Therapeutic Components

Clinical-Overview_web

Our Clinical-Developmental Model

Little Keswick School serves boys with a complex set of social, emotional, and behavioral challenges. Many students carry multiple diagnoses that represent overlays of long-standing difficulties. The most common disorders our students face are various anxiety disorders, mood disorders, processing deficits, social functioning difficulties, organization and attention deficits, developmental challenges and learning compromises. Our boys have average to superior intelligence, although many show variability across measures. We do not serve boys with drug and alcohol involvement, social maladjustment, or conduct disorders.

Predicated on the knowledge that human development is primarily mediated and facilitated by interactions within important relationships, ours is a relationship-based model. Many elements of attachment, object relations, and interpersonal therapies are utilized in our approach to treatment. Additional interventions include strategies found in behavioral, cognitive behavioral, family systems and experiential work. Because of the pervasive disruption and challenge our students face in their lives, the appropriate conceptual umbrella has to be broad enough to contain and address the widest array of needs and symptomatology.

The clinical team at LKS focuses on establishing and maintaining deep and evolving conceptualizations of students’ typically complex and multilayered disorders. Optimal treatment and specific interventions are based upon comprehensive, in-depth understandings of the underlying psychological and bio-medical processes for each student. Traditional, solution-focused, or symptom-focused therapies are not sufficient, as evidenced by most of our students’ treatment histories. Our boys do not typically benefit from traditional behavioral contingencies, insight oriented therapies, or teaching methods. They often benefit from classic cognitive behavioral intervention, but not as the primary intervention modality. Therefore, we use a very broad clinical-developmental model which addresses all areas of individual, relational, and social functioning.

Change occurs primarily through immersion in a highly structured and predictable milieu, designed and calibrated according to the individual and group needs of our students. Collaborative goal-setting, direct instruction and positive practice of a set of functional goals provide the content for hundreds of relationship-based interactions each day. Carefully engineered task demands and contextual support ensure experiences of success with appropriate objectives.

The types of functional goals targeted are defined through the Social/Emotional Curriculum which addresses objectives in executive functioning, interpersonal collaboration, competence in daily tasks and interactions, and social and relationship skills. Along with comprehensive psychiatric and psychological assessments and interventions, essential services include pragmatic language support, occupational therapy interventions. These therapies support processing, reduce anxiety, and facilitate relational and social interactions within relevant settings. Students learn to expect academic success as their individual capacities are developed and supported.

Social Emotional Curriculum

 

The Little Keswick School Social – Emotional Curriculum (SEC) is organized to provide understanding with respect to a boy’s growth and development and identifies and targets specific skills. It is designed to provide a powerful content for our students’ effort as they grow and develop effective capacities. The curriculum consists of a set of skills that students learn in each of four core ability areas crucial for personal and social success.

At LKS, the acquisition and mastery of skills is organized to maximize growth. Around every turn opportunities exist for the students to practice and learn skills.

These skills allow us to make connections between what we know from past experience and what is required in the present context. They allow us to pay attention, organize our thoughts and actions, start and sustain effort on tasks, sort out what is important from what is not, and process all of the information needed to socialize effectively. If our executive functions are in good order, we can make plans, adjust to incoming information, wait appropriately, follow schedules, and reason efficiently. If they are not well developed, we might never complete things, or fail to keep simple information in mind long enough to follow directions. We cannot form and execute simple plans independently, engage in effective goal-setting or judge the effectiveness of our efforts in the moment.

Collaboration skills are essential to build relationships with others, and to integrate our agendas and actions with important people in our lives. Accepting help when it is offered, asking for help and developing shared objectives allows us to build meaningful relationships and achieve our goals. When we have the flexibility to adjust our intentions, focus, and actions to accommodate the agendas of other people, we can smoothly operate in a social world. People without these skills are seen by others as rigid, self-centric, isolated, controlling, and different. Specific skills that are taught at Little Keswick School include participation, following a schedule, being aware of your environment, advocating for your perspective, conflict resolution, reflective listening, and negotiation.

These skills include a very wide range of competencies from basic hygiene to complete self-determination and self-management. Our self-esteem and our belief that we can be effective in the world are built on experiences of accomplishment and the feeling of “I did it.” A competent person makes conscious decisions about what he wants to accomplish, and knows that he has or can secure whatever personal, social, or material resources are needed to be successful. An incompetent person lets the world happen to him. He may follow directions, but he cannot adequately reason, problem-solve, initiate, create, or build anything himself. Examples of specific competence skills taught at LKS are: self-care, initiative, taking responsibility, labeling emotions, recognizing problems, trying new things, personal goal setting, reflecting on your progress, perseverance, and self-sufficiency.

Parents often state their primary objective for enrolling their son at Little Keswick School is to learn to relate better to others. Living well with others and being connected to them is vital for all people. Basic social skills begin with respecting personal space, greeting others, monitoring voice level and tone, telling the truth, and taking turns in conversation. Social Thinking proficiencies such as being aware of others, accurately guessing the intentions of others, and perspective checking are then directly taught and practiced intensively throughout the community. Upper level students learn to acknowledge and include others, demonstrate kindness, make good guesses about other people’s intentions, show empathy, and trust others themselves.

Social Cognitive Development at LKS

Many boys arrive at LKS having suffered a long history of social failure, poor relationship skills, and struggles to develop friendships. Although many are adequately verbal and can be highly engaging, and most have attended social skills groups most still typically struggle to maintain friendships, have meaningful connections with others, and effectively share space with friends and family.

While accruing a repertoire of effective rote social behaviors is important, reliance on traditional social skills training has resulted in huge holes in our boys’ ability to effectively relate to others and to independently generate social solutions to the challenges of living with other people. In recent years we have found that moderate adaptations to the well-known Social Thinking (Garcia Winner, M. (2007) Thinking About You Thinking About Me: Teaching perspective taking and Social Thinking to persons with social cognitive learning challenges, (2nd Ed.) San Jose, CA. Thinking Social Publishing, Inc.) model developed by Michelle Garcia Winner more powerfully supports our boys’ relational needs. Rather than teaching rote patterns of responding we focus on building the use of processes that promote thinking and social understanding.

Social thinking is a dynamic process that we break into four areas of social development.

During this phase we facilitate awareness and focus on environmental cues that help boys choose more effective social behaviors. We teach the boys to use all of their senses to gather information, check for errors in processing/understanding, and develop social hypotheses. In addition to the physical environment, we teach the boys to look at body language and facial expressions of others as a way to gather information.

When a student has developed some capacities to explore the external world we ask him to start exploring his own perceptions, feelings, and personal intentions. We work to build meta-cognitive processes; the ability to think about each situation, determine what is going on, and process what is important. We continually prompt students to think, wonder, notice, picture, remember, reflect, and make conclusions. The goal is for each student to actively work to manage the direction of his own thinking and to communicate it in a manner that is compatible with his social agenda.

When a student has built adequate capacity to develop hypotheses and reflect on his own thoughts and feelings, we start the process of considering the thoughts and feelings of others. Students begin to contemplate their ability to affect the thoughts/feelings/behaviors of others, as well as how others can influence their own thoughts/feelings/behaviors. Students learn to hold another person in mind when making decisions, check intentions others may have or clarify their own intentions. During this stage students are able to develop a greater sense of empathy.

The last components of the social thinking curriculum continues to move the student forward by simultaneously considering his own perspective and the view another person. He is able to consider others motives, agenda, and ways of operating, and then accept his own responsibility to coordinate efforts toward mutual attainment of goals and objectives. Our ultimate goal lies far beyond simple turn-taking and compromise.

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