This week’s New York Times Op-Ed section contained a piece, entitled “Psychotherapy’s Image Problem,” that any consumer of mental health services will likely read with great interest. If someone you know is aware that you or your family member is in treatment, they’ll almost surely be sending you the link to ensure you’re “in the know.”
While we at Think:Kids are proud that our treatment approach, Collaborative Problem Solving, is and continues to be well-studied—we are ongoingly giving our work research scrutiny—and that it sits on some of the current lists of evidence-based practices, there are some crucial points that we think must be spoken to.
First of all, being a program within Massachusetts General Hospital, a major academic medical center where much important psychopharmacology research occurs, and seeing complex kids, for whom medication is often a crucial component to their effective care, we are uneasy at the pitting of psychotherapy against medication. We’ve seen too many families caught in this cultural crossfire, when all they are doing is trying to do right by their kids. The fact is, even while we do tend to believe that there is good enough evidentiary support for psychotherapy that it is typically worth trying first, some patients and families, for various and complicated reasons, might prefer to start with medication, and this preference should in many cases be honored.
Second, we want to support the article’s pointing out that, simply put, psychotherapy works. It boasts very strong and long-standing evidence of being effective, with average “effect sizes” (a statistical indication of how strong an average effect of a treatment is) that surpass many well-regarded and widely accepted medical interventions.
On the other hand, virtually all of the therapy approaches that have gone to the effort to study their effectiveness have in fact been proven to be effective, leaving patient preference—what specific therapy resonates—a crucial consideration in choice of treatment approach. In many cases, and this is in fact true of our own domain of work with behaviorally challenging kids, there are multiple available “evidence based treatments” to choose from. Being an educated consumer and knowing what treatment goals are most valuable to you, and what treatment procedures will feel most congenial, is critical. For instance, we here at Think:Kids value greatly the fact that our approach has the advantage of improving the helping relationship between adult caregivers (parents or teachers) and kids as one of its demonstrated outcomes.
Finally, as the noted psychotherapy researcher Bruce Wampold has stated, “Nobody needs an empirically supported therapy that isn’t working for them.” Which is to say, we still have to make sure that a particular patient is benefitting, and monitoring your treatment progress, or possible lack thereof, is an essential aspect of our involvement with patients.
As is typically the case, the reality of any situation is often more complicated than meets the eye. Let us know your own responses to this article, and to these issues!
In a WSJ article published earlier this month, columnist Joanne Lipman expressed her surprise when late music teacher, Mr. K, received an outpouring of support from former students who felt indebted to him for the methods he employed which pushed them, beyond how they might’ve imagined, toward success. These now full-grown, successful adults were able to reflect upon the lessons they learned as youngsters which generalized to their later passions and pursuits in life beyond music class.
“Work hard.” “Practice makes perfect.” “No pain, no gain.” We’ve all heard these pearls of conventional wisdom. Many kids, those with the skills needed to sustain focus during a group activity absent support, to ignore irrelevant noises and people in class, and to tune- out unnecessary pieces of information, might do just fine in a classroom full of students and a teacher similar in theory to Mr. K. Other kids, however, might not.
It’s the child who already noticed that he is less able than others to follow a set order who will inevitably miss the beat. It’s the child who is less able to understand spoken direction from a teacher who may not be able to tolerate hearing, just one more time, an adult who refers to him as “lazy,” when the child isn’t quickly at work on a given task. It’s the child who isn’t able to think in shades of gray who interprets Mr. K’s strict manner as a personal attack, rather than coming from a place of love. It’s the child who is unable to delay gratification, to think ahead to the future of next week, and keep in mind a possible feeling of pride they might experience next week, were they able to play a musical piece, despite the fact that their fingers are bleeding right. It is that child who will drop out.
Whether the loss of these children occurs in silence or the process unfolds by way of an active protest (i.e. a child who shouts back in his defense when referred to by a teacher as “unmotivated”), these are the children for whom a musical education (and a curious, compassionate adult in charge of helping them to learn in a way that works for them) will be most vital.
Share with us your experiences, and thoughts about the potential impact of classroom policy on our children’s ability to learn, develop their skills, and grow!
There is renewed interest in the effects of chronic, overwhelming stress and trauma on children’s development. So-called trauma-informed care is emphasized more than ever. Yet, parents, educators, clinicians, mental health workers and law enforcement alike still struggle to understand the impacts of trauma on brain development in a concrete and tangible way. Perhaps even more so, adults trying to help these children and adolescents long for concrete strategies that operationalize what brain science tells us will be helpful to facilitate development arrested as a result of complex developmental trauma.
The Neurosequential Model of Therapeutics (NMT) and Collaborative Problem Solving (CPS). NMT is a developmentally sensitive, neurobiology‐informed approach to clinical problem solving. NMT is an evidence‐based practice and not a specific therapeutic technique or intervention. It is an approach that integrates core principles of neurodevelopment and traumatology to aid in the selection and sequencing of therapeutic, educational and enrichment activities that match the needs and strengths of the individual. CPS offers an evidence‐informed approach to assist parents, teachers and mental health providers identify children’s skill deficits that lead to challenging behaviors. It helps adults teach children flexibility, problem solving, and emotion regulation skills.
If you want to know how trauma impacts the brain and what to do about it, please join Dr.Stuart Ablon and Dr. Bruce Perry on March 27th and 28th for an exciting 2 days of learning and collaboration. Learn more and register here
Learn more about NMT here
Learn More about CPS here
At the Children’s Mental Health Network conference in Tampa last week we met a woman involved in the making of a film on the stigma of mental illness. In our Department of Psychiatry here at Massachusetts General Hospital we often say that “no family goes untouched.” Our experience is that whenever someone is brave enough to talk openly of mental illness, whomever they are sharing the experience with invariably has a story themselves – from their own life or someone they love. And yet, the stigma around mental illness continues to be a major barrier to treatment.
We are hoping the power of film can help break down some barriers especially when it comes to children’s mental health. Check out Illness, a critically acclaimed film by Jonathan Bucari.
Also, check out: https://www.facebook.com/illnessthemovie and https://www.indiegogo.com/projects/illness
Recent research sheds some additional light on the “real” problem of ADHD- that is, when a child who’s wired for novelty-seeking is placed in an environment that’s regimented, structured, and lacks the level of complexity they are biologically prepared to manage, there becomes a problem. The result is problematic. But, what’s the solution?
In his recent column for the New York Times, Richard A. Friedman, points to prevalence rates to better understand what adults who no longer are bogged down by problems associated with ADHD might be doing differently in hopes that a better balance of the equation might be found for kids, earlier on in development.
What’s Friedman’s remedy? “First,” he suggests, “we should do everything we can to help young people with A.D.H.D. select situations—whether schools now or professions later on—that are a better fit for their novelty-seeking behavior, just the way adults seem to self-select jobs in which they are more likely to succeed.”
“In the right environment,” Friedman asserts, “these traits are not a disability, and can be a real asset.”
Check out the full piece here!