Therapeutic Approaches for Children

1. Three Main Types of Therapy for Children:

o Psychodynamic and Play Therapy: Helps children express feelings through play
and understand their emotions.
o Cognitive Behavioral Therapy (CBT): Helps children change negative thoughts and
behaviors.
o Family Therapy: Involves working with the child’s family to improve
communication and relationships.
2. Importance of Developmental Stage:
o Therapies must be adjusted to the child’s age and maturity level.

o Example: A 5-year-old may express feelings better through play, while a teenager
may benefit more from talking or CBT.
3. Goals of Therapy for Children:
o Encourage healthy development that suits their age.

o Help them replace immature behaviors (like tantrums or withdrawal) with more
mature, adaptive responses (like talking about feelings or problem-solving).

I. Psychodynamic Child Psychotherapy

1. Origin
 Play is central in psychodynamic therapy with children.
 Pioneers: Sigmund Freud, Anna Freud, Melanie Klein, and Winnicott.
 Freud's first case: Little Hans – a boy afraid of horses. Freud interpreted his drawings and
fantasies to understand hidden fears.
2. Why is Play Important?
 Play gives insight into a child’s inner world—fears, wishes, conflicts.
 Like dreams in adults, play is a window into the unconscious.
 Children often cannot express deep emotions in words, but they show them through play.

3. Purpose of Psychodynamic Play Therapy

 To help children move forward in their development.
 Therapy helps them:
o Understand and manage emotions.

o Improve behavior and learning.

o Build healthier relationships.

Therapist’s Role
 Help children learn to play in a meaningful way.
 Support symbolic, emotional, and flexible play.
 Not all play is therapeutic:
o Repetitive or flat play may show emotional block.

o Chaotic play may reflect trauma.

7. Types of Play Used

 Younger children: imaginative play, storytelling, toys.
 Older children: may prefer board games, sports, or crafts.

8. Importance of Structure
 Regular, consistent sessions (1–3 times/week) help:
o Build trust.

o Support deep emotional work.

Example Case (Simplified):

A 7-year-old boy throws tantrums and can't talk about why he's upset. In therapy, he begins to play
with dolls who "fight and cry." The therapist helps him build stories with the dolls, gently connecting
them to real-life feelings. Over time, he learns to name emotions and handle frustration better at home
and school.

Conclusion
Psychodynamic play therapy focuses on:
 Helping children express feelings safely through play.
 Supporting emotional and social growth.
 Using the therapeutic relationship as the main tool for healing and change.
II. 🧠 Cognitive-Behavioral Therapy (CBT) with Children

🔹 1. Theoretical Framework of CBT

CBT with children is based on several key psychological theories:
 Behavioral science (Herbert, 1994)
 Social learning theory (Bandura, 1977)
 Cognitive developmental theory (Bruner, 1990)
 Cognitive theory of emotional disorders
🔬 CBT adopts a "scientist-practitioner" model:
 Emphasizes empirical research, evidence-based practice, and formal hypothesis testing.
 Therapists explain their treatment model to clients and collaborate on understanding and
solving problems.
📌 Note: While collaborative, CBT takes more of an expert role compared to more client-led (social
constructionist) therapies.

🔹 2. Current Practice of CBT with Children

 CBT has evolved into a flexible mix of techniques, blending:
o Cognitive strategies (e.g., changing negative thoughts)

o Behavioral methods (e.g., reinforcing positive actions)

Kendall (2000) described CBT as a way to retain the strengths of behavioral therapy while adding
cognitive strategies to deepen change.

🔹 3. Behavior Modification & Parent Training

✅ Behavior Modification
 Based on classical and operant conditioning (rewards and punishments).
 Used for:
o Anxiety disorders (e.g., phobias, OCD)

o Conduct problems

o Developmental issues (e.g., sleep, bedwetting)

🔍 Begins with a functional analysis:

 Identifies what triggers (antecedents) and reinforces (consequences) the child’s behavior.

