını aktarabilecekleri en iyi yöntemin oyun terapisi olduğu araştırmalarla kanıtlanmıştır. Bu noktada çocuklarla çalışan profesyonellerin oyun terapisiyle ilgili bir donanıma sahip olması önem arz etmektedir. Mesleki yaşamlarında sıkça çocuklara temas eden sosyal hizmet uzmanları, oyun terapisi uygulayıcısı olarak alanda yer almalıdır. Ancak alan yazın incelendiğinde konuyla ilgili ülkemizdeki uygulama ve çalışmaların çok az sayıda olduğu görülmüştür. Çocuklarla sosyal hizmet uygulamasında oyun terapisinin yeri ve öneminin literatürdeki araştırmalar ve uygulamalar ışığında sunulduğu bu çalışmada, çocuklarla çalışan sosyal hizmet uzmanlarının oyun terapisini bir yöntem olarak kullanmalarının önemine dikkat çekilmiştir. Oyun terapisinin sosyal hizmet uygulama ve araştırmalarında daha geniş yer almaya ihtiyacı olduğu görülmüştür. Konuyla ilgili sosyal hizmet eğitim, araştırma ve uygulamalarında oyun terapisinin yaygınlaştırılması için önerilerde bulunulmuştur.
Chapter
A play is referred to the language of children through which they express and communicate their feelings, thoughts, and behavior in a playful way. Play therapy enables children to gain an understanding of themselves and the world around them and helps them to overcome behavioral, emotional, social, and various other issues through play activities. The chapter majorly focuses on the effectiveness of play therapy in different neurodevelopmental disorders. Recent trends and studies suggested that play therapy is one of the most favored therapeutic approaches used in the children with various neurodevelopmental disorders.
Article
Full-text available
Psychodynamic psychotherapy (PDT) for children and adolescents has a long tradition. However, the evidence base for this therapeutic method has not been firmly established with studies aimed at examining treatment efficacy (i.e. RCT studies) until recent years. The present paper describes the principles of PDT with children and adolescents and addresses the evidence of psychodynamic psychotherapy with children and adolescents suffering from a range of mental health problems. The paper points to particular advantages of PDT, such as taking the child’s developmental stage into account in treatment, working through creativity and play and being sensitive to the environmental context of the child. The method seems particularly suitable for children with complex or comorbid conditions for which treatment approaches focusing primarily on symptoms have been attempted but without success. To illustrate this therapeutic approach, the authors describe a real life case-example of a psychodynamic therapy with a young girl, «Nora». Keywords: Children and adolescents, clinical practice, evidence, psychodynamic psychotherapy.
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Using Cox regression modeling, this longitudinal study examines child and case characteristics associated with changes in placement among 5,909 Rhode Island children in foster care. Results suggest that half of all children experience at least one placement change while in care. Infants change placements least, and risk increases with child age. Emergency shelter settings have the highest risk of placement change, followed by nonrelative settings, group home settings, and relative foster care. The reasons for removal from the home and the history of previous placements also predict placement changes, as do the interactions between foster care setting and some child characteristics.
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The efficacy of psychological interventions for children has long been debated among mental health professionals; however, only recently has this issue received national attention, with the U.S. Public Health Service (2000) emphasizing the critical need for early intervention and empirically validated treatments tailored to children's maturational needs. Play therapy is a developmentally responsive intervention widely used by child therapists but often criticized for lacking an adequate research base to support its growing practice. A meta-analysis of 93 controlled outcome studies (published 1953-2000) was conducted to assess the overall efficacy of play therapy and to determine factors that might impact its effectiveness. The overall treatment effect for play therapy interventions was 0.80 standard deviations. Further analysis revealed that effects were more positive for humanistic than for nonhumanistic treatments and that using parents in play therapy produced the largest effects. Play therapy appeared equally effective across age, gender, and presenting issue. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Relationships among attachment to each parent, children's social self-efficacy, and the quality of peer relations (attachment to peers and perceptions of victimization) were explored with 67 fifth and sixth graders (31 female) attending a rural elementary school. Results of hierarchical multiple regression analyses revealed main effects for gender and attachment to mother relative to the attachment to peers variable, with girls and more securely attached children reporting higher quality attachment to peers. Main effects were also detected for gender and attachment to father relative to social self-efficacy, with girls and more securely attached children exhibiting higher self-efficacy. No main effects were observed relative to the peer victimization variable. None of the interaction effects involving gender and attachment to each parent relative to attachment to peers, peer victimization, and social self-efficacy were significant. Finally, evidence for mediation of attachment to father on attachment to peers by children's social self-efficacy was revealed. Implications of the results are discussed and ideas for future research are provided. Copyright © 2003 John Wiley & Sons, Ltd.
Article
Play therapy is examined as an intervention for traumatized children. Difficulties in assessing Post-Traumatic Stress Disorder (PTSD) in children according to the existing criteria are described, and the aspects of play therapy that facilitate the curative potential in children are analyzed. Release Play Therapy and Child-Centered Play Therapy are discussed as possible approaches in the treatment of traumatized children.