Chapter 1
General Principles for Counseling Children and Adolescents

Key Concepts

• Content and process
• Deficit model of childhood
• Reinforcement association
• Self-efficacy
• Speaker-listener neural coupling

Aligned 2016 CACREP Standards

Standard 2.F.5.f. Counselor characteristics and behaviors that influence the counseling process

Standard 2.F.5.g. Essential interviewing, counseling, and case conceptualization skills

Both of us began our counseling careers working with children. In this chapter, we describe our background in counseling children and adolescents, discuss the lessons we learned, and propose principles for working effectively with children and adolescents from a neuroscience-informed perspective. These principles are generally consistent across clients.

Thom's Background

I began my counseling career as a behavior specialist at a school for children with severe disabilities. I worked primarily with a late adolescent who had multiple diagnoses, including autism, intellectual disability, Tourette's syndrome, bipolar disorder, and obsessive-compulsive disorder. This person was also taking multiple psychotropic medications, including an antidepressant, antipsychotic, anxiolytic, mood stabilizer, and atypical stimulant (i.e., the five major classifications of psychotropic medications). The experience was formative for me, as I developed a strong relationship with a person who had few words and could barely write their own name legibly. I came to know, respect, and cherish this person and understood who they were beyond their diagnosis or label.

During the 2 years I worked at the school, I volunteered with a local crisis hotline to see whether I would enjoy working with people in more of a counseling capacity (i.e., more active listening, less behavioral intervention). I then took a position as a mental health counselor at an inpatient psychiatric hospital for children and adolescents and worked at that hospital for the next 6 years throughout graduate school. I once did the math and tallied that I provided counseling to more than a thousand children and adolescents during that time period. As a result, I saw the gamut of mental health conditions. I observed the vital role of family and environment in supporting or detracting from a child's mental health. I also became familiar with using formal counseling techniques in individual and group counseling modalities. I had three supervisors, each with decades of experience, who identified with family systems therapy, cognitive behavior therapy (CBT), and psychodynamic therapy. I benefited greatly from that diversity of thought regarding client work.

When I took my first full-time academic job after graduating with my doctorate, I joined a group private practice and continued to work with children and adolescents. The transition from providing short-term counseling in an inpatient setting to providing long-term counseling in a private practice setting was easier than I expected. The issues that children, adolescents, and families faced were quite similar to the ones I saw in the hospital, except perhaps less acute. Many of the adolescents I worked with had strained relationships with their parents and were struggling to forge their own identities. I also often assisted parents and guardians in navigating their own role transition as their children became more independent and needed more support than direction.

During my counseling career, I had several experiences working with younger children. For example, I completed my doctoral internship at an elementary school counseling program. I recently decided to stop providing play therapy to young children in private practice because I noticed that I had less energy for my own kids when I came home after my clinic day. I have learned that I have to take care of myself if I am to be helpful to others. I have found that play therapy with young children requires more energy and attention than regular talk therapy.

Today I see clients in individual private practice 1 day a week in addition to my academic responsibilities. My counseling work is refreshing and often the highlight of my week.

Michelle's Background

I began my career working as an assistant houseparent in a group home for troubled children. I physically lived at the group home Friday through Monday mornings (in my separate quarters). This allowed me to see the young men from the time they entered the group home until their discharge. I was their pseudoparent, administrator, and disciplinarian. These young men were typically between the ages of 12 to 19 (occasionally a young man decided to remain until his 21st birthday, but this was rare). I saw a multitude of diagnoses in this setting, including major depression, anxiety, obsessive-compulsive disorder, reactive attachment disorder, intermittent explosive disorder, attention-deficit/hyperactive disorder, bipolar disorder, substance use and addictions, and conduct disorder. Comorbidity, or having more than one diagnosis, was common. In addition, the young men typically came from dysfunctional homes, had received services in the mental health system for more than half of their young lives, struggled academically, displayed problem behaviors, and were involved with the legal system. They were also often taking psychotropic medication. My time at the group home was challenging yet rewarding. I learned a significant number of things from other mental health professionals, but most important from the young men themselves.

I remained with the group home until I went to work in a temporary emergency shelter for children. I later returned to the group home setting two additional times but in different roles: as a case manager and an independently contracted therapist. In the years that followed, I began to notice the systemic concerns surrounding so many young women and men being in the negative feedback loop of the social systems in which they resided (dysfunctional homes, trouble in school, trouble within the community, and ultimately legal troubles).

As I continued to work in various settings that focused on helping children and adolescents, I realized that I needed and wanted to support this population in a different way. Completing my master's degree while serving as a case manager at the same group home and getting licensed allowed me to take on a more significant role as an intensive in-home therapist. This work brought me face to face with families, extended families, school administrators, probation officers, parole officers, judges, and community leaders. This crystalized for me the need for a holistic approach to meeting the needs of these young people. The levels of trauma, stress, disappointment, and inconsistency they often endured were off the charts. This did not excuse their behaviors, but it helped me understand their current problems rather than solely view them as being defiant and deviant. These experiences helped me develop the holistic approach that I take to the work I continue to do as a licensed professional counselor.

While pursuing my doctorate, I continued to work with young people as an independently contracted therapist. I worked at a residential acute stabilization setting in a hospital and also worked as a counselor at a community college, where I worked with emerging adults.

Today I am licensed in two states and plan to work with children and families in some capacity while continuing my academic responsibilities as a faculty member. If I can help one young person see that their life can change for the better, no matter the systemic barriers that person faces on a daily basis, my heart will rejoice!

Three Primary Principles for Working With Children and Adolescents

From our narratives, you may have already picked up on a few lessons that will become important in your own work with children and adolescents. In this section, we outline three major principles for child and adolescent counseling.

Principle 1: Seek to Know People Beyond Labels

Most master's-level counseling students are very excited to take their psychopathology course and to learn the grisly details of abnormal behavior. If we are honest with ourselves, there is an allure to learning about why people behave in dysfunctional ways. For decades, mental health professionals have relied on the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2013) to understand why people experience distress and declines in overall functioning. In today's current practice climate, counselors are required to use diagnostic codes from the International Classification of Diseases and the associated DSM symptom criteria to bill both public and private party health care reimbursement systems for counseling services. Often counselors are required to make a provisional (i.e., preliminary) diagnosis after only one session with a client to receive insurance reimbursement. The primacy of diagnosis in mental health services can be understood through the lens of the greater medical system. If you see a dentist to get a filling, the dental provider will diagnose the problem (tooth decay) and select an approved intervention that addresses the problem (composite filling). Counselors who bill health care insurance companies for reimbursement of medical procedures must use diagnostic codes.

The use of diagnosis in counseling is often challenging, however, because clients do not present with exact diagnostic...