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About this book

Introducing key psychodynamic theory, concepts and techniques, this text examines the challenges and opportunities of counselling adolescents and children. The book explores a wide variety of settings and contexts, from schools to community projects and mental health services. It is an invaluable guide for counsellors and therapists at all levels.

Table of Contents

Key Theories and Techniques

Frontmatter

1. Introduction

Abstract
The worrying prevalence of child and adolescent emotional difficulties is now widely recognised. The often quoted figure given by the UK Office of National Statistics 2004 is that 1 in 10 young people suffer severe mental health problems. There have also been increasing indications that disturbance is being experienced, expressed and therefore picked up by concerned adults at ever earlier stages of development. Primary school staff are receiving children aged 4 and 5 who are already significantly concerning. In January 2008, just under 150,000 children in UK primary schools were assessed as having behavioural, emotional and social difficulties — and this only covers those having Special Educational Needs status of ‘school action plus’ and Special Educational Needs statements. Therefore the total number of children with such difficulties is likely to be far higher (DCSF 2008). In UK national statistics and in the study by Meltzer et al. (2000), it has been found that 10% of boys and 5% of girls aged 5 to 10 have a mental disorder, and by the age of 11 to 16 the proportions were 13% for boys and 10% for girls.
Sue Kegerreis

2. Key Theoretical Ideas in Psychodynamic Thinking

Abstract
Psychodynamic thinking has its origins in psychoanalysis. Freud’s original formulation of psychoanalysis, both as a way of understanding human development and its vicissitudes, and as a method of treatment for psychological difficulties, has been refined, elaborated and extended by different writers and practitioners who have applied his models and systems in ever richer ways. In this chapter, some of the key ideas underpinning the psychodynamic approach are outlined, to clarify its main features and in so doing briefly indicate how it differs from other possible orientations.
Sue Kegerreis

3. Key Elements of Psychodynamic Technique 1

Abstract
One of the beauties of psychodynamic understanding is that it can be used to underpin the employment of a wide variety of techniques. Psychodynamic counselling itself uses techniques that have their roots in psychotherapy and psychoanalysis, and these will be described below, but a psychodynamically informed practitioner can also harness his or her understanding to the effective employment of many other kinds of intervention. The psychodynamic theoretical framework provides a way of perceiving the deeper levels of what is going on within and between people, and of how someone is experiencing themselves in relation to others. It can then guide us in our choices, even if we are not in a setting where psychodynamic counselling itself would be appropriate (Clare Winnicott 1955; Dyke 1984). For example, a teacher or social worker has a different role from that of a counsellor, but she can still use her psychodynamic understanding to help her respond to what is really going on in the child, rather than react to the surface manifestations. A practitioner who is using cognitive behavioural techniques or offering problem-solving strategies is going to be much better equipped to devise useful interventions if they are in touch with the underlying communications in children’s behaviour or ways of relating.
Sue Kegerreis

4. Key Elements of Psychodynamic Technique 2

Abstract
The techniques described in Chapter 3 lend themselves to many settings and can be used to help towards a variety of approaches with children. The tools described in this chapter are more specifically aimed at those working in a more formal and boundaried counselling setting.
Sue Kegerreis

5. The Developmental Perspective

Abstract
Anyone working with children and adolescents needs to have a strong sense of the developmental perspective in their work with their clients. By this I mean that it is crucial that the child’s presentation is understood in the context of a grasp of the particular features, challenges and tasks of their age group. How we understand a child and how we assess their ways of functioning has to be closely connected to their developmental stage, and if we are to see what is going badly or well for them we need to have a sense of where their development is progressing as expected and where it may be blocked or slow, or indeed precocious and premature. We also need to have a sense of what their key underlying preoccupations are likely to be at different ages, so that we can better tune in to how they are managing the transitions inherent in growing up.
Sue Kegerreis

6. Learning — The Hardest Task of All

Abstract
All children, by definition, are in the business of learning. Learning in the educational sense is an essential part of their experience but in addition the fundamental tasks inherent in being a child are to learn in a broader sense about themselves and their world and thereby to develop into an adult. Psychodynamic and psychoanalytic theory is centrally concerned with the emotional aspects of learning and the conscious and particularly the unconscious barriers that can impede it (Salzberger-Wittenburg 1983; Youell 2006). Much psychoanalytic literature centres on the difficulty of learning from emotional experience and being able to think (Bion 1962b; Britton 1987), which are obviously far wider issues than learning in the formal sense, but these theoretical contributions are relevant to both kinds. Learning is a complex process for all of us, fraught with the emotional conflicts around dependence, taking in from others, tolerating not knowing, coping with failure, managing success and digesting and making use of what we are ‘fed’. For children who have experienced trauma, deprivation and inconsistency in their early life, the process is made extremely challenging.
Sue Kegerreis

7. Using Play and Art

Abstract
Work with children, especially of primary age, is unlikely to take the form of simply talking. The counsellor needs to provide the child with equipment that can be used to express what is going on in their inner world, and to be able to understand the language that the child will use. This means being able to decipher how play is used to express what is going on unconsciously, and how art and craft may be understood as direct routes into the internal world, much as dreams can be used with older clients.
Sue Kegerreis

8. Behaviour

Abstract
When working psychodynamically with adults, there is a great deal to be observed in their non-verbal communications — how they enter the room, how they sit, what they wear and whether and how they fiddle with things. There may also on some occasions be more large-scale behaviour that requires attention — for example, if someone jumps up and paces the room, or hides their face, or perhaps even throws something in fury or walks out. However, these more extreme events will be relatively rare in adult work, where for the most part clients spend their sessions talking.
Sue Kegerreis

