School Refusal Hope

Types of Providers & Therapy


Mental Health Providers

 
 

Psychiatrist

 

A psychiatrist is a doctor who specializes in the diagnosis and treatment of mental health disorders. They are trained medical doctors who completed medical school and then a residency. They prescribe medication, monitor and manage their use. Some psychiatrists also do psychotherapy (talk therapy). They provide guidance and support, can provide a treatment plan and a referral to a therapist.

 

Psychologist

 

They provide talk therapy, support and guidance. They diagnose and use the same diagnostic criteria as psychiatrists. They receive a PhD or PsY and then do a clinical internship with several years of supervised practice. They can also provide a treatment plan and often work in conjunction with your psychiatrist.

 

Therapist

 

This is a broader term that can refer to a psychologist, psychiatrist, or social worker who provides therapy.  They can have a variety of degrees. They provide support and guidance and help patients and families.


The National Alliance on Mental Illness provides a more detailed description on providers.
They explain what all those abbreviations mean… like LCSW, LPC…and more.

Types of Therapy

 

Psychotherapy:

  • Also know as talk therapy, it is a way to treat people by helping them understand their illness.

  • Therapists provide strategies and tools to help patients deal with unhealthy thoughts and behaviors.

  • Psychotherapy helps people manage their symptoms and function at their best in everyday life.


Evidence Based Treatments for School Refusal

Cognitive Behavioral Therapy and Exposure Response Therapy are the two most commonly used and studied forms of therapy for school refusal. Many therapists also utilize Dialectical Behavioral Therapy and Acceptance and Commitment Therapy, so I have included descriptions of them as well.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy focuses on the patient’s thoughts and beliefs and how they affect mood and actions

It asks the patient to take notice of those unhealthy thoughts or assumptions.

Assess and challenge them to determine if they are an accurate depiction of reality.

Uses strategies to challenge and overcome distorted thoughts.  Focuses on solutions.

An example of a CBT though record

Therapists often employ “homework” which allows patients to take an active role in their therapy.

Research has shown that CBT can benefit numerous conditions, such as major depressive disorder, anxiety disorders, OCD, PTSD, eating disorders and other conditions.

Therapists often employ “homework” which allows patients to take an active role in their therapy.

*Psychology Today, 2019, www.psychologytoday.com/us/basics/cognitive-behavioral-therapy.


Exposure Response Prevention Therapy

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Exposure Response Prevention Therapy is based on the premise that the more that we do something we are afraid of doing, or are exposed to something that we are afraid of, the less afraid we tend to be.   It works best when we know what triggers our anxiety, and are aware of avoidance and safety behaviors that we use when anxiety presents itself.

The goal of exposure is to gradually expose ourselves to whatever it is that we are avoiding, which helps us reduce the anxiety and make progress toward our life aims based on exposing the patient to a hierarchy of anxiety provoking situations.

The exposures are customized to the patients triggers and goals from easiest to hardest.

This guide from the University of Michigan is a comprehensive step by step guide on how ERP works to give you an understanding of the therapy.

It’s laid out as a self-help module but I don’t recommend that you do this on your own with your child. ERP is always most effective if overseen and done with a trained professional.

*Exposure and Desensitization. University of Michigan, (https://medicine.umich.edu/sites/default/files/content/downloads/Exposure-and-Desensitization.pdf.)


Dialectical Behavioral Therapy

Dialectical Behavioral Therapy was developed by Psychologist and Researcher Marsha Linhean in the 1980’s first as a treatment for borderline personality disorder. Since then, it has been used to treat PTSD, depression, substance dependence, eating disorders and other conditions.

