RICAP

1
RICAP

• Reflective Interpersonal Therapy for Children
  and Parents
• Hermione Roff
• hermione_at_roff.org.uk

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ODD PRESENTING PROBLEMS.

• Often loses temper
• Often argues
• Defiant
• Often deliberately annoys
• Often blames others
• Often touchy
• Angry
• Spiteful

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CD PRESENTING PROBLEMS

• Swears
• Steals
• Runs away from home
• Lies
• Sets fires
• Truants
• Broken into property
• Physically cruel to animals/people
• Used weapons
• Physical fights

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THERAPIST AND CHILD

• What do these children do?
• (A description of behaviours)
• Who are these children?
• What is the interpersonal world they live in?
• How do they understand themselves?
• How do they understand their significant others?
• Within these understandings, what choices do they
  want to make about their actions and
  interactions?

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THERAPIST AND PARENT

• How does who I am colour my understanding of my
  child?
•  
• What understanding do I have of my child?
•  
• What understanding do I have of my childs
  understanding?
•  
• How does this affect my relationship with and
  interaction with my child?
• What will it mean to have a more thoughtful and
  reflective child?
• What difference will this make in my response to
  him?

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RICAP OVERALL AIM

• CHILD
• to facilitate an autonomous capacity to reflect
  and self reflect
• and to act appropriately on that reflection
• PARENT
• to understand their childs states of mind, and
  their understandings of events and relationships
• And then to make choices about their interactions
  within those understandings

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REFLECTION

• The ability to attribute mental states to others,
  making other peoples behaviour meaningful and
  predictable
• The ability to think about the mental states of
  the other
• The ability to think flexibly about thoughts and
  feelings in and between self and others

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Child Behavioural Symptoms
Both Functional, (coping strategies)and
Dysfunctional, (does not achieve their true
goal) (Distorted view of relationships and
behaviour, based on having to be in control in
order to survive, and using threat and coercion
to mobilise parents.) Child move to What
inner thoughts and feelings generate this
symptom? How can I better achieve what I
want? Parent move from Extinguish symptom
to What, in me and him, is generating and
maintaining this symptom?
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CAUSAL AND MAINTAINING FACTORS FOR CONDUCT
PROBLEMS IN YOUNG CHILDREN. Poor recognition of
own mind and mind of others in an interpersonal
setting. (Intentionality.) Poor recognition of
dilemmas and choices. No interpersonal
perspective taking (Reflection) Poor recognition
of emotional states Poor information
processing (Adversity interrupts normal
information processing) Poor patterning or
learning (Impulsivity, self agency, self
esteem)
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• Post natal depression is associated with
  increased conduct problems in boys
• Insecure attachment in infancy is associated with
  increased conduct problems in boys
• Secure attachment reduces the differences between
  post natal depression and control groups
• Insecure attachment is associated with lower
  intentionality in the face of threat at 5 years
• Increased intentionality to threat confers
  resilience in the face of post natal depression

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RICAP

• A brief intervention
• Concurrent for parent and child
• Reflective
• Interactive
• Practical

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RICAP STRUCTURE

• 14 sessions
• 1 preparatory
• 12 individual weekly (child) or
• 6 individual fortnightly (parent)
• 1 review

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RICAP METHOD

• CHILD
• Child and therapist co-create a book of drawings,
  conversations, reflections and understandings
• The therapist compiles the book in between
  sessions
• The child reads and verifies the book at the
  start of the next session

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• BOOK
• a record of sessions, a record of self
• a physical representation of thought and
  being
• thought about
• a concretion of experience
• a holding in mind and a holding of memory
• an insight into the mind of another
• a means of reflection
• an experience of construction and
  reconstruction
• a narrative, a building of a coherent story
  of self
• an acknowledgement of, respect for the child
• a context of containment
• a continuing means of communication

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RICAP METHOD

• PARENT
• The parent brings one good time and one difficult
  time with their child in the past week to each
  session
• Their task is to understand their childs
  understanding of the times they bring
• The therapist writes a letter to the parents each
  fortnight incorporating their separate and joint
  understandings
• The letters form an on-going means of reference
  and continuing reflection and of holding in mind.

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THE LETTER

• a detailed, slowed down record of an incident
• different, multiple perspectives and
  understandings of an incident
• an understanding of the interplay of
  personalities, of persons in relationship
• an understanding of the link between inner
  emotions and outer actions
• a record of the progress of their understanding
  of their childs understanding
• a written context within which change can be
  experimented with and choices made
• An on-going means of reflection and a visible
  holding in mind

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PARENT ISSUES

• understanding and allowing complexity
• exploring for meaning
• searching for, and expecting, multiple
  perspectives and understandings
• beginning the process of reflection and self
  reflection
• understanding their childs understanding
• making choices about alternative responses and
  interactions

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JIM and KAREN THREAT, ANXIETY AGGRESSION AND
REFLECTION

• At home, Karen, Jim and 2 half sisters
• Jims Dad is not his Dad
• Jims biological Dad is found and rejects him
• Jims eldest half brother, much loved by Jim,
  quarrels with K and leaves home

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JIM THREAT, ANXIETY AGGRESSION AND REFLECTION

• Need to protect self
• Protect by fighting
• Challenged
• Inner self feels threatened
• Stops thought processes to reduce danger
• Resorts to aggression to hide fear

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NEW PATTERN

• Therapist not overwhelmed by Jims anger
• Does not feel frightened
• Increases reflective capacity
• Creates space for Jims emotional arousal to
  subside
• Increases opportunity for him to use reflection
  instead of aggression

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HAVE I BEEN GOOD?

• Doing a task
• Not hitting
• Do you like me?
• Do you love me?
• Am I lovable?
• Do I have to behave well to be lovable?

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PARENTAL REFLECTION

• Hitting
• Believing
• Lying and deceiving are as hurtful as hitting
• What kind of person is believable?
• Earning trust and respect
• The value of listening and talking

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THE CAT LITTER

• An unhappy Mum is an angry Mum
• Jim learns about anger but not about underlying
  emotions
• Explosive anger is the habitual currency of the
  relationship
• Space for thought/reflection is denied
• The imaginary wheelchair
• A different parental response

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REVIEW

• Jim
• Feeling misunderstood
• Protecting Mum
• Being trusted/believed
• Karen
• Hitting
• The source of Jims anger
• Belief and trust
• Thoughtful, loving Jim

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TWO THERAPISTS

• Separate therapeutic sessions
• Regular meetings
• Model thinking and reflection both individually
  and together
• Joint understandings of process and content,
  stories and perspectives
• Supportive and integrative

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RICAP FRAMEWORK

• A framework for the child in dealing with their
  avoidance and aggressive actions in a safe and
  containing way
• A framework for the parents for looking at their
  avoidance in thinking about their child, that is
  both challenging and supportive
• A framework for the therapist in shaping and
  moulding understanding, and moving that forward,
  through reflection and self reflection, into
  relationships and interactions