Posts Tagged ‘cognitive behavioral therapy’

Cognitive Behavioral Therapy (CBT) Basics for the School-Aged Child

Saturday, September 17th, 2016

My current blog is devoted to outlining the basic elements of cognitive-behavioral therapy or CBT for your school-aged child. Anyone who has read my earlier blogs, can see that I’ve written about elements of CBT for the preschool child. I’ve outlined labelling feelings and emotions, validating feelings in others, and shaping behavior through basic behavioral change strategies. Many of the skills used for preschool children can be applied to older children or serve as the building blocks for more advanced CBT skills.

Some of the unique features of CBT for ages 7-12 are most effective in children with well-developed cognitive and memory skills. For children to make the best use of CBT, they need to have the capacity for self-observation, self-monitoring, and independent reporting of their internal states and responses to interventions. Parents still play a central role in treatment, however, they serve more as a coach and support to their child throughout therapy. Oftentimes, children will be expected to teach certain relaxation skills to their parents and may be asked to guide their parents through certain exercises during sessions. Below I’ll highlight some of the most common elements of CBT for children. Note that this list is not exhaustive and that your child’s treatment may differ depending on their particular therapist, diagnosis, and/or symptoms.

Psychoeducation – Because school-aged children can understand and process information, they will likely receive lots of psychoeducation about treatment. Psychoeducation is a big word to describe the information your child receives about his/her condition, the factors that contribute to symptoms, issues that help improve symptoms, or things that may worsen his/her symptoms. Children at this age are able to process simple explanations of research on how and why treatment works and information about what to expect in therapy. This often helps children feel more motivated and in control of their treatment. Parents often appreciate and benefit from this information as well.
Self-observation and monitoring – As a way to get a better understanding of your child’s mood, situations that trigger certain symptoms, behaviors, or thoughts (or cognitions) you and your child may be asked to keep a simple record of these things on a daily basis for a brief period of time. Your therapist may give you a printed chart to fill out in between sessions or may ask you to record things via digital methods (such as in a Google document) or an application (accessed via phone/tablet). In the beginning stages of treatment, your therapist will use this information to design the skills that he/she may need to focus on in therapy. This information also helps a therapist determine whether or not therapy is working to make changes in your child’s symptoms.

Positive self-statements –
Your therapist may work with you and your child to come up with a group or list of statements that help him/her feel hopeful, motivated, and likely to continue treatment when things are tough or he/she is being asked to do something that feels unnatural. For example, a child may be asked to practice learning new breathing patterns or using long muscle relaxation exercises. Many children find these to be tedious and boring for a brief period until these exercises become second nature and start to feel more natural to them. Positive self-statements or “cheerleading” statements are often generated with your child using his/her language. These are typically brought home from a session and posted in a highly visible place in your home. Children and parents are asked to look at and read these statements aloud on a regular basis so that they become committed to memory and become second nature.

Cognitive Restructuring – This term refers to the process by which individuals learn to change unhelpful or overly negative thoughts. For children, this process can be complex as they are asked to learn to recognize their own faulty thoughts, how to evaluate their thoughts for accuracy, and how to generate thoughts that are helpful in reducing distress and improving their overall mood. In session, they learn about the connection between thoughts, feelings, reactions, and behaviors and learn how to apply these principles to various scenarios. These mostly abstract concepts are illustrated through the use of cartoon strips, stories, videos and other methods. Children first practice generating helpful and realistic thoughts for fictional characters in the stories, videos, etc. They move from applying thought modification in fictional characters to changing thoughts about themselves. In sessions, children receive lots of coaching and guidance from a therapist to master the different steps in the cognitive restructuring process. After going through this gradual process and if treatment is effective, children and parents will notice that negative thoughts are less frequent or altogether non-existent. Parents can be valuable partners in this process by helping children to recognize, evaluate, and change their own thoughts outside of the therapy office where most negative thinking and “meltdowns” are likely to occur. Cognitive restructuring is a highly valuable and central skill in CBT that often requires lots of repetition in children.

The skills above are some of the most common elements of CBT along with the skills reviewed in my earlier blogs such as relaxation training and behavior management skills. There are other elements of cognitive behavioral therapy that are specific to certain conditions such as systematic exposure for anxiety, exposure and response prevention for OCD, and structured problem-solving for other conditions that are not covered in this blog. Look for future blogs that highlight how other CBT treatment interventions can be helpful for you and your child.

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Parents as Coaches: An Overview of Parent Involvement in Child Psychotherapy, by Jennifer Rodman, Ph.D.

