Chapter 19

Counseling Children with

Special Concerns
I have found the paradox that if I love until it
hurts, then there is no hurt, but only more
love.
Mother Teresa
2011 Brooks/Cole, A

Chapter Objectives
After reading this chapter, you should be able to:

Define child maltreatment, its causes, and protective factors

Explain interventions for child maltreatment
Discuss the difficulties of children of substance-abusing
parents
Outline treatment for children and parents in alcoholic
families
Explain childrens reactions to death and interventions for
their grief
Talk about depression and suicide and responses
Describe concerns of children in families and treatment
options
Discuss children with violent tendencies and ways to work
with them

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Special Concerns
First Items
A child may be in counseling a while before you
learn of these items
All of them are under reported
Duty to report
o

For abuse you only have to believe it was

possible

Its not for you to decide

Call Child Protective Services or equivalent

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Categories
Child Maltreatment
Substance Abuse in the Family
Death and bereavement
Depression and suicide
Divorce and separation
Children and violence

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Child Maltreatment
Physical abuse
o Beating, striking with an object, burning, biting
Physical neglect
o Failure to provide basic needs: food, medical,
protection
Sexual abuse
o Using a child for sexual gratification: range from
watching a child undress to rape
Psychological abuse
o Chronic denigration of child, isolation, terrorizing,
excessive demands, parental violence and drug use
Emotional neglect
o Failure to provide affection; failure to thrive
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Physical, Psychological
Abuse
Physical
o Long term effects not well understood
o 25% have serious MH issues: anxiety,
depression
o Overwhelming school problems, academic
failure
Psychological
o Destructive effects have been documented
Multiple behavioral and MH problems
o Enlist the school in responding to the problem
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Child Sexual Abuse

General counseling strategies
Counselor must prepare for total
involvement
Expect repeated testing of their caring
Relaxation and visualization may help self
attitude
Encourage good physical appearance and
self confident body language
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Child Sexual Abuse

Children are often guilt ridden
o
o
o
o
o
o

It is their fault that it happened (the abuser may tell

them this)
They feel they should have prevented it
Someone is in jail because they told
They may have had to tell the story too many times
Talking about the event may be its own trauma
Being removed from the home is traumatic

Needs
o
o
o

Education on what is appropriate

Reassurance
Balance protective measures with trust in the world
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Child Sexual Abuse

Childs memory of abuse

Childrens memories are susceptible to manipulation

You are not trained to interrogate for sexual abuse but
you must report suspicions
Do not jump to conclusions
Do not ask leading questions (child will try to come up
with correct answer.
Get external corroboration
Pay attention to body language
Let the child tell her story
Be empathic but neutral (do not get upset)
Use clarification and summary skills
Use child's language

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Children in Chemically
Dependent Families
8.3 million children in Americans live in an alcoholic
family
Often left out of the parents treatment
Compared with other children have significant risks
for mental illness, physical health difficulties and
learning problems
Both physical and psychological needs have not
been met
Childs environment has been unpredictable
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Children in Chemically
Dependent Families
Rules the child has had to live by

Dont talk about the problem

Dont trust anyone
Dont feel
Dont behave differently
Dont blame chemical dependency (its someone elses
fault)
Do what I want (not what you need)
Do be better and more responsible (Parentified child)
Dont have fun
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Children in Chemically
Dependent Families
Interventions:
Each family is unique
o How much protection did nondrinking parent
provide
o What familial supports are there
o How much did the child have to enable
Children need to learn to love their parents without
loving the behavior
Time and patience required to overcome their
learned behaviors
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Children in Chemically
Dependent Families
Treatment Goals:
Give emotional support to the children
Provide accurate, nonjudgmental information
about chemical dependency.
Correct childs misperceptions about being the
cause of the problem.
Help children focus on their own behavior.
Help children learn to cope with possible
situations.
Reduce childrens isolation.
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Death and Bereavement

How a child reacts is a function of
o Developmental level
o How parents deal with life normally
o How family deals with a specific death
Death is normal and bereavement should not be an
issue
But in our culture death is a taboo subject
Children believe they are immortal
Only old people die
May feel responsible for the death
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Death and Bereavement

Children need to hear:
someone will take care of them
the death is not their fault
their feelings may be different from those
around them
they can have as much time as they need to
figure things out
they do not need to rush or pretend to feel
differently
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Death and Bereavement

Themes
I am stunned by the loss of this
person.
The person is not dead.
I must find the deceased.
I am sad, hopeless, and lonely
because I have lost someone on
whom I depended.
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Death and Bereavement

Themes
I am angry because the person I
needed has abandoned me.
I am frightened that the deceased will
punish me for causing their death or
being angry at them. I am afraid that I
too may die of an illness or fatal
accident.
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Death and Bereavement

Themes
It is my fault that the person died so I
should die.
I loved and lost the person who died
and now I must carry on without them
while cherishing their memory.

