Cognitive behavioural therapy is the most studied and researched

model of psychotherapy. A large number of studies suggest that it is

effective for a variety of mental health problems. It is called cognitive

because it explores the way people think about themselves, the world and

the future and how these thoughts affect their feelings and behaviours

(behavioural). CBT therapy can help people change their negative thoughts

and behaviours that affect their everyday life. It assumes that our problems

are often derived, not from the situations that happen in our lives, but from

how we make sense of them, interpret them and react. According to CBT,

our thoughts are those who affect our emotional world and lead to specific

behaviours. The goal of CBT is to replace dysfunctional beliefs with more

realistic ones. It also encourages people within a supportive therapeutic

framework to try new behaviours, ‘test’ them and apply them in their

everyday life. As a result, the change occurs as cognitive process but is

sealed by learning new behaviours and interactions with the environment.

Changing the way we think - for ourselves and those around us - we can

greatly improve our mental disposition, our self-esteem and interpersonal

relationships. The hopeful message of CBT is that we, changing the way we

think about ourselves, to finally change ourselves.

Systemic therapy is the application of systemic theory or systems

theory in the field of mental health. It is a form of psychotherapy that

considers the person not as an individual as other forms of psychotherapy,

but as a part of the systems he/she belongs to. The relationship of the

individual with the system is dynamic, there is a constant interaction. An

individual’s mental health is considered as a function of the way they

interact with the various systems in which they belong, of which one of the

most important is the family. An important application of systems theory is

in family therapy in which the aim is the interaction of the individual with the

system (the family), the relationships between them. Systemic theory

argues that any change in a system (e.g. a family) brings changes

throughout the system and to each member separately. H systemic

treatment is particularly suitable either when there are problems in couple or

family or when a family member has a serious problem (mental illness,

addiction), in which the whole family is emotionally involved. Consequently

all the difficulties and changes which may be present in an individual are in

direct interdependence and interaction with the major systems in which

he/she belongs.

Integrative therapy is a combination of more than one kind of

therapies. It involves models and methods from different psychotherapeutic

approaches to make the appropriate setting - option for the patient and his

needs.
Several studies demonstrate that an individualized therapeutic model

increases the effectiveness of psychotherapy. The combination of more than

one scientifically proven therapeutic methods to approach the patient

according to his/hers individual characteristics, stage of development

cultural characteristics, preferences, skills and needs has been highlighted

over the past years. Since systemic therapists recognized the importance of

CBT and how effective can it when it comes do dysfunctional thoughts and

beliefs, integrative approaches started to appear for the first time. Human

behavior is so complicated that it cannot be explained by a single theory.

Also there are many factors that play a role in the etiology of human

behaviour. In this aspect a single theoretical approach is not as sufficient as

integrative psychotherapy is, in order to fully address the complexity of

problems that most people face. Therapists, who use integrative therapy,

derive efficient methods from different approaches as their ultimate goal is

to improve the effect of psychotherapy. For example cognitive

psychotherapy that aims to improve dysfunctional schemas can be combined

with some behavioral techniques to deal with a ”problematic” behavior and

systemic psychotherapy for a better understanding of the systems that an

individual is included in. Through integrative therapy, professionals try to

create a new intervention tailored for each patient. The goal is a more

flexible, effective intervention that suits to the patient and the therapist.
 Through the synthesis of different approaches, therapists can explore

in further the unique needs of children and adolescents a well as their way of

thinking and the sense they have for themselves. By using CBT, several

thought, patterns, feelings and behaviours can be altered and in combination

with systemic therapy, a deeper understanding of relationships and

dynamics between the family can be gained. As Krueng and Glass (2013)

stated, most childhood disorder derive from personal, familial and

environmental factors.

Julian is a 9 year old child, who has been diagnosed with ADHD with

hyperactive/impulsive prevalence. Julian’s parents, described him as a

restless child who is always on the move and his symptoms got worse in the

last year. Julian is also referred as a good-hearted and generous child, but

he is hyperactive and clumsy as he is not able to control his motor behaviour

because of his body mass. According to his teacher, Julian is a child that

talks all the time, cannot wait for his turn and cannot stay silent. In addition

to that, it seems that Julian has been withdrawn from his peers as he is not

able to follow any rules and he often hurts them but not in purpose. Julian

mentioned that withdrew from the basketball team because the other kids

wouldn’t pass the ball to him. Julian, prefers the company of other adults,

especially his grandparents’, and does not get along with other children and

is very shy. Three years ago, Julian’s parents got divorced. His mother left

the house and is currently living with her sister. Julian’s father, unexpectedly
lost his job and now he is a full time dad. He is in a relationship with a

divorced woman who has a child from her previous relationship but they do

not live together. His parents’ divorce was not easy but the last year their

relationship is improved.

