Uploaded by Jessica Paszek

628 Adolescent Treatment MIDTERM

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
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,
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.”
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.
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”.
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
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: