Therapeutic work with children and young people is offered in accordance with the tiered model.
Therapy delivered by Educational Psychology corresponds to Tier 2 support.
Dr Jane Yeomans offers a range of Tier 2 therapeutic interventions for children and young people. The three main therapeutic approaches offered are described below.
Drawing and Talking
Drawing and talking is a gentle, safe and non intrusive therapeutic approach. It can be used with children and young people who have experienced emotional distress or trauma. When individuals have experienced traumatic or distressing events they can sometimes find it very difficult to to talk about these events. Therefore a talking therapy (such as CBT or MI that are described below) might not always be appropriate or useful.
In a Drawing and Talking session the child or young person is asked to draw a picture of anything that they choose. They are then asked to tell the therapist about their picture. Through this discussion the child or young person is encouraged to talk about their feelings.
Drawing and Talking helps the individual to make sense of their internal world. This therapy is not designed to interpret what is drawn, because the processes of drawing and talking are inherently therapeutic. Therefore, the session does not involve any ‘why’ questions, and when the therapy is ended, the report does not give any detail about the drawings, or offer any interpretation of the drawings.
Drawing and Talking is suitable for use with children and young people from age 5. It is delivered over 12 weekly sessions.
Cognitive Behaviour Therapy
CBT is a talking therapy. It can be used to help with many kinds of social, emotional and mental health (SEMH) difficulties such as anxiety, stress or low mood. CBT has a sound evidence base of being effective for improving SEMH difficulties in children and young people. CBT looks at the relationship between our thoughts, feelings and actions (see the diagram below). What we think about an event can affect how we feel about it and how we respond to it. So it’s not the actual event that’s a problem but what we think about it. These thoughts can set off a vicious circle of negative thoughts and feelings, which can lead to unhelpful ways of responding to events. Negative thoughts are very loud and powerful, and they tend to ‘drown out’ any positive thoughts.
CBT helps the child or young person to understand the cycle, and to have some strategies and approaches for breaking it. CBT can help to develop more helpful behaviours, or to reduce or replace negative thoughts. This therapy often requires follow up in between sessions, so it will be important that the child or young person is supported to compete any between session tasks.
Some studies have shown that CBT can be used with quite young children, from age 3 in order to address anxiety. Overall, CBT can be used from Key Stage 1 upwards. There are some language demands for accessing this therapy, which should be borne in mind when deciding on a suitable therapeutic approach. CBT is delivered over a minimum of 6 weekly sessions.
Motivational Interviewing (MI)
MI is a useful therapeutic intervention that is based on the notion of ambivalence. Individuals can be unsure or ambivalent about the need to change (see the stages of change diagram below) Some individuals will continue to engage in problem behaviours even though they might be harmful, because the benefit they perceive they gain from these behaviours far outweigh any harmful consequences.
Children and young people are often referred for therapy by someone else (for example, parents or members of school staff), so they might not agree that they need to change their behaviour, or they might be ambivalent (unsure) about change. MI is therefore a helpful therapeutic approach in these circumstances. MI involves a great deal of active listening and unlike CBT there is no ‘homework’ element. The focus in this therapy is on exploring the advantages and disadvantages of change.
MI is suitable for Key Stage 2 pupils upwards. It is delivered over a minimum of 6 weekly sessions
Choosing a suitable approach.
A decision about the type of therapy to be offered is made after an initial assessment with the child or young person, and a consultation with parents and/or school staff. Sometimes the outcome of the assessment and discussions indicate that another type of therapy is needed (for example, play therapy), or that the difficulties are so severe that a referral to CAMHS (Child and Adolescent Mental Health Service) should be made for Tier 3 support. In these cases, information will be given about other referral routes.
How do we know if the therapy has been helpful?
Assessment information gathered prior to beginning any therapy provides information about the difficulties before therapy starts. A number of different measures are used, depending on the concerns and the age of the child/young person. Some examples are: the Strengths and Difficulties Questionnaire (SDQ), the Spence Children’s Anxiety Scale (SCAS), the Beck Youth Inventories and a motivation to change card sort assessment activity. Information is also gathered from the person making the referral (for example, for Drawing and Talking, the class teacher or other key member of staff is asked to note their observations of the child/young person in relation to their emotional well being). Some therapy such as CBT involves the client in goal setting. This process can then help to evaluate the outcomes of the therapy. Measures are repeated at the end of therapy in order to look at any changes.
A written summary is always provided at the end of a block of therapy. This report will give an outline of the work undertaken, the level of engagement of the child/young person and any changes before an after. However, in order to preserve confidentiality, the report will not give details of each individual session. This is particularly important for Drawing and Talking therapy, because the role of the therapist is not to place any interpretation on the drawing produced.