The treatment process

Each child's experiences of distress must always be considered in the context of the child's family circumstances, the child's stage of development, and his or her temperamental characteristics. It follows that the therapeutic approach needs to be individually tailored and adjusted for each child. Nevertheless, it is possible to arrive at some general guidelines that will assist in treatment. The concern, interest, and supportive attitude of the therapist is central to the treatment process, since it is the interaction between the child's need and the adult's response that establishes the transference relationship.

The start of the first session is particularly important because it sets the tone for the future treatment. The child should know the role that the therapist has and what the aims of the treatment are. Something needs to be said about the limits to behaviour in the session and the nature and degree of confidentiality. It is important to remember that complete confidentiality cannot be assured. For example, the therapist may be presented with information that concerns the health or safety of the child as in the case of abuse, where information has to be disclosed for the benefit of the child.

The timing and number of sessions needs to be agreed at this stage. Therefore it is often a good idea to suggest a limited number of sessions in the first instance, together with an agreement to review whether or not further sessions are required. This type of introduction helps children to feel their needs are being taken seriously, especially if they are actively involved in the process. Sessions should start and finish on time and the links between the present and any previous sessions should be clarified.

Most children will remember their treatment experience for many years to comeā€”if not for the rest of their lives. The child who feels uncomfortable, embarrassed, and misunderstood is likely to retain a memory that is painful and unhelpful. On the other hand, if the therapeutic experience was positive, where the therapist was seen as supportive, encouraging, and understanding, the memory is likely to be one that the child returns to again and again for emotional strength and support.

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