Assessment goal setting and initial formulation

The assessment aims to provide a detailed description of the presenting problem that is consistent with a cognitive-behavioural formulation of the child's difficulties. The assessment should also provide information about the child's social context and about his or her strengths and weaknesses.

The initial interview begins with a thorough review of the presenting problems and any associated symptoms. In collaboration with the child and family the therapist carries out a detailed analysis of what are often vaguely defined presenting complaints to generate more specific target problems. The aim is to generate a short list of problems that are most distressing to the child and carers and which are most amenable to treatment. Standardized measures of the child's behaviour or emotions may help in defining these problems and are often a good way of measuring change. The therapist then endeavours to identify the cognitive distortions or deficits that often accompany emotional or behavioural disorders in children (see above). Finally, an assessment is made of the child's social context in respect of family, peer relationships, neighbourhood, and education. There should be a particular emphasis on identifying strengths both within the child and within the child's family or wider social environment.

The cognitive-behavioural formulation is based on information from the initial assessment. It should be a written explanation of the problem that highlights the key cognitive and behavioural factors that are thought to play a role in the onset or maintenance of the child's difficulties. It should also reflect the role of external factors, such as family difficulties or peer problems, on the young person's views of himself and his world. The formulation is likely, then, to be multilayered and to outline several priorities for treatment. The development of a formulation is an essential part of CBT with young people.

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