Developmental issues and considerations in research and practice. In Weisz, J.R. & A. E. Kazdin (Eds) Evidence-based psychotherapies for children and adolescents

In this reading what I found particularly cogent were two ideas: that treatments are not necessarily designed with adolescents in mind and that targeting mediators instead of symptoms can be an effective way of treating an individual when dealing with adolescents or young people. This article spends a significant amount of time focusing on the developmental level of an individual and whether or not that is taken into account when the treatment modality is both chosen and applied. Tailoring the treatment to the developmental level of the individual feels a common sense solution but may not always be systematically applied.

When I see new clients I always take into account where the client is in their life and how understand or do not understand ideas that we discuss, essentially assessing where their cognitive functioning is as a means of basing the types of concepts we undertake in session. This, however, does not indicate treatments tailored specifically to their developmental level, only, as the article reiterates several times, an adaptation of an existing treatment modality. The most striking example of this may be CBT and the cognitive functioning necessary to produce favorable results at the end of treatment.

I did not have a real understanding of what the difference was between a mediator and a moderator. But targeting mediators, after reading more about what they are and how they can impact a client, seems like a practical and logical extension of therapy. With adolescents in particular, focusing treatment at least in part on working on developmental tasks that play out in their symptoms could be particularly helpful. A client I currently have comes to mind, who, despite being far removed from the adolescent age group at 31 years of age, missed out on a significant portion of her childhood with the way that her parents raised her. She was never able to experience what it was like to be a carefree child due to the pressures that were exerted on her life. In our sessions, we look back at some of the tasks and experiences that she missed out on with regard to social situations and interacting with strangers that she never understood because she was never allowed to experience them.

The simple notion from Piaget (1972) that adolescence is when formal operational thinking first emerges resonated with me. To describe thinking as operational feels right because as we move through adolescence, we begin to operate as individuals making decisions for ourselves instead of simply doing what our parents prescribe. Formalizing those operational processes as the point at which we transition from childhood to adolescence seems appropriate and further accepting that this transitional point may bring with it exacerbated symptom expression furthers the notion that working at the mediators within a clients life may have more of an impact on the symptoms than working at the symptoms directly. I also appreciate the nature of such a therapeutic intervention where the treatment is roundabout instead of hitting the symptoms head on.