“We believe that these characteristics (warmth, accurate empathy, and genuineness) in themselves are necessary, but not sufficient to produce an optimum therapeutic effect” (Beck, Shaw, Rush, Emery, 1979).

That's what the theorists say, but how does this apply in the context of working with children, young people, and their caregivers and wider systems?

•McQueen and Smith (2012) argue that it can difficult to separate positive effects of the intervention from the effects of the therapeutic alliance in children's therapy.

•Carkhuff & Truax (1967) agree with the three factors of warmth, empathy and genuine positive regard being vital, and an explicit avoidance of criticism and blame.

•There are studies which link positive therapeutic alliance with positive outcomes with children and young people (e.g. Kazdin, et al., 2006; Karver, et al., 2008; Kendall, et al., 2009 in Gilbert and Leahy, 2017).

•TA can lead to increased trust between patient and practitioner and the adherence of the patient to an agreed management plan (Wampold, 2001). 

•Good therapeutic alliance

•Ruptures in the therapeutic alliance

•Complete disengagement or persistent DNAs

•How has your practice changed because of these experiences? 

Add your comments on the following padlet

https://padlet.com/k_saville/hfscekmexznm

•Goal tracking completion

•Completion of the intervention

•Relapse Prevention session

•Step-up/onward referral, where necessary

Therapeutic ending should be predictive (i.e. both you and your client should be aware of when treatment will end). However, there may be discrepancy in this.
Have a think about the following questions and put your answers on the attached padlet;

https://padlet.com/k_saville/z8yabjnxgsnr

•What difficulties can you foresee from the CYP's perspective?

•What difficulties can you foresee from the caregiver's perspective?

•

•What difficulties can you foresee from a practitioners perspective?

•Keep in mind the collaborative approach of low intensity working

•Your client and their caregiver(s) should be aware of the time-limited nature of treatment, and know when the final session is. Having a review session at the mid-way point through treatment will help to manage expectations, as well as considering your client's progress through treatment and whether any other actions are required in supporting their therapeutic experience (i.e. extending the treatment period; onward referral; etc.)

•Client may vocalise some apprehensions about treatment ending, this will be a good opportunity to problem solve.

The CYP perspective:

•May have positive outlook on ending.

•Client may assume that contact may go on for longer

•May not feel that they are ‘cured’ or ‘better’ - how might you discuss this perspective further with them?

•They may be unsure about ‘going it alone’.

•May feel that they are not responsible for the change which can lead to further apprehensions.

The caregiver perspective: 

•There may be satisfaction with the ending of intervention – feeling input has been helpful.

•May be unsure about how to apply the techniques moving forward.

•Feeling like the difficulty is not ‘fixed’.

•Wants continued support from you.

Add any comments or anything else to consider below...