A Clinician's Guide to CBT for Children to Young Adults A Companion to Think Good, Feel Good and Thinking Good, Feeling Better

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.

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.

1. Introduction and overview

CBT as an intervention 1

CBT as a preventative intervention 2

CBT with younger children 3

CBT with young people with learning difficulties 3

Technologically delivered CBT 4

Involving parents 5

The competencies to deliver CBT 6

 Assessing competence 7

Cognitive Behaviour Therapy Scale for Children and Young People 8

CORE philosophy 12

 Child centred 13

 Outcome focused 14

 Reflective 15

 Empowering 16

2. PRECISE 19

The therapeutic alliance 19

Partnership 21

 Eliciting young person and parent’s understanding and views 22

 Encourages the young person to participate in decision making 23

 Involves young person and parent/carer in planning the intervention 24

 Encourages young person to provide feedback about sessions 24

Right developmental level 25

 Ensures a balance between cognitive and behavioural techniques 25

 Uses simple, clear. jargon free language 26 Uses a variety of verbal and non-verbal techniques 28 Appropriately involves parents/carers 28

 Courtney has anger outbursts 30

Empathy 30

 Conveys interest and concern 30

 Acknowledges and responds to emotional responses 32

 Demonstrates a respectful, non-judgemental, caring approach 33

 Empathises with parents 34

Creative 35

 Tailors concepts and methods of CBT around the young person 36

 Uses a range of verbal and non-verbal methods 37

Is creative in use of materials and metaphors 38

 Utilises the preferred media of the young person 39

Investigation 40

 Creates a process of collaborative inquiry 40

 Fully involves the young person in the design of experiments 41

 Helps to consider alternative explanations 42

 Encourages reflection 42

Self-efficacy 43

 Identifies strengths and personal resources 43

 Encourages identification of helpful skills and strategies 44

 Develops personal coping strategies 45

 Reinforces use of new skills 46

Enjoyable and engaging 47

 Uses an appropriate mix of materials and activities 47

 Maintains a balance between task and relationship strengthening 47 Incorporates young person’s interests into the intervention 48

