1. dracodomitor
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    dracodomitor Member

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    How does therapy work?

    Discussion in 'Research' started by dracodomitor, Feb 8, 2016.

    Hey, dudes.

    So, my MC is young, about ten or so, and somehow he managed to find himself attending therapy. As someone who's never done such a thing (though probably needs it), I have no directional sense as to how I'd go about writing realistically.

    I tried Youtube first, since that's where most noobs start off, but everything I was looking at just wasn't right. All the videos I could find were either too-young kids, or simply just the therapist talking about how their job helps people. That's not what I needed, so I headed to the internet, and I could still never find something specific to what I wanted. To writingforums it is, then.

    If anyone could tell me what therapy would be like for an emotionally-stunted child who suffers from PTSD and trust issues, that'd be just swell. Of course, I'm not saying you have to be that kid, because really? What are the chances of that? Just, any sort of insights into what therapy might be like for my darlin' MC. What sort of questions would the therapist ask? Would play therapy work on a ten year old of such a caliber? What methods, or techniques would MC be given to practice and implement? And how, please tell me how, one would go about convincing a child-soldier that not everyone is out to get them? Because I'm having trouble, and I'm the one writing the damn thing.

    Thanks a bunch!
     
  2. Lea`Brooks
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    Lea`Brooks Contributing Member Contributor

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    Well, I went to therapy when I was twelve. I only remember the first session. She asked me to draw a picture of a house with windows, a tree, an animal, and myself out there somewhere. It was a test, I realize now. The house represented my stability - how safe I felt. The windows represented my outlook, I think - how I viewed the world. The tree represented my environment - what my world looked like. The animal represented my connection - what the animal represented. And where I placed myself in the picture represented, obviously, me - how I saw myself fitting in and interacting with the world.

    I could be completely wrong with the interpretation, but it's a common form of therapy. I remember her asking me a lot of questions, but I don't remember any of them. I was very shy and I've tried to block out that time in my life. :p

    ETA: Apparently it's called House-Tree-Person therapy. Here's an article: http://www.intelligentietesten.com/house_tree_person_drawings.htm
     
  3. Ben414
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    Ben414 Contributing Member Contributor

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    For cognitive behavioral therapy, sessions could be structured as mood check-in -> homework review -> agenda setting -> session content -> homework assignment -> perceptions of the session.

    Mood check-in: Identify the child's current emotions and symptoms. For a 10 year-old, this could involve asking them to rate their mood on a scale of 1-10. Make sure to compare this rating to the rating from the last session, noting whether it's changed and asking what caused the change. This allows the child to learn to identify her own emotions, be able to tell the difference between scales of an emotion (e.g. feeling 6-scale sad feels different than feeling 9-scale sad), and be able to identify the causal link between her physiological/behavioral symptoms and her mood.

    Homework review: Examine whether the child has completed her homework, the content of the homework, and how the child felt about the homework. This allows the child to practice skills necessary for decreasing symptoms and improving mood, and it conveys the therapist's interest in the child's feelings and mood. As a simple example, the child may be asked to keep a daily thought record for relevant events that record the situation, her feelings, and her thoughts.

    Agenda setting: List each item and collaborate with the child to decide how much time should be spent on each. If the child had a relevant event occur since last meeting (e.g. she got scolded by a teacher for not paying attention in class or she got into a fight with her mom, etc.), she should be encouraged to tackle that item first and assign more time to it if she wishes. Other items may include talking about the child's progress towards her goals and practicing skills and strategies that will help her reach her goals.

    Session content: Go through the agenda. For this child, the sessions might revolve around teaching the child to identify her feelings and thoughts, understand the connection between her feelings and thoughts, change her thought content and process, and manage her symptoms. There are many, many different therapeutic tools to achieve these goals, and I'll let you do the research on them.

    Homework assignment: Collaborate with the child to set her homework assignment. An assignment should be chosen based off what the child thinks will help her achieve her goals. If the therapist and her agree a prior assignment is not working for her, it should be changed.

    Perceptions of the session: Ask the child what was helpful, unhelpful, and annoying about the session. This feedback should be used to improve the structure of the next session.
     
    Last edited: Feb 8, 2016
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  4. Samuel Lighton
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    Samuel Lighton Contributing Member

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    You could try contacting someone local to you who deals with such things. As a point, most psychiatrists are open to encouraging personal development, so you may find more support than you'd expect. May. There's no better information than that directly from the source.
     
