A Clinician's Guide to CBT for Children to Young Adults

A powerful and insightful clinical resource for CBT practitioners who work with children and young adults

The newly updated and thoroughly revised Second Edition of this companion to Think Good, Feel Good and Thinking Good, Feeling Better delivers guidance for clinicians using the author's seminal workbooks. This companion work builds upon the workbook materials by offering readers instruction on all aspects of the therapeutic process and a wide range of case studies highlighting specific therapies in action.

A Clinician's Guide covers topics including parental involvement, key cognitive distortions in children, formulations, challenging thoughts, guided discovery, and the use of imagery. The author also includes a chapter focusing on common potential problems that arise in therapy and strategies to overcome them.

The book highlights the underlying philosophy, process, and core skills of employing CBT with children and young people. Readers will appreciate the competency framework, which describes the CORE philosophy, PRECISE process, and the ABCs of specific techniques. The book also includes:

• Additional materials and handouts for use in therapy, including psycho-educational materials for children and parents on common problems, like depression, OCD, PTSD, and anxiety
• Downloadable, multi-use worksheets for use in the clinician's therapeutic sessions
• Practical, real-world case examples that shed light on the techniques and strategies discussed in the book
• A systematic approach to the use of cognitive behavioural therapy to treat common psychological problems

Perfect for professionals and trainees in child and adolescent mental health, like psychiatrists, clinical psychologists, educational psychologists, community psychiatric nurses, and occupational therapists, the book also belongs on the shelves of non-mental health professionals, including school nurses and social workers, who regularly work with children in a therapeutic setting.

Auteur

PAUL STALLARD is Professor of Child and Family Mental Health at the University of Bath and Head of Psychological Therapies (CAMHS) for Oxford Health NHS Foundation Trust. He is a clinical psychologist who has worked with children and young people for 40 years using Cognitive Behaviour Therapy (CBT). He is also an active researcher and has been involved in many studies exploring the use and effectiveness of CBT with children and young people.

Contenu

About this book xiii

Acknowledgements xv

Online resources xvii

1 Introduction and overview 1

CBT as an intervention 1

CBT as a preventative intervention 2

CBT with younger children 3

CBT with children and young people with learning difficulties 4

Technologically delivered CBT 5

Involving parents 6

The competencies to deliver child-focused CBT 7

Assessing competence 8

Cognitive Behaviour Therapy Scale for Children and Young People 9

CORE philosophy 13

Child-centred 14

Outcome-focused 15

Reflective 16

Empowering 17

2 PRECISE 19

The therapeutic alliance 19

Partnership 21

Eliciting the young person's and parents' understanding and views 22

Encourages the young person to participate in decision making 23

Involves the young person and parents/carers in planning the intervention 24

Encourages the young person to provide feedback about sessions 25

Right developmental level 25

Ensures an optimal balance between cognitive and behavioural techniques 26

Uses simple, clear, jargon-free language 27

Uses a variety of verbal (direct and indirect approaches) and non-verbal techniques 28

Appropriately involves parents/carers/others 28

Courtney has anger outbursts 30

Empathy 30

Conveys interest and concern using active listening, reflection, and summaries 30

Acknowledges and responds to emotional responses 32

Demonstrates an open, respectful, non-judgemental, caring approach 33

Empathises with parents 34

Creative 35

Tailors the concepts and methods of CBT around the interests of the young person 35

Uses a range of verbal and non-verbal methods 36

Creatively uses a range of methods 37

Utilises the preferred media of the young person 38

Investigation 39

Creates a process of collaborative inquiry 39

Fully involves young people in the design of experiments 40

Helps young people and parents/carers to consider alternative explanations 41

Encourages reflection 42

Self-efficacy 42

Identifies and highlights strengths and personal resources 43

Encourages identification of helpful skills and strategies 44

Develops personal coping strategies 44

Reinforces use of new skills 45

Enjoyable and engaging 45

Uses an appropriate mix of materials, activities, humour 46

Maintains an appropriate balance between task and relationship-strengthening activities 46

Attends to the young person's interests and incorporates them into the intervention 47

Presents as positive and hopeful 48

PRECISE in practice 48

Ella's obsessional thoughts 48

Joshua's negative thinking 49

3 A: Assessment and goals 51

Undertakes a full assessment of the presenting problem 51

Compliments assessment with routine outcome measures (ROMs) 53

Negotiates goals and the dates when progress will be reviewed 55

Identification of goals 56

Prioritisation of goals 57

Whose goals? 57

Inappropriate goals 58

Uses diaries, thought bubbles, and rating scales 59

Sarah feels faint 59

Tick charts 60

Thought bubbles 60

Visualisation 61

Stories 62

Rating scales 63

Pie charts 63

Theo's washing 64

Assesses motivation and readiness to change 64

Pre-contemplation 65

Contemplation 67

Preparation 67

Action 68

Maintenance 68

Relapse 68

4 B: Behavioural 69

Uses behavioural techniques to facilitate therapeutic change 70

Developing hierarchies 70

Graded exposure 72

Response prevention 74

John is worried about germs 75

Problems when undertaking exposure 75

Young person avoidance 75

Clinician avoidance 76

Anxiety does not come down 76

Is the young person focusing on their anxiety? 77

Are parents/carers appropriately involved? 77

Uses behavioural techniques such as activity rescheduling and behavioural activation 77

Activity rescheduling 77

Alison feels down 78

Behavioural activation 79

Problems when undertaking behavioural activation 80

I didn't feel like doing it 80

I did it, but I don't feel any better 81

I did it, but so what? 81

It's not important 81

Provides a clear rationale for using behavioural strategies 82

Identifies and implements reward and contingency plans 82

Models, uses role play, structured problem-solving approaches, or skills training 85

Model how to cope 85

Role play 87

Problem solving 88

Skills training 89

5 C: Cognitions 91

Facilitates cognitive awareness 92

Cognitive content 92

Levels of cognitions 92

Freya worries about making a fool of herself 93

Uses thought records and bubbles 96

Identifies functional and dysfunctional cognitions 98

Unhelpful thoughts 99

Helpful thoughts 99

Identifies common cognitive biases ('thinking traps') 99

The negative filter 100

Blowing things up 100

Predicting failure 101

Being down on yourself 101

Setting yourself up to fail 101

Facilitates thought challenging and perspective taking 102

What is the evidence? 102

The 4Cs 103

What would someone else say? 103

Jaz falls out with her friend 104

Facilitates continuum work using rating scales 104

Uses techniques such as mindfulness, acceptance, and compassion 105

Mindfulness 105

Compassion 107

Acceptance 109

Kindness 110

6 D: Discovery 111

Facilitates discovery and reflection through use of the Socratic dialogue 111

The Socratic dialogue 113

What makes…