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Therapeutic approaches

Children and young people with BESD often have complex conditions or identified mental health difficulties and, in many cases, will respond well to therapeutic interventions. Occasionally, there may be a need for several therapies to be applied alongside each other. This unit examines a range of therapeutic approaches that can help pupils with BESD.

It gives an overview of the various approaches and considers:

  • Who can deliver therapeutic approaches.
  • The professionals involved in delivering therapeutic approaches.

This mind map represents the structure of local CAMHS teams. It includes the standard complement of CAMHS members, as well as additional members that your local team may include. Select a team member to find out more.

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CAMHS

  • Psychiatrists

    These are medically trained doctors who specialise in the treatment of mental and socio-emotional health disorders. They often further specialise in specific mental health areas or the use of treatment techniques, such as psychotherapy, psychoanalysis, or family therapy. They can also make medical diagnoses and prescribe medication.

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  • Clinical child psychologists

    These psychologists usually have at least three years’ postgraduate training in the assessment and treatment of mental problems in young children. They can employ a range of therapies including CBT, psychotherapy, solution-focused therapy and counselling.

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  • Community mental health nurses

    As registered mental health or paediatric nurses with a specialism in child or adolescent behaviour, community health nurses offer support to both children and families. Mental health nurses may have training in CBT, family therapy, or solution-focused therapy.

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  • Clinical social workers

    Clinical social workers offer support to families by focusing on emotional, behavioural or relationship problems. They work with individuals and families, and sometimes focus on family difficulties in the wider context of the community.

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  • Primary mental health workers

    Often the first point of contact for families, primary mental health workers have a strong knowledge of the support services available in a community, and can give advice on assessment or intervention procedures.

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  • Counsellors

    These professionally trained specialists work with children and families to help them gain insight into their own self-defeating behaviour and make positive changes. They specialise in talking therapies and aim to alleviate distress by helping people to solve their problems on their own.

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  • Creative therapists

    Trained in the use of art, music and dance for therapeutic use, these professionals work in the treatment and rehabilitation of individuals with mental or emotional disorders.

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  • Family therapists

    Specialising in systemic approaches to mental health disorders, these therapists treat the entire family and explore the roots of problems within the family unit.

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Standard CAMHS team
Additional team members

Further support services

You can seek further advice, training and support from a number of different sources.

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Additional support and advice

  • Local authorities

    • Educational psychologists

      Educational psychologists specialise in helping children that may be having difficulty in school settings. They are trained to help with social, emotional and learning difficulties, and can implement a range of assessment and intervention programmes.

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    • Learning support services

      School, borough or county-based learning support services may also be available to provide support. These organisations offer support strategies for helping pupils with learning difficulties.

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    • Behaviour support teams

      Behaviour support services are county-wide inclusion services that specialise in the treatment of behavioural problems. They can provide guidance on anti-bullying strategies, concentration deficit therapies, antisocial behaviour programmes and nurture programmes.

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  • Local voluntary organisations

    Voluntary organisations run in schools or local institutions, like SNAAP, can offer a variety of support services, a sympathetic ear and an opportunity to connect with others.

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  • National mental health charities

    Mental health charities such as Mind often operate in national and local networks. They are dedicated to supporting people with mental health issues, and can offer information, training and consultancy services.

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Therapeutic approaches to BESD treatment include a broad range of interventions, all of which can only be carried out by trained professionals. Teachers can, however, draw on elements of these approaches in their everyday work. Select an approach from the mind map to find out more.

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Therapeutic approaches

  • Behaviour therapy

    Behaviour therapy involves the pupil learning and practising new, positive behaviour to replace negative kinds of conduct. This is achieved through positive reinforcement, using a system of rewards and sanctions, and is often implemented in schools. It is effective in helping those with:

    • Anxiety
    • ADHD
    • Eating disorders
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  • Creative therapy

    Creative therapy is used to encourage a person to express difficult problems or emotions through creative means. Therapists who deliver this approach will have trained in specific creative therapy types such as art, dance or music.

