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Review: An Integrative Perspective on Psychotherapy with Children and Adolescents with ASD
Corresponding Author(s) : Wioletta Karina Ozga
Humanities & Social Sciences Reviews,
Vol. 10 No. 4 (2022): July
Abstract
Purpose of the study: The review aims to present methods and techniques of psychotherapy for children with ASD in various approaches and extend understanding of autistic patients' difficulties in the context of psychotherapeutic interventions.
Methodology: Six different methods, approaches and technics were presented in the article: Multimodal Anxiety and Social Skills Intervention; Narrative family therapy incorporating the externalization technique; Embodied mentalization-based psychodynamic psychotherapy; Psychoanalytic family psychotherapy; Simultaneous psychotherapy with child and family based on Erica method; Psychodynamic-oriented psychotherapy of adolescents based on dream sharing and interpretation. Selection of best interventions based on technical eclecticism and theoretical integration was proposed as the most appropriate for the clients with ASD
Main findings: Various models of psychotherapy for Children and Adolescents with ASD were developed with a specific therapeutic approach. Relatively few of these treatments are widely used in everyday therapeutic practice. The benefit level for patients with ASD and their families depends on appropriate selection approaches, methods, technics, and their integration. To develop a personalized integrative approach to each case, the therapists need to be fluent in more than one therapy approach, and have know of a wide range of theories and skills.
Application of the study: The personalized intervention depending on the child's needs, especially the type and severity of difficulties, the stage of development, and the family's readiness for psychotherapy was recommended. Furthermore, the selection of methods, technics and their integration were based on described interventions.
Original/Novelty of the study: The practical example of developing a psychotherapeutic integrative approach to children and adolescents with ASD was presented in this article.
Keywords
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- Balamuth, R. (2007). An introduction to Stanley Greenspan’s clinical thinking: Autism as an intention deficit disorder. Journal of Infant, Child and Adolescent Psychotherapy, 6(3), 163–173. https://doi.org/10.1080 /15289160701657852 DOI: https://doi.org/10.1080/15289160701657852
- Bion, W. R. (1967b). Notes on memory and desire. Psychoanalytic Forum, 2, 271–280.
- Castonguay, L. G., Eubanks, C. F., Goldfried, M. R., Muran, J. C., & Lutz, W. (2015). Research on psychotherapy integration: Building on the past, looking to the future. Psychotherapy Research, 25, 365–382. http://dx.doi.org/10.1080/10503307.2015.1014010 DOI: https://doi.org/10.1080/10503307.2015.1014010
- Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.
- Gaus, V. L. (2011). Adult Asperger syndrome and the utility of cognitive-behavioural therapy. Journal of Contemporary Psychotherapy, 41(1), 47–56. https://doi.org/10.1007/s10879-010-9159-8 DOI: https://doi.org/10.1007/s10879-010-9159-8
- Goldman, R. E., Hilsenroth, M. J., Gold, J. R., Owen, J. J., & Levy, S. R. (2018). Psychotherapy integration and alliance: An examination across treatment outcomes. Journal of Psychotherapy Integration, 28(1), 14–30. https://doi.org/10.1037/int0000060 DOI: https://doi.org/10.1037/int0000060
- Hoffman, L. & Rice, T. (2012). Psychodynamic Considerations in the Treatment of a Young Person with Autistic Spectrum Disorder: A Case Report. Journal of Infant, Child & Adolescent Psychotherapy, 11, 67-85. https://doi.org/10.1080/15289168.2012.673403 DOI: https://doi.org/10.1080/15289168.2012.673403
- Johnson, J. (2012). Using Externalization as a Means to Regulate Emotion in Children With Autism Spectrum Disorders. Journal of Family Psychotherapy, 23(2), 163–168. https://doi.org/10.1080/08975353.2012.679906 DOI: https://doi.org/10.1080/08975353.2012.679906
- Kestenberg Amighi, J., Loman, S., Lewis, P., & Sossin, K. M. (1999). The meaning of movement: Developmental and clinical perspectives of the Kestenberg Movement Profile (p. 369). New York, NY: Routledge.
