Child counselling skills

1. Child counselling skills

2. Observation • Active listening • Dealing with self-concept and self-destructive beliefs • Dealing with resistance and Actively facilitating changes • Termination skills • Skills for counselling children in groups

3. Observation • Joining phase- child’s relationship with their parents, the ease of separation, child’s general behavior • Monitor self behavior, direction, self discovery Observing general appearance • way the child is dressed • the child’s level of alertness • any obvious discrepancies from normal • The degree of attractiveness of the child (physical development and level of nutrition) • Peculiar mannerisms of the child

5. Observing behaviour • quiet and careful, or noisy, boisterous, aggressive and destructive • distractible, attention span • engage in behaviour that is dangerous • willing to take risks • affectionate and dependent on the interaction of the counsellor • child’s response to physical contact • defensive, responsive or searching for contact • appropriate boundaries • approach–avoidance tendencies; for instance, by showing initiative and then waiting for cues • presence of defence mechanisms such as suppression, avoidance, denial and indications of dissociation

6. Observing the child’s mood or affect • gives clues to the child’s underlying emotional state • show little or no emotion, being flat in affect • self-absorbed • behaviours already observed will also give information about the child’s internal mood or emotional state (aggressive play; angry child) • changes in mood during the counselling session, child’s awareness of their own moods and their level of emotional reactivity during the session. Observing intellectual functioning and thinking processes • young child (4-8) initial indication of intellectual functioning - doing puzzles, naming body parts and identifying colours • older child- general conversation will point to the ability of the child to solve problems and to conceptualize, and will give an indication of level of insight

7. orientation with respect to time, place or person- asking about recent events. • By checking a child’s sense of reality, and organization of thoughts, the counsellor may become aware of any abnormal thought patterns, including the presence of delusions and hallucinations. Observing speech and language • Engaging in conversation • Inadequacy in communication, frustration • rely on non-verbal methods of communication • clear or that the child lisps, stammers or stutters

8. Observing motor skills • child’s involvement with activities in the play therapy room • whether the child sits most of the time, or walks, jumps, runs or squats • how the child moves in and out of positions – with ease, or with difficulty • whether the child appears constricted in their physical expression or free • breath-holding, sighing or gasping Observing play • Age appropriateness • observe the development of themes that arise in the content of the play • quality of the play, goal directed and following an understandable sequence • whether play materials are being used appropriately

9. creative or is stereotypic, repetitive and limited • Whether play is creative or stereotypic will give an indication of the child’s level of developmental maturity; the counsellor might notice that a child can use object substitution in play • The counsellor may also make note of whether the child’s play is regressed, infantile or maybe pseudo-mature. • three- to five-year-old; highly imaginative and creative; expression of fantasies and themes may well be a developmentally appropriate behaviour. • The child’s mode and intensity of affect in play

10. Observing the child’s relationship with the counsellor • Issue of transferance • The child’s warmth and friendliness, eye-contact, social skills level and predominant interactional style • whether a child is mainly withdrawn, isolated, friendly, trusting, mistrustful, competitive, negativistic, cooperative and so on • child be made fully aware of the counsellor’s interest in story telling. In order for this to happen, the counsellor will make use of active listening skills.

11. Active Listening • child should know that we are paying attention and valuing the information that we are receiving • four major components to active listening: • Matching body language • The use of minimal responses • The use of reflection • The use of summarizing Matching body language • Sit with the child- mirroring; no incongruence

12. speed of talking and tone of voice of the child • When the child talks rapidly- join with the child’s style of relating and responds similarly. When the child slows up, the counsellor can match the change by being more leisurely • match a child’s non-verbal behaviour and posture when appropriate • after the counsellor has been matching the child for a while, the child is likely to follow the counsellor in any significant change • matching levels of eye-contact (exceptions) • indicate to the talker that the listener is attending. • non-verbal; nod of head • Verbal minimal responses include expressions such as ‘Ah-ha’, ‘Uh-hm’, • ‘Yes’, ‘OK’ and ‘Right’. • longer responses - ‘I hear what you say’, or ‘I understand’. • story is not significantly influenced by the child’s perception of the counsellor’s approval or disapproval • powerful exclamations like ‘Wow!’ may lead the child to draw conclusions about the counsellor’s beliefs and attitudes. • distorting their story in order to gain the counsellor’s approval, or to avoid the counsellor’s disapproval.

