Post Traumatic Stress Disorder: Cognitive Therapy with Children and Young People

By Patrick Smith; Sean Perrin et al. | Go to book overview

6
Cognitive therapy for PTSD with
adolescents

Therapeutic work with adolescents – roughly defined here as secondary school age – can present unique challenges. These include issues of independence and autonomy in the context of parental involvement in treatment; the impact of trauma on self-evaluation and identity; and the importance of peer relationships and evaluation by others. Account needs to be taken of important goals and transitions. Compared to younger children, the presentation of PTSD symptoms in adolescence more closely resembles that of adults. Patterns of co-morbidity also differ: depression, for example, is relatively more common and separation anxiety relatively less common (although by no means absent) than in primary school age and pre-school children. Unlike younger children, common traumatic events for adolescents include exposure to interpersonal violence of some kind (assaults at school, violent street robbery), requiring therapists to find a way of making accurate judgements about the realistic level of danger encountered by young people – ensuring that therapeutic exposure is always safe.

Three cases are presented in some detail to illustrate some of these important aspects of adolescent work, to contextualise some of the treatment components described in Chapter 5, and to describe the therapeutic process from first assessment to post-treatment follow-up. They are based on real referrals to a specialist tertiary trauma clinic for young people, but have been altered to preserve anonymity.


Case 1: Joshua (17 years old)

Joshua was referred by his general practitioner (GP) for assessment and treatment of possible depression following a motorbike accident some six months previously.

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