Monday, October 29th, 2012

As a child psychologist, I have the pleasure of helping youngsters manage their emotions and build adaptive coping behaviors, However, experience has shown me the value of working with parents as well, and in the course of my work, I have learned that involving parents in their child’s treatment is, more often than not, essential to therapeutic progress, and is also one of the most rewarding aspects of child psychotherapy.

In order to appreciate the purpose of parent sessions, it is important to first understand the theoretical underpinnings of cognitive behavioral therapy (CBT). Cognitive behavioral psychology operates on the idea that our thoughts and behaviors are shaped by the situations that trigger behaviors (known as antecedents), as well the outcomes of our behavioral responses to these triggers. For example, if Johnny screams because his parents try to serve him pancakes for breakfast instead of eggs, the antecedent would be not getting his first breakfast choice, the behavior would be screaming, and if as a consequence of the morning cacophony his exasperated parents throw out the pancakes and cook him eggs, well, Johnny has just learned that screaming will get him what he wants and he will likely do it again when faced with the same situation. In other words, environmental conditions shape behaviors, and inevitably guardians are a foundation for their children’s environment.

One common misconception that arises when parent sessions are requested as part of a child’s treatment is that of bad parenting. This notion is inaccurate let alone unhelpful. While parenting behaviors may be involved in the maintenance of problem behaviors, often this influence is not only unintentional, but it results from the best intentions. For example, what good parent wouldn’t want their child to eat a nourishing breakfast? This thought might underlie the behavior of Johnny’s parents, who in complying with his demands, unintentionally feed the problem (no pun intended). What good parent would not want to soothe their child who is crying because she is afraid of sleeping alone in her bed? Soothing is wonderful parenting behavior, but if in addition to comforting words, this child’s parents allow her to sleep with them, the parent’s attempt at rescuing will actually send the message that escaping is the solution of choice rather than facing her fears.

Another misconception is to equate parent sessions with parent psychotherapy. While I encourage parents to seek their own treatment in circumstances in which this is deemed necessary, the focus of their child’s treatment is on the child. As a therapist, my job is to guide adults in building the strongest foundation they can to produce adaptive behavior in their children. So if bringing out the best in children is like building a sturdy house, and the parents are the “contractors” managing this operation, I guide the “contractors” in choosing materials, and planning and implementing the skills that will lead them to parenting goals they wish to accomplish.

Regardless of the presenting concern, parent sessions generally entail the following components:

• Psychoeducation about the emotional and behavioral problems of concern, including which factors typically lead to such issues in children, how they typically present, how they are being maintained, as well as typical strategies for targeting these behaviors.

• Parent Training to manage their child’s emotions and behaviors in a way that will logically lead to a decrease in symptoms of concern. It is important for parents to realize that such strategies might represent parenting behaviors that differ from how they were raised, or even how they approach parenting their other children. Parents may wonder why the child of concern requires special treatment when their other children do not. The truth is that every child presents with unique concerns. Parent training does not mean that what one was doing before was wrong. Rather, it means that the child’s behavior needs to be approached in a specific way in order to appropriately address and manage symptoms.

• Parents are trained in Coaching their children in using the coping skills learned in child sessions, such as techniques for relaxation or anger management. Just like practicing a musical instrument is critical for mastery, working on skills outside of the treatment session plays an important role in helping a child achieve therapy goals across a range of contexts, such as school and the playground, as well as the home environment.

While aspects of parent sessions for a variety of childhood disorders cannot be described in depth within the confines of this article, I will provide a brief outline for some common emotional and behavioral issues. For oppositional and defiant behaviors, parents are taught how to retrain their children to associate positive behaviors with positive consequences. The therapist thus often guides parents in establishing positive reward systems that are practical for the household, in learning how to interact with a child in a way that strengthens the parent-child relationship, and on setting limits, such as consistent consequences, in order to manage misbehavior. For anxiety disorders, parents are taught the very same coping skills that their children learn in session, and are instructed in how to serve as their child’s coach through exercises in which they are gradually exposed to anxiety-provoking stimuli. In Autism Spectrum Disorders, the therapist may work with parents on creating visual strategies, such as schedules, visual prompts, social stories and visual communication systems, as well as guide the parents in practicing social skills with their children.

Across the board, the results of research studies consistently reveal that adding a parent component to treatment enhances the effectiveness of child psychotherapy in both short and long term. In addition, parent involvement helps promote generalization of the skills acquired across time and setting. Above all, rather than placing the onus on the child to improve his or her behavior, parent involvement sends the message to your child that we are working together as a team to make life easier and more enjoyable!

Jennifer Rodman, Ph.D. is a licensed clinical psychologist whose areas of specialization include Autism Spectrum Disorder and other developmental disabilities, behavior management, and anxiety disorders. She can be contacted at jennifer@brooklynletters.com or (347) 974-1106.

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