Prelimary considerations in psychotherapy with retarded children

Journal of School Psychology 1971 • Vol. 9, No. 1

P R E L I M A R Y CONSIDERATIONS IN PSYCHOTHERAPY WITH R E T A R D E D C H I L D R E N BARBARA

I. SELWA

University of Northern Iowa

Summary: Psychotherapy for the retarded child with emotional problems may be the responsibility of the school psychologist. Because the literature dealing with the most profitable techniques and procedures is sparse, an overview of the special needs and characteristics of retarded children has been made. The child brings a language deficit, emotional attitudes related to retardedness and social experiences to the therapeutic situation. Group and individual therapy are discussed with suggestions for successful implementation. When diagnostic information reveals a disturbed and intellectually handicapped child, the school psychologist may refer him to a community treatment center, or in a number of school systems, he may administer psychotherapy himself. Research to determine the best procedures and techniques to be implemented in psychotherapy with retarded children has largely been neglected. A few studies have indicated therapy success with retardates, both in individual and group settings. Social skills have been improved through such activities as dance therapy (Goodnow, 1968) and therapy workshops involving ceramics, electrical processes, and weaving (Tincolini, Talamucci, & Bonistalli, 1968). But, to date, exploration of the needs peculiar to retarded children in the psychotherapeutic situation is scarce. Some preliminary aspects and guidelines, however, can be brought to light through investigation. In the main, mentally retarded children experience the same emotional and social problems as other children, such as sibling rivalry, puberty onset, parental pressures, etc. The retardate, however, has less intelligence to cope with his difficulties. Also he brings certain elements to the therapeutic situation that are not present in other children-qualities which are unique to his less than normal intellectual level. Special characteristics may arise from the retardation itself. The retardate may be brain damaged and hyperactive, or he may be a docile mongoloid. If his mental capacity is extremely low, his insight in the therapy process will be suppressed. The retardate also suffers from a deficit in conceptual and organizational language (Beier, Starkweather, & Lambert, 1969), and his word-defining ability tends to be less developed than his word-recognition ability (Allen & Wallach, 1969). He also has difficulty abstracting unless specific verbal mediators are present (Kirk & Bluma, 1963). The retardate thus tends to be concrete, here-and-now oriented, and he must deal less symbolically and abstractly with his emotional problems. 12 J o u r n a l of S c h o o l P s y c h o l o g y , V o l u m e 9, 1 9 7 1

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Obviously, then, psychotherapy, if it is to provide the necessary' learning opportunities, must contain concrete situations and elements. Language and therapist-child interaction must proceed only within the verbal comprehension range of the individual retardate. As materials are provided to aid academic learning in the special education classroom, so the therapist in many cases may utilize clay', painting, and/or drawing to bring out the child's aggressions, fears, and conflicts. Toys such as dolls or puppets may be given, even to teenage retardates, to help them dramatize problems and act out unfullfilled hopes. The intellectually handicapped child also brings emotional elements to the therapeutic situation which are unique to his ~etardedness. Each retardate has feelings and attitudes about his limitation and its effect u p o n him and his family. The familial or parental reactions to his restricted capacity are paramount. The child may have experienced rejection when it was learned that he would never function as well as his siblings. Some parents may have intensified inabilities through overprotection and permissiveness. Other parents may flatly deny the existence of retardedness and refuse to accept their child as "different." Because psychotherapy will be ineffective if the environment remains unchanged to include the child's new learning, it often becomes necessary to extend sessions to the parents. Understanding of the retardate's vocational and academic limitations may be fostered by family meetings with the therapist to air emotions and gain insight into various training programs available. When feasible, therapy groups composed of parents of retarded children can be organized to promote supportive sharing of experiences and expression of common feelings. Parental acceptance of the retarded child as he is, with potentials as well as deficiencies, should be stressed by the therapist in such work with families and groups in a non-threatening and congenial setting. Some special elements are brought to psychotherapy because of the retarded child's encounter with social expectations and reactions. Well-meaning adults may pour out sympathy, distorting the child's sense of reality. His normal peers may view him with pity and curiosity at first, then with indifference and intolerance (Preininger, 1968). Usually, children of average or higher intelligence will find him an uninteresting and dutl playmate. He may look "'funny" and be teased or laughed at. His self-concept may thus be severely depressed, and he may n o t be capable of understanding why people respond to him as they do. When the child has had such defeating social experiences, group therapy can be beneficial. The individual's greatest need, here, is to build self-confidence and appropriate behaviors with others. Like any group therapy member, he must gain insight into his own feelings and thoughts, and what others think and feel about him. Therapy goals should center on his seeing himself as a person worthy of affection and acceptance from others, even though he is restricted intellectually. He needs to learn that he can function effectively, and that there are other children at his level. Establishing a therapy group of disturbed retarded children may pose some Journal o f S c h o o l P s y c h o l o g y , V o l u m e 9, 1971

