By David Joel Miller.
What are the differences between youth and adult mental health treatment?
There are differences in the way a counselor might work with a child and how they might work with an adult. How to “treat” a mental health problem is a complicated subject. It needs several books to fully describe this, but let me focus here on just a few things that may influence how a professional might try to help with an emotional problem in a child.
The way a counselor works with clients is sometimes referred to as our “theoretical orientation.” How I see your issue determines how I might try to help you. I can’t speak for therapists of other theoretical orientations but I would describe my approach as largely Cognitive Behavioral Therapy, that with a dash of learning theory and occasionally a pinch of narrative therapy.
This stuff is largely “skills based.” I figure that the client is trying the best they can but that there are things they may not know and if they knew them they could do better. I could try to tell them, sometimes that works but mostly they need some help it trying on new behaviors and seeing what works for them and what does not.
Lots of people have “stories” they tell themselves about them. By story I do not mean that this is either true or false, it just is the way that person explains themselves and their life.
That story might sound like “I am such a loser.” Or “I can’t do anything right.” Kids get one thing wrong and they may start saying that they are a failure. See how having a single story that describes you rather than the thing you were not able to do could color your life experiences?
So adults have more experiences in life and may have more ways of thinking of new stories for their life that a younger person. What I am saying is that I would try as much as possible to tailor my approach to the individual, not some specific category or label.
In career counseling, the approach would be very different in working with a person who had worked at lots of jobs and was just downsized than it might be with a client who was very young and had never had a job.
What are some considerations in creating a treatment for a specific client?
Age is only a small part of the picture.
I would want to know in addition to the client’s age something’s about their abilities and their life experiences. Age, I.Q, and developmental stage are all in the mix. So might things like learning disabilities, intellectual disabilities and other developmental issues.
The approach for someone who has a form of Autism Spectrum Disorder might be different from a younger person who had a less severe challenge. The key, for me, is really getting to know the person and match my efforts to them rather than memorize a particular formula for a given age, I.Q. or disorder. Here are some things a therapist might do as the child moves through the lifespan and becomes a young adult, a mature adult and evenly an older adult.
1. Activities build relationships.
With adults, it is often possible to sit down and have a talk with them. The younger the child, the more the anxiety or the more “inside themselves” they are the more we need to work on forming a relationship.
One way to create that relationship is to do things with the client. (Yes even with a five-year-old I think of this person as a “client.”) How would I have wanted to be approached when I was that age? If I can’t remember every being that age, I take a guess at what that might have been.
So the counselor might play a game, not to waste time but to get the client to feel comfortable. Even with very adult clients, I find they will say more about their lives when we are doing something than when they are sitting in a chair and I am cross-examining them.
2. Pictures versus words in therapy.
Very young people and some adults are better at seeing than describing, they just do not have the words to tell me their story. I ask them to draw me a picture. A rainbow tells me one thing and a tornado-like creature in black and red tells a very different story.
3. Skills training is important.
You need to practice skills if you want them to be there when you need them. Adults practice golf swings. Younger people may need to practice introducing themselves, making friends and sharing appropriately. A whole lot of people tell me right up front they have an “anger management problem” they do not seem to understand that managing anger is a skill like most other things in life and you can learn that skill.
The younger or more impaired the person the more they need help in learning appropriate skills.
4. Involvement of your support system makes a difference.
With children or youths, I like to know the involvement of the support system. The more people on your side the better your chances. Some people have a parent or caregiver that can help the client through things. Other young clients have no one on their side.
Sometimes I am working on helping the caregiver to learn to help the youth and other times I am helping the client learn how to cope with their less-than-perfect caregiver.
There are a whole lot of specialized treatments for all sorts of mental, emotional and behavioral problems that a child may experience. This post has not even begun to look at all those possibilities but I hope it has given you some small idea of the ways in which a professional counselor might be able to help a child or their caregiver through a child’s emotional problems.
If you work with children consider taking the Youth Mental Health First Aid training when it is offered in your area.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books
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