What is Evidence-Based Therapy?

In the late 20th century, "therapy" was a loaded term with meaning that was not well-defined or understood. As a result, many have come to fear "therapy" as a form of subconscious or psychic manipulation that will alter one's mind and person in ways that will fundamentally change a person without their consent.

Today, licensed therapists and psychologists are generally trained and often certified in evidence-based therapies -- modes and methods of mental and emotional work with individuals, families and couples that have been shown to be helpful through rigorous statistical measurement. Thankfully, many therapeutic interventions and theories have been disproven as a result of statistical inquiry. 

Researchers measure evidence of a particular therapy's effectiveness by measuring patients' symptoms and symptom severity at the beginning of intervention, and then measuring the positive, neutral, or negative changes that have been made through the course of the interventions.  The mathematical rigor of statistics provides researchers opportunities to discover whether there was any truly helpful change. Once inquiry is complete, researchers publish their findings for the rest of the helping community to review, assess, and learn from their findings.

Methods Built on Research

Over the last ~100 years, psychological theories developed through research with children, teens, adults, and families have provided a foundation for present-day evidence-based therapies. These theories include attachment theory, family systems theory, polyvagal theory, negativity-bias, and developmental theory. However, not all theories proposed over the last century have been accepted by the helping community.

One examples of a disputed theory is Sigmund Freud's psychosexual development theory. There are few proponents of Freud's theories and methods today. Most modern, well-trained clinicians do not ascribe to 'Freudian' psychology as a whole. However, Freud did have some generally-accepted ideas which are consistent with other well-established and accepted  theories, such as psychological defenses, psychological states, psychological transference, and developmental stages. A competing and well-accepted theory is Erik Erikson's psychosocial developmental theory, based upon his research with children and families, which provided the foundation for Human Development science today.

Are Faith and Therapy Opposed to One Another?

Many faith-based licensed clinicians and programs use evidence-based therapies because they are built from the perspectives of  attachment theory, polyvagal theory, family-systems theory, or negativity-bias theory, among others. These underlying 'theories' are considered by most faith-based clinicians to be consistent with their worldview. Faith-based training institutions generally  teach their clinical trainees these modes of therapy from a faith-based perspective.

Generally-Accepted Evidence-Based Therapies

• Acceptance and Commitment Therapy (ACT)

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavioral Therapy (DBT)

• Emotionally Focused Therapy (EFT)

• Dyadic Developmental Psychotherapy (DDP)

• Trust-Based Relational Intervention (TBRI)

• Motivational Interviewing

• Solution Focused Therapy (SFT) and Solution Focused Brief Therapy (SFBT)

• Eye Movement Desensitizing and Reprocessing (EMDR)

• Somatic Therapy

• Polyvagal Stimulation

• Equine Assisted Psychotherapy (see EAGALA)

• Animal-Assisted Psychotherapy

• Sand Tray Therapy

• Play Therapy

Evidence-Based Neurological Assessments

• Cereset

• Brain Balance

• Amen Clinics Brain Scan

• qEEG

• MRI Brain Scan

Developmental Trauma Models of Therapy

Dyadic Developmental Psychotherapy (DDP)

🔗 https://www.ddpnetwork.org

Dyadic Developmental Psychotherapy (DDP) is a therapeutic approach primarily used for children who have experienced trauma, particularly those who are in foster care, adopted, or otherwise have a background of neglect, abuse, or trauma. The method was developed by Dr. Daniel Hughes, a clinical psychologist who specializes in the treatment of children with attachment and trauma disorders.

Here are some key features of DDP:

1. Focus on Attachment: DDP strongly emphasizes building and improving attachment relationships. The therapy is based on the theory that healthy development, particularly emotional and psychological development, depends highly on secure attachment relationships.

2. Attunement and Reflective Dialogue: The therapist helps the child explore and understand their emotions and thoughts through reflective dialogue. This involves the therapist being attuned to the child's emotional state and responding in a way that makes the child feel understood and supported.

3. Creating a Safe Space: DDP aims to create a safe and nurturing environment where the child feels comfortable exploring their emotions and experiences. This safe space is crucial for the child to work through trauma and build trust.

4. PACE Approach: DDP utilizes the PACE approach, which stands for Playfulness, Acceptance, Curiosity, and Empathy. This approach helps build a connection with the child and encourages open and honest communication.