13. some non-verbal minimal responses may be perceived as expressions of judgement about the content of what the child is saying • Frequency - intrusive and distracting The use of reflection • reflection of content (sometimes called paraphrasing) and reflection of feelings. Reflection of content (paraphrasing) • counsellor literally reflects back to the child what the child has said to the counsellor • picks out the most important content details of what the child has said and re-expresses them in a clearer way and in their own words rather than in the child’s • can happen during the therapist’s observation of the child in play.

14. Example one Child statement: ‘My Mum and Dad are always working. My Dad leaves home a lot to go to work, he goes to Cairns and all over the place. Mum is the boss where she works and has to stay back sometimes and tell other people what to do.’ Counsellor response: ‘Sounds like your Mum and Dad aren’t around very much for you.’ • Example two (child playing with miniature animals in the sand tray) Child statement: ‘Come on dinosaur, jump over the fence; it’s nice over here. Come on, watch me, look, come on Spiky, come over here, I’ll help you, I’ll come back and get you, look.’ Counsellor response: ‘Looks like your animal wants Spiky to come and join him.’ • Example three (child playing in the doll’s house, with the doll’s family) Child statement: ‘I told you not to make that mess on that floor. You’d better clean it up. You’ve put stuff all over the floor, you naughty boy.’ Counsellor response: ‘That mother wants the little boy to clean up the mess.’ • Example four Child statement: ‘I got all my spelling words right in my test but Tiffany didn’t. She got into trouble for talking, too. When you get naughty you have to go to the time-out room. I never go to the time- out room.’ Counsellor response: ‘Somehow you don’t seem to get into trouble but Tiffany does.’

15. child is more fully aware of what they have just said, thereby intensifying the child’s awareness • able to sort out any confusion, helping the child to move forward in their exploration Reflection of feelings • reflecting back to the child information about emotional feelings that the child is experiencing • play - reflection of feelings can also be used in relation to emotional feelings, which the child attributes to imaginary people, symbols or toy animals • encourages the child to deal with significant emotional feelings rather than to avoid them • Thoughts v/s feelings ; happy, sad, angry, confused, disappointed, surprised, despairing , overwhelmed, frightened, worried, contented, insecure, rejected, betrayed helpless, responsible, powerful

16. Realistic about negative feelings • involves making statements that include ‘feeling’ words, such as ‘You’re sad’, ‘You seem to be angry’, or ‘You look disappointed’ Example one Child statement: ‘Every time I ask Mum if I can go to Aunty Karen’s, she says “No”. Kelly’s going this weekend, and it was my turn.’ Possible counsellor responses: ‘You’re disappointed’ or ‘You sound angry.’ (The correct response would depend on the context and on non-verbal cues.) Example two (child’s brother was killed in a car accident) Child statement: ‘My brother didn’t even have his favourite dog with him when the car was hit.’ Counsellor response: ‘You’re very sad’ or ‘You sound very sad.’ Example three (child is involved in imaginary pretend play) Child statement: ‘Let’s get out of here before they find out. Quick, they’re coming.’ Counsellor response: ‘You sound scared.’ Example four (child is playing in the doll’s house, with the doll’s house family) Child statement: ‘I told you not to make a mess on that floor. You’d better clean it up. You’ve put stuff all over the floor, you naughty boy.’ Counsellor response: ‘That mother sounds very angry.’