🎯 Goal:
  Reduce rewarding outcomes for problem behavior.
 Increase positive reinforcement for good behavior.
🧑‍👧 Parent Involvement
 Parents are guided on:
o Ignoring tantrums (to reduce attention as a reward)

o Reinforcing positive behaviors like calm conflict resolution

Example Technique: The “Parent–Child Game” (Jenner, 1999)

 Therapist coaches the parent live (via earpiece and one-way mirror) during interaction with
the child.

🔹 4. Parent Training Programs

📚 Webster-Stratton Model
 Parent training delivered individually or in groups (8–12 sessions)
 Structured with:
o Video examples of typical conflicts

o Homework to practice skills at home

o Initial focus on positive playtime interactions

o Use of reinforcement, emotional labeling, and problem-solving

💡 Although behavior-focused, these approaches often indirectly address parent–child relationships.

🔹 5. Limitations of Parent-Only Focus

 Relying only on parent training can be limiting.
 Best outcomes occur when CBT for the child is added alongside parent sessions.
🧠 This dual approach helps:
 Address the child’s own thoughts and emotions
 Build problem-solving and social skills
📚 Supported by:
 Kazdin et al. (1992)
 Webster-Stratton & Hammond (1997)

✅ Conclusion
 CBT for children combines cognitive and behavioral methods, tailored to individual needs.
  Parent training plays a central role but is most effective when integrated with child-
focused therapy.
 CBT continues to evolve by including relational factors and child agency in the therapeutic
process.

🧠 Individual CBT with Children – Summary

🔹 1. Core CBT Model

CBT is based on the idea that:
 Emotional disorders in children are maintained by cognitive biases, such as:
o Fixed negative beliefs

o Dysfunctional assumptions

o Automatic negative thoughts

These affect how a child feels, behaves, and relates to others (Friedberg & McClure,
2002).

🔹 2. Key Components of CBT with Children

According to Kendall (2000) and Friedberg & McClure (2002), CBT with children involves four
main stages:

Stage Description

Engagement Building a collaborative relationship with the child (and parent)

Formulation Creating a shared understanding of the problem using the CBT model

Skill Learning Teaching new coping, emotional regulation, and problem-solving skills

Applying Change Practicing and generalizing new behaviors and thinking patterns in daily life

✅ Problems are not viewed as part of the child’s personality, but as patterns of thoughts, feelings,
and behaviors that can be changed.

🔹 3. Structure and Techniques

CBT with children is structured and active, unlike nondirective therapies:
 Therapist acts like a coach (Kendall, 2000), using:
o Guided discussions

o Practice exercises

o Psychoeducation

o Homework tasks
  Sessions often include:
o Emotional awareness

o Differentiating thoughts/feelings/actions

o Record-keeping (e.g., behavior logs, emotion diaries)

o Role-playing and rehearsal

🔹 4. Common Techniques Used

Depending on the child’s needs and CBT formulation, therapists may use:

Behavioral Techniques Cognitive Techniques

Relaxation training Identifying and challenging thoughts

Role-playing Cognitive restructuring

Behavioral experiments Problem-solving

Exposure tasks Perspective taking

Most widely used technique:

 Problem-solving: Teaching the child to generate and evaluate different ways of dealing with
difficulties, giving them a sense of choice and control.

🔹 5. Challenges in Child-Focused CBT

🧒 Children vs Adults:
1. Children rarely self-refer
o They are usually brought by caregivers.

o May resist therapy if they feel blamed (e.g., labeled as having a “behavior problem”).

2. Limited autonomy
o Children’s ability to change is dependent on their parents/caregivers.

3. Verbal limitations
o Traditional cognitive techniques (e.g., Socratic questioning) may not work.

o Must adapt to developmental level using:

 Symbolic play
 Narratives or storytelling
 Games and drawings
4. Monitoring internal states is harder
 o Children may lack the experience or vocabulary to identify and reflect on
thoughts/feelings.
📚 Bruner (1990): Young children understand the world better through narrative forms than abstract
reasoning.

