Clinical practice of cognitive therapy with children and adolescents

Friedberg, R.D., & McClure, J.M. (2002). Clinical practice of cognitive therapy with children and adolescents: The nuts and bolts. New York: The Guilford Press.
Must (a) establish relationships “based on trust, understanding, respect, and a sense of genuineness,” (b) set limits >> “By knowing what is expected, children feel safe.” Must clearly establish rules and “be consistent about enforcing them. Consistency promotes trust. If you set a limit and follow through w/ it, you are saying that your words and actions are meaningful (270).

Barkley et al. (1999) (Defiant Teens) described what impairs families. First, “parents neglect the positive behaviors and almost exclusively attend to the negative behaviors.” Parents become frustrated when children do not comply and do not consistently punish or sometimes they just give in (271). We need to teach parents to praise kids for doing good.

Emotions and Self-Monitoring

Many kids blame others for their problems. Must show them that their own behavior is contributing to problem: e.g., when mom acts bitchy, I don’t comply with her requests, and this in turn makes her bitchier (276).

Must teach kids difference b/t “taking abuse and being in control.” Brondolo:

Clients may stop treatment if they misconstrue the therapy as requiring them to tolerate the abuse. Instead, we emphasize that emotional control is a prerequisite for devising an effective response to injustice. The fact that all good martial arts training begins with training in emotional control is a good metaphor for angry clients. Sometimes a loud voice or a sharp remark is an effective and appropriate response to a provocation. However, these responses need to be employed in a deliberate, planned manner, when it seems like the most effective strategy. (p. 85)

Ann Vernon: Crack an egg, ask, “Did the egg choose to crack? Did the egg have a choice?” Then: What are some differences b/t you and the egg? When a kid mindlessly reacts, ask, “Are you being an egg?” (277).

Emphasize that it’s okay to feel angry/frustrated/etc., just not to act on feeling.

Problem Solving

Must often tie student’s behavior to direct consequences, not future consequences (281).

How to problem solve: COPE >> Catching the problem, listing the Options, Predicting the long-term and short-term consequences, Evaluating the anticipated outcomes (281).

Time Projection

E.g. — How mad were you when Tom cut in line? 10. How mad were you at dinner that night? 7 or 8. How mad are you now? 3 or 4. Right now are you mad enough to hit him? No. Let me get this right. So you are paying for 1 day of feeling angry with 3 days of suspension? (282-283).

Rational Analysis Techniques

Reframing: “He really gets you going. The volume on your anger really gets turned up...it sounds like Omar is in charge of the volume knob” (291).

To soften black-or-white thinking: Student thinks some is a total asshole >> Ask student to describe characteristics of assholes, things they do >> Then ask student to describe characteristics of people who are really cool >> Draw continuum, asshole on one end, cool on the other >> start placing different people on continuum >> Show that guy he says is asshole is not that far separated from others he says aren’t assholes.

someone trying to push your anger button

Misc.

1. Basic Behavioral Tools: Muscle relaxation exercises
2. Social Skills Training
1. Empathy training and teaching perspective taking
3. Role Playing
4. Evaluating Advantages and Disadvantages
5. Changing thoughts
1. Decatastrophizing: What’s the worst that could happen? What’s the best? What’s the most realistic? Help them think of ways to problem-solve.
2. Test of Evidence
3. Reattribution: Asks, “What’s another way of looking at this?”