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  • Cognitive behaviour therapy (CBT)

    CBT aims to change a person’s underlying attitudes or thought processes in order to alter their behaviour. It is delivered by a trained counsellor in intensive one-on-one sessions, although elements of this approach can be implemented in schools. It is often used to treat:

    • Anxiety
    • ADHD
    • Contact disorder
    • Eating disorders
    • Post-traumatic stress disorder
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  • Counselling

    Counselling is a talking therapy delivered by trained therapists. It aims to improve an individual’s sense of emotional wellbeing, and can be used to treat a wide range of difficulties, including:

    • Anger
    • Anxiety
    • Bereavement
    • Depression
    • Eating disorders
    • Relationship issues
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  • Family therapy

    Family therapy is designed to help family members find constructive ways to help each other. Varying contexts are important to therapists in this area. They take account of different family members’ perspectives, and the nature of relationships both within and beyond the family unit. Family therapy can be effective in addressing a number of issues, including:

    • Changes in family life
    • Parenting issues
    • Eating disorders
    • Child and adolescent behaviour disorders
    • Self-harm
    • Anxiety
    • Depression
    • Bereavement
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  • Psychotherapy

    Psychotherapy is usually carried out by a psychiatrist or clinical psychologist with advanced training in the area. It explores the underlying motivations and feelings associated with certain kinds of behaviour, of which an individual may not be aware. It aims to help people understand the causes for their negative or destructive actions, and identify how to adjust such conduct. In general, psychotherapy:

    • Is more helpful for psychological problems that have built up over a long period of time.
    • Will be a long-term process, lasting months or even years, based on a mutually trusting relationship between the individual and therapist.
    • Can involve a person looking back to identify how past experiences may have influenced the way they now think or behave.
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Other approaches

There are several other approaches to helping pupils with BESD that may be useful for you to consider.

Select any one approach to read more about it.

  1. Circle of friends
  2. Motivational interviewing
  3. Nurture groups
  4. Parent training
  5. Solution-focused brief therapy (SFBT)
  6. Transactional analysis

Circle of friends

Setting up one of these groups involves recruiting six to eight classroom peers to support a ‘focus child’ who has been having difficulties with behaviour and friendships.

This frequently begins with a whole-class discussion (without the focus child), during which the class:

  • Establish ground rules.
  • Identify the focus child’s strengths and difficulties.
  • Come up with suggestions on how to improve the focus child’s situation.

Volunteers for the circle then meet with the focus child in an adult-led meeting, and plan for how the pupil will benefit from the group’s support. The circle of friends will meet regularly (usually weekly) with the focus child under the careful management of an adult facilitator.

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Motivational interviewing

Motivational interviewing employs a one-on-one interview format in order to focus on changes in behaviour. It aims to:

  • Help to clarify and resolve mixed feelings about changing behaviour.
  • Motivate individuals towards desired outcomes.
  • Focus on the advantages and disadvantages of certain behaviour.
  • Encourage individuals to make informed, autonomous choices.
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Nurture groups

These in-school groups are designed to assist children who have grown up without a secure parental attachment. Such children often have difficulty integrating with other pupils in a standard classroom setting, and nurture groups provide them with a safe, homely environment in which to develop social and behavioural skills. Nurture groups aim to:

  • Provide a strong attachment bond with an adult (such as a teacher or teaching assistant).
  • Give the pupil support and encouragement.
  • Encourage structured routines.
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Parent training

Parent training provides parents with support and guidance in caring for their children. It is available through a range of providers, including educational psychologists and voluntary organisations. Its goals are to:

  • Develop parenting skills.
  • Help parents to establish clear boundaries and expectations of behaviour.
  • Address conditions such as ADHD and conduct disorder.
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Solution-focused brief therapy (SFBT)

SFBT is a short-term therapy solution designed to focus on immediate goals. It is typically much shorter than other types of intervention, consisting of six short therapy sessions which aim to:

  • Encourage individuals to think about preferred futures.
  • Help to develop and implement strategies to achieve desired outcomes.
  • Retain positive aspects through ongoing processes of change.
  • Focus specifically on achievement in the present and future, rather than on past difficulties and the underlying cause(s).
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Transactional analysis

Transactional analysis is used to help individuals to explain communicative interactions and relationships. It is designed to:

  • Closely examine communication and interaction.
  • Identify the causes of problems and develop strategies to achieve improved outcomes in the future.
  • Help people change repetitive patterns of behaviour and avoid negative cycles.
  • Be accessible and easy to learn.
  • Be easily applied in school settings.
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Mulberry Bush School: a therapeutic community

Peripatetic teacher Ray Burrows and senior training officer Dawn Davidson talk about their work at Mulberry Bush, a residential school in Oxfordshire that specialises in therapeutic care, treatment and education for ‘at risk’ primary-aged pupils from across the UK.

