In this section
Counseling and therapy
Counseling helps strengthen families. Emotional and mental health issues can have a significant impact on the physical health of children and their families. That’s why we offer a variety of counseling programs throughout Wisconsin. Our counseling services can reduce stress and conflict within families, improve parenting skills, help children and families deal with traumatic situations, and address behavioral and social difficulties.
Child and family counseling
At sites throughout Wisconsin, our licensed child and family counselors work with children – from toddlers through adolescents – and their families to address problems and strengthen family ties. Our counselors assist families with issues such as depression and anxiety, low self-esteem, anger management, abuse, parent-child conflicts and changes related to adoption or foster care placement.
In group therapy, children find out they are not alone with their illness or fears. They can talk with other children their own age who have the same problems. By working together, they can build trust with each other to share their feelings, information and successes.
Groups let children talk about their feelings in a safe and private way. They get help with their problems from the therapists and from the group.
Groups focus on many issues, such as anger management, social fears and coping with medical conditions. The therapist teaches the children skills to help them deal more effectively with their problems. The children practice these skills during group activities. Children can then use these skills in everyday life.
Types of therapy
Cognitive behavior therapy (CBT)
Cognitive behavior therapy is a form of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials for many different disorders for individuals of all ages. CBT is usually focused on the present, fairly limited in duration, and takes a problem-solving approach. Individuals learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.
Trauma-Focused Cognitive Behavioral Therapy
Trauma-Focused Cognitive Behavioral Therapy (TFCBT) utilizes the basic building blocks of traditional Cognitive-Behavioral Therapy (CBT). The components of CBT are enhanced by adding a number of elements that specifically target trauma symptoms. The trauma specific elements include education around traumatic reactions and triggers, developing a trauma narrative to address trauma-related cognitions and emotions, and building a sense of personal empowerment.
TFCBT is designed to be delivered by psychotherapists. Treatment initially is provided through parallel individual sessions with children and their parents (including foster parents or guardians). Then joint parent-child sessions are incorporated over the course of treatment. TFCBT not only helps children heal from traumatic experiences, it also helps caregivers understand the impact of trauma and how to most effectively support their child.
Who is it for?
TFCBT has been shown to be effective for children and adolescents ages 3-18 years old with a known trauma history. It is designed to treat posttraumatic stress disorder (PTSD) and related emotional and behavioral problems (depression, anxiety, shame, etc.) in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, natural disaster, medical trauma, and so forth. TFCBT has also been shown to be effective in addressing the complex trauma experienced by children placed in foster care.
What does TFCBT look like?
The acronym “PRACTICE” is used for the step-wise components of the TFCBT treatment model, which are:
- Psychoeducation and parenting skills
- Relaxation skills
- Affect expression and regulation skills
- Cognitive coping skills and processing
- Trauma narrative
- In vivo exposure (when needed)
- Conjoint parent-child sessions
- Enhancing safety and future development
Although TFCBT is generally delivered in 12-20 sessions of individual and parent-child therapy, it also may be provided in the context of a longer-term treatment process.
Parent-child interaction therapy (PCIT)
PCIT is an evidence-based treatment for young children with emotional and behavioral disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. Children and their caregivers are seen together in PCIT. Most of the session time is spent coaching caregivers in the application of specific therapy skills. Therapists typically coach from an observation room with a one-way mirror into the playroom, using a “bug-in-the-ear” system for communicating to the parents as they play with their child. Concluding each session, therapist and caregiver together decide which skill to focus on most during daily 5-minute home practice sessions the following week.” (from the PCIT international website, pcit.org)
Play Therapy is a powerful tool for addressing cognitive, behavioral, and emotional challenges. It is a natural process that builds trust, regulates emotions, reduces anxieties, promotes problem solving, elevates self-esteem, and allows children to communicate at their developmental level.
