Psychotherapy Services for Students with Emotional or Behavioral Disorders: A Legal Analysis of Issues
Etscheidt, Susan, Behavioral Disorders
The purpose of the Individuals with Disabilities Education Act (IDEA) is to provide every child with a disability a free, appropriate public education (FAPE) emphasizing special education and related services designed to meet their unique needs and prepare them for employment and independent living [20 United States Code (U.S.C.) (sec)1400(d)(1)(A)]. The nature of special education and related services for students with emotional or behavioral disorders (E/BD) has been a controversial topic in both the empirical and legal literature. Critics have argued that schools are failing in their mission to serve children with E/BD, as evidenced by poor academic progress, limited social-emotional improvement, alarming dropout rates, and dismal postschool careers (Glennon, 1993). Researchers have suggested that this failure is due to the lack of related psychological services necessary to support the educational programs for students with E/BID (Knitzer, Steinberg, & Fleisch, 1990; Steinberg & Knitzer, 1992). The provision of psychotherapy has been advocated as a critical psychological service for these students (Newcomer, 1993; Wicks-Nelson & Israel, 2000).
Psychotherapy can best be discussed as a continuum of interventions. This continuum is characterized by distinctions in the intensity and type of intervention provided. At one end of the continuum are psychoeducational techniques typically employed by school psychologists, counselors, or social workers in school settings. The psychoeducational techniques include both behavioral interventions (e.g., reinforcement, relaxation, modeling, social skills instruction, parent training, self-instruction, self-monitoring) and nonbehavioral applications (e.g., client-centered therapy, insight-oriented therapy, discussion groups) (Weisz, Weiss, Han, Granger, & Morton, 1995). Children requiring more intensive interventions may be referred for services outside the school, located further along the continuum. The nature of these more intensive psychotherapeutic interventions is based on one of three major theoretical orientations: psychoanalytic/psychodynamic, behavioral, or humanistic. The U.S. Public Health Service (USPHS, 1999) has described the various types of therapies and service options. The focus of the psychoanalytic/psychodynamic therapy is to help the child understand the origins of actions and how the unconscious influences behavior. Behavior therapy focuses on current behavior and the role of the environment in sustaining or eliminating behaviors. A therapeutic variation known as cognitive-behavioral therapy helps the child to replace faulty thoughts with self-statements that promote more adaptive behavior. Humanistic therapy focuses on the immediate experiences of the child and is designed to help the child gain knowledge of self and expand his or her potential. A growing development called psychotherapy integration (Wolfe & Goldfried, 1988) includes various aspects from all three orientations.
These more intensive psychotherapy services are typically provided by clinical psychologists, child psychiatrists, or social workers. Depending on the severity of the child's needs, these services may be provided at different points on the continuum. Outpatient psychotherapy is often of short duration and offered to individuals, groups, or families-- usually in a clinic or private office. Partial hospitalization or day treatment provides a structured daily environment that allows the child to return home at night to be with family and peers. The setting may be a hospital, school, or clinic, and it combines education, psychotherapy or counseling, and family interventions. Residential treatment centers are licensed 24-hour facilities for children with severe mental disorders. In addition to supervision, the child receives intensive psychotherapy. Inpatient hospitalization is the most restrictive type of care on the continuum of mental health services for children. …