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Cognitive Behavioral

Therapy with

CHILDREN

Cognitive Behavioral

Therapy with

CHILDREN

A Guide for the Community Practitioner

Katharina Manassis

New York London

Routledge

Routledge

Taylor & Francis Group

Taylor & Francis Group

270 Madison Avenue

2 Park Square

New York, NY 10016

Milton Park, Abingdon

 

Oxon OX14 4RN

© 2009 by Taylor & Francis Group, LLC

Routledge is an imprint of Taylor & Francis Group, an Informa business

Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1

International Standard Book Number-13: 978-0-415-99670-9 (Softcover)

Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers.

Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data

Manassis, Katharina.

Cognitive behavioral therapy with children : a guide for the community practitioner

/Katharina Manassis. p. ; cm.

Includes bibliographical references and index. ISBN 978-0-415-99670-9 (pbk. : alk. paper) 1. Cognitive therapy for children. I. Title.

[DNLM: 1. Cognitive Therapy--methods. 2. Child. 3. Community Health Services--methods. 4. Evidence-Based Practice. WS 350.6 M2675c 2009]

RJ505.C63M33 2009

 

616.89’1425--dc22

2008054211

Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com

and the Routledge Web site at http://www.routledge.com

This book is dedicated to those I have taught, to those who have taught me, and to Julia and Martin, my own children.

Contents

Preface

xiii

Acknowledgments

xxi

Author

xxiii

1. Why the Gap between Efficacy and Effectiveness?

1

What Is Known

1

Putting It into Practice

3

Client Factors

4

Children One Might Include with Caution

5

Therapist Factors

7

Organizational Factors

8

Unknowns in CBT

10

Getting Started Worksheet

12

Clinical Challenge

13

References

13

2. Leveling the Playing Field

15

What Is Known

15

Putting It into Practice

17

Assessing the Main Problem

17

Assessing the Child in Context

21

The Ideal Candidates for CBT

23

When CBT Is Part of the Solution

24

Testing the Waters: Cognitive Readiness for CBT

26

When Individual Treatment Is Preferable to Group Treatment

27

When CBT Is Not Helpful

29

vii

viii

Contents

 

 

Assessment Worksheet

30

 

Clinical Challenge

32

 

References

32

3. Priorities and Timing of Therapy

35

 

What Is Known

35

 

Putting It into Practice

37

 

The Case of Carrie

37

 

The Case of Roger

40

 

Additional Considerations

41

 

CBT and Other Psychotherapies

42

 

CBT and Psychotropic Medications

44

 

When a Full Course of CBT Is Not Possible

46

 

Timing Worksheet

48

 

Clinical Challenge

50

 

References

50

4.

Treatment Expectations

53

 

What Is Known

53

 

Putting It into Practice

55

 

Goals

55

 

Time Frame

56

 

Roles

57

 

Progress in Therapy

58

 

What Happens When the Therapy Is Over?

60

 

Common Misconceptions about CBT

60

 

Mrs. Smith’s Treatment Expectations

61

 

Expectations Worksheet

64

 

Clinical Challenge

66

 

References

66

5.

Using Manuals Appropriately

69

 

What Is Known

69

 

Anxiety-Focused Manuals

71

 

Depression-Focused Manuals

71

 

Manuals Focused on Externalizing Problems

71

 

Putting It into Practice

71

 

Manual Selection

73

 

Adherence

74

 

Modifications That May Help

76

 

Modifications That Are Inadvisable

78

 

Manuals and the Therapeutic Relationship

79

 

Contents

ix

 

Cultural Difference and Manualized Therapy

81

 

When There Is No Manual That Fits Exactly

 

 

(Modular Approaches)

82

 

How Do You Know Which Modules to Use?

83

 

Using Manuals Worksheet

85

 

Clinical Challenge

87

 

References

87

6.

How Child CBT Differs from Adult CBT

89

 

What Is Known

89

 

Putting It into Practice

90

 

The Therapy Experience from a Child’s Point of View

90

 

Cognitive Differences between Children and Adults

92

 

Getting Children to Use What They Learn (Encouragement

 

 

and Motivation)

94

 

Working with Children Worksheet

98

 

Clinical Challenge

100

 

References

100

7.

Working with Challenging Children

103

 

What Is Known

103

 

Putting It into Practice

106

 

The Disruptive Child

106

 

Engaging the Withdrawn Child: Depression

107

 

Engaging the Withdrawn Child: Anxiety

109

 

The Realistically Challenged Child

111

 

Challenging Child Worksheet

114

 

Clinical Challenge

115

 

References

115

8.

Working with Challenging Families

117

 

What Is Known

117

 

Putting It into Practice

118

 

How Does Family Functioning Relate to Child CBT?

119

 

Where Does CBT Fit in Relation to Family Functioning?

120

 

Common Family Dilemmas in CBT

121

 

Common Compromises When Working with Families

127

 

“Pearls for Parents” of Children in CBT

127

 

Challenging Families Worksheet

133

 

Clinical Challenge

135

 

References

135