5. Family Involvement: DDP often involves family members in therapy, particularly parents or primary caregivers. This ensures that the child's primary attachment relationships are strengthened and that parents/caregivers can provide the necessary emotional support.

6. Trauma-Informed Care: The therapy is informed by understanding how trauma affects the brain and development. It uses this understanding to guide interactions and interventions with the child. DDP is used not just for individual therapy with the child but also in guiding parenting practices, family therapy, and training for caregivers and professionals. It's recognized for its effectiveness in helping children with disrupted attachments and traumatic experiences develop healthier relationships and emotional well-being.

Teaching Family Model

🔗 https://www.teaching-family.org

The Teaching-Family Model is a philosophy and methodology for helping troubled youth and their families. This approach originated in the late 1960s and early 1970s as an alternative to the traditional institutional care for children and adolescents with emotional, behavioral, or social difficulties.

Here Are Some Key Features of the Family Teaching Homes Model:

1. Home-Like Setting: The program is typically delivered in a family-like setting, often in a residential home, where a small group of youth live together. This environment is designed to simulate a healthy family dynamic.

2. Teaching Parents: Professional caregivers, often called "teaching parents," live with and care for the youth. These individuals are trained to provide therapeutic care and to teach social, academic, and life skills.

3. Structured Environment: The model emphasizes a structured environment with clear rules and expectations. Behavior management techniques are used to encourage positive behaviors and discourage negative ones.

4. Focus on Relationships: Strong emphasis is placed on building healthy relationships among the youth and between the youth and their caregivers. This focus on relationships is critical to promoting emotional and behavioral change.

5. Individualized Care: Each child or adolescent receives individualized care and attention based on their needs and challenges.

6. Family Involvement: The model often involves the youth's family to improve family dynamics and relationships. This may include family therapy or training sessions for parents.

7. Skills Training: An integral part of the model is teaching life, social, and academic skills to help youth succeed in society.

8. Long-Term Support: The model often includes long-term support, even after the youth has left the program, to ensure ongoing success and adjustment.

9. Evidence-Based: The Teaching-Family Model is research-based and is effective in numerous studies. It is recognized for its positive outcomes in reducing problem behaviors and improving emotional and social functioning.

This model has been widely adopted and adapted in various settings, including group homes, foster care, and schools, and continues to influence approaches to youth care and treatment.

See Accredited Teaching-Family Model Programs:

🔗 https://www.teaching-family.org/accredited-agencies

Trust-Based Relational Intervention (TBRI)

🔗 http://empoweredtoconnect.org

Trust-Based Relational Intervention (TBRI) is an evidence-based approach to caring for children with a history of trauma, neglect, or challenging behaviors. TBRI was developed by Dr. Karyn Purvis and Dr. David Cross at the Karyn Purvis Institute of Child Development at Texas Christian University. It is grounded in Attachment Theory and neuroscience. It emphasizes creating safe, nurturing, and predictable environments for "children from hard places."

The Core Principles of TBRI include:

1. Connecting Principles: These focus on building and maintaining relationships through healthy attachment. This includes mindful awareness, playful engagement, and quality attention to the child's needs.

2. Empowering Principles: These are designed to help children regulate their behavior and emotions. It involves strategies like meeting physical needs (such as hunger, thirst, and rest), sensory processing, and creating safety routines.

3. Correcting Principles: These principles are about guiding and teaching desired behaviors respectfully and effectively. They include proactive strategies to prevent undesired behaviors and responsive approaches to address them when they occur.

TBRI is widely used in various settings, including foster care, adoptive homes, schools, and therapeutic settings. It's particularly effective for children from 'hard places' – those who have experienced adverse childhood experiences (ACEs). The intervention seeks to rebuild trust, help children feel safe, and develop the necessary skills for healthy emotional and social development.

TBRI focuses on the caregiver's role and encourages caregivers to be aware of their emotional responses and maintain a balanced approach of nurturing, engaging, and firm yet respectful.