As it is mentioned above, Julian has been diagnosed with ADHD.

Attention deficit/hyperactivity disorder is one of the most common childhood

disorders. ADHD is a developmental disorder having as basic characteristics

difficulty in staying focused and paying attention to a specific task,

hyperactivity and impulsivity. It refers to children and adults who face

serious difficulties in important areas of their lives, such as interpersonal

relationships, school, work and family life, due to excessive motor activity

and incapability to control their attention and impulse. The percentage of

school-aged children diagnosed with ADHD is up to 37%. Children with

ADHD have difficulty in responding to situations in which most of their peers

are doing very easily. They differ from most children of the same

developmental level in their ability to focus their attention into a specific

task, to control their impulses and in some cases to control their mobility.

ADHD, can cause difficulties in the child’s socialization, academic

performance, peer relationships, self-esteem and finally in family’s

relationships. American Psychological Association (as cited in Shillingford,

Lambie, & Walter, 2007), suggests that there are three types of this

disorder. There is the hyperactive-impulsive type, the inattentive type and

the one that combines inattentive and hyperactive. Children with

hyperactivity/impulsivity prevalence, like Julian, have some basic symptoms

such as: difficulty to remain in their seat, they do not think before acting,

constantly talking, difficulty to wait their turn, they interrupt or disturb

others and do not have the ability to follow specific rules. Students with

ADHD usually have poor academic performance because of the above

characteristics.

ADHD, except academic performance and peer relationships, can affect the

relationships between the families. Children with ADHD, because of their

impulsivity and their incapability to follow rules, tend to argue more with

their parents and siblings.

Julian presents most of the characteristics of ADHD. More specifically,

he is described as restless, clumsy and impulsive. He cannot control himself

and sometimes he hurts he classmates but not in purpose. His peer rejection

is something that seems to upset him. Studies have shown that children with

ADHD, are more likely to be rejected from their peers and they think that

they are not ’famous’ and that other children do not want to play or become

friends with them (Shillingford, Lambie, & Walter, 2007).

Three years ago, Julian’s parents got divorced. It is mentioned that,

separation was hard and the parents had many serious conflicts, but now

their relationship has been improved. We do not have enough information on

how Julian experienced his parents’ divorce; however indisputably, it is a

very stressful time for all the family members. 30% of marriages end in

divorce. Research has proven that, children who experienced a divorce, have

more behavioral and communication problems compared to children of

nuclear families. They are also more aggressive, impulsive, they present

antisocial behaviour and have more problematic relationships with their

mothers and fathers. Moreover, they have lower academic performance,

with a percentage up to 75% of children whose parents got a divorce,

showing dramatic decline in their performance. Children, who experience

divorce in a young age, are more likely to experience various difficulties.

Boys who live with their father and girls, who live with their mother, have

fewer difficulties than children who live with the parent of the opposite sex.

These problems become more complex when children have to change their

everyday life and habits. The intensity of psychological impact is also related

to many factors such as, the quality of parental relationship before

separation, the intensity and frequency of conflicts and the parents’ ability to

focus on their children’s need during that time. Parents are the ones who

have to provide their children with a loving a supportive environment.

Whichever the reason is, a divorce is always painful for children and their

parents. No matter who is responsible for this fact, there are no magical

solutions to adequately address this issue. The most important thing is with

how much maturity the parents will handle it. The more peacefully the
separation is, the less frustration and pain children will experience.

Unfortunately, many parents do not have the adequate information or

education to ensure that to their children and as a result, are put in the

middle of their parents’ battle (Hetherington & Stanley-Hagan, 1999).

In Julian’s case, his parents’ conflicts played a significant role in his

behaviour. As it is mentioned before, his impulsivity and hyperactivity

worsened in the last year. Therefore, we can assume that conflicts, divorce

and the adjustment in his new life are linked with the prevalence of his

symptoms. ADHD is the primary reason but the ”problematic” environment

enhanced his symptoms and behaviours.

