Interventions for Internalizing Symptoms

Question 1

Cognitive Behavioral Play Therapy (CBPT)

Answer 1

-CBT alone needs to be modified for young children to accommodate their developmental abilities

CBPT:
-For preschool and early elementary kids with anxiety disorders, some trauma, and other disorders
-Integrates CBT and play therapy
-Emphasizes child engagement
-Addresses control, mastery, and responsibility in changing behaviors

Interventions:
-Most effective when used in order, but flexibility and adjustment are important
-Psychoeducation: therapist works with child and parents on understanding of symptoms and treatment
-Somatic management (relaxation): reigning in automatic arousal through deep breathing, muscle relaxation, any common relaxation techniques
-Cognitive restructuring: recognizing, labeling, and changing maladaptive thoughts and schemas
-Exposure: systematic, controlled, increasing; imaginal and in vivo
-Relapse prevention and generalization: incorporating real life scenarios into therapy work and preparing the child for novel experiences and how to use learned skills
Parent involvement: parents should be involved in assessment, psychoeducation, and skill building phases

Question 2

Solution-Focused Sandtray Therapy

Answer 2

-Brief 5 session therapy, sometimes only 1-2 sessions for almost all developmental levels
-Child creates their world using sandtrays and miniature figures
>Communicates conflicts and experiences nonverbally
through materials
>See and play with possibilities
>Project themselves in a future where they have
reached goals
>Note personal and contextual resources
-Works best for clients who lack power over circumstances in their lives
>Can control figures and situations in the sandtray
>Practice or play out scenarios in sandtray to prepare
-Therapist views client as having competence, resources, strengths, and resilience
>Aims to help clients uncover their resilience and
embrace it
>Client is expert in their own life, not the therapist

Six Stages
1. Preparing for the child two sandtrays and miniatures
2. Introducing the sandtray process and pre-session change question (make sandtray of how things were before session)
3. Listening to the client’s story by asking client to create their world in the sand (with no preconceived notions)
4. Goal setting – creating sandtray of future goal, where client is now, etc.
5. End-of-Session Feedback: take pics and notes, feedback with compliments, link compliment with suggestion, make a suggestion based on how client sees themselves in relation to therapy
6. Post-Session: review notes from past session and make plan for next session

-Use EARS in session:
>Eliciting exceptions to the problem
>Amplifying the exception/Reinforcing
>Starting over

Question 3

Mindfulness-Based CBT

Answer 3

-Why clients develop and maintain symptoms: Symptoms arise when you do not accept your internal experience → nonacceptance of internal experience is the basic cause of maladjustment and dissatisfaction with life

Dialectical Behavior Therapy (DBT)
-Originally developed for BPD, now also used for kiddos with mood disorders, trauma disorders, conduct disturbances, eating disorders, and substance abuse
-Pendulum Swing Theory: children’s expression of emotions often leads to invalidation (i.e., punishment) which leads them to suppress their own emotions → this extreme suppression of emotion often leads to emotional outbursts
>Emotions too intense to be suppressed → explode
into behaviors such as tantrums, aggression, self-
injury, and suicide attempts
>Caregivers finally forced to acknowledge the child’s
distress and maladaptive behavior is reinforced
>Internal pendulum swing - people who succeed too
well at emotional suppression hate the numbness and
>injure themselves just to “feel something”

Interventions
-Guided mindfulness meditation techniques to identify cognitions about current situations, guiding the client through acceptance of themselves in the present moment, accepting thoughts about past or future and letting them pass
-Emotional regulation: provide skills to help client manage emotions instead of being managed by them, reduce vulnerability to negative emotions, and build positive emotional experiences
-Distress tolerance techniques: distress tolerance is the ability to perceive the environment as it is, without demanding that it be different (i.e., acceptance of reality) and recognizing that pain + non-acceptance = suffering, while pain + acceptance = ordinary pain → needs to be practiced before crisis occurs → can include engaging in activities client enjoys