PSYCHOLOGICAL SERVICES

Presenting difficulties that are more recent or have more recently worsened would be considered to have a less complex presentation. Also, when difficulties have a clear activating event or trigger, such as moving to a new city, exam stress, or fear of getting sick, then this would also be considered less complex. However, being less complex does not mean less serious. These difficulties can still lead to significant consequences, anywhere from changes in diet, sleep problems, and stopping favoured activities, to self-harming, school avoidance, and use of physical aggression. Of course, if left unresolved they can evolve into more serious and complex difficulties. 

Fortunately, there are many therapeutic techniques that are proven to provide relief in these circumstances. The most effective techniques will often be skills-based, such as Cognitive Behavioural Therapy (CBT) and that is the most likely approach that I will take. With younger clients, it will also be critical for parents to be involved in weekly sessions and possibly even ‘parent therapy’ would be needed. For clients of all ages, it will be important for you to have support at home, in school, and in the community. 

Presentations that are more longstanding, even lifelong, and have numerous contributing factors, are complex. Sometimes, less complex presentations occur simultaneously and are the main reason for seeking therapy. In those cases, the formulation of the difficulty can change and a change in therapeutic technique will often take place. Higher complexity often occurs in situations where there is a traumatic event or a series of adverse events. This is also more common when attachment or bonding difficulties are present or when someone else in the family has struggled with serious psychological or physical disorders. Finally neurodevelopmental deficits, often called neurodiversity, such as ADHD or Autism, would be, by definition, complex, since they are biologically based, and it is important to develop strategies that are sustainable and can evolve over their lifetime. 

The therapeutic techniques used here will be more intensive. Trauma-focused CBT and attachment theory-based treatments, such as Compassion Focused Therapy and Interpersonal Neurobiology, will likely comprise the main approach. It will be especially important for family members to be directly involved in therapy and for further supports to be available outside the home. It is possible that the level of complexity may demand more than what I can provide. If that is the case, I will collaborate with you in exploring available options. 

When the parent(s) is the primary focus of the direct work and the responsibility for change rests entirely or mostly with them, I give it the name of ‘parent therapy.’ It is a way of working that is focused on your role as a parent, which means that the ultimate objective of therapy continues to be to provide relief or behaviour change for your child. I often include some form of parent therapy in most of my work with young people, especially those under the age of 12. However, there are two main circumstances in which I may recommend its use as the sole intervention. 

First, with younger children, generally between the ages of 4 and 12, there may be reasons why the young person is not able to engage in direct therapy. They may struggle to sit still, or they may have significant communication difficulties, or they may engage in physically aggressive actions. In such cases, I may propose the use of parent therapy as an intervention, thus relieving the child of the responsibility of attending sessions (and the parents in getting them there). Parents have an enormous amount of influence over their children so even if the child is not directly involved it has been my experience that positive change can most definitely occur. 

Second, with older children, generally above the age of 12, they may be unwilling to participate in therapy, which can often lead to a quick end to any efforts to seek relief. Therapy is most beneficial when the young person is a willing participant and acknowledges agency with at least some of the difficulties. At the same time, it is understandable and typical for young persons to struggle to come to terms with difficulties in their mental health or their use of harmful behaviours. It is also true that young people are simply not in much control of their environments and may not feel a sense of agency over their predicament. In such cases, I will make a reasonable amount of effort to engage the young person, but if that is not effective, then I may suggest working directly with you, the parent(s), as an alternative to ending therapy, especially if there are serious consequences to doing so.