Theraplay is a child and family therapy for building and enhancing attachment, self-esteem, trust in others, and joyful engagement. It is based on the natural patterns of playful, healthy interaction between parent and child and is personal, physical, and fun. Theraplay interactions focus on four essential qualities found in parent-child relationships: Structure, Engagement, Nurture, and Challenge. Theraplay sessions create an active, emotional connection between the child and parent or caregiver, resulting in a changed view of the self as worthy and lovable and of relationships as positive and rewarding.
In treatment, the Theraplay therapist guides the parent and child through playful, fun games, developmentally challenging activities, and tender, nurturing activities. The very act of engaging each other in this way helps the parent regulate the child’s behavior and communicate love, joy, and safety to the child. It helps the child feel secure, cared for, connected and worthy.
Theraplay is appropriate for children of all ages, including babies, and when combined with other techniques, it is a great therapy for teenagers too. With Theraplay, family interaction patterns have improved and school professionals and pediatricians have reported positive changes in children’s behavior, self-esteem, and connections with others. Theraplay can help children who have experienced trauma begin to heal, can help children with developmental disorders feel more comfortable with social interaction, and can help families to experience happiness and connection.
Theraplay can help children with:
- Shy, withdrawn, or clingy behavior
- Acting-out, angry, or disruptive behavior
- Defiant, oppositional or controlling behavior
- Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder
- A history of trauma, abuse, or neglect
- Attachment disorder due to adoption or multiple changes in living arrangements
- A history of social deprivation due to living in an institution
- Psychological trauma due to medical care or serious illness
Trauma Informed Child-Parent Psychotherapy
Trauma Informed Child-Parent Psychotherapy (TI-CPP) is a family-based, evidence-based therapeutic treatment for children from birth – 5 who have early trauma histories and, as a result, are experiencing emotional, behavior, attachment, and/or mental health problems. The primary goal is to support and strengthen the relationship between a child who has experienced trauma and his or her parent (or caregiver) as a vehicle for restoring the child’s sense of safety, attachment, and regulation of affect and improving the child’s emotional, behavioral, social and cognitive functioning.
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) is a one-on-one form of psychotherapy that is designed to reduce trauma-related stress, anxiety, and depression symptoms associated with posttraumatic stress disorder (PTSD) and to improve overall mental health functioning. Treatment is provided by an EMDR therapist, who first reviews the client's history and assesses the client's readiness for EMDR. During the preparation phase, the therapist works with the client to identify a positive memory associated with feelings of safety or calm that can be used if psychological distress associated with the traumatic memory is triggered. The target traumatic memory for the treatment session is accessed with attention to image, negative belief, and body sensations. Repetitive 30-second dual-attention exercises are conducted in which the client attends to a motor task while focusing on the target traumatic memory and then on any related negative thoughts, associations, and body sensations.
The most common motor task used in EMDR is side-to-side eye movements that follow the therapist's finger; however, alternating hand tapping or auditory tones delivered through headphones can be used. The exercises are repeated until the client reports no emotional distress. The EMDR therapist then asks the client to think of a preferred positive belief regarding the incident and to focus on this positive belief while continuing with the exercises. The exercises end when the client reports with confidence comfortable feelings and a positive sense of self when recalling the target trauma. The therapist and client review the client's progress and discuss scenarios or contexts that might trigger psychological distress. These triggers and positive images for appropriate future action are also targeted and processed. In addition, the therapist asks the client to keep a journal, noting any material related to the traumatic memory, and to focus on the previously identified positive safe or calm memory whenever psychological distress associated with the traumatic memory is triggered.
The underlying mechanism for how this process works to reduce trauma-related stress, anxiety, and depression is unknown. Researchers have theorized that the positive effect is due to adaptive information processing, the theoretical model behind EMDR. Through adaptive information processing, the dual-attention exercises disrupt the client's stored memory of the trauma to allow for an elimination of negative beliefs, emotions, and somatic symptoms associated with the memory as it connects with more adaptive information stored in the memory networks. Once recall of the trauma no longer elicits negative beliefs, emotions, or somatic symptoms and the memory simultaneously shifts to a more adaptive set of beliefs, emotions, and somatic responses, it is stored again, overwriting the original memory of the trauma.
