Child and Adolescent Anxiety Psychodynamic Psychotherapy

2018 ◽  
Author(s):  
Sabina E. Preter ◽  
Theodore Shapiro ◽  
Barbara Milrod
Keyword(s):  
Parent Involvement ◽  
Psychodynamic Psychotherapy ◽  
Child Psychotherapy ◽  
Reflective Functioning ◽  
Child And Adolescent ◽  
Anxiety Symptoms ◽  
Historical Background ◽  
Maladaptive Behaviors ◽  
Adolescent Anxiety ◽  
Psychodynamic Treatment

Child and adolescent anxiety psychodynamic psychotherapy (CAPP) is a new, manualized, tested, 24-session psychotherapy articulating psychodynamic treatment for youths with anxiety disorders. The book describes how clinicians intervene by collaboratively identifying the meanings of anxiety symptoms and maladaptive behaviors and communicating the emotional meanings of these symptoms to the child. The treatment is conducted from a developmental perspective, and the book contains clinical examples of how to approach youth of varying ages. The authors demonstrate that CAPP can help children and adolescents: • Reduce anxiety symptoms by developing an understanding of the emotional meanings of symptoms • Enhance the skill of reflection and self-observation of one’s own and others’ feelings and motivations (improvement in symptom-specific reflective functioning) • Diminish use of avoidance, dependence, and rigidity by recognizing how underlying emotions (e.g., guilt, shame, anger), as well as conflicted wishes can be tolerated and understood • Understand fantasies and personal emotional significance surrounding the anxiety symptoms to reduce symptoms’ magical, compelling qualities and impact on the child The manual provides a description of psychodynamic treatment principles and techniques and offers a guide to the opening, middle, and termination phases of this psychotherapy. The book contains chapters on the historical background of child psychodynamic psychotherapy, on developmental aspects of child psychotherapy, and on the nature of parent involvement in the treatment. This manual is intended to be used by clinicians from diverse therapy backgrounds, and it will appeal to the student reader as well as to the experienced clinician.

The Three Phases of CAPP

2018 ◽  
Author(s):  
Sabina E. Preter ◽  
Theodore Shapiro ◽  
Barbara Milrod
Keyword(s):  
Psychodynamic Psychotherapy ◽  
Separation Anxiety ◽  
Reflective Functioning ◽  
Anxiety Symptoms ◽  
Sexual Fantasies ◽  
Middle Phase ◽  
Adolescent Anxiety ◽  
Clinical Vignettes ◽  
Termination Phase ◽  
Opening Phase

Chapter 4 describes how to perform child and adolescent anxiety psychodynamic psychotherapy (CAPP) and includes clinical vignettes. Each phase is followed by a delineation of Tom’s treatment. The opening phase describes how the therapist’s listening and assessment of the material lead to a provisional psychodynamic formulation, which is verbalized to the youth. Typical dynamisms are separation anxiety; difficulties tolerating angry, aggressive, and ambivalent feelings; conflicted sexual fantasies; guilt; and ambivalence regarding independence. During the middle phase, therapist and patient collaboratively understand the central psychological conflicts identified and make adjustments to this formulation as needed. The goal is a deepening understanding of the meaning of the anxiety symptoms, with improvement in reflective functioning. The termination phase serves to review the recent changes and to revisit earlier symptoms, particularly if there is a rearousal of symptoms in which separation conflicts are experienced with the therapist. Adaptive and sensible autonomy-seeking is encouraged.

Including Parents of Children and Adolescents in Dynamic Psychotherapy of Anxiety

2018 ◽  
Author(s):  
Sabina E. Preter ◽  
Theodore Shapiro ◽  
Barbara Milrod
Keyword(s):  
Parent Involvement ◽  
Therapeutic Alliance ◽  
Children And Adolescents ◽  
Psychodynamic Psychotherapy ◽  
Parent Participation ◽  
Child And Adolescent ◽  
Dynamic Psychotherapy ◽  
Adolescent Anxiety ◽  
Letting Go

Chapter 5 focuses on the nature and meaning of parent involvement in child and adolescent anxiety psychodynamic psychotherapy (CAPP). Most of CAPP is conducted with the therapist and child or teen alone. The importance of parent participation relates to the practical and natural developmental dependence of the child on the parent, as well as the importance of a solid therapeutic alliance with the parents, which is essential to sustain and maintain the treatment of the youngster. Separation anxious parents are sometimes conflicted about letting go of the child and allowing a relationship to develop with the therapist that largely excludes the parent. It is important for the therapist to be aware of such tendencies in parents so that they can be addressed when they occur and will not interfere with treatment. Specific guidelines are described regarding working with younger children and working with parents of teens.

Time-Limited Psychodynamic Psychotherapy

2018 ◽  
Author(s):  
Sabina E. Preter ◽  
Theodore Shapiro ◽  
Barbara Milrod
Keyword(s):  
Selective Attention ◽  
Psychodynamic Psychotherapy ◽  
Reflective Functioning ◽  
Mental States ◽  
Anxiety Symptoms ◽  
The Unconscious ◽  
Adolescent Anxiety ◽  
Psychotherapeutic Technique ◽  
Important Mediator ◽  
Age Related

Child and adolescent anxiety psychodynamic psychotherapy (CAPP) follows psychoanalytic principles by addressing the unconscious meaning of the child’s symptoms, while employing a time-limited, twice-weekly frame, which affects technique. In Chapter 2, the authors illustrate how the therapist establishes a collaborative and empathic relationship with the child, identifies a central psychological dynamism early, and consistently refocuses on the presenting anxiety symptoms and the jointly identified psychological dynamisms. The authors describe variations in psychotherapeutic technique necessitated by the age-related capacities of the young patient. Important psychodynamic principles, such as transference, are described. Reflective functioning, which is the capacity to be reflective about one’s own mind and to envision mental states in others, is explained. Selective attention is paid to symptom-specific reflective functioning, which refers to the capacity to reflect on the specific anxiety symptoms and their meanings as an important mediator of change.

