Imagine that you are a school counselor working with an 8-year-old boy named Josh who gets into frequent conflicts with his peers. In the classroom, these conflicts are ve
al and he can often be redirected by the teacher. But on the playground, Josh sometimes becomes physically aggressive when angry. His teachers and the principal have punished him repeatedly for this behavior but it has not reduced Josh’s angry outbursts and fights with other students. In his first session with you, Josh expressed that he feels his classmates don't like him and often exclude him from games and activities. He says that he does not know what he can do to get along better with his peers but that he would like to have more friends to work and play with in school. You have contacted Josh's parents and they said they are willing to come in to have a few sessions with you and Josh together.
Main Response
Now, develop a main response in which you:
·
iefly describe how you might address Josh’s problem using a cognitive-behavioral approach and then using a solutions-focused approach.
· Discuss the pros and cons of each, refe
ing to the required reading.
· Which do you think would be more effective with Josh and why?
Please answer the bullets and I provided the reading for the cognitive-behavioral approach and solutions-focused approach below.
M4 Content Guide: Overview of CBT and SFT Approaches
Cognitions and Solutions
This module’s assigned readings go into depth about the two counseling paradigms we are examining: cognitive-behavioral therapy (CBT) and solution-focused therapy (SFT). These two approaches are quite different in how they conceptualize the client’s difficulties and in the helping strategies that they employ but there are also some similarities between them. You will have an opportunity to discuss these differences and similarities in this module’s discussion.
Cognitive Behavioral Therapy
The basic principle of CBT is that a person’s cognitions (thoughts), feelings, and behavior are not separate, but rather, interact and influence each other. With both children and adults, the CBT model suggests that emotions and the behaviors that follow them are the result of the individual’s belief system—that is, how that person interprets a situation. Both positive and negative events are filtered through the belief system which then influences how the person feels and behaves. For example, if a child believes that she is not liked by her peers, she is likely to interpret minor slights by others as major rejection. She may feel sad and think negative thoughts about herself and then act on these thoughts and feelings by avoiding peer interaction.
CBT uses strategies that help a client understand this interaction and then work to change their thoughts and behaviors, ultimately leading to a reduction in symptoms. The child in the example above who thinks that she is unlikeable and rejected by peers may have what in CBT is known as a cognitive distortion. Cognitive distortions, sometimes called thinking e
ors, are patterns of thinking which are unrealistic, exaggerated, or otherwise inconsistent with the real nature of the situation. Some other common thinking e
ors are:
· Black and white (or all-or-nothing) thinking, when a person sees the self, others, or events as either all good or all bad, with little gray area in the middle. E.g. “I got a C on a test so I’m a bad student.”
· Catastrophizing, like the old expression “making a mountain out of a molehill.” It may also involve assuming that the worst is going to happen. E.g. “I had an argument with my friend and now she’s never going to speak to me again.”
· Blaming others instead of taking responsibility for one’s own feelings and actions. E.g. “It’s not my fault that I’m doing badly in math; my teacher is unfair!”
· Emotional reasoning, when a person believes that just because they feel something, it must be true. This pattern doesn’t allow for weighing the evidence for and against a belief if it feels true. E.g. “It feels bad when Mom punishes me so she must not love me.”
CBT interventions focus not just on thoughts but also on changing behaviors. This might involve teaching and practicing with a child behaviors that help her to be more effective socially, sometimes called social skills training. The CBT therapist (along with parents) can coach the child to do things differently which can lead to more positive feelings and a change in belief system. Returning to our example of the child who feels unliked, a CBT intervention might involve role playing with the child how to approach another child on the playground and asking him or her to play. After practicing this social skill with the therapist, the child then tries it in the real world. If the interaction is successful, this can help reframe the child’s belief that she is not liked by others, which, in turn, will reduce her sadness. If the playground interaction does not go well, the therapist will support the child in trying again or trying a different approach, help her to avoid thinking e
ors that reinforce the negative belief, and work on building resilience and optimism.
CBT is often delivered to children in structured formats such as manuals that contain worksheets, tracking sheets, and experiential homework assignments. Many child- and adolescent-friendly CBT workbooks and manuals have been developed to teach CBT concepts and provide practice exercises in developmentally-appropriate ways. CBT has also been incorporated into play therapy interventions to help keep child clients engaged. Involving parents is crucial, as they may be unintentionally reinforcing unhelpful beliefs and behaviors in the child. Parents should participate in CBT psychoeducation, which teaches them about the principles of CBT and how they can support their child in making changes in thoughts, feelings, and actions.
Solution-focused Therapy
SFT (sometimes refe
ed to as Solution-focused Brief Therapy or SFBT) takes a practical approach to counseling in that it emphasizes, not the problem itself or its origin, but possible solutions. This way of conceptualizing a mental health problem has children and teens focusing on their strengths and can empower them toward finding their own ways to address their difficulties. SFT interventions tend to be flexible, as they can be applied to many different types of issues and in a variety of settings.
Some of the underlying assumptions of SFT are:
· understanding the origin of a problem is not necessary in resolving it;
· the primary goal of therapy is understanding what the client wants for the future;
· no matter how stuck the client might seem, he or she is already doing things to resolve the problem;
· small changes can set important changes in motion; and
· therapists should focus on the ways in which the client is cooperating with the therapist, rather than focusing on resistance.
Therapists use a variety of strategies with children in SFT, all of which draw upon and emphasize the client’s strengths. The orientation of therapy is in the present or future; SFT therapists spend little time exploring things that have happened in the past, except when searching for characteristics or behaviors of the client that have worked to solve problems in the past. SFT therapists frequently compliment the client on things that he or she is already doing well. This is meant to validate the client, build a relationship, and encourage him or her to continue doing things that have been working. Another common technique is called the miracle question, in which the therapist asks the client to imagine that a “miracle” has happened and the problem they are discussing has suddenly disappeared. The follow up questions ask what small things the client might do differently. These small steps act as building blocks as clients begin to envision behavioral changes that they can make.
SFT is said to be especially useful with children and teens because of it’s emphasis on solutions. Many children and adolescents are reluctant about therapy because they fear being criticized or blamed for their or their family’s problems. SFT’s positive, future-oriented tone may be less intimating to young people than other therapeutic modalities. SFT also makes it easy for the therapist to use clear, concrete language that is easy for children to understand.
You may view all or parts of these videos to help you understand the concepts and application of cognitive behavioral therapy and solution-focused therapy with children. These videos are optional but will likely help you as you participate in the Module 4 discussion.
· Cognitive-Behavioral Child Therapy with Bruce Masek, PhD
· Solution-Focused Child Therapy with John J. Murphy, PhD