RUNNING HEAD: Piaget’s Theory and School Shootings The Use of Developmental Theories in Treatment Jessica Paszek MFT 628: Adolescent-Focused Family Therapy Touro University Worldwide July 26, 2020 RUNNING HEAD: Piaget’s Theory and School Shootings Introduction School violence in the form of mass shootings causes feelings of horror, fear, and disbelief among students who suddenly lose their previously safe environment. Subsequently, survivors can suffer from various trauma-related symptoms such as acute stress disorder (ASD), posttraumatic stress disorders (PTSD) symptoms, depression, and anxiety. The severity of life danger and loss of close peers increases the risk for mental health problems. Not all survivors are similarly affected by traumatic events as each can have unique resources that contribute to recovery. These recourses are related, for example, to personality, social relations, and worldviews.” (Turen et al, 2014). Piaget’s Theory Jean Piaget's theory of cognitive development suggests that children move through four different stages of mental development. His theory focuses not only on understanding how children acquire knowledge, but also on understanding the nature of intelligence. Piaget's stages are: Sensorimotor stage (birth to 2 years), Preoperational stage (2 to 7 years old), Concrete operational stage (7 to 11 years old), and Formal operational stage (12 years and up). (Cherry, 2019) For the purpose of this essay, I want to focus on the last stage of Paiget’s theory, since the main focus for his course is adolescents. However, I think it is important to briefly discuss the other stages so we can fully understand the importance of development. During the sensorimotor stage, children learn about the world through basic actions such as sucking, grasping, looking, and listening; and they learn that their actions can cause things to happen in the world around them (Cherry, 2019). The preoperational stage is important because, at about this time, children start to develop and solidify their personality and have a sense of what “values” are. “Children at this stage tend to be egocentric and struggle to see things from RUNNING HEAD: Piaget’s Theory and School Shootings the perspective of others; they also can tend to think about things in very concrete terms” (Cherry, 2019). The concrete operational stage is important because during this stage they begin to think logically about concrete events, they begin to understand conversation, and their thinking becomes more logical” (Cherry 2019). Finally, during the formal operational stage (adolescence) the child is able to “think abstractly and reason about hypothetical problems; and they begin to think more about moral, philosophical, ethical, social, and political issues that require theoretical and abstract reasoning” (Cherry, 2019). It is my understanding that each of these stages are critical in helping the child/ adolescent move forward in their development. If a stage or part of a stage is missed or the child is not given enough time/nurturing to learn/explore these skills; deficits in functioning can occur, especially when faced with trauma and needing to cope with stressors, such as a school shooting. It has been my experience that when stressors arise for adolescents who have not been given the opportunity to appropriately move through their stages, they will revert back to whichever stage they are “stuck” in. Questions I Would Ask According to the Piaget Model To begin our session, I would open up the conversation with asking the client if they would like to talk about anything in particular (their week, friend/ family drama, school frustrations, a great concert they just attended) before we start with their session. This may relieve some tension, help build rapport, and hopefully make the patient feel more relaxed. Staring the session this way would be classified as using discovery-oriented questions . Although the adolescent may have been brought into treatment to help them process witnessing the school (Birkenmaier et al, 2014) shooting, their most pressing concerns may be something completely different and they need to process through those issues first. RUNNING HEAD: Piaget’s Theory and School Shootings Once the session officially starts/ the next session occurs, and we begin to talk about the school shooting. First, I would ask them to tell me, if they’re comfortable, what happened the day of the shooting. What do you remember? What did you see/ hear/ smell? This is an openended question (Birkenmaier et al, 2014) and allows me to get an idea of what is important to the client. I would ask the adolescent about how they view the situation and what their understanding is of what happened. I would also ask them about how this event has impacted their school, social, and family life. I would empathetically paraphrase and act as a sounding board for the client. I would use phrases like: “Let me make sure I understand” and “So what you’re saying/ telling me is...”, in order to make sure I have a clear understanding of how they feel and how this situation is affecting them. Some direct/closed questions (Birkenmaier et al, 2014) I could ask would be, “are you able to talk to a friend/ family member about the nightmares you are having?” or “how many times per day are you having negative/intrusive thoughts?”