Man is a social being. His behaviour and actions have an impact on the society in which he lives. The behaviour of an individual should thus be in coherence with the accepted norms of the society. Every individual behaves in a particular manner based on his mental development and his perception of the environment in which he lives. Accordingly, the cognitive development of every individual is unique. This cognition in turn influences his various skills that govern his interaction with the society. Psychology plays a pivotal role in determining how a person thinks, behaves and what triggers this behaviour. Psychology can thus be defined as the scientific study of the human mind and behaviour.
Innumerable theories have been put forth by several psychologists that give us an outline of the various factors that determine the behaviour of an individual. These factors can be biological, physiological, mental and/or environmental, and in turn govern the explicit behaviour of a person. Cognitive theory is a widely accepted psychological theory that gives us an image of the influence and impact of thought processes on the explicit behaviour of an individual and his/her interaction with the society.
Jean Piaget was a Swiss developmental psychologist who was the first to put forth a theory that attempts to explain the development of thought processes and human intelligence in a person, and the impact of this cognitive development in his/her behaviour. According to Piaget, cognitive development was a gradual and continuous structure and organization of the mental processes in a child based on its biological development and its environmental influence. Thus, children develop an understanding of the world based on what they observe, then experience variation and distinction between what they are already aware of and what they come across in the environment. Accordingly, Piaget put forth the theory of cognitive development and emphasized that cognitive development occurs in various stages. There are three processes that work continuously to determine the thoughts and actions in a child – assimilation, accommodation and equilibration. These three processes work hand in hand for the child to behave in a specific manner in a given situation. Assimilation involves the conversion of incoming information into a specific form that can be easily comprehended by the child. Accommodation refers to the usage and translation of this information to a completely new situation. Equilibration is to strike a proper balance between the first two entities in order to create stability in understanding. This theory thereby forms a foundation for the various cognitive methods that are employed and interpreted within the counselling of children and adolescents.
One of the most successful and widely accepted methods used for counselling in children and adolescents is the usage of cognitive behaviour therapy (CBT). It is based on the principles of cognitive theory. It is widely used in the treatment of anxiety and depression. CBT is employed for particular problems and specific strategies and solutions are given to address the problem. Thus we can say that CBT is problem focused and goal oriented. CBT involves techniques that enable the children and adolescents to understand their thoughts and feelings governing their behaviour. Consequently, it emphasizes that a child / adolescent might not be able to control the happenings in the environment but can alter the way in which the happenings of the environment can be perceived and dealt with which in turn has an impact on the behaviour. Thus CBT ensures the achievement of equilibration state by altering the accommodation based on the assimilation.
Alterations in the cognitive processes play a key role in various psychotic disorders in children and in adolescents and these vary from emotional disorders to compulsive orders. These bear a negative impact on their behavioural, social and problem solving skills. Thus, CBT aims at primarily causing changes in the assimilation and accommodation processes which changes the basic cognitive outlook and perception. Goal oriented therapies aim at uprooting the maladaptive thinking and perception and replacing these thoughts with more conducive, effective and realistic thoughts that can reduce emotional distress and self afflicted disorders (Deblinger et.al. 1990).
Thus, counselling of children / adolescents through self analysis and cognitive method is very crucial as it assists them to develop the right frame of mind towards all their future endeavours.
The current era has not only been an age of technology and modernization but has also been a witness to a number of social problems that have been growing at an alarming rate. Innumerable children and adolescents have been victims to these social problems that have affected their lives at different levels. This has been an obstacle in their paths of physical, mental and emotional development, and has also hampered their social skills. Counselling, thus plays a prime role in assisting these victims to transcend their problems, improve their self image and esteem and also promote overall well being.
A wide range of counselling skills and techniques have been designed by several psychological experts to address the problems faced by these traumatized children and adolescents. The Cognitive Based Theory (CBT) for counselling has been extensively incorporated to look into the problems of children and adolescents.
Child sexual abuse has been an evil in the society that has tormented the lives of several children / adolescents. It has been found that most of the victims have been girls. CBT has been extensively used to look into the traumas of these victims and transcend their issues through counselling.