✅ Conclusion
 Individual CBT with children focuses on changing negative thoughts and behaviors using a
structured, skill-based, and collaborative approach.
 Adaptation is key — especially in making techniques developmentally appropriate.
 Success depends on involving both the child and their environment (especially parents), and
making therapy engaging and understandable.

👪 Working with Parents in CBT for Children – Summary

🔹 1. Importance of Parent Involvement

 Many CBT programs neglect parental involvement, which is a key limitation (Lochman et
al., 1991).
 Including parents:
o Strengthens treatment effects

o Promotes generalization and long-term maintenance of therapeutic gains

o May increase overall effectiveness (Mendlowitz et al., 1999; Barrett et al., 2001)

🔹 2. Parent Roles in CBT

Parents can play three major roles, depending on the therapeutic model:

Role Description

Supports child’s therapy by cooperating occasionally (e.g., updates with therapist) –

Facilitator
minimal involvement (Kendall, 2000)

Actively participates in teaching, rewarding, and reinforcing the child’s new behaviors
Co-therapist
and skills (March & Mulle, 1998)

Receives CBT themselves for personal emotional/behavioral difficulties, either alone

Client/Patient
or in family therapy (Barrett, 1998; Cobham et al., 1998)

🔁 Parents may shift roles during therapy, but sudden changes can be disruptive for the child.

🔹 3. Need for Integrated Models

  There is still no well-established model for consistently involving parents in child-focused
CBT.
 Therapists must consider family relationships, parental styles, and individual needs.

🔹 4. Evidence for Effectiveness

✅ Strong Evidence for:
 Behavior Modification (BM) for:
o Conduct problems in young children (Kazdin, 1985)

o Developmental difficulties (e.g., enuresis, sleep) (Christophersen & Mortweet, 2001)

 Parent training, especially when combined with child-focused CBT:

o Results in better generalization and stability of treatment effects (Kazdin et al., 1992;
Webster-Stratton & Hammond, 1997)
o Enhances child’s social and problem-solving skills

⚠️Mixed or Limited Evidence for:

Condition Evidence Summary

Anxiety (general/specific) Strong support for both individual and group CBT

Pediatric & developmental

CBT improves physical outcomes (e.g., sleep, toileting)
issues

Depression (pre-adolescent) Limited evidence

Depression (adolescents) Moderate help, but risk of relapse without longer-term care

Conduct problems CBT (problem-solving, social skills training) alone often insufficient;
(adolescents) best used in multimodal treatments

ADHD/attentional Some effect on behavior, but less effective than medication; can
problems complement meds and reduce dosage

🔹 5. CBT Mechanisms: Still Under Investigation

 Early studies suggest:
o Anxious children perceive the world as more threatening (Kendall & Panichelli
Mindel, 1995)
o Children with conduct problems assume hostility in ambiguous situations (Dodge,
1985)
🚫 But: There’s still insufficient evidence to confirm:
 Whether CBT causes cognitive change in children
 Whether cognitive change is essential for behavioral/emotional improvement (Stallard, 2002)
✅ Conclusion
 Parental involvement in CBT is essential, yet underutilized.
 Best results occur when parent training is combined with direct work with the child.
 Evidence strongly supports CBT for certain problems (e.g., anxiety, conduct issues in younger
children), but more research is needed to validate its mechanisms and effectiveness across
disorders and ages.

✅ Summary: Conclusions of CBT with Children

1. Wide Use of CBT
CBT is now used in many different ways to treat emotional and behavioral problems in
children.
2. Evidence of Effectiveness
There is some research support showing that CBT helps with various childhood disorders,
but it is not yet fully proven for all cases.
3. Evolution of Behavioral Approaches
Older methods like behavior modification and parent training have now added cognitive
elements, involving both:
o the child’s thinking, and

o the parents’ role.

