Individual Therapy at Apple Orchard
Each young person is seen for one hour each week for individual therapy. In the absence of convincing evidence that any particular treatment model is more clinically effective, (Mc Crory 2011) our interventions draw from various therapeutic approaches such as but not exclusively, Cognitive Behavioural Therapy 1, Attachment Theory 2, Transactional Analysis 3, and Mentalization 4. These are used in accordance with the young person’s presenting needs. The goals of therapy are openly created between the young person and therapist with a principle objective being to achieve the aims collaboratively. Therapy sessions sometimes include the young person’s keyworker to ensure that the issues covered and goals set in individual therapy are generalised into other areas of the young person’s placement. Sometimes, especially at the beginning of a placement, it is necessary to use specific therapeutic skills to address particular problems such as P.T.S.D and other trauma symptoms, Depression, self harm, G.A.D. and O.C.D. and so forth before any focus on sexual harm can commence.
CBT is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behaviour) all interact together. Specifically, our thoughts determine our feelings and our behaviour. Therefore, negative and unrealistic thoughts can cause us distress and result in problems. When a person suffers with psychological distress, the way in which they interpret situations becomes skewed, which in turn has a negative impact on the actions they take. CBT aims to help people become aware of when they make negative interpretations, and of behavioural patterns which reinforce the distorted thinking. CBT is, in fact, an umbrella term for many different therapies that share some common elements. Two of the earliest forms of Cognitive behavioural Therapy were Rational Emotive Behaviour Therapy (REBT), developed by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s.
The cognitive behavioural therapist teaches clients how to identify distorted cognitions through a process of evaluation. The clients learn to discriminate between their own thoughts and reality. They learn the influence that cognition has on their feelings, and they are taught to recognize observe and monitor their own thoughts.
The behaviour part of the therapy involves setting homework for the client to do (e.g. keeping a diary of thoughts). The therapist gives the client tasks that will help them challenge their own irrational beliefs. The idea is that the client identifies their own unhelpful beliefs and them proves them wrong. As a result, their beliefs begin to change. (McLeod 2008)
“The study of pre-adolescent onset SHB in boys is a relatively recent development, but evidence is now emerging from perspectives ranging from neuroscience to qualitative case analysis to suggest that a complex interweave of factors helps explain why some children begin to display this worrying behaviour while others do not. Neglect and maltreatment (often including sexual abuse) experienced within the family is a core influence on child development, in particular on closely linked relational faculties of attachment and sexuality. Genetic predisposition (Caspi et al, 2002) and unresolved trauma suffered by a parent, in particular the mother (Skuse et al, 1998), tend to erode resilience to maltreatment in boys. This results in disorganised/disoriented attachment in infancy, and a diminished capacity to contain emotions and to reflect on them. Subsequently, in childhood they adopt externalised coercive strategies to manage relationships.” (Hawkes 2009)
Transactional Analysis (TA)
Transactional Analysis (TA) is both a theory of personality and an organized system of interactional therapy. It is grounded on the assumption that we make current decisions based on past premises – premises that were at one time appropriate to our survival needs but that may no longer be valid. The goal of transactional analysis is autonomy, which is defined as awareness, spontaneity, and the capacity for intimacy. In achieving autonomy people have the capacity to make new decisions (redecide), thereby empowering themselves and altering the course of their lives. As a part of the process of TA therapy, clients learn how to recognize the three ego states-Parent, Adult, and Child-in which they function. Clients also learn how their current behaviour is being affected by the rules they received and incorporated as children and how they can identify the ‘lifescript’ that is determining their actions. This approach focuses on early decisions that each person has made, and it stresses the capacity of clients to make new decisions to change aspects of their lives that are no longer working. TA emphasies the cognitive and behavioural aspects of the therapeutic process. (Cory 2009)
Mentalization, ‘or better mentalizing, is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically’. (Bateman and Fonagy 2010. See Mentalization Based Therapy-MBT)