Paper
An ecosystemic psychodynamic intervention for children with mild psychosocial problems and academic difficulties: prospects and limits of the evaluation process
- issue: Issue 1 / 2009
- authors: Elias E. Kourkoutas
- keywords: ecosystemic, problems, Greece
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- downloaded: 0
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abstract
Background. Children's social, emotional, and behavioral wellbeing is significantly related to academic achievement and to school-community social integration, as well as later aggression, criminality, and mental health problems. Evidence indicates that children displaying emotional, behavioral and/or learning problems within school settings are likely to be rejected by both their classmates and their teachers. In consequence, these children are at greater risk in developing emotional/behavioral disorders or antisocial tendencies, especially when their family system is also problematic. Antisocial behavioral patterns are positively associated with peer rejection and teacher-child conflict, and negatively associated with class participation and academic achievement. Evidence also suggests that children who demonstrate social and behavioral problems such as hyperactivity/impulsivity, noncompliance, and aggression, as well as serious academic difficulties are at greater risk than typical children for delinquent and antisocial behavior, particularly if they do not receive early and ongoing intervention.
School-based prevention and intervention programs appear to significantly reduce children's emotional and behavioral problems and to promote their social integration. School-based prevention and intervention programs can be part of the general school setting, allowing children to receive more intensive or specialized services, in a less stigmatizing environment. Studies suggest that children are more likely to utilize school-based services than clinic-based or psychiatric-oriented services.
The ecosystemic transactional approach for behavior disorders in childhood constitutes a new epistemological paradigm that appears very promising in terms of the related holistic interventions (Sameroff & Gutman, 2004). Children's psychosocial problems are considered to be a product of multiple and complex continuous transactions between school, family and the child itself (Fraser, 2004). In this chapter, a child and family centered intervention that has already been implemented in Greek primary schools will be presented.
Method. The intervention is based on psychodynamic theory and practice, as well as on ecosystemic models of child psychopathology, resiliency and social exclusion. Based on the above theoretical framework, an integration of different techniques targeting the development of inherent capacities (resilience) for children with social/ behavioral problems, their families and their teachers was preferred. More specifically, we combined the following interventions:
- Psychodynamic counseling strategies in order to deal with children's troubled emotions. Various techniques (such as role-play, projective techniques, narrations) were utilized as parts of a comprehensive and child-focused therapeutic approach that aimed to resolve children's inner or interpersonal conflicts (Chethik, 2000).
- Parent counseling and family support in order to assist parents with every day life problems, as well as to challenge their distorted conceptions and feelings about their "problematic" child (Kourkoutas, 2007).
- Behavior management techniques and implementation of related educational strategies in order to support teachers deal with classroom problems. Individual counseling sessions with teachers were also included in order to assist them deal with their own negative feelings and attitudes towards children (Kourkoutas, 2007). Interventions were tailored to the needs of individual teachers (who taught students included in the study) and they were not available school-wide (as it would be expected according to this approach) due to lack of resources and organizational support. The absence of systematic intervention in peers' groups and other school faculty is considered as one of the study's limitations since attitudes of the remaining teaching staff and school peers are considered as essential factors for the successful inclusion of children with behavioral and emotional difficulties.
The target group of the intervention program was fifteen children (6-13 years old) demonstrating various degrees of emotional and behavioral problems, that were mostly accompanied by academic difficulties. The program was implemented in a period of three consecutive school years. During this period 200 counseling sessions were completed with the target children, their families, teachers, as well as other school faculty. All sessions took place within school premises. Specifically, each child participated in approximately 10 individual sessions during the first year of the intervention and 5 sessions in the second year. Accordingly, the child's parents participated in 5-7 sessions and the child's teacher join in 5 to 10 sessions during the first couple of years. In addition, 3 more sessions were scheduled during the second and third year with each child, parent, and teacher for evaluation purposes. These sessions aimed to assess the emotional and behavioral state of the participating children as well as the degree and stability of academic and social inclusion (follow-up). Measures included semi-structured interviews, the Child Depression Inventory, the Revised Child Manifest Anxiety Scale and the Child Behavior Checklist (both parent and teacher forms). Evaluation of the inclusion process had an ongoing and dynamic character. All treatment sessions, evaluation interviews and assessment measures were conducted by the research team of two clinicians. Despite the strong theoretical perspective of the intervention, the program had purposefully adopted a clear action research orientation. Many interventions are proved to be effective in experimental studies. However, most of them are conducted in university- and laboratory-based clinics, often in the context of randomized clinical trials lacking ecological validity that can only be ensured within a natural /clinical setting.
Conclusion. Results from this intervention program clearly demonstrated that when parents and children were seriously engaged in the treatment process, a significant progress was ensured at emotional, behavioral, and academic level for the majority of the children in the target group. Seriousness of problems, and teachers' attitude towards children roubles were both significantly correlated with improvements in emotional and behavioral aspects.
The final purpose of the study is to discuss both at the theoretical and practical level the various parameters that interfere with the successful implementation of similar interventions within school settings, their limitations, as well as issues related to evaluation and the assessment of outcomes process. Finally, theoretical issues regarding efficacy and effectiveness of this type of interventions will also be discussed.
Key references
Chethik, M. (2000). Techniques of Child Therapy: Psychodynamic Strategies. New York, U.S.A.: Guilford.
Fraser, M. W. (2004). The Ecology of Childhood: A Multisystemic Perspective. In M. W. Fraser (Ed.), Risk and Resilience in Childhood. An Ecological Perspective (pp.1-12). Washington, DC: NAWS Press.
Kourkoutas, E. (2007). Children with problem behaviors. Interventions within family and school context. Athens: Ellinika Grammata.
Sameroff, ΑJ. & Gutmann, L. M. (2004). Contributions of risk research to the design of successful interventions. In P. Allen-Mears & M. W. Fraser (Eds.) Intervention with children and adolescents. An interdisciplinary perspective (pp.9-26). Boston: Pearson.
Contacts: E. E. Kourkoutas, Professor of Psychopathology and Special Education, University of Crete, PTDE, University Campus, Gallos, 74100, Rethymno, Crete, Greece. E-mail:hkourk@edc.uoc.gr, Phone +302831077647.