Differences from adult psychotherapy

A number of interesting paradoxes and dilemmas occur when treating children with psychotherapy. For example, who should give consent for treatment. Should it be the child, a parent, both parents, or all three? Clearly, this depends on the age and understanding of the child, and each case should be approached in a way that puts the child's needs first. It is generally best to obtain consent from the child and both parents. Any other arrangement is likely to lead to problems at some stage. Psychotherapy and counselling are traditionally non-directive and patient-led, but children, unlike most adults, need to be given some direction otherwise they become easily lost and confused. They cannot be expected to find their own solutions without guidance and support. Most psychotherapeutic approaches for adults are based on coming to terms with and finding explanations for problems that are rooted in the past. However, children are still busy making their past, and their main focus of concern and interest is the present and the immediate future. A further dilemma in child psychotherapy concerns the management of the transference relationship between therapist and patient, which is a reflection of the parent-child relationship. (1) A high degree of trust has to be established to use the transference effectively. At the same time, it could be argued that it is not really appropriate for young children to develop high levels of trust and dependence on a therapist whom they only meet briefly in very artificial circumstances. Thus any interpretation of the transference relationship in child psychotherapy must be done carefully and with a good understanding of the subtle complexities of a child's dependency on the parent.

Adult psychotherapy is usually based on a single theoretical model that explains mental mechanisms. Children, however, benefit from the freedom to experiment with a number of different models of their inner world and to learn how to use these ideas in a flexible and constructive way. The use of a single-theory therapy in child psychotherapy is best avoided.

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