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INTERVENTIONS IN
EDUCATIONAL SETTINGS
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COGNITIVE-BEHAVIORAL
INTERVENTIONS IN
EDUCATIONAL SETTINGS
A HANDBOOK FOR PRACTICE
second edition
Edited by
Rosemary B. Mennuti, Ray W. Christner, Arthur Freeman
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Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
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LB1027.55.C63 2012
370.1528--dc23 2011033324
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I dedicate this book with love to Jean.
She provides me the support and
encouragement to remember how to y.
Rosemary B. Mennuti
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Contents
SECTION 1 Foundations
vii
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viii Contents
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Contents ix
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One
An Introduction to
Cognitive-Behavioral
Therapy with Youth
I
n recent years, signicant advances have occurred in the
use of cognitive-behavioral interventions for child and ado-
lescent emotional and behavioral difculties. Specically,
cognitive-behavior therapy (CBT) has been applied to a num-
ber of common clinical problems in youth, including anxi-
ety, attention decit hyperactivity disorder (ADHD), conduct
disorder, depression, eating disorders, and oppositional
deant disorder, to name a few. Additionally, over the past
several years, a number of excellent references have been
developed for child and adolescent clinicians on the prac-
tical and empirical support of using CBT with youth (see
Christner, Stewart, & Freeman, 2008; Friedberg & McClure,
2002; Kendall, 2006; Reinecke, Dattilio, & Freeman, 2003;
Silverman & Hinshaw, 2008).
However, despite the growth of literature on the use of
CBT with young clients, there remain only few resources on
its use with children in educational or school settings. Given
the critical role of schools and school staff in the cognitive,
behavioral, emotional, social, and interpersonal development
of children and adolescents, it is only tting that school-based
clinicians and school systems begin considering the imple-
mentation of CBT intervention services to help children and
adolescents in need. With growing evidence supporting the
use of cognitive-behavioral interventions with young clients
(see Kendall, 2006; Ollendick & King, 2004), CBT or cognitive-
behavioral interventions are promising for use within school
settings.
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Situational
Aective/
Physiological
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CBT in Schools
Although many educators believe that psychological counsel-
ing services are difcult to t into the educational culture,
the structure and framework of CBT parallel other educa-
tional services, making it more easily accepted among edu-
cators (Christner & Allen, 2003; Christner, Mennuti, Heim,
Gipe, & Rubinstein, 2011; Christner, Mennuti, & Whitaker,
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t Constitutional handicaps
t Skill-development delays
t Emotional difculties
t Family circumstances
t Interpersonal problems
t School problems
t Ecological risks
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12 Rosemary B. Mennuti and Ray W. Christner
Motivation to Change
Final factors that school-based practitioners should consider
when providing services to children and adolescents include
the students motivation and attitude. These factors not only
affect the collaborative relationship but also inuence subse-
quent intervention implementation and outcomes. Take, for
instance, a student who is referred for being disruptive within
his classroom. Using a directive approach discussing reasons
why he should not disrupt classroom instruction will likely
be met with opposition and resulting failure. Instead, clini-
cians who have know-how will use the students motivation
(e.g., Lets nd ways of getting your teacher off our back.) to
increase intervention adherence and further promote the part-
nership with the student.
The idea of readiness or motivation for change is not a new
concept in general, although it is one that is novel to many prac-
titioners in an educational setting. In school settings, when a
student has a problem, no matter if it is academic or behav-
ioral, many automatically assume that the student is ready
and motivated to make the necessary change. Consequently,
plans that require action for success are often developed
and implemented and then fail because the student is neither
ready nor motivated. To serve children and adolescents bet-
ter, we advocate for school-based clinicians to begin match-
ing interventions to the childs stage of change. For example,
action therapy, experiments, etc., may best serve those chil-
dren who are in the preparation for action or action stage. The
work of Prochaska and DiClemente (Prochaska & DiClemente,
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Relationship
Client Therapist
Case conceptualization
Components Session
of practice structure
Figure 1.2 A model of CBT with youth. 2010 R. W. Christner & R. B. Mennuti.