Hypothetical Case Study for Child Sexual Abuse
Tania is a 14 year old girl who lives with her parents in the Chicago metro area, USA. Her school is at a distance of 1 mile from her place of residence and she is habituated to walk back home every day. On August 5th, she stayed back at her school library beyond the scheduled time to complete her geography assignment. She lost track of time and it was late evening by the time she started her journey back home. The shortest route to her place was through a lonely road which she usually avoided. In the given circumstances, she decided to take that road. Alas! She didn’t know that a couple of drunken men staged themselves on that road. Tania didn’t notice these two men standing and when she was mid way down the lane, she realized that she was cornered by these two predators. The two men savagely attacked Tania and raped her leaving her unconscious on the deserted lane. She was found by a middle aged woman who was walking her dog in the road perpendicular to the scene of crime. She then rushed Tania to the hospital and intimated her school and parents using her school identity card. The doctors said that Tania was in a state of physical and mental trauma and had to undergo counselling to get back to her normal routine.
The above mentioned case study is a clear example of child sexual abuse suffered by Tania. This cruel act has affected her physical, psychological, interpersonal, behavioural and social well-being. One of the cognitive techniques put forth by the psychological experts is the implementation of Trauma - Focussed Cognitive Based Theory (TF - CBT) to combat the sufferings of Tania and to get her life back to normal.
Sexual abuse has a profound influence over the alteration in the development of the sense of self and it can lead to several psychological traumas like depression, anxiety, sense of loneliness and loss, aggression, fear, dissociation etc. Therefore, it is very crucial for the victims to undergo counselling to lead a healthy happy life (Hibbs and Jenson 1996).
TF - CBT is a widely used technique to combat the after effects of events that cause trauma and this technique includes an integration of Cognitive therapy, behavioural therapy and family therapy. The cognitive therapy helps to influence the behaviour of a person by addressing the thoughts and perceptions that lead to negative impacts and feelings. Behavioural therapy aims at altering the behaviour and response to certain stimuli. Family therapy helps to improve the interpersonal relationships with the family members to create conducive environment. The few components that have been cited as TF - CBT protocols which are used in counselling include:
- Good parenting skills to bring about awareness in the parents about typical behaviour of the victim after the incident and to train the parents with regard to behavioural management strategies and communication.
- Relaxation techniques like deep breathing and relaxation of muscles.
- Cognitive coping to help the child to analyse her feelings, thoughts and behaviour and express appropriate behavioural attributes to everyday events.
- Educating the child about healthy interpersonal skills and safety skills to cope with her incident related reminders.
Thus, these protocols can act as a guide to effective counselling and can slowly lead to the progress of the victim (Kendall 2011).
The idea of person-centred approach for therapy was established by Carl Rogers, an American psychologist. Roger’s theory became especially popular in psychotherapy and counselling of children and adolescents. It is an extensive set of nineteen propositions, primarily governed by the phenomenal field theories. In other words, it assumes that in a particular therapeutic environment, a person will naturally choose a psychologically healthy and growth-producing direction to lead his/her life. Further, a person perceives reality from his/her own world of experience, in which he/she is at the centre. The concepts in this theory continue to be used even today, and have formed the basis of adolescent counselling. The aim of this essay is to analyze these concepts by reviewing their key features.
Psychopathology and incongruence are key concepts in person-centred therapy. The former refers to the mindset of a person, in terms of how open-minded he/she is with regard to new experiences. The latter is based on the difference between reality and perception. In other words, a person may see himself as someone (perception), when he is actually not that person (reality). These two concepts lead to the definition of a fully functioning person, who has undergone optimal psychological development.
As far as children and adolescents are concerned, identifying their stage in becoming a fully functional individual is important. This helps in understanding the deeper problems buried in the sub-conscious, and in bringing them to the surface to be dealt with. In order to get here, counsellors use the following three stages as standards:
1. Non-directive – This is the initial phase where the counsellor establishes an amicable environment for the person, and builds trust by creating a non-judgmental platform for the person to express himself/herself.
2. Person-Centred – This phase deals with the identification of incongruities, and trying to resolve them. This usually involves long hours of reflection by the person, while the counsellor just listens and interrupts only when absolutely necessary to aid the flow.
3. Increased Personal Involvement – This can be considered as the final stage, where the therapist is more open-minded about introducing broader range of subjects for discussion, especially by relating to the counsellor’s own experiences.
For these stages to go well, the following core conditions need to be considered. These are some major factors that help in achieving the goal.
