Services

What sort of counseling services are provided by Dr. Knight?

Dr. Knight provides counseling services for a variety of difficulties most of which fall under the category of mood control. Services are provided for generalized, performance and social anxiety. Counseling for anger control, oppositional defiant behavior as well as depression is also offered. Dr Knight also has extensive experience in providing counseling for obsessive compulsive disorder (OCD). Counseling is also provided for older children to help gain a better understanding of their developmental difficulty such as Autism Spectrum Disorders (including Asperger’s Syndrome) ADHD and Dyslexia.

Counseling is also available for parents on how to deal with their child’s behavioral/development difficulty as well as family issues such as coping with divorce/separation and dealing with a child who has developmental difficulties.

Are the counseling sessions with my child individually or are parents involved?

Counseling sessions include a combination of time with both parent and child either individually or together. Parents are actively involved in understanding the counseling approach and helping the child to apply what they have learned in the sessions. Typically the parent is involved to some degree in each session especially with children in middle childhood or early adolescence. For older adolescents less time is typically spent with parents and child together but the parent is informed as to the goals and the degree of cooperation that the child is displaying as well as their progress towards achieving the goals.

What approach does Dr. Knight use in counseling?

Dr. Knight’ s approach is based around Cognitive Behavioral Therapy (CBT). CBT is an active, directive approach to counseling. It has excellent support in the research as one of the best therapeutic methods for mood control difficulties. An approach that utilizes parts of CBT called Cognitive Strategy Instruction can also be used to help children that have attention problems.

CBT focuses on teaching the child about the nature of their difficulties and motivating them to take an active role in addressing whatever issue they may have. In contrast to other counseling methods CBT is focused on the present, has specific goals and time limits and is very problem-solving oriented. The ultimate goal of CBT is to teach the child specific skills for managing their mood and emotions that can be applied as they move through their life and face difficult situations. When the child has demonstrated that they understand the techniques it is then emphasized that practice, effort and attention to the problem are needed to manage difficulties as they occur.

The basic idea behind cognitive behavioral therapy is that our thoughts and perceptions have a major determining factor in how well we can control our mood when faced with challenging life situations. Typically a person with mood control difficulties can have some distorted perceptions and over exaggerate or over focus on their negative thoughts and emotions and this in turn makes their mood go in the wrong direction (more anxious, more angry, more depressed). For example, A typical child may approach a difficult academic task and say to themselves ”Well this is difficult, it’s going to take a lot of time and it’s kind of boring, but I’ve got to try and do the best I can”. A child with a lot of anxiety may be thinking ”This is just too hard, I’ve got to do it just right, if I don’t do well everyone will notice and my parents will feel disappointed”. So it is not necessarily the situation that makes the child or any person feel the way they do it’s how they are thinking about it and what they run through their head that can make their mood go one direction or the other.

When a person starts to feel excessively anxious, depressed or angry their thought patterns may be unrealistic and excessive. CBT helps A person identify the situations that lead to distorted thoughts and self talk and understand why it is wrong and leads to more difficulty controlling emotions. They are then taught more logical thinking and self talk when they face situations that might make them more anxious, depressed or angry. They are also taught that positive outcomes will result from making an effort to change the way they think when they get in situations that provoke difficulties with mood control as well as what will happen if they continue to engage in distorted thinking.

If the child can learn to control their thought patterns in a more realistic way, it will hopefully result in them feeling better and having reduced time that they have problems controlling their mood. The emphasis is on consistently problem-solving and trying to change behavior. The child is also made aware that excessive worrying, anger etc. takes time away from more enjoyable activities in life. Writing things down is always involved in CBT. In some cases the child will do the writing, but in most cases Dr Knight will ask questions and help the child identify scenarios that cause mood control difficulties, talk about what sort of self talk the child is engaging in at that time, and then discuss what is a more rational, adaptive and generally better way to think and respond. Dr. Knight may do the writing for the child but after the session there is usually a written summary of what the child has learned that is reviewed with parents. The child is also consistently reminded that both parents and Dr. Knight appreciate the fact that they acknowledge that they have some difficulties and are willing to make an effort to work on them. It is emphasized to the child that the main expectation is that they try and that no one expects them to be perfect. What is expected is effort and attention to address the problem.

How old does my child have to be to benefit from CBT?

Children as young as 7 can be taught to use some of the methods in CBT to help control their mood and emotions. Most of the children that Dr Knight sees are at least 8 years old with the majority being in the 10 to 18-year-old range. Dr. Knight also sees young adults with mood control difficulties. A child needs to have at least an average IQ in most cases to benefit from CBT as it does take a reasonable level of receptive and expressive language skill. Children with significant cognitive disabilities (moderate learning difficulties) or serious language problems may not benefit from CBT.

How many counseling sessions will be needed?

