Clinical Practice of Cognitive Therapy with Children and Adolescents

Contents
CHAPTER 1. Introduction 1
Who Are We? 1
Why Write a Book on Cognitive Therapy with Children
and Adolescents? 2
What Will This Book Teach You? 2
What Is Cognitive Therapy? 3
What Are the Similarities between Cognitive Therapy
with Adults and Cognitive Therapy with Children
and Adolescents? 7
What Are the Differences between Cognitive Therapy
with Adults and Cognitive Therapy with Children
and Adolescents? 7
A Word about Our Transcripts and Examples 9
CHAPTER 2. Case Conceptualization 11
Case Conceptualization: Once Is Never Enough 11
Case Conceptualization and Treatment Planning 12
Case Conceptualization and Diagnosis 12
Case Conceptualization: “Dressing Up” the
Client Picture 13
Components of the Case Formulation 15
Planning and Thinking Ahead: Provisional Formulation,
Treatment Plan, and Expected Obstacles 26
Case Conceptualization Example 27
Conclusion 33
CHAPTER 3. Collaborative Empiricism
and Guided Discovery
34
Continuum of Collaboration and Guided Discovery 37
Conclusion 44
CHAPTER 4. Session Structure 45
Mood or Symptom Check-In 47
Homework Review 51
Agenda Setting 54
Session Content 58
Homework Assignment 61
Eliciting Feedback 62
Conclusion 67
CHAPTER 5. Introducing the Treatment Model
and Identifying Problems
68
Introducing the Treatment Model to Children 68
Introducing the Treatment Model to Adolescents 74
Identifying Problems with Children and Adolescents 77
Conclusion 81
CHAPTER 6. Identifying and Connecting Feelings
and Thoughts
82
Identifying Feelings with Children and Adolescents 82
Identifying Thoughts and Connecting
Thoughts to Feelings 91
Using the Content-Specificity Hypothesis to Guide
Identifying Thoughts and Feelings 98
Avoiding Confusion between Thoughts and Feelings 100
Helping Children and Adolescents Complete a Daily
Thought Record 100
Conclusion 102
CHAPTER 7. Therapeutic Socratic Dialogues 103
Considerations in Constructing a Therapeutic
Socratic Dialogue 104
Hints about Constructing a Socratic Dialogue 107
Universal Definitions 110
Metaphorical and Humorous Questions 116
Conclusion 124
CHAPTER 8. Commonly Used Cognitive
and Behavioral Techniques
125
Dimensions of Cognitive-Behavioral Techniques 125
Skill Acquisition (Psychoeducation) versus Skill
Application (Psychotherapy) 126
Basic Behavioral Tools 127
Social Skills Training 129
Basic Self-Instructional Techniques: Changing Thought
Content 137
Basic Rational Analysis Techniques: Changing Thought
Content and Process 138
Basic Exposure Therapy: Developing Self-Confidence
through Performance Attainment 142
Conclusion 145
CHAPTER 9. Creative Applications of
Cognitive–Behavioral Therapy
146
Storytelling 146
Play Therapy Applications 150
Games, Storybooks, Workbooks, and Making Masks 155
Thought–Feeling Hoops 158
Priming Exercises 161
Conclusion 166
CHAPTER 10. Homework 167
General Considerations in Assigning Homework 167
Homework Noncompliance 172
Conclusion 179
CHAPTER 11. Working with Depressed Children
and Adolescents
180
Symptoms of Depression 180
Cultural and Gender Considerations 185
Assessment of Depression 187
Treatment of Depression: Choosing an
Intervention Strategy 189
Suicidality with Depressed Children and Adolescents 190
Behavioral Interventions for Depression 200
Problem Solving 206
Self-Monitoring 207
Self-Instructional Approaches 209
Rational Analysis Techniques 211
Conclusion 217
CHAPTER 12. Working with Anxious Children
and Adolescents
218
Symptoms of Anxiety in Youth 218
Cultural and Gender Differences in Symptom Expression 220
Assessment of Anxiety 222
A Word on Medical Evaluations 223
Choosing Interventions in Anxiety Disorders 223
Self-Monitoring 226
Relaxation Training 230
Systematic Desensitization 232
Social Skills Training 235
Cognitive Self-Control 238
Exposure 251
Conclusion 260
CHAPTER 13. Working with Disruptive Children
and Adolescents
263
Common Symptoms of the Disruptive Disorders 263
Cultural Context and Gender Issues 265
Assessment of Disruptive Behavior Problems 267
Treatment Approach 268
Building Relationships with Disruptive Children
and Adolescents 270
Teaching Parents about Behavior Management and Family
Problem Solving 271
Education and Self-Monitoring 276
Individual Problem Solving 280
Time Projection 282
Social Skills Training 283
Empathy Training 285
Self-Instructional Approaches 286
Rational Analysis Techniques 290
Moral Reasoning 294
Exposure/Performance Attainment 296
Conclusion 298
CHAPTER 14. Working with Parents 299
Establishing Realistic Expectations for Behavior 299
Helping Parents Define Problems 302
Helping Parents Increase Their Child’s Desirable Behaviors:
“I Just Want Him to Behave” 305
Teaching Parents to Give Commands/Directions 312
Linking Child Behavior to Parental Consequences:
Contingency Management 314
Helping Parents Deal with Their Child’s Unde




