Treatment orientation refers to the philosophic and intellectual framework that clinicians use in approaching treatment. A clinician’s treatment orientation can affect his treatment interventions, which problems he addresses, and how long treatment takes. Three common orientations are outlined here: psychodynamic, cognitive-behavioral, systemic, and solution-oriented.
Clinicians with a psychodynamic orientation view mental health symptoms as representative of underlying emotions such as anger or grief, often relating to experiences early in life. These clinicians usually direct their treatment towards helping children and families express and understand their feelings. While psychodynamic psychotherapists do aim at concrete behavioral improvements, they also attempt to better children’s understanding of themselves, improve their self-esteem, interact more effectively with others, and cope with ongoing and past conflicts. Clinicians with a psychodynamic orientation usually conduct treatment for relatively long periods (at least several months). They may work in individual, group, or family formats.
Behavioral and Cognitive-Behavioral
Behavioral therapists generally focus on one or two presenting problems. They often work with parents to set up behavior management plans in order to improve their children’s behavior. They frequently use specific techniques to address discrete problems such as phobias or bed-wetting. They may also work with children to improve their abilities to cope with stress, and to develop their social skills. Cognitive-behavioral therapists augment behavioral interventions with attempts to modify children’s underlying beliefs about themselves and the world that may contribute to their negative moods and behaviors. Cognitive-behavioral therapists, and especially behavioral therapists, often conduct brief treatment (usually less than twelve sessions). They may work with children and families intermittently or meet with them less than one time per week. They may hold sessions with individual children, with parents alone, with families, or with groups of children. For a closer look at cognitive-behavioral therapy, please click here.
Family Systems and Multi-Systemic
While therapists of any orientation may hold family sessions, therapists with a family systems orientation focus their energy on improving family relationships, and aim to heal individual children as a result of such improvement (See The Healing Power of Family Therapy). They usually work with as many family members as possible. Therapists with a multi-systemic orientation view children’s difficulties within the context of their extended family, school, and community, and may involve several persons or entities outside the family in the treatment. Treatment can be brief or longer-term, depending on the presenting problems.
Therapists who work from a solution-oriented perspective try to change the focus from “the problem” to “the solution”. They explicitly avoid exploring problems in detail and instead help families to develop their own solutions. They usually avoid direct advice, and instead encourage children and families to recognize and build upon the skills they already have. Solution-focused therapists do not delve into the origin of difficulties. Solution-oriented therapists may practice individually, with families, or in groups. Treatment is usually brief, and tends to terminate when the presenting problem is resolved.
- Two additional orientations of note that therapists often apply include interpersonal and emotion-focused.
What treatment orientations work best?
Successful treatment for children most depends on factors other than treatment orientation, such as the therapist’s experience, intelligence, empathy, and willingness to involve the family in treatment. Nevertheless, certain approaches tend to be more effective for certain problems. Therapists with a systemic orientation are usually particularly helpful for children and adolescents with behavior problems. Behavioral therapy can be very effective for children with anxiety (especially phobias), or discrete behavioral problems. Solution-oriented treatment can be very helpful in resolving minor difficulties. Cognitive-behavioral therapy is often very effective in treating children and adolescents who suffer from depression. Therapists with a psychodynamic orientation are usually best equipped at assisting children and families with broad concerns such as self-esteem, self-understanding, and relationship enhancement.
Most effective therapists use a mix of approaches depending on a child’s and family’s needs and circumstances. A therapist should be able to clearly explain his or her treatment orientation (s), and how this orientation will affect his or her therapeutic interventions.