EMDR is typically delivered in 60- to 90-minute sessions, although shorter sessions have been used successfully. The number of sessions varies with the complexity of the trauma being treated. For an isolated, single traumatic event, one to three sessions may be sufficient for treatment. However, when the trauma involves repeated traumatic events, such as combat trauma and physical, sexual, or emotional abuse, many more sessions may be needed for comprehensive treatment. Although all the studies reviewed for this summary involved adults, the intervention was also developed for use with children and adolescents.
Triple P (Positive Parenting Program)
Triple P is a parenting intervention used by a variety of professionals and practitioners, including primary care doctors, therapists, and community officials. The program consists of multiple levels so it can be used in a variety of settings with different populations- 1:1 with parents, groups, and even communities. Many parents seeking this type of support may receive Triple P training from their primary care doctor, community worker, or therapist.
Positive parenting is an approach to parenting that gives parents tools and strategies to raise their child in an environment that is safe, loving and predictable. Triple P’s positive parenting allows parents to decide what is important to them. It doesn’t tell parents how to raise their children, but gives them the confidence and skills to build good relationships with their child, set boundaries and rules, and follow up with consequences that aren’t harmful.
Triple P helps to:
- Raise happy, confident kids
- Manage misbehavior so everyone in the family enjoys life more
- Set rules and routines that everyone respects and follows
- Encourage behavior you like
- Take care of yourself as a parent
- Feel confident you’re doing the right thing
Triple P has been tested with thousands of families over more than 35 years and been shown to help families in many different situations and cultures. Triple P has been shown to help reduce kids’ and teens’ problem behavior and also reduce children’s emotional problems. The evidence also shows it helps parents feel more confident, less stressed, less angry and less depressed.
The five principles of Triple P are:
- Create a safe, interesting environment: bored kids are likely to misbehave. Bored teenagers may find trouble. So create an environment that allows kids to explore safely and develop their skills
- Have a positive learning environment: if a child or teenager comes to you for help or a chat, they’re ready to learn; give them positive attention, even if only for a minute or so and encourage their ideas and opinions
- Use assertive discipline: set clear rules and boundaries and follow through with fair consequences- you can negotiate some of these with older kids and decide on the rules and consequences together and praise little and big kids to encourage the behavior you like
- Have realistic expectations: nobody’s perfect – kids, teenagers or adults – so don’t expect your child to do more (or less) than they’re capable of; and remember, we all make mistakes sometimes.
- Take care of yourself as a parent: it’s all about balance, you’ve got to look after your own needs too, so make sure you’re getting some support, time with friends, and maybe even a little time to yourself
Child and Family Traumatic Stress Intervention (CFTSI)
CFTSI is a brief (5-8 sessions) evidence-based early intervention model for children. It was designed to decrease the negative effects of recent potentially traumatic events. It is focused on increasing family support and communication and reducing traumatic stress symptoms and preventing longer term psychiatric difficulties.
The Social Fitness Club (SFC) is a cognitive-behaviorally oriented skills group for adolescents which instills social skills during fitness-based activities. For at-risk adolescents social skills can be difficult to cultivate so if some barriers are removed (through better participant engagement and naturalized settings) adolescents are more likely to build and continue practice these skills. It is a novel way to present social skills with at-risk populations.
This program and curriculum has been adapted to be completed at local fitness facilities. The goal is to educate professionals in community agencies and afterschool groups and to provide science-driven social programming as part of an ongoing curriculum. (contact: John Parkhurst)
Find a mental health provider
To make an appointment, call the psychiatry and behavioral medicine program.
For new referrals or new patient appointments, please call (414) 266-3339.