- Mahler, M. (1967). On human symbiosis and the vicissitudes of individuation. Journal of the American Psychoanalytic Association, 15, 740–763. https://doi.org/10.1177/000306516701500401 DOI: https://doi.org/10.1177/000306516701500401
- Mazefsky, C. A., & White, S. W. (2014). Emotion regulation: Concepts & practice in autism spectrum disorder. Child and Adolescent Psychiatry. Clinics of North America, 23(1), 15–24. https://doi.org/10.1016/j .chc.2013.07.002 DOI: https://doi.org/10.1016/j.chc.2013.07.002
- Nilsson, M. (2019). Simultaneous psychotherapy with an autistic boy and his parents. Journal of Child Psychotherapy, 45(3), 340–355. https://doi.org/10.1080/0075417X.2019.1693611 DOI: https://doi.org/10.1080/0075417X.2019.1693611
- Rhode, M. (2015). ‘Paralysed associations’: countertransference difficulties in recognising meaning in the treatment of children on the autistic spectrum. Journal of Child Psychotherapy, 41(3), 218–230. http://dx.doi.org/10.1080/0075417X.2015.1090693 DOI: https://doi.org/10.1080/0075417X.2015.1090693
- Rodgers, J., Hodgson, A., Shields, K., Wright, C., Honey, E., & Freeston, M. (2016). Towards a treatment for intolerance of uncertainty in young people with autism spectrum disorder: Development of the coping with uncertainty in everyday situations (CUES(c)) programme. Journal of Autism and Developmental Disorders. 47(12), 3959–3966. https://doi.org/10.1007/s10803-016-2924-0 DOI: https://doi.org/10.1007/s10803-016-2924-0
- Rustin, M. E. (1989). Encountering primitive anxieties. In L. Miller, M. E. Rustin, M. J. Rustin & J. Shuttleworth (Eds.), Closely observed infants (pp. 7–21). London: Duckworth.
- Sapountzis, I., & Bennett L. (2014). Sharing Alien States and Experiences through Dreams: Working with Adolescents on the Autism Spectrum. Journal of Infant, Child, and Adolescent Psychotherapy, 13,154–163. https://doi.org/10.1080/15289168.2014.905345 DOI: https://doi.org/10.1080/15289168.2014.905345
- Shapiro, T. (2009). Psychotherapy for Autism. Journal of Infant, Child, and Adolescent Psychotherapy, 8(1), 22–31. https://doi.org/10.1080/15289160802683070 DOI: https://doi.org/10.1080/15289160802683070
- Singletary, W. M. (2015). An integrative model of autism spectrum disorder: ASD as a neurobiological disorder of experienced environmental deprivation, early life stress and allostatic overload, Neuropsychoanalysis, 17(2), 81-119. https://doi.org/10.1080/15294145.2015.1092334 DOI: https://doi.org/10.1080/15294145.2015.1092334
- Sossin, K. M. (2015). A movement-informed mentalization lens applied to psychodynamic psychotherapy of children and adolescents with high functioning autism spectrum disorder. Journal of Infant, Child & Adolescent Psychotherapy, 14(3), 294–310. https://doi.org/10.1080/15289168.2015.1066630 DOI: https://doi.org/10.1080/15289168.2015.1066630
- Tustin, F. (1990). The protective shell in children and adults. London, England: H. Karnac Books.
