We often have parents ask us about doing cognitive-behavioral therapy (“CBT”) with their children, in the hope that we might work with their child around developing better “coping strategies,” to address anxiety, etc. Often they’re uncertain about quite how to think about the relationship between that family of therapy approaches and our own work. So it seemed worth saying a bit about all this.
First of all, as implied above, there is no one version or kind of CBT. Indeed, our approach is often placed under that heading when discussed. Second, while there are some cardinal features of what makes a treatment “cognitive-behavioral,” what it often seems to come down to is that parents are expressing this desire for CBT out of an interest in directly addressing and training some of the thinking skills their child lacks, and doing so in a structured, time-limited, and research-supported fashion (all of which are of course true of our approach itself, by the way).
Such a general approach can be very helpful for many individuals, children included, and there’s certainly good empirical support for CBT of various kinds in the literature. Generally CBT approaches don’t tend to conflict with our own greatly – unless of course the therapist emphasizes the “B” more than the “C” in CBT. You see, our approach is a very Cognitively oriented one since we focus on teaching lagging thinking skills – cognitive is just a fancy word for thinking. But most Behavioral approaches focus on operant procedures to motivate more compliant behavior which you’ll realize does conflict greatly with our approach since we prefer to view challenging kids as lacking skill not will!
What is worth adding, however, is that when one problem-solves collaboratively with a child around specific unsolved problems and unmet expectations, skill development is being addressed indirectly. (It’s also being addressed naturalistically, which is to say in the ordinary environment of a child, with their existing caretakers.) That is, if we’re thinking with a child about what’s getting in the way of tackling homework, and part of the issue is that a child gets nervous that they may not succeed at the task, the adult and child would perhaps be working on a tendency toward anxiety-provoking cognitive distortions and how to keep those in check in the context of homework. (That’s a big part of what a cognitive-behavioral approach involves, and what would in some respects define it.) But we would not be teaching a child, more directly and systematically, to learn to identify different kinds of cognitive distortions and challenge those distortions in a more classic cognitive-therapy fashion. Nor would we be teaching, for example, relaxation or self-talk techniques to use as anxiety around homework builds.
Those latter moves might be quite helpful in many cases. But the takeaway here is this: Just because we’re working on skill development indirectly via problem-solving, don’t assume “indirectly” somehow equates to “less effectively” or in some second-best fashion. And remember that in order to be able to fully partake of some kinds of CBT, you need a child to agree that they have a particular problem or skills deficit, and for them to authorize the therapist to be the one to teach them. That’s not always the case. As we sometimes say to parents, it’s the rare kid who comes to treatment saying, in so many words, as adults more typically do, “Doc, here’s my problem.” This particular kind of buy-in fortunately isn’t needed in order to still make significant progress with our approach. We think that it’s often an advantage!