Education and engagement of the child and family

All forms of CBT should begin with an explanation of the diagnosis and the model of treatment for the child and family. The nature of this explanation depends on the child's level of cognitive development. Young people who have developed what Piaget (14) called formal thinking skills can usually understand the kind of explanation of CBT that would be given to adults. Such an explanation might, for instance, include the relationship between the way a person thinks about himself and his environment, and his behaviour or feelings. However, many children and young adolescents find it difficult to think about thinking and require explanations that are more appropriate for their developmental stage. For example, the therapist might present to the child a story about a social situation that could have several different interpretations (e.g. a stranger knocking at the door) and explore with the child the various different thoughts and feelings that could occur. How would the child feel, for example, if he or she thought the stranger looked like the murderer shown on the evening news? Children's stories such as The Emperor's New Clothes can also be a useful way of getting over ideas such as the power of thought and belief in determining how we behave. (23)

Although CBTs are usually viewed as individual or group treatments, there is a growing trend towards encouraging parents to have a role. Parental involvement is important for several reasons. First, parents or significant others can often be very helpful in implementing a therapeutic programme. For instance, they can help to reinforce homework assignments. Moreover, they can provide information about ongoing stresses in the child's life and about the continuation of certain symptoms that the child may be reluctant to talk about (e.g. peer relationship problems, antisocial behaviour). Second, there is the practical reason that it will often be the parents who bring the child for therapy. Third, parental behaviours and attitudes may be important predisposing or maintaining factors for the child's problems. For example, it is quite common to find that parents of anxious or obsessive-compulsive children are inadvertently reinforcing avoidance behaviours.

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