See the Interactive Database for TBRI. Clinicians and Therapists

🔗 http://www.child.tcu.edu/resources

Sexual Trauma Therapy for Children

Therapy for children who have experienced sexual trauma is a compassionate and specialized field. It involves a range of therapeutic approaches tailored to the child's age, developmental stage, and the specifics of their trauma. The primary goal is to help the child heal and develop healthy coping mechanisms and regain a sense of safety and trust.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This approach is widely used and evidence-based. TF-CBT helps children process trauma and learn coping skills to deal with the distressing thoughts and feelings related to their trauma. It typically involves both the child and their caregivers.

Play Therapy: Play therapy can be highly effective, especially for younger children who may not have the words to express their feelings or understand what happened to them. Therapists use play to help children process their emotions and experiences in a safe, controlled environment.

Eye Movement Desensitization and Reprocessing (EMDR): EMDR is another evidence-based therapy often used. It involves the child focusing on trauma-related imagery, thoughts, emotions, and body sensations while simultaneously experiencing bilateral stimulation (typically eye movements), which is believed to reduce the power of emotionally charged memories of past traumatic events.

Art Therapy: Like play therapy, art therapy allows children to express their feelings and thoughts through creative activities. This can be particularly useful for those who struggle to verbalize their experiences.

Family Therapy: Sexual trauma affects not only the individual child but also the family system. Family therapy can be crucial in rebuilding trust, improving communication, and providing support within the family.

Group Therapy: In some cases, group therapy can be beneficial, especially for older children or adolescents. It provides a space to connect with others who have had similar experiences, reducing feelings of isolation and stigma.

Psychopharmacology: Sometimes, medication might be used as part of the treatment plan to manage symptoms of depression, anxiety, or PTSD that can accompany trauma. This is used in conjunction with therapy.

Mindfulness and Relaxation Techniques: These techniques can help children manage anxiety and stress responses, which are common in those who have experienced trauma.

Safety and Stabilization: This initial phase of therapy focuses on ensuring the child's safety, establishing trust, and stabilizing emotions. The therapy needs to be conducted by a credentialed mental health professional with specialized training in working with children who have experienced sexual trauma (see CSAT – Certified Sexual Addiction Therapists are trained in sexual trauma therapy).

The therapist should create a safe, non-judgmental, and supportive environment for the child. Collaboration with other professionals, such as pediatricians, teachers, and child welfare personnel, is often part of a comprehensive treatment approach. Parents or caregivers also play a crucial role in the therapy process, providing support and stability at home.

To find a CSAT, see the IITAP Foundation – 🔗 https://iitap.com

Expressive Therapies

Expressive therapies offer a valuable approach to helping children with RAD or DSED by providing alternative ways to express thoughts, feelings, and experiences that may be difficult to communicate verbally. These therapies can play a crucial role in the treatment and support of children facing these attachment disorders by fostering emotional expression, building trust, and developing healthier relationships.

Why Expressive Therapy Helps

1. Facilitates Emotional Expression

Children with RAD or DSED often struggle with expressing their emotions and experiences in words in healthy ways. Expressive therapies, such as art, play therapy, or music therapy, provide a non-verbal medium through which children can explore and express their feelings, often leading to significant therapeutic breakthroughs.

2. Builds Trust and Safety

Engaging in creative activities within a therapeutic setting can help create a sense of safety and predictability for children with attachment disorders. Over time, the therapeutic relationship developed through these activities can help build trust towards adults, a critical step for children with RAD or DSED.

3. Improves Self-Esteem and Self-Understanding

Participating in expressive therapies can help children gain a sense of  accomplishment and self-worth. As they engage in creative expression, they learn more about themselves, their preferences, and their abilities, which can contribute to a stronger sense of identity.

4. Develops Social Skills

Specific expressive therapies involve cooperative and interactive elements, like drama therapy or group music sessions. These settings can encourage children with DSED to engage in more appropriate social interactions and learn the value of meaningful relationships while also helping children with RAD observe and practice social cues in a safe environment.

5. Regulates Emotions

Expressive therapies provide an outlet for intense emotions in a controlled setting. Activities like dance, movement therapy, or therapeutic drumming can help children constructively channel their energy and emotions, promoting emotional regulation skills.

6. Encourages Attachment and Bonding

By engaging in expressive therapies with caregivers or therapists, children with RAD or DSED experience positive, supportive interactions that reinforce the concept of secure attachment. For example, equine-assisted therapy can mirror care, trust, and communication, which are fundamental to healthy relationships.

