Anxiety and Phobic Disorders: A Pragmatic Approach

150 Pages·1996·3.99 MB·English

by  Wendy K. Silverman

Anxiety and Phobie
Disorders
A Pragmatic Approach
~
Clinical Child Psychology Library
cCP
Library Series Editors: MichaelC.RobertsandAnnetteM. LaGreca
ANXIETY AND PHOBIC DISORDERS
A Pragmatic Approach
Wendy K. Silverman and William M. Kurtines
PARENT-CHILD INTERACTION THERAPY
Toni L. Hembree-Kigin and Cheryl Bodiford McNeil
SEXUALITY
A Developmental Approach to Problems
Betty N. Gordon and Carolyn S. Schroeder
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Anxiety and Phobic
Disorders
A Pragmatic Approach
Wendy K. Silverman and
William M. Kurtines
Florida International University
Miami, Florida
Springer Science+Business Media, LLC
Llbrary of Congress Cataloglng-ln-Publ1catlon Oata
Silverman. Wendy K.
Anxiety and phobie disorders a pragmatie approach I Wendy K.
Si Iverman and WiIIiam M. Kurtines.
p. em. -- <Clinieal ehild psyehology libraryl
Includes bibliographieal referenees and index.
1. Anxiety in children. 2. Phobias in ehildren. I. Kurtines.
William M. II. Title. UI. Series.
[ONLM, 1. Anxiety Disorders--in infaney & childhood. 2. Anxiety
Oisorders--diagnosis. 3. Anxiety Disorders--therapy. WM 172 S587a
1996l
RJ506.A58S55 1996
618.92·85223--de20 96-4862
CIP
ISBN 978-0-306-45227-7 ISBN 978-1-4757-9212-6 (eBook)
DOI 10.1007/978-1-4757-9212-6
© SpringerScience+BusinessMedia New York1996
Softcoverreprintofthehardcover 1stedition 1996
Originallypublishedby Plenum Press, New Yorkin1996.
10987654 321
All rightsreserved
Nopartof thisbook mayberepraduced,storedinaretrieval system,ortransmitted inany
form orbyanymeans,electronic,mechanical, photocopying, microfilming,recording, or
otherwise,withoutwritten permissionfram thePublisher
In memory of my father, Nathan
-WKS
Foreword
Formanyyears,anxiety andphobiedisorders ofchildhoodandadolescencewere
ignored bycliniciansandresearchersalike.Theywereviewedaslargelybenign,
asproblemsthat were relativelymild,age-specific,andtransitory.With time,it
was thought, they would simply disappear or "go away"-that the child or
adolescent would magically "outgrow" them with development and that they
would not adversely affect the growing child oradolescent. As aresult ofsuch
thinking,itwas concludedthat these "internalizing"problemswere not worthy
or deserving of our concerted and careful attention-that other problems of
childhood and adolescence and, inparticular, "externalizing" problems such as
conduct disturbance, oppositional defiance, and attention-deficit problems de
manded ourprofessional energies and resources.These assumptions and asser
tions have been challenged vigorously inrecent years. Scholarly books (King,
Hamilton, & Ollendick, 1988; Morris & Kratochwill, 1983) have documented
the considerable distress and misery associated with these disorders, while
reviews oftheliteraturehavedemonstratedthatthese disorders areanythingbut
transitory; for a significant number ofyouth these problems persist into late
adolescence and adulthood (Ollendick & King, 1994). Clearly, such findings
signal theneedfortreatmentprograms that"work"--programsthatareeffective
inthe short term and efficacious over the long haul, producing effects that are
durable and generalizable,asweilaseffects thatenhancethe lifefunctioning of
childrenand adolescentsand the families that evince such problems.
Inthis context,WendySilverman andBillKurtines presenttheirtreatment
orientedbook,AnxietyandPhobieDisorders:APragmaticApproach.Thebasic
premise ofthis book is, ofcourse, its emphasis on pragmatism. Pragmatism
representsboth anattitude about treatmentandanapproachtowarddetermining
and implementingtreatments that work.As they succinctlynote, the pragmatic
therapist"doeswhat isuseful and whatworks" (p. 11).The pragmatic therapist
isguidedbyaproblem-solvingapproach thatexaminesproblemssuchasanxiety
and phobias in the rich contexts in which they are embedded and that selects
treatmentsthatworkfromadiversity oftheoreticalviewpointsinordertoresolve
or at least ameliorate these problems.Thus, both apragmatic and contextualist
vii
viii Foreword
approach is recomrnended by Silvennan and Kurtines. The bulk ofthis book
explicatesand illustratesthis approach inthe assessmentand treatmentofthese
difficultandfrequentlyrefractoryproblems.Consistentwith theirpointofview,
SilvennanandKurtinesacknowledgethattheprocedurestheyrecommendmight
not be effective or efficacious with all youth who present with such problems;
insuch instances,theyrecomrnendareturntotheircontextualisticandpragmatic
problem-solving approach to select and implement (or, in some cases, design)
treatments that do work.
SilvennanandKurtineshavedoneamajorservicetoprofessionalclinicians
workingwith youth and their families by writing this bookand sharingwith us
theirrich insightsandclinicalacumen.Forthepracticingclinician,there ismuch