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Introduction
When we began writing this book, we thought about “How do we begin?”
As cognitive therapists, we found it natural to begin with a series of
questions to introduce the purpose of the book, its content, and its format,
as well as ourselves to you.
WHO ARE WE?
We are cognitive therapists at different stages in our careers. Robert
Friedberg is a clinical psychologist who is in the middle stages of his career,
while Jessica McClure is beginning her professional career. Dr.
Friedberg has worked with children and their families in a variety of outpatient
and inpatient settings. His work is fundamentally shaped by the
writings of Aaron Beck and Martin Seligman, as well as by his mentors
Christine Padesky and Raymond Fidaleo. Dr. McClure has had clinical
experience with children and adolescents in a variety of settings, including
inpatient psychiatric hospitals, pediatric medical centers, outpatient
clinics, and innovative prevention programs.
We began writing this text together when Dr. McClure trained under
Dr. Friedberg’s supervision in the Preventing Anxiety and Depression in
Youth program at Wright State University School of Professional Psychology.
We thought that a book written by two psychologists at different
points in their careers would speak to professionals with different levels
of experience.

WHY WRITE A BOOK ON COGNITIVE THERAPY
WITH CHILDREN AND ADOLESCENTS?
We wanted to write a book that makes use of cognitive therapy principles
and offers a coherent theoretical framework. Cognitive therapy as developed
by Aaron T. Beck is a robust clinical and theoretical system that has
been applied to many adult problems and populations (A. T. Beck, 1976,
1985, 1993; A. T. Beck, Emery, & Greenberg, 1985; A. T. Beck, Rush,
Shaw, & Emery, 1979), but few cognitive therapy texts on children apply
Beck’s approach to youngsters (Knell, 1993; Ronen, 1997). In addition,
child psychotherapy often lacks a coherent theoretical focus (Ronen,
1997).
WHAT WILL THIS BOOK TEACH YOU?
This book offers a complete guide on how to do cognitive therapy with
schoolchildren and adolescents. In addition to teaching many techniques,
the book will also emphasize the guiding principles that shape Beck’s cognitive
therapy. Collaborative empiricism and guided discovery, the leitmotifs
of cognitive therapy, are defined in Chapter 3 and subsequently illustrated
throughout the text. The session structure that characterizes
cognitive therapy is described in Chapter 4. Applying cognitive-behavioral
techniques in the absence of a case conceptualization is a major clinical
error (J. S. Beck, 1995). Furthermore, techniques disembodied from theory
fall flat. Accordingly, case conceptualization is a basic blueprint for
success in cognitive therapy (J. S. Beck, 1995; Persons, 1989); the nuts
and bolts we use to build a case formulation are presented in Chapter 2.
This book also takes into consideration developmental and multicultural
issues throughout the text. Developmental sensitivity is crucial
for successful cognitive-behavioral work with children (Ronen, 1997;
Silverman & Ollendick, 1999). Accordingly, social developmental issues
are delineated at the end of this introductory chapter. Further, we explain
how you might modify different techniques for younger children and adolescents.
Chapter 2 discusses the incorporation of multicultural considerations
and familial factors into a comprehensive case conceptualization.
Chapters 5 through 14 describe various cognitive-behavioral treatment
strategies, ranging from problem identification to techniques for
crafting a Socratic dialogue with children to child-friendly forms of cognitivebehavioral
intervention. Each chapter deals with the application of these
methods with young children and adolescents. Moreover, cognitivebehavioral
approaches for depressed, anxious, and aggressive youth are
addressed in individual chapters