attending, or may not agree that therapy is needed
to address their behavior. Many children attend
therapy as a result of their parents’wishes, but not
their own. Compounding these complexities fur-
ther, parents legally have a right to learn anything
that occurred between the therapist and the child in
therapy, although most therapists will discourage
parents from intruding on the confidentiality of
their work with a child. Consequently, the process
of setting goals and determining a course of youth
treatment involves several discussions to help
engage the child in the process of therapy, establish
trust with the child who may have been coerced to
attend by their parents, and educate parents about
their expectations and the importance of the thera-
pist’s neutral stance as an advocate for both the par-
ent and child simultaneously.
Again, it is important to understand that vari-
ous features of the contract may be modified as time
goes on. One must deal with clients in terms of
what they are prepared to accept now. An espe-
cially anxious or defensive client may be willing
to accept only a limited set of goals or procedures.
As therapy proceeds, that client may become more
open and comfortable and thus better able to accept
an expanded set of goals. Then, too, additional
information about the client may surface during
therapy, with the result that some modifications
may be necessary. Some clients will want to expand
their goals for treatment as they gain more confi-
dence and trust in the therapist. Discussion of goals
and methods must be handled with discretion, sen-
sitivity, and skill.
Therapists must try to take clients only where
they are psychologically prepared to go. Moving
too fast or setting up grandiose treatment objectives
can frighten or alienate certain clients. It is usually
desirable to proceed with enough subtlety and skill
so that clients feel they are the ones establishing or
modifying the goals.
Implementing Treatment
After the initial goals are established, the therapist
decides on the specific form of treatment. It may be
client-centered, family-systems,cognitive,behavioral,
or psychoanalytic, for instance. The treatment may
be very circumscribed and deal only with a specific
phobia, or it may involve a broader approach to the
client’s personality style. All of this must be carefully
described to the client in terms of how it relates to
the client’s problems, the length of time involved,
and perhaps even the difficulties and trying times
that may lie ahead. Exactly what is expected of the
client will be detailed as well—free association,
“homework” assignments, or self-monitoring, for
example. Inherent in all of this is the issue of
informed consent. Just as participants in research
have a right to know what will happen, therapy
patients have the right to know what will happen
in therapy. Children also have the right to know
about therapy and what it will provide, although
their capacity to truly understand the therapeutic
agreement will naturally vary by age. Box 11-4 pro-
vides an outline of the information to which outpa-
tients should have access.Termination, Evaluation, and Follow-up
It is certainly to be hoped that a client will not be in
psychotherapy her or his entire life. As the therapist
begins to believe the client is able to handle his or
her problems independently, discussions of termi-
nation are initiated. Sometimes termination is a
gradual process in which meetings are reduced,
for example, from once a week to once a month.
As termination approaches, it is important that it be
discussed in detail and that the client’s feelings and
attitudes are thoroughly aired and dealt with. Cli-
ents do sometimes terminate suddenly, in some
cases before the therapist feels it is appropriate.
Whenever possible, however, it is important to
find the time to discuss at least briefly the client’s
feelings about leaving the support of therapy and
the possibility of returning later for additional ses-
sions if necessary. In other instances, the termina-
tion is forced because the therapist must leave the
clinic, and a referral to a new therapist is offered.
Many therapists find that“booster sessions”sched-
uled months after termination—perhaps 6 months
and then 1 year later—can be quite helpful. These
booster sessions are used to review the client’sPSYCHOLOGICAL INTERVENTIONS 331