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Family therapy model
Individual therapy model: Gardner (1976) advocates using individual psychotherapy, along with play therapy, observation, games, monologue and dialogue with children of divorce. He believes that the reason for some children's maladjustment to divorce is that some parents may be using them in various pathological activities (i.e. spying, informing or exposing them to constant conflict), thus causing them to develop maladaptive responses to the loss resulting from the separation. Therefore deeper therapy such as psychodynamic psychotherapy, utilizing catharsis and desensitization, is appropriate to rework their pathological grief reactions. According to Hodges (1986), individual child psychotherapy (always combined with work with one or both parents) is the treatment of choice when the parents are psychologically unavailable for working in family therapy; when the child needs to learn to separate his/her identity and problems from those of the parents; when the child could benefit from a consistent predictable therapist in the midst of a chaotic family life; and when the child needs someone who does not have divided loyalties. Hodges stipulates that the work with children always has to be done in combination with work with one or both parents. Kalter et al. (1989) go further by suggesting that supportive parental guidance, parenting support groups, and individual therapy for the custodial parents may be amongst the most effective ways of helping children adjust to the stresses encountered in the divorce process. Hozman & Froiland (1977) adopted Kubler-Ross's grief process model in their therapeutic work with children of divorce. In this model, the approach is that the custodial parent may need to be given insights into some of the losses and griefs the child is struggling with, in order to be more sensitive and effective in the parent role (Hodges, 1986). Individual sessions with the child based on an approach such as non-directive play therapy, utilizing symbolic play rather than verbal communication alone, may permit the child to express conflicts in a more age-appropriate manner (Axline, 1947; Piaget, 1970).
Research on effectiveness: There is a paucity of studies of individual therapy for children of divorce. Lee et al. (1994) carried out a substantive review of intervention outcome studies for families undergoing divorce and discovered that there were no studies that examined the efficacy of individual psychotherapy for such children. Emery (1988) states that, beyond the observation that divorced families are particularly likely to drop out of traditional child-guidance clinics (Rembar et al., 1982), individual therapy for post-divorce family members has not been systematically studied. He goes on to note that 'unfortunately the question of how divorced family members fare in established problem- and theory-focused treatments is rarely asked' (Emery, 1988, p. 105). Garvin et al. (1991) point out that there are very few empirical evaluations assessing counseling program effectiveness: 'although no interventions can be equally effective for all participants, there has been no attempt to identify the characteristics of children who benefit from these efforts whose needs are not being met' (p. 439). The majority of research into counseling children of divorce has been conducted in North America where counseling services are more established than in Britain. Over the last 15 years, counseling services in Britain for such children have begun to develop, but no research has been conducted to establish their effectiveness. As Bolger (1989) points out, no one can be confident that all methods of counseling are equally helpful to clients; if counseling is to remain credible and clients are to be protected, then its outcomes must be evaluated. This is especially true of interventions for children of divorce, who face a particular type of stress and loss due to their parents' separation. This article seeks to address this issue by outlining an evaluation of the first counseling service for children of divorce in Britain.
The counseling service: Children were normally seen on a weekly basis for a 45-minute session. It was the custom of the counselor to inform the non-custodial parent that their child was attending counseling. The form of counseling used by the counselor was eclectic in nature. The counselor did not claim to work from any particular theoretical base, and drew on ideas and experience relevant to each individual. The counseling most closely resembled a combination of directive play therapy and gestalt therapy. The play therapy was more directive than the standard Axlinian model, with the counselor using a more direct questioning approach. Axlinian play therapy involves allowing the children to lead the counseling sessions, with the therapist being engaged in very little interpretation of their behavior, but reflecting back their feelings so that they gain insight (Axline, 1947). Sometimes fantasy techniques were used, similar to those described by Oaklander (1978) which involve elements of gestalt therapy. Gestalt counseling focuses on ways to help children verbalise and express their feelings and give voice to their inner conflicts (Thompson & Rudolph, 1988).
Conclusions and implications for practice: From the children's perspective, one-third said they felt better and one-third said they felt worse about their parents' separation after the counseling. The two main issues for the children were the interrogative nature of the counseling and the issue of confidentiality. Some struggled with the direct approach the counselor used: they did not appreciate being interrogated. Possibly a more indirect and non-verbal approach should have been adopted with the majority of the children. More play therapy and art therapy techniques rather than a heavy reliance on verbally-based counseling techniques might have been more effective. Some children felt that their trust in the promised confidentiality had been breached, which undermined the effectiveness of the intervention. Nearly half of the mothers felt that their children were worse rather than better post-counseling. Some mothers complained that there was no communication between them and the Children's Counselor. It is highly likely that this was due to the fact that the children were offered individual confidential counseling; this erected a barrier between the mother and the Children's Counselor, which was not helpful for these mothers. This raises the question of the appropriateness of this type of counseling for children of divorce. Are there other more appropriate models that could be used with this particular client group? Would more joint sessions with the mothers and children have been more appropriate? One of the lessons learned from the evaluation is that the type of counseling model used needs to be appropriate for the presenting problem. A thorough analysis of the factors which have contributed to the counseled children being in need of support is vital in making the decision as to which model and approach is more suitable for which child. As was seen in one 'successful' case, flexibility on the part of the counselor to work jointly with the mother and daughter led to the key issue of their relationship difficulties being resolved.
In 10 of the 15 'unsuccessful' cases, the counselor considered that the parent's problems (i.e. unresolved emotions surrounding the separation or interparental conflict) impeded the resolution of the children's problems. If the parents are unwilling to be involved in counseling (individually, or jointly in mediation, or with a Family Counselor, or jointly with the child), then the positive outcome of their child receiving counseling will be minimal. Hodges (1986) stipulates that individual therapy for children of divorce should only be conducted in combination with counseling with one or both parents and only when the parents are psychologically unavailable to work in family therapy. In conclusion, it can be said that two main lessons have been learned from this evaluation about counseling children of divorce: the importance of contracting and of assessment. First, a clear contract needs to be established at the beginning of counseling in order to avoid misunderstandings about the issue of confidentiality. Also, the boundaries of the counseling relationship need to be established in a contract so as to clarify what constitutes the end of counseling and to minimize the 'opting out' which seemed to characterize many of the counseling cases in this evaluation. Second, there is a need for a thorough assessment of the presenting problem in order to decide which approach would be the most appropriate: individual counseling for the child and the custodial parent, or jointly counseling them; and whether more play therapy rather than verbally-based counseling would be better for the younger children. One-off evaluations are not enough to ensure that good quality services are provided; ongoing evaluations are important if counseling services for children of divorce are to continue to develop in a healthy and constructive way.
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