ABSTRACT
Overview .......................................................................................................... 475 Overview of Child Treatment ......................................................................... 477 Case Conceptualization ................................................................................... 480 Implementation ................................................................................................ 482
Duration and Spacing of Meetings ............................................................. 482 Structure and Format of Meetings ............................................................. 484
Core Therapeutic Components ........................................................................ 486 Affective Education ..................................................................................... 486 Goal Setting ................................................................................................. 487 Coping Skills Training ................................................................................ 487 CPD: A Tool to Promote Activation and Coping ........................................ 489 Problem-Solving Training ........................................................................... 490 Cognitive Restructuring .............................................................................. 494
Establishing the Rationale for Cognitive Restructuring ....................... 494 Identifying Negative Thoughts ............................................................... 496 Cognitive Restructuring Strategies ........................................................ 497
Building a Positive Sense of Self ................................................................ 500 Overview of Parent Training ........................................................................... 501
Parent Training Skills ................................................................................. 501 Clinical Insights from Implementation of the Action Program .................... 503
Individualizing a Group Intervention ........................................................ 503 Overcoming Obstacles to Treatment .......................................................... 505
Summary .......................................................................................................... 506 References ........................................................................................................ 508
As noted in Weersing and Gonzalez’schapter (see Chapter 21), cognitive-behavioral therapy (CBT) is one of the preferred and most empirically tested psychosocial interventions for depressive disorders among youth. CBT for depressed youth represents a downward extension of the adult
models for treating depression (e.g., Beck, Rush, Shaw, & Emery, 1979). In general, there are few differences in the content of the treatment programs for youth relative to adults. The differences are in the way that the interventions are delivered to children and adolescents. The core treatment components, including affective education, coping skills, problem solving, and cognitive restructuring are the same, however, they are taught to youngsters using a more interactive and experiential approach. Adults can learn and will commonly apply the skills following a didactic presentation. Children, in contrast, need an engaging didactic presentation, then they need to actually enact the skill and experience the benefi ts of it on mood in order to learn it and try to independently use it. For example, the girls in our latest treatment study taught us how to best help them learn to use cognitive restructuring strategies. They benefi t from externalizing the negative cognitions to an external source (the Muck Monster), and then they can learn to talk back to the negative thoughts that are directed at them from the Muck Monster. Girls also need repeated practice before they understand how to use the skill, and are likely to independently use it outside of the meetings. There are a number of other important differences between standard CBT for depression in adults and youth. Therapeutic homework is a central part of CBT for the treatment of depression. Adults seem to have a higher rate than children and adolescents of completing therapeutic homework. Another difference between adult and child clients may be that adult clients enter therapy of their own volition because they are experiencing pain, or recognize that they are having some problems. Thus, they are motivated to use therapy. Children, in contrast, are often brought to treatment by their parents and don’t think that they need it so they are not as motivated to engage in therapy. Adults have an intuitive idea about what therapy is going to entail or they learn about it through the media. Children have no idea what to expect during therapy, and they don’t know how to maximize the benefi ts of treatment. We have found that it is important to teach children and adolescents “good client” behaviors so that they can maximize their experiences. Another difference between the existing studies with children and adults is that the child treatments are commonly delivered using a group format, whereas the adult treatments are commonly delivered using an individual format. In a few studies, parents are involved in the child treatments, but parents commonly are included in their child’s treatment in clinical practice.