A Developmental Approach to Children’s Communications

2018 ◽  
Author(s):  
Sabina E. Preter ◽  
Theodore Shapiro ◽  
Barbara Milrod
Keyword(s):  
Language Development ◽  
Developmental Stage ◽  
Psychodynamic Psychotherapy ◽  
Child And Adolescent ◽  
Story Telling ◽  
Developmental Approach ◽  
Adolescent Anxiety ◽  
School Aged Children ◽  
Communicative Abilities ◽  
Theoretical Overview

Chapter 3 addresses the implications of age and developmental stage of the youth on the therapist’s behavior and how the therapist conducts treatment. The authors provide a theoretical overview across development as it relates to child and adolescent anxiety psychodynamic psychotherapy (CAPP) (Piaget, Bowlby, Erikson, Mahler, Winnicott, among others), and the authors explain how making therapeutic contact is adjusted to the stage related competence for understanding. Particular attention is paid to language, development of communicative abilities in general, and the capacity to treat nonverbal play as well as verbal story telling symbolically, by providing a framework built on the most prominent developmental theorists and researchers (Vygostky, Bowlby, Stern, Fonagy, Nelson, among others). The capacity for empathy and reflection across the developmental span is explored. Examples of encounters with children of all ages, school-aged children, preteens, and teenagers are offered and prefaced by comments about their respective developmental uniqueness and how this affects communication between child and therapist.

Introduction

2018 ◽  
Author(s):  
Sabina E. Preter ◽  
Theodore Shapiro ◽  
Barbara Milrod
Keyword(s):  
Anxiety Disorders ◽  
Psychodynamic Psychotherapy ◽  
Historical Background ◽  
Adolescent Anxiety ◽  
Child Patient ◽  
The Individual ◽  
The Impact ◽  
Care Costs ◽  
Significant Health

Chapter 1 acquaints the reader with child and adolescent anxiety psychodynamic psychotherapy (CAPP), a novel time-limited psychodynamic psychotherapy for children with anxiety disorders, which has undergone preliminary studies. CAPP’s unique feature is that it is focused on the individual meanings of the symptoms, rather than solely on behavioral and symptomatic change. CAPP works to help to reveal the meaning of the symptoms, increases the capacity to reflect, and actively engages the child patient in bringing about change. The literature is reviewed regarding the impact of anxiety disorders on the child and family, as well as the societal burden in terms of the significant health care costs. The authors elucidate the historical background of child psychodynamic psychotherapy and explain the background of CAPP as a developmentally modified version of panic-focused psychodynamic psychotherapy (PFPP), the only psychodynamic psychotherapy to meet evidence-based criteria for adults with anxiety disorders. Two patients, Marie and Tom, who will be followed throughout the book, are introduced. Chapter 1 concludes with an overview of the three phases of treatment.

Mothers’ and fathers’ internalizing symptoms influence parental ratings of adolescent anxiety symptoms.

2017 ◽  
Vol 31 (7) ◽  
pp. 939-944 ◽  
Author(s):  
Krister W. Fjermestad ◽  
Wendy Nilsen ◽  
Tina D. Johannessen ◽  
Evalill B. Karevold
Keyword(s):  
Internalizing Symptoms ◽  
Anxiety Symptoms ◽  
Mothers And Fathers ◽  
Adolescent Anxiety ◽  
Parental Ratings

Indicated preventive interventions for anxiety in children and adolescents: a review and meta-analysis of school based programs

2019 ◽  
Author(s):  
Siobhan Hugh-Jones ◽  
Sophie Beckett ◽  
Pavan Mallikarjun
Keyword(s):  
Meta Analysis ◽  
Child And Adolescent ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Control Groups ◽  
Adolescent Anxiety ◽  
School Based ◽  
Intervention Intensity ◽  
Randomised Controlled ◽  
And Control

Schools are promising sites for the delivery of prevention and early intervention programs to reduce child and adolescent anxiety. It is unclear whether universal or targeted approaches are most effective. This review and meta-analysis examines the effectiveness of school-based indicated interventions and was registered with PROSPERO [CRD42018087628].MEDLINE, EMBASE, PsycINFO and the Cochrane Library were searched for randomised controlled trials comparing indicated school programs for child and adolescent anxiety to active or inactive control groups. Twenty original studies, with 2076 participants, met the inclusion criteria and 18 were suitable for meta-analysis. Sub-group and sensitivity analyses explored intervention intensity, delivery agent and control type. A small beneficial effect was found for indicated programs compared to controls on self-reported anxiety symptoms at post-test (g = -0.28, CI = -0.50, -0.05, k= 18). The small effect was maintained at 6 (g = -0.35, CI= -0.58, -0.13, k = 9) and 12 months (g = -0.24, CI = -0.48, 0.00, k = 4). Based on two studies, >12 month effects were very small (g = -0.01, CI= -0.38, 0.36). No differences were found based on intervention intensity, delivery agent and control type. There was evidence of publication bias and a relatively high risk of contamination in studies. Findings support the value of school based indicated programs for child and adolescent anxiety. Effects at 12 months outperform many universal programs. High quality, randomised controlled and pragmatic trials are needed, with attention control groups and beyond 12 month diagnostic assessments are needed.

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