4. Child-Centered Focus
Modern CBT now places the child at the center of therapy, which is a positive ideological
shift because it shows respect for the child’s thoughts and feelings.
5. Remaining Uncertainties
However, it’s still uncertain whether CBT truly addresses the key cognitive causes of
childhood disorders.
6. Need for Broader Models
To better understand and treat children's difficulties, CBT might need to expand its framework
to include:
o Attachment patterns

o Family relationships

o Social development factors

🔍 Example:
A child with anxiety might not only be influenced by negative thoughts (as CBT focuses on), but also
by:
  Insecure attachment to caregivers
 Ongoing family conflict
 Poor social skills or peer rejection
A broader model would take all of these into account, not just the child’s thoughts.

✅ Simple Summary: Family Therapy

What is Family Therapy?
Family therapy is a type of counseling that helps families work better together by improving the
way they interact and communicate. It's not just about helping one person, but about looking at the
whole family system — how people affect each other through their words, actions, and feelings.
🧩 Think of a family like a puzzle. If one piece is damaged or missing, the whole picture doesn’t look
right. Family therapy helps fix or rearrange the pieces so they all fit better together.

📚 What Does It Focus On?

 It works on changing unhealthy patterns between family members.
 It aims to improve the functioning of the entire family, not just one person.
 Therapists look at how people interact, not just how they feel inside.
For example: If a child is acting out at school, family therapy might look at:
 The parents’ communication style (e.g., always arguing)
 How the child is being disciplined at home
 Sibling rivalry or jealousy

🧠 Types of Ideas Family Therapy Uses:

 Systemic thinking – The family is seen as a whole system, where everyone influences each
other.
 Narrative therapy – Helping families understand the stories they tell about themselves (e.g.,
“He's always the troublemaker”) and rewrite them in healthier ways.
 Constructivist ideas – Understanding that each family member may see the same situation
differently based on their own perspective.

📉 Recent Changes in Practice

 In the past, therapy mainly focused on just the child.
 Now, therapists include the whole family because:
o Children live and grow in a family environment.

o Problems often arise from family dynamics, not just individual issues.
🧒👨‍👩‍👧 For example: If a teenager is depressed, therapy might involve parents learning to listen better,
or the family agreeing on more shared time together.

🏡 Not Just “Traditional” Families

Family therapy is not only for mom-dad-kids type of families.
Therapists respect all types of families — single parents, stepfamilies, same-sex parents,
grandparents raising kids, etc.
💬 A therapist might work with:
 A single mom and her teenage daughter
 Two dads raising a child
 Grandparents raising grandchildren after a family crisis

🌟 In Short:
Family therapy looks at relationships, not just problems.
It helps people talk, listen, understand, and support each other better — which often leads to
improvement in the child’s behavior or emotions.

✅ Simple Summary: Children and Young People in Family Therapy

🧠 What is Family Therapy About?
Family therapy focuses not only on the child’s problem, but also on how the family as a whole
communicates and functions together. It looks at relationships, interactions, and family patterns — not
just one person.

🎨 How Can Therapy Be Meaningful to Children?

In the past, children were often present in family therapy but not really involved. Since kids express
themselves through play, creativity, and stories, these elements should be included in therapy to
help them participate more fully.
Example: Instead of only talking, therapists may use drawing, role-playing, or storytelling so that
even young children can share how they feel.

🧩 Different Approaches to Family Therapy (with Examples):

1. Structural Family Therapy (Minuchin)
 Believes children’s problems come from how the family is organized (e.g., unclear rules,
weak boundaries).
 Therapist gives clear instructions and asks the family to act out real situations.
 Useful for chaotic families or those with behavioral issues.
Example: If siblings always fight, the therapist may guide the family to practice how to share space
calmly during the session.