17. With practice, it is possible to notice feelings such as distress, sadness or anger from the child’s posture, facial expression, movements and play behaviour. • Emotional displays, release of feelings • Reflecting back anger to a child can sometimes have a dramatic outcome, act out • counsellor may feel alarmed; encourage the child to direct their anger more appropriately through the use of media The use of reflection of content and feelings • Combining Example one Child statement: ‘Steven and I used to play princes and princesses in the garden. He always wanted to be the king and sit on this rock which was the throne. He can’t do that now he’s in heaven.’ Counsellor response: ‘You’re sad because you can’t play with Steven anymore.’ Example two Child statement: ‘Even when you walk away the big kids just follow you. If you tell the teacher they get you after school. Nothing really works.’ Counsellor response: ‘You feel helpless because you can’t deal with these bullies.’

18. Example three (an older child) Child statement: ‘I wrote all my subjects down with my preferences next to them. I posted it off to my mother so that it would get there in time, and she still hasn’t taken it up to the school.’ Counsellor response: ‘You’re angry because your mother has let you down.’ • Be it short, non intrusive • helping a child to own a feeling which they are trying to suppress ( thus help not to avoid) if reflection of feeling alone is used The use of summarizing • confusion of child by the detail of their own stories • Summarizing clarifies what the child has been saying and puts the information into an organized format so that the child has a clear picture and can be more focused. • Useful in terminating an individual counselling session.

19. Helping the Child to tell their Story and get in Touch with Strong Emotions • too much painful issues, unconsciously hidden, misconceptions about the past traumatic event • some children who are brought to see a counsellor may not be ready to work through their issues and need to be respected by not being pressured to do so. • Interactive environment is created by; • observation and active listening skills • questions • statements • media. • Children are already occupied with a number of questions by the parents • Play- statements than questions • Pressure for right answers, please the questioner since childhood • not necessarily what the child believes to be true and they may not fit with the child’s experience or with what the child is thinking- useless in therapeutic processing

20. direction in which the counselling session heads is likely to be influenced and controlled by the questions the counsellor asks, instead of following the direction in which the child’s energy leads. • If a counsellor asks too many questions, the child will quickly learn to expect questions and will wait for more questions to be asked instead of thinking for themselves and talking about what is important for them. • reflective counselling skills will encourage a child to continue telling their story without the need for questioning. • Closed questions are questions which lead to a specific answer Did you come here by car today? Are you frightened of your brother? Are you angry? How old are you? Do you like school?

21. give a short factual answer and may not enlarge on that answer. • feel limited and may not feel free to answer the question in a meaningful way. • may wait for another question instead of feeling free to talk openly. Open ended questions give the child lot of freedom to explore relevant issues and feelings, instead of inviting a single-word answer. What is it like living with your brother? Can you tell me about your family? How do you feel? What can you tell me about your school?

22. ‘Why’ questions tend to generate answers which relate to matters or events external to the child, aren’t connected to the child’s inner experience, are lacking in emotional content, and are often trivial or unconvincing. The answers to ‘why’ questions frequently fall into the categories of excuses or rationalizations. • Ask only those questions that are needed. Never ask questions just to satisfy your own curiosity • before you seek information, check whether you really need it. Questions to raise awareness; • Gestalt therapists • enable the child to make connections between the way they feel internally physically, and their emotional feelings and thoughts. - If your tears could talk what would they say? - Can you tell me what you are thinking right now? - Can you tell me how your body feels right now? - Now that you notice that your body is uncomfortable, how do you feel emotionally?

23. When I am angry I talk in a loud voice. child who is suppressing their anger and talking quietly Statements • give permission for the child to feel and express a particular emotion.

