At the moment, when children are deemed to need help to change their behaviour, their therapy will be based on one of four main theoretical approaches and their derivatives:
1. Behavioural: Problems due to maladaptive learning - uses rewards and punishments.
2. Person-centred: Problems due to the child's self-concept - aims to redress discrepancies between a child's actual and ideal self.
3. Cognitive behavioural: Problems due to maladaptive thinking - uses training for erroneous or unrealistic thinking.
4. Psychodynamic: Problems due to unresolved unconscious conflicts - helps the child to gain insight and increase ego strength.
A fifth approach
What we have been describing in a forthcoming book might be described as a fifth approach:
5. Interactive behavioural: Problems due to maladaptive parental teaching that has create a temporary leadership imbalance between parent and child - an 'interactive behaviour imbalance'.
This approach sees 'bad' behaviour as being rewarded and maintained by the responses of parents during interactions with their children. It works exclusively with and through the training of parents. First, it uses an augmented version of Behaviourist methods that does not merely have as its target changed behaviour, but rather a change in the child's decision to enact it, and strives to have the child decide to comply. Second, this is combined with a proactive attempt to change from negative to positive the child's perception of how he or she is perceived by the parent.
This approach is limited to the change of behaviour in children and adolescents and those in dependent relationships. It trains parents and parent-figures how to train their charges. Unlike the other approaches, except, perhaps, the family therapies, it does not see 'bad' behaviour as the child's problem at all, but rather as an interactional problem between child and parent, which the child is incapable of changing. Therefore, unlike even the family therapies, it works exclusively through parents, through their perception of what is happening and their responses.
It also sees the training of parents in the use of effective interactive techniques as crucial, even when - especially when - the child has a serious underlying condition or disorder.
Because it sees inappropriate behaviour as frozen in place and being maintained by the child's interactions with his or her parents, it views any approach that works directly with the child as seriously handicapped. Recognition that 'bad' behaviour is created and maintained by parental response is the major difference from other approaches, and the major advantage of this new approach. Other advantages of the interactive behavioural approach, compared with the other approaches, include:
1. Not having to accommodate itself to, or wait for, the child's conceptual or emotional developmental stage; this new approach will work however young the child might be.
2. The training works to change and augment what the parents are already doing, since all parents already use some form of intuitive behavioural approach.
3. As the child usually does not know that the trainer/therapist is involved, there is no need for such a person to build a relationship with the child or be accepted by them. With other approaches, acceptance of the therapist can be crucial, may be extremely time consuming and may never be achieved
(Acceptance of the therapist by the child is, of course, replaced by the need for the trainer and the parents to build a successful relationship, but this is far easier to achieve and much less crucial.)
4. As it does not rely on the therapist talking directly to the child, it avoids the perennial problem of all other remedial work of rewarding the child's 'bad' behaviour with attention or increasing their perception of the specialness that comes from an even larger negative label. The child does not even know that he or she is the centre of major discussions and innovations.
(I asked a prominent clinical psychologist why he had brought his problems with his son to me rather than to one of his (or another) team of behaviour specialists. He said: "I did not want them, in an attempt to validate him (part of the process needed to build their own relationship with the child), to end up validating his 'bad' behaviour.")
5. It enables the parents to remain the 'agents of change, hence they can proceed without the loss of leadership that occurs when the child is also interacting with a therapist from outside the home who has his or her own leadership role.
6. Since one of the main presenting problems, and therefore a main indicator of success for all the approaches, is the child's acceptance of, and normal response to, reasonable parental guidance and/or authority, an approach that looks directly at these issues has obvious benefits.
This model differs from the parental guidance models that include the children in the sessions. They are not included because the key issues being discussed of leadership and security and consequences are not appropriate for a child. They are also not included because with the therapist taking the lead when the family group gets together there is a very real danger is that the child will think that someone outside the family is telling their parents what to do and further undermine their leadership.