2. Solution-Focused Brief Therapy (Berg & de Shazer)

 Focuses on what’s working, not just the problem.
 Encourages families to find their own strengths and past solutions.
 Helps children feel less blamed and more hopeful.
Example: Instead of asking “Why are you always angry?” the therapist may ask, “Can you tell me
about a time you felt calm at home?”

3. Postmodern Therapies (e.g., Reflecting Teams)

 Focus on language and how it shapes a family’s reality.
 Therapist doesn’t act like an expert but has conversations to help the family discover new
ways of thinking.
 May be harder for small kids to understand.
Example: Teenagers may benefit from hearing different viewpoints from a therapy team, helping
them feel supported and understood.

4. Narrative Therapy (White & Epston)

 Based on the idea that we all tell ourselves stories about who we are.
 Helps children separate themselves from the problem.
 Uses techniques like externalizing ("the anger is the problem, not you") and encourages
storytelling.
Example: A child who feels like "a bad kid" may be helped to tell a new story like "I’m a kid who’s
learning to manage big feelings."

👦 Do Children Want to Be Involved?

Yes! Research shows that:
 Children want to understand what’s going on in therapy.
 They want to help solve problems, not be blamed.
 They feel more comfortable over time, especially when toys and play are used and when they
know the “rules” of therapy.

📚 Is There Evidence That Family Therapy Works?

Yes, there’s strong evidence that family therapy helps with:
✅ Conduct Disorders
Especially for older children and teens who show aggression or break rules.
✅ Substance Misuse & Offending Behavior
Programs like Multisystemic Therapy (MST) reduce repeat offenses and are cost-effective.
Example: Teens getting in trouble repeatedly may benefit from therapy that involves the whole
family, school, and community settings.
✅ Anorexia Nervosa
Family therapy helps young people recover better than individual therapy—especially if the illness
is recent and not long-term.
✅ Other Conditions
Some support exists for family therapy in treating:
 Depression
 Self-harm
 Chronic illness

🧾 Additional Findings
 Involving parents (even if they’re not in the same room) improves outcomes.
 Family therapy tends to have lower dropout rates and higher satisfaction.
 It may produce longer-lasting effects than some other therapies, which often need "booster"
sessions.

🌟 Final Thought:
Family therapy isn’t just about fixing a child’s problem. It’s about improving how the whole family
works together, using creative and engaging methods so everyone—especially children—feels
involved and supported.

Conclusion on Family and Systemic Therapy for Children

Research shows that family and systemic therapy can help some young people. These therapies don’t
just focus on the individual—they also consider how families interact and how those patterns affect
the child. While the older approaches (like structural or strategic models) are better researched, newer
styles (such as narrative therapy or those based on social constructionist ideas) are still being
explored.
One problem in family therapy is that children can sometimes be left out while the adults do most of
the talking. But modern approaches now make a real effort to include children—using creative tools
like play, storytelling, and drawing to make therapy meaningful for them. Studies show that even
young children can understand and actively take part in therapy if it’s explained clearly and made
child-friendly.
Bringing it All Together: A Developmental Approach to Child Psychotherapy
When deciding how to help a child through therapy, it’s important to think about more than just their
age. What matters is their stage of development, their personality, family environment, and even
biology.
For example:
 Younger children may benefit more from frequent sessions and therapies that involve
parents.
 Older children or teens might respond better to treatments like CBT that focus on thoughts
and behaviors.
This approach builds on the ideas of experts like Anna Freud, who believed that all behaviors in
children should be seen in the context of their development—how they are growing and learning over
time. Later thinkers expanded this into what we now call developmental psychopathology, which
looks at how emotional and behavioral problems develop through complex interactions of genetics,
environment, and personal experiences.
Here are some key ideas from this approach:
 Development is a dynamic process, shaped by both the child and their environment.
 Children are not just passive recipients—they give meaning to their experiences and influence
those around them.
 One single cause rarely explains a child’s problems. Usually, it’s a mix of many factors.
 Some children show resilience—even when exposed to difficult situations, they manage to
adapt and grow stronger. Therapy can help build this resilience.
 We now know that some mental health issues in children are affected by early brain
development. Because of this, the goal of therapy may not always be to "cure" but to help the
child function better and live more comfortably.
Finally, therapy should be seen within a larger system: the child, their family, school, society, and
even their biology all interact to shape how they feel and behave. A good therapist takes all these parts
into account, rather than focusing on just one area.