24. help a counsellor to float ideas about what might be happening for the child at a particular moment. • provide counsellors with a tool with which to affirm a child’s strengths. • can be used to highlight significant events during an activity. • can be used to give feedback, without judgement, about what the child is doing. • can be used to raise the child’s awareness of an element of their activity, and/or to float an idea which the counsellor has about the child’s issue. • Explore opposites and absences in the child’s story. • Give permission for contradictory feelings to exist. • Focus on contact functions to help the child to access suppressed emotions (tools of contact- looking, talking, touching, listening, moving, smelling and tasting)

25. Dealing with Resistance and Transference • deflection ; child becoming silent and withdrawn, or may avoid the issues by becoming loud and boisterous • conscious or subconscious Child’s defense mechanisms Regression • Younger children use more primitive ways of coping with their anxiety than older children

26. Denial • When the reality of a situation is very disturbing, young children may deny this reality by distorting it and fantasize about a scenario which is more acceptable to them • Older children usually find alternative ways to cope with troubling feelings without distorting reality Avoidance • When a child starts to experience uncomfortable emotions they may deflect the conversation from a painful or troubling topic - Eg; a child may move to the doll’s house and offer to tidy it for you when asked about their relationship with an abusive mother

27. Repression • use denial and avoidance when confronted by triggers which might normally remind them of the initial painful experience- older ones • child may invent logical alternative reasons to explain the events Projection • project unwanted emotional feelings on to another person or object Intellectualizing and rationalizing • help the child to talk about experiences without making contact with the emotions accompanying the experiences

28. Reaction formation • The use of defence mechanisms in young children is quite normal. • it is maladaptive for an older child to make use of defence mechanisms as a predominant way of coping. • Additionally, the child might exhibit extreme distress when certain issues are discussed, or show poor concentration when learning a new game or while playing alone Dealing resistance • raising the child’s awareness of the resistance by identifying the resistance and giving the child feedback about it. • validate, make it clear that it is legitimate to feel that way and that it is acceptable to respond by withdrawing.

29. Directly identifying the resistance • Sometimes, child will use denial and continue to avoid talking about useful material • Then, allow the child to withdraw into free play and focus on maintaining a positive relationship with them; change the media • Prolonged resistance- One option is to recognize the child’s predicament, acknowledge it, and then talk to the child and also the parent/s or carer/s; The counsellor might then help the child to discover practical strategies for dealing with day-to-day problems • Parents are informed of the limits to counselling outcomes and made aware that, at some time in the future, the child may need to restart the counselling process when they are able to talk about the difficult issues that are currently blocked • Another option - engage the child in long-term psychotherapy involving free play, with the counsellor focusing on maintaining a positive relationship with the child

30. Dealing with transference • step back from the immediacy of the counselling relationship and to be as objective as possible • be vigilant so that we can remain sufficiently detached and objective to avoid behaving like a parent • raise the child’s awareness of the transference process • Connect with supervisors • Female counselors- child feels like good mothers, will satisfy all the needs. Counter transference- protecting, cuddling or nurturing the child. Child would be set up for disappointment in the long term and diverted from facing the painful issue of not getting their needs met by their real mother • Bad mother- aggressive or abusive to the therapist, and counter-transference might result in the counsellor becoming angry or punitive to the child. Child might be withdrawn, submissive or compliant, and countertransference might result in the counsellor becoming impatient or exasperated.

31. SPIC model - 3rd phase - self perception (Narrative therapy) • Phase 4- self destructive beliefs - CBT • Children absorb ideas and beliefs from the adults and children around them; influenced by culture • Systems Eg; child trained to be polite to all- others take advance - labelled as useless • How the child sees themselves and their beliefs, thoughts and attitudes will reflect the child’s self-concept. • The extent to which the child values themselves is an indication of their self- esteem

32. Self Concept • Children are renowned for thinking that they are responsible when things go wrong, blame themselves • moving naturally and gently with the child’s spontaneous questioning about themselves is a useful way to help the child develop a positive self-concept. • A negative self-concept can develop when the child interprets their participation in past and subsequent experiences as sneaky, incompetent, inept, disloyal, secretive, naughty, nasty or stupid. • A positive self- concept can be promoted if the child can be helped to remember events or experiences in their past that have been different from those they are focusing on and which resulted in more positive outcomes for them. • Such exceptions- give alternative outlooks • start to see themselves positively and to describe themselves using positive adjectives such as brave, honest, skilful, caring, and so on.

