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Philosophy: As a licensed psychologist since 1985, I have
a wide range of training and experience in dealing with numerous life
issues and mental health conditions, with a primary focus of providing
services for the child and adolescent population. Between 1985
and 1995, the problem areas most commonly dealt with in my practice
involved early trauma, including neglect and abuse; and
children/adolescents in foster care and in adoptive homes. This
focus led to interest in attachment issues. Since 1995, my
practice has increased in terms of the number of clients being
assessed and services provided for attachment issues and Attachment
Disorder. At the present time, the only new clients accepted
involve attachment-related issues and/or Attachment Disorder. Target
Population: The current client population involves children and
adolescents with attachment difficulties and/or Attachment Disorder.
Parental figures of children/adolescents with attachment difficulties
and/or Attachment Disorder are also involved in the client population.
Program/Practice Overview: The philosophy of the services
provided in my practice at Life Management Associates involves an
understanding of the importance of attachment in a child's overall
level of functioning and in terms of a child/adolescent's functioning
within a family system. Improving attachment skills and an
appropriate attachment relationship between a child and a parental
figure is a primary goal of treatment. Attachment is viewed as
the foundation from which other developmental skills can be attained.
Attachment-focused therapies focus on healing attachment disruptions
and early trauma, for a child to be able to lead a happier, healthier
and more productive life.
As parental figures for the child/adolescent are a vitally
important part in this process, services are also provided to parents.
Education, support and guidance, in terms of the most appropriate and
effective parenting strategies are provided, to allow parental figures
to provide therapeutic parenting. In this manner, parental
figures are viewed as part of the treatment team. In many ways,
my role is to facilitate attachment between the child/adolescent and
his or her parental figure, as well as providing a safe and secure
environment for the primary caregiving figure to be the most important
agent of change.
My philosophy is to provide appropriate and effective outpatient
attachment-focused psychotherapy utilizing a model of providing the
least restrictive and intrusive programming as is warranted for each
individual client and family system. Theraplay is frequently a
primary intervention particularly in the beginning stages of
treatment. Theraplay is a structured play therapy for
children/adolescents and their parental figures. The primary
dimensions of the Theraplay sessions focus on structure, nurture,
engagement, challenge and playfulness, which are all important
ingredients in a positive parent-child relationship. Once an
attachment has been established and/or repaired, it is often necessary
to provide services more directly related to early unresolved trauma.
Through the attachment and trauma treatments, additional therapeutic
modalities may be utilized to include narratives, EMDR, Emotional
Freedom Techniques, Internal Family Systems, role playing, journaling,
and principles consistent with Dyadic Developmental Psychotherapy and
the Nurtured Heart Approach.
Outpatient psychotherapy services include individual and family
therapy, with a focus on attachment building and resolution of
attachment issues. Theraplay is frequently the modality used as
a foundation for other services. Although we do not provide a
two week intensive program, this psychologist is willing to make
recommendations when appropriate and be involved in the treatment
during a two-week intensive program as needed, as well as providing
the after care psychotherapy is recommended.
Description of Services:
- Intake/Admission Progress. The appropriateness of a referral
to my practice is generally made with a brief telephone conversation
with the referral agency and/or parental figures. If it is
determined our services are appropriate, an appointment is scheduled.
If it is determined our services are appropriate, an appointment is
scheduled for a psychological assessment or psychological evaluation,
unless an assessment or evaluation has been previously made by another
mental health professional specializing in attachment difficulties
and/or Attachment Disorder. Appropriate releases, if necessary,
are obtained; for example, if a child is not in the legal
custody of the parental figure.
If it is not determined a referral to my practice is appropriate,
which can be due to insurance and/or financial issues, distance from
the client's home to our office or a level of treatment is necessary
which is not conducive with outpatient psychotherapy, a referral
would be made to a more appropriate treatment provider.
- Assessment Process. A psychological assessment and/or a
psychological evaluation (including intellectual measures) is the
first part of the admission process. As part of the
assessment/evaluation procedure, an in-depth clinical interview is
conducted with parental figures and with the child/adolescent as well.
Information obtained includes, but is not limited to:
developmental history, attachment history, medical history,
educational history, assessing symptoms related to emotional and
behavioral functioning, obtaining information regarding past or
current treatment history, including services provided, outcome and
medication, if applicable. Although the specific
assessment/evaluation tools can vary based on the age of the child,
history obtained, family dynamics, and the specific referral
questions, the following list includes some of the
assessment/evaluation tools which can be utilized: projective
measures - Draw-A-Person, House-Tree-Person, Draw-A-Family, Children's
Apperception Test, Thematic Apperception Test, attachment-related
tools such as the Marshak Interaction Method and checklists including
the Randolph Attachment Disorder Questionnaire, and the Behavior
Assessment System for Children-Second Edition; intellectual
measures - Wechsler Intelligence Scale for Children -IV, Peabody
Picture Vocabulary Test - III, Wechsler Adult Intelligence Scale -
III. Part of the assessment process involves either verbal
feedback regarding the referral questions and/or a written report,
depending on the circumstances.
- Treatment Planning. Based on the information
obtained from the psychological assessment/evaluation, a treatment
plan is devised, which in the most general sense recommends whether
attachment-based psychotherapy is warranted and if so, recommends a
modality of attachment-based psychotherapy which is felt to be most
appropriate and effective for the specific child/family.
Specific treatment goals are also delineated, which include
measurable goals. Regarding child clients, the treatment plan
is discussed with appropriate parental figures and/or agencies.