Conduct Disorder in Adolescents: Summary

What is Conduct Disorder?
Conduct disorder involves persistent patterns of aggressive, defiant, and rule-breaking behavior at
home and school. These problems are common in teenagers and are one of the main reasons they are
referred for psychological help. Such behaviors are not only upsetting for families and schools but are
also difficult to treat.

Traditional Treatment Approaches

Traditionally, severe conduct problems have been treated with:
 Long-term psychotherapy aimed at helping with emotional problems like:
 o Low frustration tolerance

o Poor empathy

o Trouble forming relationships

o Fragmented sense of self

 Milieu therapy in special environments like residential homes or therapeutic schools.

However, placing multiple conduct-disordered youth together in group settings may actually make
things worse (Dishion et al., 1999).

Evidence-Based Treatments
Clinical research over the past 20 years has led to the development of several treatments. Ten of these
have good evidence supporting them (Brestan & Eyberg, 1998), but most are designed for younger
children, not adolescents.
Examples:
 Social problem-solving training
 Parent management training
 Anger management training
These treatments are effective for children aged 13 or younger but less effective for older
adolescents (Strain et al., 1981).

Adolescent-Specific Treatments
Only a few therapies are designed specifically for teenagers with conduct problems. One notable
example is:
Anger Control Training with Stress Inoculation (Feindler, 1991)
 Focuses on helping adolescents recognize what makes them angry.
 Teaches them to:
o Use self-instruction to control anger

o Relax or calm themselves down

o Think before acting aggressively

o Use assertiveness instead of aggression

 Involves role-playing, modeling by the therapist, and practice under different anger
situations.
 Typically lasts for 12–25 sessions, and can be done in individual or group formats.
Effectiveness
 Results have been mixed but promising.
  Improvements seen in:
o Problem-solving skills

o Self-control (as reported by teachers)

o Fewer school penalties for disruptive behavior

 However, not all studies showed the same benefits, and different versions of the therapy were
tested.

Final Thoughts
 While anger control therapy helps in some areas, it may not be enough on its own to treat all
the complex issues in conduct disorder.
 Conduct disorder in teens is complicated and may require multiple strategies tailored to the
individual.
 More adolescent-specific, comprehensive treatments are still needed.

Family-Based Therapies for Conduct Disorder in Adolescents

Overview
Conduct disorder in adolescents often stems from family-related issues such as:
 Poor parental supervision
 Inconsistent discipline
 Disengaged family relationships
 Patterns of behavior reinforced unintentionally through family interactions
Because of this, family-based therapies have emerged as highly promising approaches to treatment.

1. Functional Family Therapy (FFT)

Developed by: Alexander and Parsons (1982)
Theoretical Basis: Social learning theory
Core Idea:
 Problem behaviors in adolescents are often reinforced unintentionally through family
dynamics.
 For example, a child’s whining or aggression may cause parents to withdraw, which
reinforces the behavior.
Therapeutic Goals:
 Modify dysfunctional family patterns
  Improve parental monitoring and disciplinary strategies
 Enhance family communication and reciprocity
 Teach negotiation skills
Key Techniques:
 Parent behavior management training
 Family sessions focused on communication and negotiation
Effectiveness:
 Studies show FFT reduces recidivism in juvenile offenders more effectively than other
treatments.
 One study found a 25% recidivism rate in FFT vs. 47–50% in other therapies.
 However, replication standards have not consistently been met, so it is considered
“probably efficacious.”