The Dynamics of the Counselling Relationship in Context

Frontmatter

9. Understanding and Working with Groups

Abstract
Groups are powerful for all of us. They can foster the best in us and can bring out the worst. We are not the ‘same person’ in different groups, being steered by the culture of the group and our relationship with the task of the group into positions where different elements of our personality gain ascendancy. We all have a range of responses and defences that come into play in groups that may be considerably different or operate more strongly than in our more intimate and one-to-one relationships.
Sue Kegerreis

10. Consent and Clienthood

Abstract
If an adult comes to a counsellor it is generally clear that the adult themselves is the client. Sometimes there is an element of legal compulsion or pressure from employers but generally speaking counselling is a voluntary activity by the adult who makes himself a client by seeking help. There are (important) arguments about how much the client is informed in his consent, in that he may not understand what counselling entails or what the ‘contract’ is going to involve, but at least he is coming under his own auspices and it is understood that he can withdraw at any time.
Sue Kegerreis

11. Working with Difference

Abstract
Working with children in any setting is going to bring with it the need to consider carefully the child’s cultural background and other possible areas of difference. This may give valuable insight not only into the child’s world but also into how the child may be experiencing the counsellor, the setting and the offer of help. There will in many cases be important differences between the culture of the home, whether in terms of ethnicity, class or other dimensions, that are of great relevance to how the child sees the adults with whom he is dealing. This is different from the transference, in that it is not in a simple sense the projection of elements of the child’s personal inner world of fantasy, but relates more to the real differences that the child perceives. The meaning of these will have conscious as well as unconscious dimensions.
Sue Kegerreis

12. Working in Different Settings

Abstract
Anyone working with children or adolescents will need to grasp the implications of working in their particular setting. Some understanding of the psychodynamics of the organizations and networks around both the child and the counsellor is vital as otherwise we will struggle to remain effective.
Sue Kegerreis

13. Family Consultation Centres, Community Adolescent Services and Beyond

Abstract
Child and adolescent mental health services/family consultation centres A counsellor or other professional offering counselling in a Child and Family Consultation Centre is in a different position from one in a school. As part of the multi-disciplinary provision the counselling would be one of a wide range of interventions available to families. Children are likely to have an assessment as a separate venture, often by other professionals, and then referred to counselling where this is seen as appropriate. The counsellor is therefore not the front-line provider as in a school, so we may have more control over the referral criteria and be more active in the thinking about which kind of cases are taken on. Mental health and psychological treatment are the core preoccupations of the agency, unlike in a school, and so the counselling is situated very differently within the agency and in relation to its primary task.
Sue Kegerreis

14. Short-Term and Time-Limited Work

Abstract
One of the differences usually identified between counselling and psychotherapy relates to the issue of length of treatment. In general, psychotherapy is more likely to be long-term and/or open-ended. Counselling is often short-term and/or time-limited. It is useful to be clear that there are two different elements at play here, the actual length of time and the question as to whether there is a set time frame before the work starts. Open-ended work can be short-term, and long-term work can be time-limited, as in a contract for 2 years of psychotherapy. There can of course also be short-term time-limited work, for example if what is offered is 6 sessions of counselling. Different problems and opportunities arise with each kind. There are differences in the approach to issues of time between the trainings for psychotherapy and counselling. This has an effect on the mind-set of psychotherapists and counsellors, particularly at the start of their careers. In psychoanalytic psychotherapy trainings there is a requirement to see a certain number of patients for a certain time. Trainees typically have to see patients regularly for the 18 months or 2 years before being eligible for qualification. Even a small shortfall can mean that that work may not count towards the clinical requirement and keeping the therapy going can feel like an end in itself.
Sue Kegerreis

15. Assessment

Abstract
It may seem odd to have left the topic of assessment until near the end of this book. This is partly because those at the beginning of their career as counsellors, for whom this book is predominantly aimed, are likely to be working in agencies where the assessment thinking is going to be done by a more experienced practitioner. It is also because assessment requires much of the understanding that is outlined in the earlier chapters. So although assessment has to take place at the beginning of the encounter with the child, this chapter would not be well placed at the beginning of the book. Relating to this, it is during the assessment process that skilled supervision has the utmost importance. Supervision is key to setting up the best possible start to the work, both in order to tune in more accurately as to what is going on in the child, and to assess the appropriateness of the provision.
Sue Kegerreis

16. Endings and Outcomes

Abstract
Children may be in counselling for one session only (Chapter 14) or in some cases for several years, with every possible variation in between. Whenever they have been attending for any substantial amount of time, the ending and the handling of it is going to provide a significant part of what can be taken away with them from the process of counselling (see Dyke 1984, on which some of this chapter is based). Endings may be long foreseen, for example when the counselling has been time-limited (Chapter 14) or when the child is leaving school. In these circumstances the work done on finishing the relationship and negotiating the separation can be of crucial importance. On the other hand, both when endings have been planned, and when they are not yet in view, circumstances may intrude, taking the child out of counselling without warning and therefore precluding careful preparation, for example if the child suddenly and unexpectedly moves school. Or after a thoughtful countdown, last sessions can get missed through illness, school events or other unforeseen disruptions. This can be painful for both child and counsellor, and the more one understands about the importance of endings the harder it can be when the ending does not go according to plan.
Sue Kegerreis
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