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Barbara I. Selwa

difficulty. The therapist must contemplate the effects each candidate will have on the others. Shy, withdrawn children should be balanced with outgoing extroverted types; impulsive acting out children should have stable, calm counterparts. If the group is dominated by one personality type or another, the group's direction may produce undesirable effects. In general, a blending of personality types best stimulates emotionally charged interchanges. Certainly, there are children who would n o t fit practically into any group; such children need individual psychotherapy. Decisions must also be made as to the non-personality criteria for grouping. Retardates of the same chronological age may differ markedly in mental maturity. IQ has been found to influence play behavior significantly within chronological age range (Capobianco & Cole, 1960), and homogeneity in intellectual level might therefore be a prime consideration in selection of group participants. Children with physical handicaps such as brain damage or epilepsy should be selected carefully and added only when they will promote the flow of emotional interactions and healthy group process. Such factors as sex, socio-economic background, race, and religion should also be considered. The therapist also brings unique elements to the group or individual therapy situation. His attitudes can be critical in determining the outcome. If he is to aid the child and his family, he must believe that retardate-therapy is a promising endeavor, and he must provide an atmosphere of hopefulness and positiveness. The retardate's improvement may be slower than that of normal-intelligence children, and there may be more setbacks. The therapist has to set goals which are realistic for the particular children with whom he is involved. After the school psychologist has engaged retarded children in psychotherapy, it is important that recommended changes of school environment for therapeutic reasons be carried out. The psychologist can consult with teachers, administrators, and others to promote maximum benefit for each child. Such members of the school staff should be encouraged in the thought that psychotherapy with the retarded can produce beneficial results, and that they can aid the child's well-being by accepting and rewarding optimistic new behavior. REFERENCES

Abel, T. Resistances and difficulties in psychotherapeufic counseling of mental retardates. Journal o f Clinical Psychology, 1953, 9, 9-11. Allen, R. M., & Wallach, E. S. Word recognition and definition by educable retardates. American Journal or Mental Deficiency, 1969, 73(6), 883-885. Beier, E. G., Starkweather, J. A., & Lambert, M. J. Vocabulary usage of mentally retarded children. American Journal o f Mental Deficiency,1969, 73(6), 927-934. Capobianco, R. J., & Cole, D. A. Social behavior of mentally retarded children. American Journal of Mental Deficiency, 1960, 64, 638-651. Clawson, W. B., & Schlanger, B. B. Oral vocabulary responses of educable mentally retarded adolescent boys in a dyadic situation. Exceptional Children, 1968, 34(10), 761-762. Goodnow, C. C. The use of dance in therapy. Parsons State Hospital Tal Training Center, Kansas, Bulletin, 1968, 5(4), 9%102. Journal of School Psychology, V o l u m e 9, 1971

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Kirk, S. A. & Bluma, W. B. (Eds.) Behavioral research on exceptional children. Washington: Washington Council for Exceptional Children, NEA, 1963. Michal-Smith, M., Gottsegen, M., & Gottsegen, G. A group technique for mental retardates. International Journal of Group Psychotherapy, 1955,5, 84-90. Preininger, D. R. Reactions of normal children to retardates in integrated groups. Social Work, 1968, 13(2), 75-77. Thorne, F. C., & Dolan, K. M. The role of counseling in a placement program for mentally retarded females. Journal of Clinical Psychology, 1953, 9, 12-15. Tincotini, V. G., Talamucci, G., & Bonistalli, E. I1 problema degli insufficienti mentali mediogravi: Metediche di addestiamento al lavore. Rivista di Neurobiologia, 1968, 14(1), 105-108. Yepsen, L. N. Counseling the mentally retarded. In J. F. Magary (Ed.), School psychological services. Englewood Cliffs, N. J.: Prentice-Hall, 1967. P. 409. Mrs. Barbara I. Selwa

204 Cedar Crest Drive Cedar Falls, Iowa 50613 Received: March 21, 1970

Journal of S c h o o l Psychology, V o l u m e 9, 1 9 7 1