Dr. Charles H. Elliott, a clinical psychologist in NM, provides one of the clearest explanations of what “dialectical” actually means; “dialectics represent the mind’s way of understanding concepts by understanding and appreciating their polar opposites. Dialectics are one of the important unifying concepts that reflect how the mind fundamentally understands and perceives most core concepts and ideas. And the field of psychology contains an abundance of such concepts, including self- esteem, trust, courage, honesty, rage, passivity, withdrawal, impulsivity, inhibition, blameworthiness, guilt, risk taking, and on and on. Dialectics are based in part on the fact that we cannot fully understand any of these abstract concepts without appreciating that they consist of bipolar opposites with a higher level of integration somewhere in between them. For example, what would light mean without understanding darkness, what would wetness mean to a fish who had never experienced anything else, what would blue mean in an all blue world, what would inhibition mean without appreciating what complete disinhibition looks like? Dialectics breaks down our concepts into their seemingly opposite parts–viewed another way, as thesis, antithesis, and synthesis (or white, black, and gray).”

Treatment is often composed of individual therapy, group therapy and in situation coaching or practice. It is made up of 4 components: Mindfulness, Interpersonal Effectiveness, Distress Tolerance, Emotional Regulation             


Acceptance and Commitment Therapy

Acceptance and Commitment Therapy is a kind of cognitive behavioral therapy where patients learn to accept their feelings as appropriate responses to certain situations. Instead of avoiding, denying or struggling with these difficult emotions, committing to making changes in behavior regardless of how they are feeling.  It is used to treat anxiety, social anxiety disorder, depression, obsessive-compulsive disorder, psychosis and substance dependence. According to Psychology Today “The theory behind ACT is that it is not only ineffective, but often counterproductive, to try to control painful emotions or psychological experiences, because suppression of these feelings ultimately leads to more distress. ACT adopts the view that there are valid alternatives to trying to change the way you think, and these include mindful behavior, attention to personal values, and commitment to action. By taking steps to change their behavior while, at the same time, learning to accept their psychological experiences, clients can eventually change their attitude and emotional state” The Association for Contextual Behavioral Science is one of the leading associations of ACT in the US. ACT was founded by Dr. Stpehen Hayes, a Professor at the University of Nevada. The website the below also provides a database search for ACT therapists in your area.

 

Levels of Treatment

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Outpatient

This is your basic once or twice a week therapy session at your provider’s office.  This is appropriate when you need help but symptoms aren’t bad enough to affect your daily functioning. w

Intensive Outpatient (IOP)

Usually incorporates multiple visits per week (2-5) with more structured programming for clients with more severe symptoms. Hours per day will vary among programs. When the program is for youth or adolescents, they are often offered after the school day

Partial Hospitalization Program (PHP) aka Partial Care Program (PCP)

Partial programs are a way to get intensive treatment without being in a residential setting or hospitalization. These are day programs where the hours of treatment usually around 9am – 5pm, five days a week. Sometimes partial programs are utilized as a “step down” program. Going from an inpatient setting and then gradually reducing the intensity and level of care. This type of program is also used as an alternative to inpatient. 

Inpatient Hospitalization

This is the most intensive level of care. 24 hours a day and is at a hospital. Inpatient hospitalization is usually a shorter time frame ranging from a few days to a couple of weeks at most. Some inpatient hospitals do provide specific intensive treatment for particular disorders and the length of stay will be longer. A person can be referred for inpatient from an emergency room.  A parent can bring their child or can be referred by your psychiatrist or psychologist

Residential Treatment Center (RTC)

Residential treatment is 24 hours a day and is usually a step down from inpatient. It is appropriate when clients have been stabilized. They are no longer is crisis, but still need treatment and/or ongoing care. Usually they are located in a more home like environment. The days are structured with treatment, school and therapeutic activities.

Acute Inpatient Hospitalization

You will determine if your child is in a crisis and they need immediate psychiatric stabilization. Your choices are to go to the ER or find availability at an inpatient hospital with a child/adolescent/youth psychiatric unit. You should call ahead to see if they have a bed available. These hospital stays are only long enough to resolve most urgent issues. They can last a few days to a few weeks with the average sty being 3-5 days.

The Emergency Room

If your child is in crisis and/or you fear he may be in danger, do not hesitate to go to your local emergency room. Some hospitals have a pediatric emergency room. If you have been considering this option and have time without jeopardizing safety you can call the hospital ER and ask them.  Some ER’s also have a space for mental health evaluations.