 Presents as positive and hopeful 49

PRECISE in practice 49

 Ella’s obsessional thoughts 49

 Joshua’s negative thinking 50

3. A: Assessment and Goals 52

Undertakes a full assessment 52

Compliments assessment with routine outcome measures 54

Negotiates goals and when progress will be reviewed 56

 Identification of goals 57

 Prioritisation of goals 58

 Whose goals? 58

 Inappropriate goals 59

Uses diaries, thought bubbles and rating scales 59

 Sarah feels faint 60

Tick charts 60

 Thought bubbles 61

 Visualisation 62

 Stories 62

 Rating scales 64

 Pie charts 64

 Theos washing 64

Assessing motivation and readiness to change 65

 Pre-contemplation 67

 Contemplation 68

 Preparation 69

 Action 69

 Maintenance 69

 Relapse 69

4. B: Behavioural 71

Developing hierarchies, graded exposure and response prevention 71

Developing hierarchies 71

Graded exposure 73

Response prevention 75

 John is worried about germs 76

Problems when undertaking exposure 76

Young person avoidance 76

 Clinician avoidance 77

 Anxiety does not come down 77

 Is the young person focusing on their anxiety 77

 Are parents appropriately involved 78

Uses activity rescheduling and behavioural activation 78

Activity scheduling 78

 Alison feels down 79

Behavioural Activation 80

 Problems with behavioural activation 80

 I didn’t feel like doing it 81

 I did it but I don’t feel any better 82

 I did it but so what 82

 It’s not important 82

Provides a clear rationale for use of behavioural strategies 82

Identifies and implements reward and contingency plans 83

Models, uses role play, problem-solving and skills training 85

Models how to cope 85

Role-play 87

Problem solving 88

Skills training 89

5. C: Cognitions 91

Facilitates cognitive awareness 91

Cognitive content 91

Levels of cognitions 92

Uses thought records and bubbles 96

Identifies functional and dysfunctional cognitions 98

 Unhelpful thoughts 98

 Helpful thoughts 99

Identifies cognitive biases (thinking traps) 99

 Negative filter 99

Blowing things up 100

Predicting failure 100

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 102

What would someone else say? 103

 Jaz falls out with her friend 103

Facilitates continuum work through rating scales 103

Uses mindfulness, acceptance and compassion 104 Mindfulness 104

 Compassion 107

 Acceptance 108

 Kindness 110

6. D: Discovery 111

Facilitates discovery through the Socratic dialogue 111

The Socratic dialogue 113

Memory questions 113

Translation questions 113

Interpretation questions 114

Application questions 114

Analysis questions 115

Synthesis questions 115

Evaluation questions 115

What makes a good Socratic question? 116

 Mike is worried about his cat 117

 Common difficulties 120

Facilitates perspective taking 122

 Perspective taking 122

 Responsibility pies 123

 Joshua’s accident 123

Attends to overlooked information 124

 Analogical comparisons 125

 Testing assumed relationships 125

 Marla worries she will pass germs to others 126

Evaluates cognitions thought behavioural experiments or prediction testing 127

 Planning a behavioural experiment 128

 Prediction testing – Caleb thinks he is a failure 129

 Active experiment – Laura’s social anxiety 130

 Information gathering experiments – Adam’s formulation 131

7. E: Emotions 134

Develops emotional literacy 134

Identifies key bodily signals 135

 Body signals 135

 Feeling diaries 136

 William feels sad 136

Emotional logs 137

 Isabella feels down 137

Develops relaxation, guided imagery, controlled breathing and calming activities 138

Progressive muscle relaxation 139

Calming imagery 141

 Aisha’s calming image 141

 Diaphragmatic (controlled) breathing 142

 Change the feeling 143

Develops physical activity, let the feelings go, emotional metaphors 144

 Physical activity 144

 Let the feeling go 144

 Emotional metaphors 144

 Emotive imagery 145

 Anthony’s humorous image 145

Develops self-soothing, mind games and mindfulness 146

 Self-soothing 146

 Mind games 147

Mindfulness 147

Talk to someone 148

8. F: Formulations 150

Provides a coherent and understandable rationale for the use of CBT 150

Links thoughts, emotions and behaviours (maintenance formulations) 152

Mini-formulations (two or three system models) 152

 Rhiannon is unhappy and scared 152

 Maintenance formulations 155

 Naomi cuts herself 155

Four system formulations 156

 Abdul’s anxiety 156

Remember the strengths 158

Includes past events (onset formulations) 160

 Mary’s anxiety 162

Includes role of parents/carers 164

Sally’s anxiety 164

Activities and goals are clearly linked to the formulation 166

Common problems 168

Difficulty identifying thoughts or feelings 168

 Distinguishing between different levels of cognitions 169

Can’t put the information together 170

Not sure the formulation is right 170

Can’t find all the information 171

9. G: General skills 172

Prepares and brings the necessary materials and equipment 172

Manages the young person’s behaviour 173

Sessions have an agenda, clear goals and structure 174

 General update 175

 Outcome measure update 176

 Home assignment review 176

 Session topic 176 Home assignment 177

 Session feedback 177

Good timekeeping 178

Sessions are appropriately paced and responsive 179

 Gary is worried about germs 181

Prepares for endings and relapse prevention 181

10. H: Home assignments 186

Negotiates home assignments 186

Assignments are meaningful and related to the formulation 188

Assignments are consistent with development and interests 189

Assignments are realistic and safe 191 

Assignments are related to goals 193

Harry wants get fitter 193

Fatima’s unhelpful thoughts 195

Assignments are reviewed and reflection encouraged 196

11. Putting it all together 199

Anxiety 199

Effectiveness 199

Rationale informing the intervention 200

Core components of CBT interventions for anxiety disorders 200

Parents 201

Important cognitions 202

Depression 202

Effectiveness 202

Rationale informing the intervention 203

 Core components of CBT interventions for depression 204

 Parents 205

 Important cognitions 205

Obsessive Compulsive Disorder (OCD) 206

 Effectiveness 206

 Rationale informing the intervention 207

 Core components of CBT interventions for OCD 208

 Parents 209

 Important cognitions 209

Post-traumatic Stress Disorder (PTSD) 209

 Effectiveness 209

 Rationale informing the intervention 210

 Core components of CBT interventions for PTSD 210

 Parents 211

 Important cognitions 212

When it doesn’t go right 212

Is the young person motivated to change? 213

 Sam’s cost of change 216

Are the young person and their family engaged with the intervention 217

 Jade is anxious and depressed 219

How has the intervention been delivered 223

12. Resources  227

The chain of events 228

What happens? – negative trap 229

Four systems 230

How did this happen 231

Session rating scale 232

Scales of change 233

Anxiety intervention plan 234

Depression intervention plan 235

OCD intervention plan 236

PTSD intervention plan 237

Motivation 238

Engagement 239

Intervention delivery 240

Reflective practice 241

Cognitive behaviour therapy scale for children and young people (CBTS-CYP) 242

Beating anxiety 257

Fighting back depression 263

Controlling worries and habits 268

Coping with trauma 273

13. References 277

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.