You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Mental health practitioners who work with children with externalizing behaviors—defiance, disruption, aggression—can find them baffling and so provocative that it is difficult to maintain empathy for them. These children present as an obstacle to treatment because they behave as if it is the
parents, teachers, and therapists who cause their problems. They are most often diagnosed with ODD, ADHD, DMDD, and CD. This manual lays out a short-term treatment of such children and their parents that differs substantially from Parent Management Training programs, Cognitive Behavior Therapy, or the use of psychotropic medication. The focus of this treatment is not on re-directing the children's actions but on exploring with the child his/her inability to regulate implicit—unconscious—emotions. The authors' aim is to present this use of what they have termed Regulation-Focused Psychotherapy so that it can be applied and eventually evaluated in a systematic way.
Their rationale is based on the major tenet of psychodynamic thinking: all of a person's emotions and behavior have meaning. Two observations that have been systematically verified by clinicians support this assumption. First, events in childhood affect emotions, behavior, and personality in later life; second, much of a child's as well as an adult's mental activity occurs outside of his/her conscious awareness. In particular, painful emotions may be avoided through the use of various defenses like denial and projection.
Thus when working with a child who wants to fight, mess up, or leave the room, Hoffman et al. outline a strategy in which the clinician focuses on understanding the emotions driving the behavior and conveying that understanding to the child, even while setting limits and preventing harm to anyone in the room.
In the introductory chapter the authors provide a clinical example of a 7-year-old girl who made life tense at home and was so disruptive at school that the family was threatened with her suspensio