1. Empathetic Understanding – This is probably the most important skill required for counselling a kid/adolescent. Most teenagers refuse to open up to older people because they are convinced that they wouldn’t be understood. So unless the counsellor can prove to them that they are in the same boat and that he/she can really relate to their problems, there can be no progress. Empathetic Understanding has got a lot to do with being responsive rather than reactive. This means the counsellor is able to listen patiently, and mirror the perceptions of the teenager by voicing them out loud.
2. Respect – As far as kids and adolescents are concerned, they generally feel left out or have an inferiority complex. Teenagers especially, have many insecurities and suppressed emotions. It is important for the counsellor to tell the adolescent that he/she is normal, if not extraordinary. This can happen only by showing respect for his/her opinions, without being judgmental at any point.
3. Genuineness – Whatever the counsellor has to say must actually get to the kid/adolescent and make him/her feel safe. This is possible only if the kid is convinced that the counsellor is genuine.
With these points in mind, a therapist needs to get appropriate training to be a successful counsellor (Thompson and Brown 2007).
1. Plan of first session
a. To make the teen feel comfortable with my presence, the setting, and the idea of therapy.
b. To strongly establish that I’m merely a catalyst in the whole process and that progress is in the hands of the teen.
It is important to make him feel relaxed and safe. Different genres of music, chocolate, a range of magazines, a squeeze ball, a colour cube, and some money are required for the first session. These are made available in the room such that they are easily accessible.
2. Some dialogue questions I would use:
a. I want to talk to you about something that I think is important in any relationship – trust. It is not easy to come by, and if it is, it may not last. Trust requires constant effort and can only be built over time. I just want you to know that I consider trust very sacred and will do everything I can to earn and maintain yours. Now, can you tell me the difference between trust and confidentiality?
b. I’m bound by two contradicting ethics – one to tell your parents about our sessions, and two to keep your trust. I’m not willing to compromise on either, since these are values I stand by. So I’m going to choose a middle path. I will tell you exactly what I intend to inform your parents. I shall not go ahead with it, unless you give me consent. I shall keep my end of the bargain, I give you my word. Do you think this is fair enough? If not, I would like to hear out your suggestions or honest opinion on this issue.
c. I know that this is probably the last place you want to be in, right now. But I want to appeal to your rationality directly. Right now, you have to be here; it leaves you with 3 choices that I can think of. One, you can show your frustration of having to be here, by totally non-cooperation, or even doing something to make sure you don’t have to come here again. In fact I wouldn’t be surprised if you want to take revenge on your parents and me for putting you through this. Two, you don’t want to get into trouble, but you really think this is pointless. So you have already set your mind to just kill time here by being superficial and disinterested while playing games in your head. Or three, you could actually give this a shot. After all, you have nothing to lose. It is difficult to keep trying to kill time and rebel; it is much easier to relax and have fun with what I have to offer. You don’t have to believe that this will help you; you just need to have the attitude to try. The choice is yours. But I have one question to help you make it. How do you feel when people judge you unfairly, even before trying to get to know you?
d. Have you heard of the saying “You can only take the horse to the pond”? What do you think about it? Is it possible for a person to truly make another do something?
e. I’m very envious of your generation. You are all tech-savvy and have information at the tip of your hands. Sometimes I wish I was a part of the younger crowd; to have so many opportunities, and the freedom to grow is very tempting. I hear some of these common phrases you people use and it makes me go nuts. I might as well make use of this opportunity to find out. So, tell me what this is all about – the ‘cool dude’ and ‘yo man’ stuff.
f. Do you ever just sit alone and contemplate on the meaning of life, or who you are?
3. The Course of Action:
a. In order to understand the current mindset of the teen, the session starts off with a casual chat involving small talk. It is important to understand his interests, routine, circle of friends, etc. The discussion will include the dialogues explained in the previous sub-section.
b. In order to observe the teen better, I explain that I have to take care of something urgent and excuse myself for 15-20 minutes. I tell him that In the meantime that he can help himself to music, magazines, and/or anything else in the room. While I’m away, I observe him through the one-way glass door.
c. I come back, apologizing for the delay, before ending the session on a comfortable level.