7. Addresses Trauma

Many children with RAD or DSED experienced trauma or neglect. Expressive therapies can be particularly effective in trauma treatment, as they allow children to process traumatic events indirectly through symbolic expression, reducing the risk of re-traumatization.

8. Enhances Communication Skills

Although primarily non-verbal, expressive therapies can enhance verbal communication over time. As children become more comfortable expressing themselves creatively, they may find it easier to verbally articulate their thoughts and feelings in therapy and other settings.

Expressive therapy is tailored to the individual's interests, needs, and therapeutic goals. A multidisciplinary approach, incorporating diverse types of expressive therapies and more traditional therapeutic interventions, can offer a comprehensive treatment plan that addresses the multifaceted needs of children with RAD or DSED.

What are the Different Types of Expressive Therapies?

1. Art Therapy: Utilizes drawing, painting, sculpture, and other forms of visual art creation to help adolescents express themselves. Art therapy can uncover thoughts and feelings that adolescents may not be able to articulate verbally.

2. Music Therapy: Involves using music—such as playing instruments, singing, writing songs, or listening to music—to express emotions and improve mental health. Music therapy can help adolescents with emotional expression, stress reduction, and self-esteem.

3. Dance/Movement Therapy: Uses movement to help adolescents express themselves and process emotions. This therapy can be particularly beneficial for those who find verbal communication difficult, as it emphasizes body movement as a form of expression.

4. Drama Therapy: Involves role-play, storytelling, and theatrical performances as therapeutic activities. Drama therapy can help adolescents explore their identities, express feelings, and resolve personal issues through the enactment of scenes and stories.

5. Creative Writing Therapy: Encourages writing as a form of therapy, including poetry, stories, journals, and other written forms. Writing can offer adolescents a private space to express emotions, explore thoughts, and work through issues.

6. Phototherapy: Uses photography as a means of expression and exploration. Adolescents can capture images that reflect their thoughts, feelings, and perspectives, which can be used as a basis for discussion and analysis in therapy.

Brain Technology Therapies

Neurofeedback

Neurofeedback has been explored as a treatment for a variety of conditions, including ADHD, anxiety, depression, epilepsy, and insomnia. It is based on neuroplasticity, the brain's ability to reorganize itself by forming new neural connections throughout life. Neurofeedback aims to help the brain function better by encouraging specific brainwave patterns.

Neurofeedback, or EEG biofeedback, is a therapeutic intervention that provides immediate feedback from a computer-based program that assesses a client's brainwave activity. The process involves measuring the brain's electrical activity using sensors placed on the scalp. This real-time feedback helps individuals learn to regulate and control their brain functions.

Brainspotting

Brainspotting is used for the treatment of trauma, including post-traumatic stress disorder (PTSD), as well as anxiety, depression, and other mental health disorders. It is also employed to improve performance and creativity in sports and the arts. Practitioners of brain spotting assert that it can provide a deep and powerful therapeutic process, often quicker than traditional talk therapies.

Dr. David Grand developed Brainspotting Techniques in 2003. Brainspotting says that where you look affects how you feel. Brainspotting is based on the observation that distinct positions of the eyes can bring forward different emotions and feelings from the brain.

The therapy works by identifying "brainspots," or eye positions, which correlate with emotional and physiological stress and trauma. A brainspot is a point in the visual field that helps access unprocessed trauma in the subcortical brain.

Cereset

Cereset's approach involves using non-invasive sensors to mirror the brain's electrical activity back to itself through sound. This process supports the brain's natural ability to reset and rebalance its rhythms without requiring drugs or invasive procedures.

The mirrored brainwave frequencies are delivered to the client through headphones, and the brain is believed to use these sounds as a mirror to see itself in action. By reflecting the brain's activity to it in this way, Cereset aims to help the brain recognize its imbalances and work towards correcting them.

qEEG

qEEG is a valuable tool in neuroscience research, offering insights into brain function and the neural correlates of cognitive processes and disorders. By providing detailed information about brain function, qEEG can assist in tailoring treatments for psychiatric and neurological conditions. It can also be used to monitor the effectiveness of interventions over time, including medication, neurofeedback, and cognitive therapy.

Brain MRI