Therapeutic Relationship
A component central to the use of CBT with children and
adolescents is the working relationship. Interestingly, those
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Case Conceptualization
Case conceptualization is at the heart of the therapeutic treat-
ment. It is the thinking process and understanding of who
we are treating that must occur and be genuinely understood
before proceeding with therapy. Case conceptualization is
like a tapestry, where the complexity of all of the threads is
studied as individual components and then woven together to
develop the picture of the child and their issues and concerns.
These ideas and understanding serve as the building blocks
to treatment planning and intervention selection. Although
collecting the data needed can be an easy task, the skill is
in knowing what to gather and how to weave it all together.
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Session Structure
This section of the model deals with the procedures for
carrying out the actual therapeutic sessions where you will
be conducting the specic appropriate strategies. Let us rst
touch upon the fundamentals of using CBT with children. It
is critical that the session length be appropriate for the spe-
cic child. This is often inuenced by age and/or develop-
mental level. The other basics include expanding the childs
emotional vocabulary, identifying and disputing dysfunc-
tional ideas, teaching self-instructional techniques, teach-
ing problem-solving skills, providing the opportunity to
role-play specic skills, providing opportunities to practice
skills learned (akahomework), allowing the opportunity for
generalization, and reinforcing positive behavior and skill
mastery. The actual session is stuctured in such a way that it
provides a consistent approach to each meeting. The session
always begins with a relational check-in followed by these
steps:
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CONCLUSION
Given the need for short-term, exible mental-health services
within school settings, the CBT model is ideal. The structure
and framework of CBT parallel the existing organization of
school systems, while allowing for interventions that focus on
situation, cognitive, behavioral, affective, and social factors
inherent in many difculties seen in youth. CBT has much
promise for enhancing and modifying service delivery in
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REFLECTION QUESTIONS
1. What is your current theoretical approach to psycho-
therapy? How might you incorporate CBT into your
practice and move toward a CBT orientation?
2. How might you determine a childs readiness to
change, and what interventions might you include in
your treatment planning as a result of determining
that readiness?
3. Think of one of your current cases. How might you
approach the case differently using a CBT conceptual-
ization and modular-based interventions?
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Professional Resources
Association of Behavioral and Cognitive Therapies (ABCT).
www.abct.org.
Academy of Cognitive Therapy (ACT). www.academyofct
.org.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New
York: Guilford Press.
Freeman, A. Pretzer, J., Fleming, B., & Simon, K. M. (2004).
Clinical applications of cognitive therapy (2nd ed.).
New York: Kluwer Academic/Plenum Publishers.
REFERENCES
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive
therapy for depression. New York, NY: Guilford Press.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond.
NewYork, NY: Guilford Press.
Burns, D. D. (1999). Feeling good: The new mood therapy
(Rev.ed.). New York, NY: Avon.
Chorpita, B. F. (2007). Modular Cognitive-Behavioral Therapy
for Childhood Anxiety Disorders. New York, NY: Guilford.
Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007, May).
Understanding the common elements of evidence-based
practice: Misconceptions and clinical examples. Journal of
the American Academy of Child & Adolescent Psychiatry,
46(5), 647.
Christner, R. W., & Allen, J. S. (2003, Spring). Introduction to
cognitive-behavioral therapy (CBT) in the schools. Insight,
23(3), 1214.
Christner, R. W., Allen, J. S., & Maus, M. R. (2004, Winter). An
overview for selecting CBT techniques in the treatment of
youth in schools, Insight, 24(2), 810.
Christner, R. W., Mennuti, R. B., Heim, M., Gie, K., Rubinstein,J.
(2011). Facilitating mental health services in schools:
Universal, selected, and targeted interventions. In T. M.
Lionetti, E. Snyder, & R. W. Christner (Eds.), A practical
guide to developing competencies in school psychology.
New York, NY: Springer Publishing.
Christner, R. W., Mennuti, R., & Stewart-Allen, J. (2004,
August). School-based cognitive-behavior therapy (CBT).
Pennsylvania Psychologist Quarterly, 64(8), 2223.
Christner, R. W., Mennuti, R. B., & Whitaker, J. S. (2009). An
overview of school-based mental health practice: From
systems service to crisis intervention. In R. W. Christner &
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