to offer.Clearguidelines for selectingand usingmajorassessmentdevicesand
treatment procedures are presented. In addition, verbatim transcripts ofactual
cases illustrate how and when to use these various strategies, aswell as how to
problemsolve when "blocks"orobstaclesare encounteredinthe assessmentor
treatment process. The book is, however, much more than a handbook or
"cookbook."Itinstructsusinhowtousethepragmatic,contextualapproachand
how to solve problems that we will inevitably encounter in our own clinical
practices. For many ofus, our practiceswill be enhanced as a result ofreading
this bookand using the recommendationscontainedtherein.
Theauthorshavealsopresentedaconsiderablechallengetotheresearchcomrnu
nity.Theiremphasison"treatmentsthatwork"goesagainstthegrainofmanyofour
long-held beliefs that effectiveandefficacioustreatments mustbe wedded to, and
presumably derived from,well-deftnedand articulatedtheories.Wemight ask, for
example, whether treatments thatborrow from such diverse theories aspsychody
namictheoryandsociallearningtheorycanbetrulyintegratedintoaviabletreatment
plan.Wouldnot,atleastinsomeinstances,thetenetsofthesetheoriesconflict and
predict different treatment or assessment strategies? Do not some strategies or
procedures based on theory "work" better than others? Defining "treatments that
work"is,ofcourse,acontentiousissueatthistime(Chambless,1995),andonethatis
noteasilyresolved.SilvennanandKurtinesaretobecommended forpresenting us
withthisfascinatingchallenge.TheballisinOUfcourt.
In sum, this is an excellent book. Clinicians and researchers alike will be
stimulatedbyitscrispandpenetratinganalysisofthe"realities"oftreatinganxious
andphobie children andadolescents.Wehaveignoredtheseyouthforfartoolong;
they deserve our concerted attention and energies. It iscomforting to know that
seasonedcliniciansandresearchers suchasSilvennanandKurtinesareaddressing
theproblemsoftheseyouth andtheirfamilies.Theyareingoodhands.
Thomas H. Ollendick
VirginiaPolytechnicInstitute
andState University
Blacksburg, Virginia
Foreword ix
REFERENCES
Charnbless, D. (1995). Training in and dissemination of empirically validated psychological
treatments:Reportand recommendations. TheClinicalPsychologist. 48.3-23.
s
King,N.J.,Harnilton,D.1.,&Ollendick.T.H.(1988).Children phobias:Abehaviouralperspective.
Chichester:JohnWiley& Sons.
s
Morris, R. 1., & Kratochwill, T. R. (1983). Treating children fears and phobias: A behavioral
approach.NewYork:Pergamon Press.
Ollendick.T.H.,&King,N.J.(1994).Diagnosis.assessment,andtreatmentofintemalizingproblems
inchildren:Theroleoflongitudinaldata.Journal0/ConsultingandClinicalPsychology. 62,
918-927.
Preface
This book is addressed to students and professionals in the mental health field
whoworkwithchildrenwhosuffer fromexcessivefearandanxiety.Inthisbook
wesharewithyousomeofourideasaboutwhatyoucandotoenhancethequality
oflife for these children and their families. Durideas about how treatmentcan
beusedtohelpchildrenwere refinedaspartofaprogramoftherapyandclinical
research that has been evolving atthe Child and Family Psychosocial Research
Centerat Florida InternationalUniversityinMiami. The centergrew outofour
earlierefforts to address the problem ofdeveloping effective interventions for
use with internalizing problems in children and adolescents. The center is
comprisedofanumberofprograms and laboratories andprovidesmultifaceted
childandfamilyinterventionsthatincludebothoutpatientandcommunity-based
services. The centerhas been actively involved in formulating and articulating
systematic and broad-basedapproachesto all types ofinterventionswith youth
and families, including both preventionandtreatment.
The techniques and procedures for helping anxious children described in
this book were refined as part ofthe activities ofthe Childhood Anxiety and
PhobiaProgram(CAPP)atthecenter.Withinthecenter,CAPPhasthedistinctive
missionofdevelopingandevaluatingapproachestoassessmentandintervention
specifictothephobic andanxiety disorders ofyouth.CAPPiscurrentlyconduct
ingtwoprojects involved inthe developmentofthisinterventionfunded by the
National Institute of Mental Health (#44781 and #49680), with other grant
applications under review or preparation for projects that seek to extend and
refine this intervention.
CAPP'sgoalofdevelopinginterventionstargeted atinternalizingyouth and
their families emerged from a persistent problem in the literature that has
considerable implications for both practitioners and researchers: Because chi1
dren andadolescentswith externalizingdisorders arelikely tohave adirectand
disruptive effect on the lives ofother individualsand institutions, these are the
youth who have been more likely tobe referred to mental health professionals,
and who have thus been the primary focus ofresearch attention. As a conse
quence, our conceptual and practical knowledge pertaining to internalizing
xl