CBT for Children
Cognitive Behavioral Therapy (CBT) is an empirically-based treatment for psychological disorders of adults, adolescents and children. Cognitive behavioral therapy for the treatment of children has been effective in the treatment of anxiety, depression and behavioral problems. There are various challenges a cognitive behavioral therapist may face when working with children.
Challenges for Child Therapy
Rapport building is one of the first hurdles in cognitive behavioral therapy (CBT) for children. A cognitive behavioral therapist must be vigilant of the child’s motivation to engage in treatment and work with the child at his own level. Cognitive behavioral therapists often choose to meet with the child along with his parents during the first few sessions, especially if separation anxiety is prominent. Report building techniques may include playing games, coloring or drawing. Once the child appears ready to meet with the cognitive behavioral therapist alone, the therapist may excuse the parents to the waiting area and spend some time alone with the child for a limited period. Cognitive behavioral therapist must be sure not to overload a sensitive child with numerous questions or material that is to psychologically laden, especially during the beginning of that therapeutic alliance. Rapport building should do just that, slowly build a therapeutic relationship between the cognitive behavioral therapist and child. Once the therapist is confident that the therapeutic alliance has been established, she may move toward other therapeutic techniques to reach specific emotional and behavioral goals that had been set by the therapist, child and parent.
CBT Goal Setting
During cognitive behavioral therapy for children, it is important to set behavioral and emotional goals in conjunction with the parents and child. Parents play an integral role in treatment when cognitive behavioral techniques are used. Behavioral goals must be specific and address particular behaviors that the child exhibits. Children are often seen for cognitive behavioral therapy with goals of reducing defined behaviors and improving emotional control.
CBT Treatment Planning
If children are being seen for cognitive behavioral therapy for the reduction of maladaptive behaviors, it is important to set a specific goal. For children under the age of seven, it is quite often that a cognitive behavioral therapist will meet alone with the parents without the children. Parenting skills training may be a key component in addressing behavior problems in children. While it is important for the child to understand the behavioral modification system put in place, the parents often need education and guidance about how to implement the program before it begins. Parents are first provided with psychoeducation about behavioral management. This means that the parents must first identify triggers that set off the child maladaptive behavior. Triggers are often something that has occurred in the environment that prompt the child to behave in a specific way. Triggers may also involve internal factors, such as the child’s mood, fatigue or if the child has eaten. Once triggers have been identified the therapist works with the parents to either help prevent these triggers from occurring or learn techniques to prevent the child’s behavior from escalating if a trigger is unavoidable. Psycho education to parents also involves teaching them about reinforcing consequences for the child’s behavior. One type of reinforcing consequence is parental attention. If the therapist and parents determine the function behind the child’s behavior is to gain the attention of his/her parent, ignoring would be a useful technique that parents can use to extinguish an unwanted behavior. Children may also behave in certain ways to escape or avoid a certain task. If the function of a child’s behavior is escape/avoidance, a therapist will work with parents to provide consistency and enforce rules and a household so that a child is not escaping certain tasks by behaving in an inappropriate way.