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Death and Bereavement

Four tasks for children
Accepting the reality of the loss
Experiencing the pain of the loss
Adjusting to a new environment
Relocating the person while finding a way
to memorialize her

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Death and Bereavement

Three immediate needs of children
Having their emotions validated
Being given accurate information
Reassurance about the future

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Death and Bereavement

Counseling strategies
Listen carefully and respond clearly
Allow children to express their grief
Help with understanding talk about a plant or
animal dying
Work with family's clergy
Always a question on whether they should attend
the funeral depends but probably
Work to reduce stress
Beware of possible regression
Watch for triggers of grief
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Depression and Suicide

Signs of depression
o
o
o
o
o
o

Persistent sadness
Hopelessness
Loss of interest
Change in eating/sleeping habits
Truancy, sudden drop in grades
Thoughts of death and suicide

All the normal risk factors plus

o
o

Learning disabilities
Giftedness

Single best predictor is persistent suicidal ideation

(and access to a gun)
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Depression and Suicide

Strategies

Tell parents to find a psychiatrist

Consult an expert
Do not ignore threats or insinuations
Listen in detail
Give them permission to call any time
Confront the child
Allow the child to talk about recent problems
Ask about their plan: a well thought out plan is serious
Use projective techniques: stories, pictures
Watch for a long time after initial threat
A sudden recovery may be a danger signal
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Depression and Suicide

Question checklist

Have you had a problem with feeling sad, trouble

sleeping, not eating?
Has anything happened recently that particularly upset
you?
Did you ever feel so upset you wished you were dead?
Did you ever do something so dangerous you knew you
could get killed?
Did you ever tell anyone you wanted to die?
What would it be like if you died?
How did it feel when you thought about killing yourself?
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Interventions for Suicide

Trust your suspicions.
Never ignore threat, hints or comments.
Tell the young person you are worried.
Ask direct, specific questions.
If they admit thoughts, ask about their plan.
Do not debate.
Do not promise to keep secret.
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Interventions for Suicide

Do not leave child alone.
Remain actively involved with the youngster.
Confirm with parents
Use available resources.
Assure child something is being done
Enhance self-esteem.
Listen carefully and non-judgmentally.
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Interventions for Suicide

Allow them to have phone numbers for
people to call if they are in distress.
Talk with parents.
Talk with children about their lives.
Ask them about their fantasies and dreams.
Be aware they may not understand the
finality of death.
Be cautious for the months after the threat.
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Family structure
Children of divorce
The most important item is parental support
Tasks children must work through
o Acknowledging the reality of the marriage breakup
o Disengaging from parental conflict
o Resolution of loss
o Resolving anger and self blame
o Accepting the permanence of divorce
o Achieving realistic hope regarding relationships
the child may be afraid of developing new
relationships
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Family Structure
Children in step families
o

Primary task is attachment between step kin

Counselors can help people work out their

roles

Stages in stepfamily development

o

Early stages: fantasy, immersion, awareness

Middle stages: mobilization, action

Later stages: contact, resolution

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Family Structure
Children in single parent homes

Twenty-three percent of children in U.S. being raised

in mother-only families
Single mothers vulnerable economically because
earnings are low and many do not receive child
support
Single mothers and fathers identify parenting skills,
family management and good communication as their
personal strengths
Emphasis on family education is necessary
Counseling strategies similar to many described for
children of divorce and in stepfamilies
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Family Structure
Homeless children - Counseling tasks
Case management
Help child build trust
Be alert for possible abuse and neglect
Educational assessment
Insure remedial work including social
skills
Advocate for the child
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Children and Violence

Most common antisocial behaviors of young people:
Aggression and coercive misbehaviors in the family
Problems in school that often lead to a diagnosis of
conduct disorder
Community and school problems such as fighting and
property destruction
Minor criminal activity such as vandalism, substance
use and running away
Major criminal activity such as theft, robbery and
larceny
Violence and gang membership.
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Children and Violence

Violence in schools due to poor parenting,
disenfranchised students, lack of role
models, hate crimes, bullying, media violence
Risk-taking behaviors, criminal activities and
violence toward other people
Poor parent-child relationship, little
supervision or discipline, having neglectful
parents, poor school performance and
attitude
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Children and Violence

Effects on children
Young children effected even without verbalizing
More likely to respond nonverbally
o Behavioral problems
o Adjustment problems
School age children
o Anxiety
o Sleep disturbance
o ADHD like symptoms
o Constrained play
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Children and Violence

What do we do
Therapists
o Provide

children with freedom to talk

o Requires

specialized training

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Children and Violence

Teach this:
Step 1: What am I supposed to do?
Step 2: I have to look at all my possibilities.
Step 3: I had better concentrate and focus.
Step 4: I need to make a choice.
Step 5: I did a good job or I made a
mistake.

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Children and Violence

Role of schools
o

From the National School Safety Center

Establish clear behavior standards
Provide adequate adult supervision
Enforce rules consistently
Supervise closely and sanction consistently
Cultivate parental support
Control campus access
Create partnerships with outside agencies
Believe they can make a difference
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