This audio clip relates to task 1 in your PDF of unit 12.

Show transcript

Narrator:

Mulberry Bush is a residential school in Oxfordshire specialising in therapeutic care, treatment and education for ‘at risk’ primary aged children. A large number of pupils coming to the school from across the UK, have difficulty developing relationships, leading to a variety of social, emotional and behavioural difficulties. Ray Burrows is a Peripatetic Teacher at the school, and the Senior Training Officer is Dawn Davidson.

Dawn Davidson – Senior Training Officer

It’s not a sort of a regular mainstream school. We work with the children in what we’ve described as a “therapeutic milieu” which means that during the course of the day, all of the interactions that we have with the children are considered to be therapeutic: they are considered, the staff work together in a form, what we would describe as reflective practice, so we think about each of the interactions we have with the children, we develop plans for working with them, to help understand their behaviours and help them to develop, and change and become a more integrated, more together child really.

More and more, the kind of children who come to our attention are the children who are physically aggressive, or display oppositional behaviours, because they are the children who are the most difficult to manage within a mainstream setting, because their behaviours are not only disturbed, but disturbing for other children within the classroom setting.

Ray Burrows – Peripatetic Teacher:

I’m thinking of one particular child who displayed very risky behaviour, putting himself in unsafe situations; for example, climbing where he could up on to roofs. Now obviously, we make that as difficult as possible, but was a very agile little boy, and generally, risky behaviours that created quite a lot of anxiety in people. And the way that we worked with that, and understood that, is that he was feeling, in our terms, not contained, and that people weren’t preoccupied with him.

So we put in a particular way of working with him which meant he had a lot of close contact with the adults who looked after him, but at the beginning of the school day, he’d meet with whoever was heading up the education day at that time, with one of his education staff and with one of the residential staff. They’d reflect with him about how his day had been, and that went on for some time, but was gradually able to reduce, and that was a very concrete way of demonstrating to him that he was very much in people’s minds, and actually we noticed improvements, he was able to, sort of, take more responsibility for himself.

Dawn:

We find that with the children that we work with, that they can be quite vulnerable children, and some of the things that help a child to feel resilient are having a secure base. But in order for the other, the other sort of resilient strings to be enacted, a child really needs that first and foremost. But, you know, in order to be able to access education, a child needs to feel confident and have a sense of the ability to achieve, and themselves as a learner and themselves as a positive human being. And some of the children who have problems with attachment or have early difficulties in their relationships find it very difficult to access the education.

Ray:

I think one example that might be the child who teachers or supports staff experience as choosing what they want to do, and just avoiding some things because they don’t like maths, and so on, and actually when you talk about that and you ask questions about that, and you think about what’s going on, very often at the bottom of that is a huge level of anxiety, and very often underlying that anxiety is that huge fear of failure. And that failure is very often linked to lack of secure base in attachment terms. The child who has a secure base is very happy to explore and come back to, and then go off and explore a bit more, and then come back again. The child, who doesn’t have that secure base, is far, far less able to undertake that exploration and so those children rather than find something that they can’t do, will avoid doing it altogether. And so that’s when understanding attachment, the child’s attachment might well help, it’s one tool in perhaps trying to understand the meaning of what children are doing. They’re not just avoiding or being difficult or, you know, it’s probably some sort of deep, you know, quite high level of anxiety that’s underlying that.

Dawn:

One of the resilience streams is about talents and interests, and I think one of the things that we’re very good at, at the Mulberry Bush, is to try and find ways to harness what the children are really good at so, for example, there will be opportunities for them to engage in music and drama, for them to go out and experiencing different things. We have something that we call secondary experience, where the children have an opportunity to just go out experience things in the outside world.

We also work on things like social competences as well, so trying to get the children to understand how they will work within a regular environment. So what’s socially acceptable, so taking them out restaurants, or taking them to museums, or somewhere where they have an opportunity to see how other people experience life, but also helping them to be able use money for themselves, or to use public transport if that’s appropriate.