33. Metaphor • figure of speech containing an implied comparison; expresses one thing in terms of something else. • It uses an alternative picture and its contents to represent the real-life picture symbolically. • It’s underlying assumption that if some aspects of the metaphor agree with reality, then other aspects will also agree. This assumption can be useful in enabling the counsellor to make use of metaphor with the child to explore the child’s perceptions of themselves more fully.

35. ‘Where does this tree grow; on its own in a field or in a garden with other trees, or in an orchard with similar fruit trees?’- how they see themselves with regard to their social and interpersonal relationships • ‘How does this tree manage in a fierce storm?’ to explore the child’s perception of themselves with regard to managing their fear, or ‘What happens to this tree in the winter?’ to explore the child’s perception of their own inner strengths and resources. • invite the child to think of times when, for example, ‘the tree’s branches didn’t fall off’, and what would have to happen so that the ‘fruit could grow all year round’.

36. Self-destructive beliefs • explore any inappropriate beliefs that have supported a negative view of themselves • Inappropriate beliefs - become disempowered, anxious and compliant, and also have difficulty with interpersonal relationships • Involve parents/carers • common self- destructive belief related to the effect of trauma- irreversible negative change

37. I’m responsible for my father hitting my mother. • I don’t have any control because I’m too little. • Boys are better than girls. • It’s not fair when I get treated differently from my brother. • I’m naughty; that’s why my mother doesn’t love me. • You have to be tough to be popular. • Parents split up when kids misbehave. • My parents should never punish me. • If you tell the truth you get into trouble. • My Mum and Dad will always look after me. • You should always be good mannered. • You should always be polite to grown-ups. • It’s bad to show that you’re angry. • You should never say ‘no’ to a grown-up. • I must never make mistakes. • I must always win. • I must not cry.

38. Challenging self-destructive beliefs • REBT • challenge inappropriate and/or self- destructive beliefs and to replace them by more helpful or adaptive beliefs. • Thus moves to the next phase of SPICC - child looks at their options and choices. • reflect back to the child what the counsellor perceives to be the child’s belief. Eg- ‘You believe that you are responsible for your father hitting your mother.’ • help the child to test out the validity of the beliefs; identify to what extent the belief comes from the child’s own experience and to what extent it comes from what others have told them. Eg- ‘How do you know that it is your fault that your Dad hits your Mum?’

39. child’s parents should be involved in the therapeutic process so that this belief can change. 3. invite the child to consider alternative beliefs. Can ask like: • ‘If you hit someone, would it be your fault or someone else’s fault?’ • Thus the counsellor raises the child’s awareness of other possible beliefs, which in some way the child is overlooking or failing to identify for themselves. The counsellor might also help the child to compare their experiences with theirperceptions of other children’s experiences. • Child may not be accepting the information in reality • child may need to own and accept responsibility for some parts of the events which have troubled them. It is important to help the child to separate out those parts of the events for which they were responsible from those parts for which they were clearly not responsible.

40. Example one Imagine that a boy has been in a violent home in which there have been strong messages that females are inferior and should not have the same rights as males. • Reflection - ‘You believe that boys are better than girls.’ • Validity - ‘How do you know that’s true?’ The child might give an answer which suggests that the males in his family get preferential treatment. • Alternative ideas - ‘What things can Mum do that Dad can’t do?’ or make statements such as, ‘Boys and girls are different’. • recognize that difference does not imply better or worse, but that each gender has different attributes

41. Example two Consider a child who believes that her parents should never punish her. • Reflection, validation: where the belief came from The child might say, ‘My Mum does things that she shouldn’t do, and she doesn’t get into trouble.’ • explore the child’s logic, which includes an underlying assumption that children and parents are equal - ‘Does your best friend, Trudy, get punished by her mother?’ and ‘Who makes the rules in families, parents or children?’

42. Reframing • alter the way the child perceives their situation. This can be done by accepting the child’s picture of their world and expanding that picture to include additional information so that the child will perceive their situation differently and more constructively. • For example, a girl might be complaining that her older brother is continually telling her to keep her room tidy. A reframe might be: ‘Is it possible that your brother cares about you so much that he wants to prevent you from getting into trouble because your room is untidy?’