Agreement to the treatment plan is provided by written signature of
the appropriate parental figure and/or agency professional.
Specific verbal contracting with children depends on the type of
treatment utilized. However, treatment planning always
includes ensuring the least restrictive and intrusive level of
therapy, which is deemed appropriate and effective, be utilized.
Specific verbal contracting with child clients depends on the form
of psychotherapy and the specific needs of the child/family system.
With adolescent clients, the treatment planning procedure is more
direct. Treatment goals and procedures are discussed.
Depending on the age of the child and level of functioning, and if
the teen is 14 years of age or older, the adolescent will also be
involved in signing the treatment plan. Therefore, there is a
verbal and/or written contracting which occurs between the client
and therapist before any treatment begins.
- Treatment Techniques Used. Individual and/or family
therapy, including attachment building skills and/or resolution of
attachment issues can involve play therapy, art therapy, Theraplay
activities, journaling, along with a variety of therapeutic
techniques to be utilized to reach specific treatment goals.
The majority of our child/adolescent clients are referred for
Theraplay, which in our practice at Life Management Associates
involves a co-therapist model - one therapist assigned to work as a
primary therapist with the child/adolescent, with a second therapist
assigned to work with the parental figure to provide support,
education, parenting strategies, resolution of any individual issues
which may impair the attachment process, etc. Therapeutic
interventions can include cognitive techniques, therapeutic stories,
EMDR, Emotional Freedom Techniques, Internal Family Systems, role playing, principles associated with dyadic developmental
psychotherapy, and the Nurtured Heart Approach, etc., to assist the child/adolescent to reach
therapeutic goals personally and within the family system. If
the child/adolescent has been involved in a two week intensive
program and is referred to our agency for the after care, this
psychologist will follow the recommendations of the referring
agency.
Safety/Risk Management Plan: Before any psychological
treatment is begun, risk factors are taken into consideration during
the assessment/evaluation process. Our agency has a two-room
suite for attachment psychotherapy, in which parental figures are
either in the same room with the child/adolescent or are monitoring
the interaction between the child/adolescent and the therapist with
video/audio equipment. The majority of our attachment-based
psychotherapy is videotaped to ensure the safety of our clients and
of the therapist as well. The least restrictive, intrusive and
confrontational approach which is deemed appropriate and effective
will be utilized to ensure that the physical and emotional
well-being of all participants are being addressed. No client
is ever put in a situation which could be physically endangering.
Child/adolescent clients are always informed of the reason for any
therapeutic holding and any concerns which are appropriate,
regarding any of the participants, are addressed and resolved to the
best of the therapist's ability. Evaluation/Outcome/Follow-up:
During the course of psychotherapy, the treatment plan is
reviewed and appropriate additions and/or changes are made. At
times, progress is assessed by having the parental figures complete
once again checklists which were originally completed at the
psychological assessment/evaluation, such as the Randolph Attachment
Disorder Questionnaire, to determine whether or not progress is
occurring and in what areas. If appropriate progress is not
occurring, discussions between the parental figures and/or agencies
involved, and/or including the child/adolescent as deemed
appropriate, occur to determine whether or not additional services
and/or different strategies would be more appropriate and/or
beneficial. Referrals to outside agencies and/or other mental
health professionals are made as necessary. At the time of
discharge, an evaluation form regarding the services received is
sent to the parental figures for completion and the results are
reviewed by this therapist. Follow-up services in the form of
consultation, telephone calls, and/or returning to a form of
involvement in outpatient psychotherapy in the future are all
possibilities and are discussed at the time of closing the case.
Qualifications: Cheryl Walters has a Masters of Science
degree in Psychology from Millersville University (formerly
Millersville State College) from 1981. She obtained her
license to practice in the field of psychology in Pennsylvania in
1985. Her primary field of experience involves child and
adolescent issues. Specific attachment training and education
is as follows:
- 1994 - The Broken Connection: Attachment Theory and
Therapy - 6 hours
- 1995 - Seventh Annual Conference on Attachment and Bonding -
20 hours
- 1996 - Introduction to Theraplay - 21 hours
- 1997 - Filial Therapy - 6 hours
- 1997 - Intermediate Theraplay - 21 hours
- 1998 - Treating the Effects of Trauma in Adults and Children -
12 hours
- 1999 - Treating Attachment Disorders in Foster and Adopted
Children - 24 hours
- 2000 - 11th Annual International Conference on Attachment and
Bonding - 16 hours
- 2002 - Eye Movement Desensitization and Reprocessing - 17
hours
- 2003 - Attachment... From the Beginning - 20.5 hours
- 2004 - "Pathways to Healing: The Role of Attachment in
Families" - 22.5 hours
- 2005 - Childhood Developmental Disorders - 6 hours
- 2006 - Broken Attachments: Treating the Traumatized
Child - 5.5 hours
- 2006 - Developing Healthy Attachments - A Dyadic Developmental
Perspective - 12 hours
- 2006 - Trauma, PTSD, and Traumatic Grief - 6 hours
- 2007 - Transforming the Difficult Child - 6.5 hours
- 2008 - Enhancing Attachment: Strategies for Families &
Professionals - 6 hours
- 2008 - 20th Annual ATTACh Conference: Attachment:
Developing Connections/Changing Lives - 14.5 hours
- * This therapist has also been involved in five two week
intensive programs with referred clients at the Attachment Center
at Evergreen and Evergreen Consultants. During one of the
intensive programs, this therapist was involved in the therapist
training program.
Certified Theraplay Therapist. Member of Pennsylvania
Psychological Association.
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