4. Rationale behind the session outline:
a. Since this is the first session, it is important to keep it at a comfortable level and not make it too personal. It is also essential to not directly ask any questions that may close him from responding further. So the aim is to just keep him neutral, and feel at home. This is essential for making the person open up and to gradually build trust.
b. The dialogues and questions have been designed to gradually accustom the teenager to the idea of therapy. It is important that he does not feel abnormal or ashamed of meeting a counsellor. It is also vital that he considers that I’m not here to judge or advice, but to just help him understand himself and his problems better. Finally, he should get the feeling that the forthcoming sessions would be as interesting and enjoyable and must look forward to them.
c. The idea of using media tools mentioned above is to get to know him better. Whatever he tells me may or may not be true initially, but when left alone he is sure to be more himself than with me around. His choice for passing time will help figure out his tendencies. For example choice of music and magazines can speak volumes about his interests and mood. The squeeze ball and colour cube are just curious items that any average person will want to examine. What they do with it upon examination can also lead to important answers. Next, what he does with the chocolate and money are indicators of lurking tendencies. Finally, there is a possibility that he chooses to do nothing, which makes him harder to figure out.
Man has combated with himself and his environment from time immemorial and has emerged as the most developed social animal. He/she faces several challenges to live as per the norms of the society right from his/her childhood with respect to challenges at home, in the neighbourhood, with friends, at school etc. The magnitudes of these challenges have a direct impact on the physical, physiological, psychological, cognitive and social development of the child/adolescent. This affects his/her explicit behaviour in the society. It is therefore very critical to address the issues faced by children/adolescents to mould them into healthy individuals. Accordingly, it is advisable to take the help of professional experts who would help the child/adolescent to overcome these issues by the help of psychotherapy.
What is Psychotherapy?
Psychotherapy refers to the interaction between a person /a couple/ a group of people with a trained mental health professional to address certain mental problems and finding solutions for one’s own well being. It aims at exploring the thoughts, feelings and behaviour of a person and altering them accordingly to achieve an increased sense of well being in the person. Psychotherapy usually includes a better understanding of oneself through self observation and analysis to achieve changes in cognition, insight and behaviour.
Difference between Psychotherapy in Adults and Children/Adolescents
The counselling and psychotherapy of a child and adolescent is completely different from that of an adult. The mental and physical development of children and adults, and their environmental conditions have to be considered before the practice of psychotherapy. It is thus very essential to develop a therapeutic relationship between the counsellor and the child/ adolescent to effectively address the issues.
Therapeutic Relationship in Child and Adolescent Counselling
The therapist who is specialized in child/ adolescent counselling must be adept with the stages of human development in all aspects and should be capable of making a clear distinction between the normal behaviour and extremely deviant behaviour. Certain aspects of behaviour that are considered to be pathological in adults might be normal in a child/adolescent. Thus, it is essential to carefully observe the development stage of the child/adolescent and then counsel accordingly. The therapist should also be capable of setting goals and monitoring progress during the session to check whether the desired target is achieved. The counsellor must consider the mental capacity of the child/ adolescent before suggesting suitable psychotherapeutic measures.
It is hence very crucial for the therapist to develop a good relationship with the child/adolescent and this would indeed speed up the entire process and can fetch better results. The psychotherapeutic relationship can bring about significant and consistent changes in the child/adolescent in all aspects including behavioural, cognitive, humanistic etc. The rate of progress of the child/adolescent is directly proportional to the relationship of the client with the therapist. It also offers a better insight with regard to the strategies and techniques employed for the treatment and this helps to adopt certain custom made techniques to improve the efficiency of the treatment. The therapist should have a positive attitude towards the child/ adolescent and should be empathetic. This strengthens their relationship and can hasten the progress of the child/adolescent.
Ethical Codes and Legislation with Respect to Psychotherapy in Children and Adolescents
There is a wide difference between the psychotherapy of adults and that of children and adolescents. Child and adolescent psychotherapists come across several ethical codes that have to be considered during the therapy. There are several factors that increase the complexity of the practice of therapy in child and adolescent psychiatry. This has lead to the formation of several codes governing their practice. According to the American Academy of Child and Adolescent Psychiatry, 10 principles have been published as the code of ethics that have to be followed by all mental health care professionals in child and adolescent psychiatry.
PRINCIPLE 1: Developmental Perspective emphasizes the importance of the development of the child/ adolescent with regard to his/her physical, physiological, mental, emotional and social aspects which influence the explicit behaviour. It also states that the chronological age and mental development need not go hand in hand. Thus the therapists should consider the underlying developmental factors before the start of the therapy and should incorporate only those therapies that are conducive to the development of the child/ adolescent in all aspects.