2. Multisystemic Therapy (MST)

Developed by: Henggeler et al. (1998)
Theoretical Basis: Bronfenbrenner’s ecological model
Core Idea:
 Adolescents' behavior is influenced by multiple systems: family, school, peers, and
community.
 Unlike traditional treatments, MST does not remove youth from their environment but works
within it to promote change.
Therapeutic Approach:
 Combines methods from multiple therapies (CBT, family therapy, strategic/structural
approaches)
 Tailors interventions based on specific contextual factors in the adolescent's life
Process:
 Focuses on present-oriented, action-based change
 Involves collaborative goal setting and ongoing monitoring
 Uses existing systemic strengths (like supportive extended family) for positive change
Effectiveness:
 Shown to reduce:
o Conduct problems

o Substance abuse

o Juvenile recidivism
  Effects are sustained over time
 Considered highly promising, though still awaiting independent replication to be deemed
“well-established”

Conclusion
 Family-based therapies are among the most effective interventions for adolescent conduct
disorder.
 FFT focuses on improving family dynamics and parenting strategies, showing strong but not
definitive results.
 MST adopts a comprehensive, systemic approach across multiple life domains, with
sustained positive outcomes and broad applicability.
 Both therapies reflect a shift away from institutional placement toward community-based,
ecological interventions.

🧠 Case Summary: CBT for Conduct Disorder – Jackie (14 y/o)

Presenting Concerns:
 Multiple school suspensions
 Argumentative and defiant behavior at home and school
 Failing grades in most subjects
 Low self-esteem, impulsivity, inattention (suggestive of ADHD)
 Rule violations and minor property destruction
 Conflicted relationship with mother
 Father: peripherally involved, history of substance abuse

🧾 Assessment Findings:
 No significant depressive symptoms
 Presence of comorbid ADHD symptoms
 High levels of parent–teen conflict (elevated scores on the Issues Checklist)
 Peer group involved in substance use (Jackie denied use)

🔄 Treatment Plan (Multicomponent CBT Approach):

1. Medication Consultation:
 For symptoms of impulsivity and inattention (ADHD)
2. Individual Therapy (Social Problem-Solving Training):
  Goal: Improve Jackie’s coping with school challenges and interpersonal conflicts
 Focused on:
o Negative automatic thoughts (cognitive restructuring)

o Alternative interpretations of teacher behavior

o Problem-solving steps:

 Identify and define problem

 Define goal
 Brainstorm solutions
 Evaluate outcomes
 Implement plan
 Use of role-play and feedback to rehearse coping strategies
Rapport-building was crucial due to Jackie's resistance to therapy. Therapist used interests like
music and fashion to engage her.

3. Parent Management Training (PMT):

 Involved Jackie's mother
 Training in:
o Consistent discipline and monitoring

o Use of positive reinforcement at home for school-related improvements

4. School Collaboration:
 Implemented a weekly report card system between mother and school staff
 Targeted homework completion and behavior regulation
 Positive consequences at home tied to school performance

5. Dyadic (Mother–Daughter) Sessions:

 Began after 4 months of individual work
 Aimed at reducing conflict and improving communication
 Techniques:
o Active listening training

o Graded exposure to conflict issues:

 Started with low-intensity (e.g., dishes)

 Gradually moved to high-conflict topics
 o Behavior monitoring (interrupting negative interactions)

o Assigning joint positive activities weekly

o Therapist modeling of communication skills

✅ Outcomes After 6 Months:

 Reduced intensity of conflicts (per Issues Checklist)
 Only one school suspension during treatment (vs. three in the prior month)
 Jackie promoted to high school
 Both Jackie and her mother reported an improved relationship

🧩 Key Takeaways:
 CBT for conduct disorder requires multifaceted intervention, including:
o Cognitive restructuring

o Problem-solving skills training

o Parent involvement

o School collaboration

o Dyadic therapy to improve family communication

 Engagement strategies are essential for reluctant teens

 Gradual skill-building, reinforcement, and structured tasks can reduce conduct problems and
improve outcomes