The amount of sessions that are necessary to address a specific difficulty in controlling mood is variable, but most of the time a total of 3 to 10 sessions (one session per week) with follow-up booster sessions (typically on a monthly or bimonthly basis) is an appropriate amount of time that hopefully results in some positive behavioral change. In some cases 3 to 5 sessions is all this necessary to teach the child and parent the basic skills and then provide follow-up booster sessions as needed. There is of course no guarantee that counseling will be effective. All children respond differently, but in most cases there is some degree of positive change. Dr. Knight will discuss the child’s progress with parents openly and give an opinion as to whether or not it is a good idea to continue the sessions.

What happens before counseling begins? Is some assessment necessary?

Prior to starting any counseling sessions some assessment of the child will be completed. In many cases Dr. Knight has already completed a comprehensive psychological evaluation. In other cases a one hour consultation with parents to gather background information, get a good definition of the problem and outline the basics of the counseling approach is all that is needed. The amount of assessment necessary will be discussed with parents during the first consultation.

What are some details of the content and procedures for a typical counseling session?

After it is established that the child will participate in counseling the procedure is as follows:

Session 1 and 2

For children that are in middle childhood or early adolescence part of the first session would be a meeting between Dr. Knight, parents and child. Dr. Knight will have given the parents a script of the questions that they will be asked. This is basically getting them to talk about strengths of the child and giving examples of when the child has been able to manage their mood appropriately when faced with a difficult situation. Parents are also asked to give some examples of how they manage their mood in difficult situations utilizing self talk to adjust their thinking. Then the hard part comes, where parents are asked to directly state what they would like their child to learn as a result of counseling sessions. This is crucial to help establish goals.

For older adolescents the parent may not be involved in the first session if the child is uncomfortable with that. However, Dr. Knight communicates to the child that he will be talking to the parent about the goals of the counseling and whether or not the child is taking an active part in being cooperative and trying to problem solve. Some level of confidentiality is maintained with older adolescents to maintain rapport.

During the first and subsequent sessions part of the process is establishing rapport with the child, outlining the basics of CBT and setting up goals. During the sessions the child will be asked to identify situations in which they might feel excessive difficulty with mood control and what sort of self talk or thinking they may have. Then the child is asked to come up with some strategies ”Attitudes and actions that will help” to address the difficulty. This is when instructions are provided of a better way to think that will keep a persons mood from going in the wrong direction and the positive consequences they will experience if they can learn to utilize the strategies that are taught.

How fast a child is able to move through the above problem-solving steps is variable. Every child is different in how willing and able they are to problem solve in the above manner. However, typically Dr. Knight is able to teach the child and parents the basics of CBT and get through at least one or two problem-solving scripts that will help them to try and think about things differently in order to manage their mood.

Sessions 3 and beyond

Basically the child and parents are asked to identify situations that are causing mood control difficulties on an ongoing basis and discuss and problem solve various ways to address those difficulties as outlined above. Feedback and motivation for the child to continue to make progress are provided. Increasingly the child is asked to demonstrate more independence in going through the various steps of identifying situations that cause mood control difficulties, identify the irrational thought patterns that lead to these difficulties and figure out better self talk and thought patterns that will lead to better control of mood. This is guided by Dr. Knight and reinforced by parents.

CBT sounds very directive and requires my child to have a lot of insight, maybe he/she is too young and immature?

The basics of CBT are the same for a child whether they are age 7 or 18, or even for adults. Dr. Knight adjusts the language and methodology such that it is appropriate for the developmental level of the person that is receiving the counseling.

How long has Dr. Knight been providing counseling service and using CBT?

Dr. Knight has been practicing psychology since 1989 and has thousands of clinical hours, providing CBT to children and adolescents as well as adults.

If I want my child to participate in counseling how do I talk to them about it?

Basically you would present Dr. Knight as a person who has some expertise or knowledge about how to help people get along better in life. There will need to be some direct conversation between parent and child about the difficulties that need to be worked on. If a child is initially resistant parents can present it as something that they would just like the child to try and if they really don’t like it afterwards they don’t need to continue. It is also important to emphasize that you as a parent are also looking at counseling as a way for you to learn how to do things in a more positive way to make the whole family function better. Again, the approach the parents take will vary based on the age of the child and the overall level of motivation that the child displays for participation in counseling. Dr. Knight will give advice to parents on some specifics of how to handle talking to the child about participating in the initial consultation session.

Summary

As you can see, CBT is a fairly directive straight forward approach to counseling. It is one of the few counseling approaches that actually has a proper scientific research base establishing it as a method that can really work. In the Dr Knight’s clinical experience there is usually some positive effect. However, it may not be appropriate for all children and may not have the positive therapeutic approach that parents or the child expect. The other thing that can happen is that children learn the skills, but may not apply them consistently and effectively. However, when they get older and experience difficulties and need to participate in CBT again, they can most likely learn the methods faster and apply them more effectively.