Clinical Practice of Cognitive Therapy with Children and Adolescents: The Nuts and Bolts

366 Pages·2002·2.97 MB·English

by  Robert D. Friedberg Phd

Clinical Practice of Cognitive
Therapy with Children
and Adolescents
v
The Nuts and Bolts
ROBERT D. FRIEDBERG
JESSICA M. MCCLURE
THE GUILFORD PRESS
New York London
 2002 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
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Library of Congress Cataloging-in-Publication Data
Friedberg, Robert D., 1955–
Clinical practice of cognitive therapy with children and adolescents:
the nuts and bolts / Robert D. Friedberg, Jessica M. McClure.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-57230-723-4 (hardcover : alk. paper)
1. Cognitive therapy for children. 2. Cognitive therapy for
teenagers. I. McClure, Jessica M. II. Title.
[DNLM: 1. Cognitive Therapy—methods. WM 425.5.C6 F899c 2002]
RJ505.C63 F75 2002
618.92′89142—dc21
2001054319
AAbboouutttthheeAAuutthhoorrss
About the Authors
Robert D. Friedberg, PhD, is a clinical psychologist on the faculty of the
WrightStateUniversitySchoolofProfessionalPsychology.HeisanAsso-
ciate Professor and directs the Predoctoral Internship Program and the
Preventing Anxiety and Depression in Youth Program (PANDY). Dr.
Friedbergistheauthorofthreeotherbooksonchildrenandadolescents:
SwitchingChannels(withCarolynMasonandRaymondFidaleo),Thera-
peutic Exercises for Children (with Barbara Friedberg and Rebecca
Friedberg), and A Professional Guide to Therapeutic Exercises for
Children(withLoriCrosby).Hehasauthorednumerousarticlesinschol-
arly journals and delivered presentations on cognitive therapy with
children and adolescents to professional audiences. Dr. Friedberg is a
Founding Fellow in the Academy of Cognitive Therapy.
JessicaM.McClure,PsyD,worksasaclinicalpsychologistspecializingin
the assessment and treatment of children and adolescents for the Child-
ren’s Hospital Medical Center in Cincinnati, Ohio. She is an adjunct
faculty member at the Wright State University School of Professional
Psychology,wheresheteachesseveralchild-focusedcourses.Dr.McClure
has coauthored presentations and articles on the treatment of children
and adolescents and currently serves children and adolescents experienc-
ing depression, anxiety, behavior problems, and developmental delays.
v
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Acknowledgments
Thank you to my wife, Barbara, and daughter, Rebecca, whose love and
supportinspiredmethroughoutthisproject.Ivaluethecollaborationand
collegiality with my coauthor, Jessica McClure, whose attention to detail
is peerless. Kitty Moore, our editor, was an exceptional guide, shepherd-
ing us through this project with creative and insightful comments. The
many clinical trainees I supervised deserve mention, as our lively discus-
sionsledmetorefinemanyideas.Iwanttoacknowledgethemanyyoung
clients and families my trainees and I served and thank them for entrust-
ingtheircaretous.IamgratefultotheWrightStateUniversitySchoolof
ProfessionalPsychologyforgivingmetheopportunitytopursuemyclini-
calserviceandresearch.Finally,specialthanksgoestoCarolSmart,who
typedandretypedearlierversionsofthemanuscriptwithprofessionalism
and good humor.
ROBERT D. FRIEDBERG
I would like to acknowledge the invaluable support that my family and
friends provided me throughout this endeavor. I express my deepest ap-
preciation to my husband, Jim McClure, for all of his patience and en-
couragement over the countless hours of work. Thanks to my coauthor,
Robert Friedberg, for his great sense of humor and collaboration on this
project.IamgratefultomycolleagueDenisePrice,whoendurednumer-
ous questions and provided endless encouragement throughout the pro-
cess.Finally,CarolSmart’sclericalskillsweremuchappreciatedthrough-
out the writing of this book.
JESSICA M. MCCLURE
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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
ix
x Contents
CHAPTER 3. Collaborative Empiricism 34
and Guided Discovery
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 68
and Identifying Problems
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 82
and Thoughts
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
Contents xi
CHAPTER 8. Commonly Used Cognitive 125
and Behavioral Techniques
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 146
Cognitive–Behavioral Therapy
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 180
and Adolescents
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