A Clinician's Guide to CBT for Children to Young Adults. Paul Stallard
The first version of the CBTS‐CYP consisted of 14 items, with home assignments initially being subsumed within the discovery competence. Following review, these were separated, with the current iteration, like the CTS‐R, having home assignments as a separate and discrete set of competencies. Table 1.1 summarises how the CTS‐R items map on to the 15 items of the CBTS‐CYP.
In an initial evaluation of the CBTS‐CYP, video clips of clinicians undertaking CBT were assessed by independent raters (Stallard, Myles, et al. 2014). Face validity and internal reliability were high, and convergent validity with the CTS‐R was good. It compared well with the CTS‐R in discriminative ability and demonstrated an increase in skills through a course of CBT training.
The CBTS‐CYP can be used for clinical reflection and self‐assessment. It should be completed in an open and honest way so that strengths, weaknesses, and development needs can be identified. These competencies can then be self‐monitored and reflected upon after clinical sessions as a way of developing practice.
A copy of the CBTS‐CYP is included in Chapter 12. The subsequent chapters will explore each competence in detail and provide specific examples.
Table 1.1 Comparison of items on the CBTS‐CYP and CTS‐R.
| CBTS‐CYP process item | Equivalent CTS‐R item |
|---|---|
| Partnership working (P) Establishes a collaborative partnership with the child/young person (and, as appropriate, their carers) in which they are actively engaged in working together towards a set of joint goals and targets | Collaboration |
| Right developmental level (R) Engages with the child/young person and family at a level and in a manner that is consistent with their developmental level and understanding | None |
| Empathy (E) Empathises with the child/young person and their carers/family through the development of a genuine, warm, and respectful relationship | Interpersonal effectiveness |
| Creative (C) Adapts the ideas and concepts of CBT to facilitate the understanding of and engagement in therapy of the child/young person and their parents/carers | None |
| Investigation (I) Adopts an open and curious stance that facilitates guided discovery and reflection | Feedback |
| Self‐efficacy (S) Adopts an empowering and enabling approach in which self‐efficacy and positive attempts at change are promoted | None |
| Enjoyable and engaging (E) Makes therapy sessions appropriately interesting and engaging | None |
| CBTS‐CYP methods item | |
| Assessment and goals (A) Establishes clear goals for the intervention and appropriately uses diaries, questionnaires, and rating scales for assessment | None |
| Behavioural techniques (B) Demonstrates appropriate use of a variety of behavioural techniques to facilitate therapeutic change | Eliciting behaviours Application of change methods |
| Cognitive techniques (C) Demonstrates appropriate use of a variety of cognitive techniques to facilitate therapeutic change | Eliciting key cognitions Application of change methods |
| Discovery (D) Appropriately uses a variety of methods to facilitate self‐discovery and understanding | Guided discovery |
| Emotional (E) Appropriately uses a variety of emotional techniques to facilitate therapeutic change | Eliciting appropriate emotional expression Application of change methods |
| Formulation (F) Facilitates the development of a coherent understanding which highlights the relationships between events, cognitions, emotions, physiological responses, and behaviours | Conceptual integration |
| General skills (G) Sessions are well prepared and conducted in a calm and organised way | Agenda setting and adherence Pacing and efficient use of time |
| Home assignments (H) Uses home assignments to gather data and transfer skills between clinical sessions and everyday life | Homework setting |
CORE philosophy
In addition to the process and core methods of undertaking CBT with children, adolescents, and young people, it is helpful to remain aware of the underlying philosophy.
This is the CORE philosophy which is
C: Child‐centred
O: Outcome‐focused
R: Reflective
E: Empowering
Figure 1.1 provides a visual summary of the core philosophy, therapeutic process, and methods that embrace CBT with children, adolescents, and young people.
Figure 1.1 Core philosophy, therapeutic process, and methods of undertaking CBT with children, adolescents, and young adults.
Child‐centred
The CORE philosophy clearly places the young person at the very centre of the intervention. Children and young people are a vulnerable group and for this reason it is important to ensure that they are safe, that potential risks are minimised, and that they are appropriately protected from potential harm. There is a need to remain mindful of potential physical, emotional, or sexual harm or exploitation from adults or peers either in person or via the Internet and to take appropriate action to safeguard the young person.
The child‐centred philosophy also ensures that the intervention remains focused on the young person and their problems. Maintaining this focus is important, particularly if parents/carers have their own problems or needs which may dominate clinical sessions and overshadow those of the young person. Parent problems may need to be directly addressed, particularly if they are significantly impacting on the young person’s problems or progress. This needs to be discussed with the parent/carer, whose problems and needs should be acknowledged, and, where appropriate, signposted or referred for direct help in their own right.
Parents/carers or other adults may have their own views about what needs to change, and this may not necessarily be shared by the young person. These views are important, and they need to be heard and acknowledged. However, adult goals may be held and ‘parked’ and returned to at a later stage. The initial focus, wherever possible, should remain on directly engaging the