. Examples of open-ended questions would be: “how do you feel about the way you are handing your emotions?” or “tell me what your average school day looks like.” Responses It is important to listen to my client and also respond to them so they know I’m actively listening and care about what they have to say. Some ways to do this would be paraphrasing clarifying, and summarizing (Birkenmaier et al, 2014) what the client is saying. For example, paraphrasing can sound like, “so what I hear you saying is that you didn’t know how to react when you saw the shooter and you feel like you should have stepped in to protect your friends?”. This tells the client that you are listening and have a deeper understanding of what they are saying. An example of clarifying is, “let me make sure I understand...” or “can I tell you what I’m hearing you say? Correct me if I’m wrong.”. Summarizing and paraphrasing are similar, but RUNNING HEAD: Piaget’s Theory and School Shootings summarizing means that you would take all of the main points and make sure that you understand what your client is trying to accomplish/ say in session. All three of these skills can be used at the same time and interchangeably. Empathetic Communication Empathetic communication (Birkenmaier et al, 2014) is a skill used to let the client know that you are listening, you care, and you want to understand how they feel. This type of communication starts the moment your client walks into the office; eye contact, body position, posture, verbal tracking, and voice tone are all forms of empathetic communication (SommersFlanagan &Sommers-Flanagan, 2014). Silence is also a form of empathetic communication; it is okay if you don’t know what to say to your client. When my adolescent client tells me the story of how the school shooting happened, the trauma involved in that situation is immense, and there are no words to describe that feeling. Transference Especially when working with adolescents, in my experience, transference (Shapiro et al, 2015) comes up more often with this population than it does with adults. Adolescents see you as an authority figure (parent, teacher, older sibling, other older family member) rather than a medical/ mental health provider. It can me helpful to “call a spade a spade” and ask “who do I remind you of?” or “I think you are having a hard time opening up to me because I remind you of someone else, who would that be?” Brining attention to an uncomfortable feeling can be enlightening for the adolescent and can be helpful in assisting the client in understanding that the clinical setting is different than dinner with their family, feeling pressured to talk about their day or “how they feel”. Interpretations RUNNING HEAD: Piaget’s Theory and School Shootings Providing interpretations (Shapiro et al, 2015) can be a helpful way to encourage the client to dig deeper and find answers to why they are feeling a certain way or acting out. I urge caution with this because it can be easy, especially for a vulnerable adolescent to attach onto something you say and make that their interpretation, rather than coming up with it on their own. I would propose interpretations in the form of questions; like “what would it look like if you thought about life in a more positive way?”. RUNNING HEAD: Piaget’s Theory and School Shootings References Birkenmaier, J., Berg-Weger, M., & Dewees, M. P. (2014). Chapters 1-7: The Practice of Generalist Social Work, Third Edition: The Practice of Generalist Social Work, Third Edition (3). Florence, GB: Routledge. Retrieved from ebrary ebooks. Cherry, K. (2019) The 4 Stages of Cognitive Development: Background and Key Concepts of Piaget's Theory. Retrieved from https://www.verywellmind.com/piagets-stages-ofcognitive-development-2795457 Shapiro, J. P., Friedberg, R. D., & Bardenstein, K. K. (2015). Child and Adolescent Therapy: Science and Art (2). Somerset, US: John Wiley & Sons, Incorporated. Retrieved from ebrary ebooks. Sommers-Flanagan, J. &Sommers-Flanagan, R. (2014) Clinical Interviewing: Intake, Assessment & Therapeutic Alliance. Mill Valley, CA: Psychotherapy.net. Retrieved from Psychotherapy.net database in the Touro library. Tuija Turunen, Henna Haravuori, Raija-Leena Punamäki, Laura Suomalainen & Mauri Marttunen(2014) The role of attachment in recovery after a school-shooting trauma, European Journal of Psychotraumatology, 5:1, DOI: https://doi.org/10.3402/ejpt.v5.22728