43. Normalizing • Sometimes it is helpful for a child to know that their thoughts, feelings and/or behaviours are similar to those of other children. • Giving a child this information is called normalizing the child’s experience. For example, a counsellor might say, ‘Many children whose parents have split up believe that it is their fault that their parents have separated.’ • When normalizing it is important not to invalidate the child’s feelings and associated discomfort.

44. Actively Facilitating Change • SPICC model- Phase 4; Cognitive Behaviour Therapy to help the child to consider their options and choices • Phase 5- the child can be encouraged to rehearse and experiment with new behaviours through the use of Behaviour Therapy Exploring options and choices • use ideas from Glasser’s Reality Therapy approach to help the child recognize that they can choose to use whatever behaviour they wish, but must take responsibility for the consequences of the behaviour they choose. • This Reality therapy idea can be introduced through the use of a comic strip.

45. The comic strip exercise • In the first frame, at the left-hand end of the comic strip, the child is encouraged to draw sketches, or to use abstract symbols, to represent particular behaviours which are causing problems for them – unhelpful behaviours. • In the third frame, at the right-hand end of the comic strip, the child is encouraged to draw sketches, or to use abstract symbols, to represent alternative behaviours – helpful behaviours – which are likely to produce more positive outcomes and which could be used in place of the unhelpful behaviours that have been illustrated in the first frame. • In the centre frame the child is encouraged to draw a self-portrait.

46. case study Adam is a boy who is continually getting into trouble at home for punching his sister, and for deliberately throwing things and breaking them when he is angry, because this is the way he has learnt to respond to his frustration over a long period of time Counselor; • helped Adam to tell his story and to get in touch with and release his angry emotions. • it is important for him to learn how to replace his unhelpful behaviours with more helpful ones • Making use of comic strip; • talk with Adam about those behaviours of his that counselor know get him into trouble, also he could think of that

47. 2. ask him to draw sketches in the left hand frame of his comic strip to illustrate these problematic behaviours. Explain to him that the counselor would like to help him to avoid getting into trouble and help him to realize that these behaviours are a problem for him C: “what might have happened before you got angry and punched your sister”? A: ‘She takes my things, and she’s always teasing me.’ C: “your sister might be very annoying and provocative, that provocation does not justify abuse, and punching your sister is abusive. You’ll be into an awful lot of trouble and I would like to help you to avoid getting into trouble

48. 3. Invite Adam to draw two other pictures in the left-hand frame. One to show his sister taking his things, and another to show her teasing him as shown at the top of the left-hand frame. Can ask to draw the depiction of informations shared by parents also 4. look at each of Adam’s sketches in turn, and explore with him things that he could do that would have better outcomes for him; things that he could do instead of punching his sister, and instead of throwing and breaking things. • initially encourage Adam to think of helpful behaviours himself, and after that I would tentatively make suggestions of other behaviours that I thought might be useful and would discuss these with him to see whether or not he agreed

49. sketch- Adam walking away from his sister without responding to her when she teases him. • talking to his mother, explaining that his sister has taken one of his possessions without permission. • Adam visiting one of his friends • Going for a ride so that he can get right away from his sister • Adam goes into his bedroom when he’s really angry and shuts the door, lies on his bed imagining that the mattress represents his anger. The picture shows him pummelling the mattress while repeatedly saying, ‘I hate being angry, I hate being angry’. This is a way for him to let his anger out without hurting anyone or damaging anything • Include parents also for environmental interventions • Risk of anger release on objects

50. 5. ask the child to draw a picture of themselves in the central frame. • The counselor should deliberately avoid trying to pressure the child into believing that they should always behave in the way that is described by the pictures in the ‘helpful behaviours’ frame, instead make them aware of their choices and consequences of actions- high chances of changing behaviour • some children are extremely impulsive and may need help in managing their impulsive behaviour or they will not succeed in replacing unhelpful behaviours by helpful ones- role of self management skills