  5. dracodomitor
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    dracodomitor Member

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    Thanks for the help, everyone. Ben414, Lea'Brooks, I'll definitely take your suggestions, and Samuel, I never really considered that an option, since I simply assumed that most psychiatrists would not be willing to help me out, but now that I know differently, I'll be looking into practices in my area. Thanks again!
     
  6. Mckk
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    Mckk Moderator Staff Supporter Contributor

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    You may want to contact charity workers. I'm sure there are NGO bodies working in the rehabilitation of child soldiers, and the social workers, caregivers, councillors etc who work directly in this area would be able to give you some insights I'm sure. I think for something like this, you're gonna have to interview a professional working in the area.
     
  7. Sack-a-Doo!
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    I was in therapy back in 2004 and I was totally blindsided.

    TV and movies tell us that therapy is a conversation between therapist and patient. It's not (at least, not in my experience here in Canada). I was told outright that that type of therapy has gone by the wayside.

    And here's the bit that really floored me: The stated goal of the contemporary therapist is to get the patient back into the workforce as soon as possible, cured or not.

    As long as you're a good little working unit, they aren't concerned about anything else.

    So, almost every therapy includes drugs. If a therapy doesn't include drugs, it's because the psychiatrist has decided you aren't sick enough to warrant their use.

    As a result of finding all this out, and with the help of my wife, I sought alternative treatments. I can't say I'm no longer nuts (how could I be a writer if I wasn't?) but depression and mood swings no longer control my life... which to me means, I'm cured, but on my terms, not theirs.

    So the bottom line is, unless your character is from a wealthy family, conventional medicine will prescribe drugs.
     
  8. Shadowfax
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    Shadowfax Contributing Member Contributor

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    1/ TV and movies as an accurate representation of a medical procedure? When my daughter comes home from her job as a nurse, one of the great things is watching a medical drama with her. I say watching, but most of it is filled with her ranting about how appallingly unrealistic it all is.

    2/ Since 2004, Cognitive Behavioural Therapy has come into vogue (at least in the UK). The object is very much to get you back to work as quickly as possible. However, the method isn't drugs, but the teaching of what are, effectively, coping mechanisms. Teaching the patient behaviour that will enable him to handle a situation that would previously have reduced him to a mental wreck.
     
  9. Sack-a-Doo!
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    This response makes me think you didn't read my entire post, but whatever. I agree with your daughter.
    I was offered none of that, just drugs. I took the Nancy Reagan stance. :)
     
  10. Ben414
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    Ben414 Contributing Member Contributor

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    I should add my post comes directly from two practioning child and adolescent psychologists. I don't have the will to give lengthy explanations of various therapeutic tools, so maybe talking to a therapist would help for that. But the session structure I posted is legitimately used by psychologists.
     
  11. Shadowfax
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    Shadowfax Contributing Member Contributor

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    No, I was agreeing with you.
     
  12. Sack-a-Doo!
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    Sack-a-Doo! Contributing Member Contributor

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    Ah. Okay, my apologies. I guess I read that wrong. Perhaps it was the question you posed that threw me off.
     
  13. Jack Asher
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    Jack Asher Wildly experimental Contributor

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    Okay, first off it seems there is some confusion between psychiatry and psychology. Psychiatrists are medical doctors, they have little therapy training. Their job is to figure out what drugs will make your brain better. They are not usually experienced counselors. On top of that, most psychiatrists won't see you unless you're getting some kind of frequent therapy. I've been to several offices where seeing a counselor regularly was a prerequisite to any kind of psychiatric help.

    Two, talk therapy is very very much alive. While a lot of psychologists like CBT you won't find a lot who are doing only CBT. The issue in the States is that your insurance provider wants to see some kind of rubric for the success of your therapy, and CBT can provide that. But CBT involves a lot of higher cognitive functioning that a child just isn't capable of. A 10 year old is not physically capable of thinking like an adult, whatever your memories of being 10 are like. At 11-12 they're able to reason as adults, but they aren't experienced at it, and in some cases may just choose not to. CBT would be very inappropriate to try on a 10 year old.

    Now for child therapy, and this I have a lot of experience with. The counselor can't just sit down with a kid and get them to talk for an hour. They have to get circuitous. Drawing is a big way to understand how a child is thinking, but playing with clay, or blocks, or other toys allows them to focus on something while they talk to you. Most child psychologists keep an office full of toys.