- Tselika, M., & Anagnostaki, L. (2019). Finding meaning, making links, creating space: an early intervention with children on the autistic spectrum and their families. Journal of Child Psychotherapy, 45(3), 356–370. https://doi.org/10.1080/0075417x.2019.1689407 DOI: https://doi.org/10.1080/0075417X.2019.1689407
- Weinberg, R. (2016). The impossible reparation. Journal of Child Psychotherapy, 42, 152–162. https://doi.org/10.1080/0075417X.2016.1191203 DOI: https://doi.org/10.1080/0075417X.2016.1191203
- White, S. W., Ollendick, T., Albano, A. M., Oswald, D., Johnson, C., Southam-Gerow, M. A., Kim, I. & Scahill, L. (2012). Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 43(2), 382–394. https://doi.org/10.1007/s10803-012-1577-x DOI: https://doi.org/10.1007/s10803-012-1577-x
- White, S.W., Albano, A., Johnson, C., Kasari, C., Ollendick, T., Klin, A., Oswald, D. & Scahill L. (2010a). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review, 13(1), 77–90. https://doi.org/10.1007/s10567-009-0062-3 DOI: https://doi.org/10.1007/s10567-009-0062-3
- Weiss, J. A. (2014). Transdiagnostic case conceptualisation of emotional problems in youth with ASD: An emotion regulation approach. Clinical Psychology: Science and Practice, 21, 331–350. https://doi.org/10.1111/cpsp.12084 DOI: https://doi.org/10.1111/cpsp.12084
- Winnicott, D. W. (1963). The maturational processes and the facilitating environment. Madison CT: International Universities Press.
References
Balamuth, R. (2007). An introduction to Stanley Greenspan’s clinical thinking: Autism as an intention deficit disorder. Journal of Infant, Child and Adolescent Psychotherapy, 6(3), 163–173. https://doi.org/10.1080 /15289160701657852 DOI: https://doi.org/10.1080/15289160701657852
Bion, W. R. (1967b). Notes on memory and desire. Psychoanalytic Forum, 2, 271–280.
Castonguay, L. G., Eubanks, C. F., Goldfried, M. R., Muran, J. C., & Lutz, W. (2015). Research on psychotherapy integration: Building on the past, looking to the future. Psychotherapy Research, 25, 365–382. http://dx.doi.org/10.1080/10503307.2015.1014010 DOI: https://doi.org/10.1080/10503307.2015.1014010
Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.
Gaus, V. L. (2011). Adult Asperger syndrome and the utility of cognitive-behavioural therapy. Journal of Contemporary Psychotherapy, 41(1), 47–56. https://doi.org/10.1007/s10879-010-9159-8 DOI: https://doi.org/10.1007/s10879-010-9159-8
Goldman, R. E., Hilsenroth, M. J., Gold, J. R., Owen, J. J., & Levy, S. R. (2018). Psychotherapy integration and alliance: An examination across treatment outcomes. Journal of Psychotherapy Integration, 28(1), 14–30. https://doi.org/10.1037/int0000060 DOI: https://doi.org/10.1037/int0000060
Hoffman, L. & Rice, T. (2012). Psychodynamic Considerations in the Treatment of a Young Person with Autistic Spectrum Disorder: A Case Report. Journal of Infant, Child & Adolescent Psychotherapy, 11, 67-85. https://doi.org/10.1080/15289168.2012.673403 DOI: https://doi.org/10.1080/15289168.2012.673403
Johnson, J. (2012). Using Externalization as a Means to Regulate Emotion in Children With Autism Spectrum Disorders. Journal of Family Psychotherapy, 23(2), 163–168. https://doi.org/10.1080/08975353.2012.679906 DOI: https://doi.org/10.1080/08975353.2012.679906
Kestenberg Amighi, J., Loman, S., Lewis, P., & Sossin, K. M. (1999). The meaning of movement: Developmental and clinical perspectives of the Kestenberg Movement Profile (p. 369). New York, NY: Routledge.