 INTERVENTION PLAN

Recognizing the evidence that shows how effective a combination of

CBT and systemic approach can it be, an individualized intervention plan will

be developed tailored to Julian’s needs. The main goal is a holistic

intervention that will enhance Julian’s individual, family and school life. CBT

techniques will be used to alter negative and distorted cognitions. Systemic

approach will aim to engage all the systems that Julian belongs to and

improve the relationships between their members. For this reason Julian, his

family, peers and school staff will be included in this intervention. Therefore

an integrative approach is considered as the most suitable one for this

purpose as it will offer a broader approach and will combine multiple

techniques.

After the ADHD diagnosis by the GP and the child psychiatrist, a first

assessment was conducted in order to explore the relationships and

interaction between the family system and its subsystems; Julian with his

mother, Julian with his father and then the mother with the father. Through

this assessment the Lausanne Trilogue Play was used. During the first phase

Julian and his mother played; the father although he knew that he was not

allowed intervening, he tried to. It was only when Julian asked him for

something, when he seemed to control himself. During the second phase

where Julian and his father played together, Julian’s mother did not pay

attention to them and was occupied with something else. It is worth noticing
that when Julian dropped a toy, his mother corrected him. Finally, during the

last phase where all the family was supposed to collaborate, the mother and

the father chose to sit far away from each other and did not interact at all,

while Julian had to put some effort to interact with both of them.

The first assessment can give us very useful information about the

family relationships and dynamics. Simonelli, Bighin and De Palo (2012)

suggest that the family alliance depends on the degree of coordination

between the family. In this case, parents were not willing to cooperate with

each other and therefore, the alliance was not positive.

Divorced families, usually face difficulties in sharing their feelings and

trying to find ways to effectively communicate with each other. Julian’s

parents, although their relationship was improved in the last year and there

are no conflicts anymore, it is clear that their cooperation needs to be

”smoothed“. The purpose of systemic approaches is to see the family as a

whole and build an intervention that will enable them to share their feelings

and at the same time strengthen their relationships. The goal is to address

the conflicts between the mother and the father. These conflicts can hurt

children and follow them throughout their lives. Through a systemic

approach, all the subsystems could be identified and the alliances, dynamics

and cohesions will be analyzed. By obtaining that, communication will be

enhanced and therefore the relationship between the parents and between

parents and children will be improved.

K ΑΛΛΑ ΓΙΑ ΤΟ SYSTEMIC ΚΑΙ Πως ΜΠΟΡΩ ΝΑ ΕΝΙΣΧΥΣΩ ΤΟΥΣ ΓΟΝΕΙΣ.

ΚΑΤΙ ΠΙΟ ΣΥΓΚΕΚΡΙΜΕΝΟ ΑΥΤΑ ΕΙΝΑΙ ΜΟΝΟ ΓΕΝΙΚΑ.

ΚΟΛΛΑΣ CBT ΝΑ ΚΑΝΟΥΝ IDENTIFY TA THOUGHT GIA TO ADHD OI ΓΟΝΕΙΣ.

ΒΑΛΕ ΟΠΩΣΔΗΠΟΤΕ ΓΙΑ ΑΘΛΗΤΙΣΜΟ ΚΑΙ ΤΙ ΝΑ ΚΑΝΟΥΝ ΣΤΟ

ΣΠΙΤΙ(ΔΩΜΑΤΙΟ ΧΩΡΙΣ STIMULI, RULES ΚΛΠ ΚΛΠ)

ΕΠΙΣΗΣ Η ΜΑΜΑ ΝΑ ΕΠΙΣΚΕΠΤΕΤΑΙ ΠΙΟ ΣΥΧΝΑ ΤΟ ΠΑΙΔΙ.

Julian except his family system belongs to the school system. Julian’s

teacher described him as a child that cannot wait for his turn, is always on

the move and always runs and jumps. It would be very useful if some

guidelines were given to the teacher to deal with Julian…..

Children with ADHD, due to their hyperactivity, cannot stay in their seat and

therefore they want to stand up, walk and play all the time. Consequently,

they will have the same behaviour while they are in the classroom. His

teacher then, can make Julian her ‘assistant’. He will be in charge to pass

out the papers to all the other children, to clean the blackboard or to help

the teacher carry something. In that way, he will not have to remain in his

seat the whole time and at the same time he will not be the target.

Through sports, he will be able to control his mobility, he will