PRINCIPLE 2: Beneficiary aspects of the child/adolescent consider the factors that are best suited and nurture the progress and well being of the children/ adolescents individually and as a part of a group. External pressures from the society and family should not hamper the progress of the child/adolescent.
PRINCIPLE 3: The therapists should avoid any practice that would affect the desired progress of the child/adolescent and should ensure that the therapeutic relationship is not harmful in any way to the well being of the client.
PRINCIPLE 4: Regarding and respecting the decisions of the child/adolescent help in the development of trust in the relationship. Care must be taken to see that the therapy for a client below the age of 18 should have the consent of the guardian.
PRINCIPLE 5: Fidelity to the client and the guardian is a very critical code of ethic and care must be taken to see that the confidentiality is not disclosed without the permission of the guardian except in times of emergency.
PRINCIPLE 6: The influence of external factors/ people should be monitored by the therapist and he / she should ensure that these interventions do the affect the progress of the client and should support only the well being of the client.
PRINCIPLE 7: Advancement in knowledge and practice is facilitated by additional research. But this research should not hamper or compromise with the welfare of the client.
PRINCIPLE 8: Equality and justice must be followed to ensure that the mental health care facilities are available to all the children / adolescents at times of need and it should not be confined only to a few.
PRINCIPLE 9: The professional laurels and achievements of the therapist should not affect the progress and well being of the child / adolescent.
PRINCIPLE 10: The therapists must be aware of the local and federal laws governing the practice of psychotherapy and should ensure that conflicting laws do not compromise with the well being of the child / adolescent.
Therapeutic relationship between the therapist and the child / adolescent is a key that opens the door for the success and welfare of the client. The laws and codes governing this relationship and facilities for the therapy must be extended to even those children / adolescents who might not be able to afford the therapy. Thus, the therapist must play a pivotal role in nurturing the child/adolescent in aspects that not only cater to the mental stability but also physical, behavioural and social forms in such a way that it would make him/her a desirable individual having an optimistic outlook towards life (Thompson and Henderson 1992).
The core conditions to be kept in mind while counselling children and adolescents are empathetic understanding, building mutual respect, and being genuine. However, these cannot be achieved by sitting in a room for specified hours every week. After a point, the kid will begin to think that everything is an act, since the counsellor doesn’t seem to care about him/her outside of any particular session. So, the third condition of being genuine involves being there for the kid at all times. This doesn’t mean calling him/her up every day, or nagging the child all through the week, but finding a system appropriate for the kid, so that you are aware of what happens in his/her life, especially of important events.
In many cases, the one-to-one approach to find a particular system for an individual may not be effective. This is because of a lack of understanding from the counsellor’s side, of the cultural sensitivities that the individual is a part of. Hence a comprehensive analysis of the person as a unique individual with a particular background and history is required to empathize with him/her (Roth et.al. 1996). The following are the core components associated with a therapeutic environment while counselling a child or adolescent:
a. Building psychological contact – We talk of physical, emotional and even spiritual contact, but psychological contact seems more abstract and unusual. It means that the counsellor has succeeded in establishing contact with the person’s deepest thoughts, natural tendencies and urges, and with his/her sub-conscious. Establishing this kind of connection is by no means easy; it depends on the quality of the relationship and the abilities of the counsellor in taking it forward.
b. The incongruence in the child/adolescent that makes him vulnerable or anxious – It is very important to identify this in the individual, since it is the triggering factor for wanting change. Most people under the age of 20 are not mature enough to accept that they need professional help; they seek counselling only because they have been forced to. So inevitably almost all of them come prepared to remain closed and end the session as soon as possible. The main point perhaps, which can change this attitude, is when the counsellor hits the nail and addresses their fears exactly as they feel them (Penny and Durlak 1998).
c. Unconditional positive regard – The therapeutic environment must make the individual feel safe and at ease. To achieve this, the counsellor must be willing to appreciate the individual’s ideas, no matter what they are, and always instil some positivity in every action of the individual.
d. Environment that fits the child’s internal frame of reference – This is a gradually changing factor, that evolved with the relationship between the individual and the counsellor. As the latter begins to understand and relate to the former, better, changes in the environment to accommodate these changes will be effective. However, these changes cannot be abrupt; they need to complement the therapy gradually and subtly.
e. The child/adolescent’s acceptance of therapy – This means observing the feedback or response of the individual, to therapy. Most adolescents are doubtful of the counsellor’s intentions for a very long time. Though they may have opened up, and feel comfortable, there is generally a red-alert at the back of their minds, waiting to surface should anything go wrong even in the least. Should that happen, there is a good chance that the entire relationship will crash beyond repair. So, the psychological contact must be strong enough for the counsellor to access and observe the individual’s response to therapy (Weisz, Alan 2010).