Mahler, M. (1967). On human symbiosis and the vicissitudes of individuation. Journal of the American Psychoanalytic Association, 15, 740–763. https://doi.org/10.1177/000306516701500401 DOI: https://doi.org/10.1177/000306516701500401
Mazefsky, C. A., & White, S. W. (2014). Emotion regulation: Concepts & practice in autism spectrum disorder. Child and Adolescent Psychiatry. Clinics of North America, 23(1), 15–24. https://doi.org/10.1016/j .chc.2013.07.002 DOI: https://doi.org/10.1016/j.chc.2013.07.002
Nilsson, M. (2019). Simultaneous psychotherapy with an autistic boy and his parents. Journal of Child Psychotherapy, 45(3), 340–355. https://doi.org/10.1080/0075417X.2019.1693611 DOI: https://doi.org/10.1080/0075417X.2019.1693611
Rhode, M. (2015). ‘Paralysed associations’: countertransference difficulties in recognising meaning in the treatment of children on the autistic spectrum. Journal of Child Psychotherapy, 41(3), 218–230. http://dx.doi.org/10.1080/0075417X.2015.1090693 DOI: https://doi.org/10.1080/0075417X.2015.1090693
Rodgers, J., Hodgson, A., Shields, K., Wright, C., Honey, E., & Freeston, M. (2016). Towards a treatment for intolerance of uncertainty in young people with autism spectrum disorder: Development of the coping with uncertainty in everyday situations (CUES(c)) programme. Journal of Autism and Developmental Disorders. 47(12), 3959–3966. https://doi.org/10.1007/s10803-016-2924-0 DOI: https://doi.org/10.1007/s10803-016-2924-0
Rustin, M. E. (1989). Encountering primitive anxieties. In L. Miller, M. E. Rustin, M. J. Rustin & J. Shuttleworth (Eds.), Closely observed infants (pp. 7–21). London: Duckworth.
Sapountzis, I., & Bennett L. (2014). Sharing Alien States and Experiences through Dreams: Working with Adolescents on the Autism Spectrum. Journal of Infant, Child, and Adolescent Psychotherapy, 13,154–163. https://doi.org/10.1080/15289168.2014.905345 DOI: https://doi.org/10.1080/15289168.2014.905345
Shapiro, T. (2009). Psychotherapy for Autism. Journal of Infant, Child, and Adolescent Psychotherapy, 8(1), 22–31. https://doi.org/10.1080/15289160802683070 DOI: https://doi.org/10.1080/15289160802683070
Singletary, W. M. (2015). An integrative model of autism spectrum disorder: ASD as a neurobiological disorder of experienced environmental deprivation, early life stress and allostatic overload, Neuropsychoanalysis, 17(2), 81-119. https://doi.org/10.1080/15294145.2015.1092334 DOI: https://doi.org/10.1080/15294145.2015.1092334
Sossin, K. M. (2015). A movement-informed mentalization lens applied to psychodynamic psychotherapy of children and adolescents with high functioning autism spectrum disorder. Journal of Infant, Child & Adolescent Psychotherapy, 14(3), 294–310. https://doi.org/10.1080/15289168.2015.1066630 DOI: https://doi.org/10.1080/15289168.2015.1066630
Tustin, F. (1990). The protective shell in children and adults. London, England: H. Karnac Books.
Tselika, M., & Anagnostaki, L. (2019). Finding meaning, making links, creating space: an early intervention with children on the autistic spectrum and their families. Journal of Child Psychotherapy, 45(3), 356–370. https://doi.org/10.1080/0075417x.2019.1689407 DOI: https://doi.org/10.1080/0075417X.2019.1689407
Weinberg, R. (2016). The impossible reparation. Journal of Child Psychotherapy, 42, 152–162. https://doi.org/10.1080/0075417X.2016.1191203 DOI: https://doi.org/10.1080/0075417X.2016.1191203
White, S. W., Ollendick, T., Albano, A. M., Oswald, D., Johnson, C., Southam-Gerow, M. A., Kim, I. & Scahill, L. (2012). Randomized Controlled Trial: Multimodal Anxiety and Social Skill Intervention for Adolescents with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 43(2), 382–394. https://doi.org/10.1007/s10803-012-1577-x DOI: https://doi.org/10.1007/s10803-012-1577-x
White, S.W., Albano, A., Johnson, C., Kasari, C., Ollendick, T., Klin, A., Oswald, D. & Scahill L. (2010a). Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review, 13(1), 77–90. https://doi.org/10.1007/s10567-009-0062-3 DOI: https://doi.org/10.1007/s10567-009-0062-3
Weiss, J. A. (2014). Transdiagnostic case conceptualisation of emotional problems in youth with ASD: An emotion regulation approach. Clinical Psychology: Science and Practice, 21, 331–350. https://doi.org/10.1111/cpsp.12084 DOI: https://doi.org/10.1111/cpsp.12084
Winnicott, D. W. (1963). The maturational processes and the facilitating environment. Madison CT: International Universities Press.