    When they talk to the child they'll talk about things that matter to the child. This might be movies they've seen, they way their friends behave, and frequently the way their parents act and talk to one another. Sometimes this might involve some kind of structure, where the child acts out a particular scenario, and how his parents would act in it. Sometimes they'll play with doll and show how their conception of adults fits into their world. And other times the therapist just talks to them while they do something else.

    For a child with PTSD the situation becomes complex. Most of the time the child is going to lack the understanding or vocabulary to articulate what has happened to them. Dealing with their emotions, rather than their thoughts becomes the primary goal. In many cases the child is going to have a great deal of guilt over what has happened. Because they are the center of their attention they assume that they are the center of everyone else's as well. Unpacking their emotions becomes a difficult problem, and for the first 2-3 sessions the therapist is simply going to let them play in the room while they observe them. When they talk it will be to ask about their feelings. The common question is, "Can you remember a time when you felt -------? What was that like?" Establishing trust between the therapist and the child is of paramount importance, and if the child starts to withdraw the therapist would back off immediately and just let them play again.

    Children like to talk as they play, and a therapist can get a lot of headway just by talking with them about what they are playing with.

    I've got a minor in psych and 27 years of therapy, so I'll do my best to answer any questions you have.
     
  14. ddavidv
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    ddavidv Contributing Member

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    @Jack Asher sent you a conversation request so I don't crap up the OP's thread. I have some related questions.
     
  15. Ben414
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    Ben414 Contributing Member Contributor

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    I agree with your post, but I do want to point out I know of professional psychologists who use CBT--among other therapies--on 10 year old's.
     
    Last edited: Feb 11, 2016
  16. Storm
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    Storm New Member

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    One technique that therapists sometimes use to help with one of the common symptoms of PTSD flashbacks (reliving the traumatic event/s sometimes to the degree that the sufferer loses track of the present, feels as though they physically emotionally and sensually back in that moment and finding it hard to bring themselves back and reassure themselves that they are not in actual fact experiencing that event, but instead remembering it in a safe environment) is something called Grounding. This is a technique commonly used for both adult and child sufferers of PTSD and can be adapted to be age appropriate. It involves encouraging the person experiencing the flashbacks to focus on their breathing and then to slowly go through each of their senses noticing something that is present Now such as the Sight of a table what colour it is whether it has sharp or curved edges etc, how the table Feels to the touch, is it rough is it smooth and so on, what can be Heard when exploring the table e.g does it make a hollow or dull sound when tapped etc, is there a Smell to the table e.g wood treatment, varnish smells. This technique can be used on anything present in the person's environment and has been proven to be very useful to many suffering from flashbacks to bring them back to reality and is a technique taught by some therapists. I also thought this particular therapeutic technique might lend itself well to story writing and description, fleshing out the character's surroundings and experiences for the reader.
     
  17. terobi
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    terobi Contributing Member

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    Might this help?

     
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  18. Jack Asher
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    Jack Asher Wildly experimental Contributor

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    There are a lot of grounding techniques, but the ones for a 10 year old have to be a little unique. You can't ask them to just settle down, because to a kid settling is something adults tell them to do. A common one is to have them count the number of lights in the room. Or the number of squares or circles around them.

    You've probably head of "going to your special place"? Well it's a real technique to calm children down. They visualize a place in which they feel safe and then go through each sensation, imagining what the place would look, sound, feel and smell like. It's different from grounding, but still helps the child relax. They aren't present, but they're relaxed enough the can listen and pay attention to what an adult is telling them, which is sometimes a very important thing for a child.
     
  19. Ben414
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    Ben414 Contributing Member Contributor

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    Eye Movement Desensitization and Reprocessing is also becoming fairly common for PTSD treatment. It has a solid backing in evidence, but psychologists disagree about why its effective. Some claim it's only effective because it has aspects that resemble CBT, while others claim it has aspects distinct from other therapies that make it effective.

    Here's a good website that critiques various therapies for trauma in children and adolescents based on how strongly they are evidence-based: http://www.cebc4cw.org/topic/trauma-treatment-for-children/
     
  20. dracodomitor
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    dracodomitor Member

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    Wow, you guys!

    All of this was really informative and I'm actually getting some help from a distant cousin of mine who's studying to be a psychologist. I actually didn't know she existed until I mentioned this post to my family, so that's...really helpful.

    I'll definitely make use of all the info and resources you've given me.
     

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