Being a therapist means taking responsibility and being accountable for a patient’s conditions. Though this is more on ethical grounds, certain administrative responsibilities that are bound by the law cannot be escaped. For example, therapist-client confidentiality is a must in almost every part of the world. However, in case of minors, this rule does not always apply. The parents have the right to know about the events during the private sessions; the counsellors are expected to give them transparent feedback. In many countries, parents can sue the therapist for not disclosing vital information regarding their children, which is not possible while treating adults.
In case of substance abuse which is common in adolescents, the counsellor has the right to not report it, owing to client confidentiality. In other words, the law gives the therapist the card to not go against the client under any circumstances, including cases of criminal accusations. Though these do not apply to all scenarios, they are commonly referred to in case of children and adolescents.
Proper treatment of minors according to the law is mandatory. In case of children below the age of 10, extra clauses to protect the child are ensured. For example, there have been cases reported, where therapists themselves have abused children. To keep a check on such practices, transparency clauses can be evoked. Administrative responsibilities of the counsellor include keeping a track of all sessions without skipping anything. These days, electronic recording is used as transcripts, which make things easier for therapists. From the start till the end of the session, recording is mandatory. Further, since digital evidence is easy to copy or manipulate, it is the therapist’s responsibility to keep it safe. Finally, the license and qualifications of the therapist can be checked by any parent to verify authenticity (Thompson and Brown 2007).
The most effective therapeutic tool so far, used very commonly in children of ages 3 through 11, is play therapy. For adolescents, group activities and media-based activities have proven very effective. Below is a brief outline of these tools.
Play therapy is beneficial in two ways: it helps in diagnosis, as well as in treatment. It is modelled so that the counsellor can make observations based on how the child uses the toys/activities provided. This observation usually leads to a diagnosis of what is disturbing the child. Once that is identified, half the well is crossed. The same play activities can be used to treat the child in overcoming his/her problems. Play therapy is generally modelled in 2 ways:
a. Nondirective play therapy: This is a flexible model which is based on an individual’s requirement. Though it has some boundaries, it is generally non-intrusive. In the sense, it simply acts as a catalyst in aiding the individual to make his or own decisions in facing their problems. Most activities under non-directive play therapy are unstructured and depend on how the individual chooses to take it forward. For example, allowing the individual to play with a huge pile of sand, without imposing any restrictions is a common activity used (sand-play therapy). Finally, this approach can also be used in adolescents by using appropriate activities.
b. Directive play therapy: This is a more structured model that believes that guiding the child through any play or activity can help in achieving better results. For example, cognitive behavioural play therapy is commonly used in children of ages two through six. Also, the same example of sand-play therapy can be made directive by incorporating talk therapy in the activity.
Group activities that involve interaction are used in therapy for adolescents. This are again mostly non-directive, since it is considered better to let adolescents make their own choices and observe them when they are not restricted. For example, a group of young adults may be put in a room, without any further instructions. What they do, how they interact, how they respond to the group, etc. are observed. Though this is useful in diagnosis, a more directive approach is preferred for treatment. Examples of directive approach to make the individuals think includes letting them play Spin-the-yarn and finding out something positive about the others in the group (Sheila, Nelson and Boggs 2008).
Media is a very important tool used in therapy. For instance, children of the age 3 through 10 are most expressive when given a paper and some colour pens. This is a non-directive approach that lets the children draw or write whatever they want on the paper. Almost every child is open to this activity, unlike in activities that may involve interaction with other children. Another tool that can be used for therapy is music. Though this isn’t as established as other methods mentioned above, it is gaining popularity. Many scientific research studies show that music can be very helpful, in both diagnosis and treatment of psychological problems. For example, certain scales have been proven to induce specific moods in most people. Other tools may involve parents or teachers to carry out specific activities at home and in school, which are directive approaches. Reinforcement of activities over a period of time has been shown to be effective in therapy (Weisz et.al. 1995).
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