Cognitive Behavioural Therapy (CBT) Children and Adolescents
Cognitive Behavioural Therapy is based on the idea that psychological disorder is caused or maintained by ‘dysfunctional’ patterns of thoughts and behaviours.
Cognitive-behaviour therapy (CBT) helps improve a child’s moods, anxiety and behaviour by examining confused or distorted patterns of thinking. CBT therapists teach children that thoughts cause feelings and moods which can influence behaviour. During CBT, a child learns to identify harmful thought patterns. The therapist then helps the child replace this thinking with thoughts that result in more appropriate feelings and behaviours. It appears that the majority of children can distinguish between thoughts, feelings and behaviours by seven or eight years of age (Salmon and Bryant, 2002) and may therefore benefit from CBT.
Several methods of CBT may be used, depending on the particular problem. CBT is considered short-term therapy, with anywhere from 4-20 sessions needed in general.
Some of the key tools in Cognitive Behavioural Therapy (CBT) are:
- Developing a shared formulation. (How did the problem begin and what is maintaining it?).
- Psychoeducation to make sense of the maintaining role of thoughts and behaviours.
- Guided discovery (helping the child or adolescent to consider other points of view and put alternative thoughts or beliefs to the test).
- Behavioural experiments (test the validity of the child or adolescent’s existing beliefs and to develop and test out new alternative beliefs)
- Relapse prevention.
Relapse prevention is a very important consideration when working with children and young people as many report an increase in symptoms during periods of stress or illness. For example, symptoms may increase during the months approaching important exams. Therefore, towards the end of treatment it is useful to review what was helpful in treatment and further goals to work towards along with a plan for dealing with setbacks. As the end of therapy approaches these aspects are reviewed and discussed with the child or adolescent to formulate a relapse plan.
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The benefits of Cognitive Behavioural Therapy (CBT) may include:
- Receiving emotional support
- Resolving conflicts with others
- Understanding how feelings impact thoughts and actions
- Reversing negative patterns of thinking, addressing bad habits
- Appropriately dealing with stress and frustration
- Participating positively in a variety of activities
- Setting goals to replace negative patterns of behavior with positive ones
- New ways of learning and self-help techniques are reinforced
- Increase in self-esteem
- Improved performance at school, at home and in social situations
As with adults Cognitive Behavioural Therapy (CBT)can be used to treat a wide variety of psychological issues including:
- Low mood or depression
- Anxiety based disorders
- Eating difficulties and disorders
- Relationships and Family issues
- Social skills
- Bullying and school based issues
- Low self-esteem
- Body image issues
- Anger management
- Obsessive Compulsive Disorders
- Emotional issues
Cognitive Behavioural Therapy (CBT) and Engagement
Engagement is extremely important when delivering Cognitive Behavioural Therapy to children and adolescents. This age group are especially sensitive to feeling criticized and may have issues with authority figures. To skillfully engage the young person requires a balance between being an ‘expert’ while simultaneously being able to learn from the young person. It is important that the therapist appears willing to understand the child or adolescent’s perspective rather than criticize it and demonstrate an attitude that is different to parents or other authority figures. Having several years of experience of working with this age group I am able to engage their attention by showing that I am genuinely interested, want to understand their issues and want to help.
Cognitive Behavioural Therapy (CBT) and Collaboration
In most cases, it is not the child or adolescent who has sought therapy but their parent, carer or another significant adult. Collaboration is fundamental when delivering CBT with children and young people and it is important to communicate that the therapeutic relationship is a joint enterprise. This promotes the child or adolescent’s sense of self-efficacy and control. Using this approach promotes the development of skills that can continue to be used independently from the therapist once the sessions have ended thus equipping the child or adolescent to deal with any future setbacks.
Cognitive Behavioural Therapy (CBT) and Motivation
As mentioned above, in most cases it is not the child or adolescent who has sought therapy but their parent, carer or another significant adult. Therefore it is important to consider their motivation to change right from the beginning. We can do this by looking at the pros and cons of changing how things are at the moment. It is also useful to consider the short term and long term goals of the child and how their issues are affecting them. Another important consideration is to allow the child or adolescent to express their likes or dislikes about the therapeutic process. For example, are the sessions too long? Should someone else attend too? It is important to review motivation regularly in sessions to minimize disengagement as the young person is unlikely to express their dissatisfaction and from experience will simply refuse to come back.
Cognitive Behavioural Therapy (CBT) and Family
While it is important that the child or adolescent feels that they have their own safe place to talk about their issues, it is necessary to ensure that their current environment promotes change. This is likely to involve working with family members to some extent to ensure that they are reinforcing the young person to take risks and be brave in order to overcome their problem. This will be negotiated at the start of therapy so that all parties are happy with boundaries regarding what information will be shared with parents. It may be necessary to have separate sessions with family members to avoiding encroaching on the child or adolescent’s safe space.
Are you worried about your child or teenager lately? Are they behaving differently or do they seem more distant? Unsure how to approach this? I can help.
If you are interested in or considering CBT for a child or adolescent then please get in touch with me by phone or email to see how I can help you.
Why not get in touch today?
For expert therapeutic support