Introduction to Abnormal Child and Adolescent Psychology. Robert Weis
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Название: Introduction to Abnormal Child and Adolescent Psychology
Автор: Robert Weis
Издательство: Ingram
Жанр: Психотерапия и консультирование
isbn: 9781544362328
isbn:
Recall that behavior therapists typically perform a functional analysis of their clients’ problematic behavior in order to determine situations that elicit the behavior (antecedents) or conditions that reinforce it over time (consequences). Then, behavior therapists work with clients to find ways to avoid these environmental triggers or alter the consequences of the behavior that maintain it (Miltenberger, Miller, & Zerger, 2015).
Recall that Anna’s most problematic behavior is her tendency to binge and purge. A behavior therapist would carefully note the frequency of Anna’s bingeing. Then, the therapist would try to identify situations that often precede a binge. For example, Anna might report that she tends to binge after school, when she is feeling lonely, and when she is hungry. The therapist would also try to determine how Anna’s bingeing is maintained over time. Anna might report feeling less lonely and hungry immediately after bingeing; thus, bingeing is negatively reinforced by the withdrawal of these unpleasant feelings (Fishman, 2018a).
Over the course of treatment, a behavior therapist might teach Anna to monitor her binge eating, its antecedents, and its consequences. Then, the therapist might help Anna avoid antecedents that trigger binges. For example, the therapist might help Anna eat more regular, balanced meals to avoid feelings of intense hunger. Similarly, the therapist might help Anna identify ways to avoid the loneliness and boredom that often elicit her binges. The therapist might encourage Anna to become more involved in after-school activities or teach her to develop more satisfying peer relationships. Alternatively, the therapist might help Anna identify coping strategies, like relaxation techniques or exercise, to manage negative emotions. By altering environmental factors that elicit or reinforce her binges, Anna should be able to decrease their frequency.
Cognitive Therapy
Cognitive therapy focuses primarily on the client’s patterns of thinking about herself, others, and the future. One cognitive therapist, Aaron Beck (1976), argued that people experience psychological distress and impairment when they engage in systematic errors in thinking called cognitive biases and cognitive distortions. A cognitive bias occurs when someone selectively attends to negative aspects of her life rather than looking at situations in a more balanced, realistic way. For example, a girl with social anxiety who is giving a class presentation might focus exclusively on her classmates’ laughs or snickers rather than on her teacher’s nods of approval. Similarly, a boy with depression might attend to the fact that only one classmate sits with him during lunch instead of feeling supported by his friend who chose to spend time with him.
From Science to Practice: Cognitive Therapy With Children
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Cognitive therapists teach children that the way we think affects how we feel. If we can change the way we think about a situation, we will likely feel better. A therapist might use the cartoon of the elephant and the mouse to teach this concept to a young child with anxiety.
Therapist: How is the elephant feeling?
Child: He’s scared.
Therapist: Why?
Child: He thinks the mouse will hurt him.
Therapist: Will the mouse really hurt him?
Child: No. The mouse is so little.
Therapist: If the elephant had a different thought like, “Look at that cute little mouse,” would he feel differently?
Child: Yes. Maybe he’d be happy and want to play with the mouse.
Therapist: So the way we think about situations affects how we feel.
Child: Yes, just like the elephant.
A cognitive distortion occurs when someone twists reality to fit her negative worldview. For example, the girl with social anxiety might misperceive her classmates’ giggles during her speech as a sign of criticism. She might think, “They’re laughing at me. They think I’m stupid.” These distorted thoughts, in turn, might interfere with her ability to give a good presentation and lead to actual criticism from others, thus confirming her expectations. Similarly, the boy with depression might misperceive the fact that few friends sat with him during lunch as a sign that he is worthless. He might think, “No one likes me. I’m such a loser.” His distorted thoughts, in turn, might cause him to act mopey or avoid others, thus leading his classmates to reject him and confirming his negative view of himself (DiGiuseppe, David, & Venezia, 2018).
An initial goal of cognitive therapy is to help clients recognize the close connection between our thoughts, feelings, and actions. Although we usually have little direct control over our feelings, we can control what we think or do. If we change the way we think or act, we can often improve the way we feel. The From Science to Practice section demonstrates one way a cognitive therapist might teach the relationship between thoughts, feelings, and actions to a child (Beidel & Reinecke, 2016).
Cognitive therapists help clients identify and challenge biases and distortions and adopt more accurate ways of thinking. A primary technique in cognitive therapy involves asking clients for evidence to support their beliefs. For example, a therapist might ask the girl with anxiety, “How do you know that your classmates think you are stupid? What evidence do you have to support your belief? Is there any evidence to the contrary, that maybe they actually liked your presentation?” Similarly, a therapist might ask the boy with depression, “What’s the evidence that no one wanted to sit with you during lunch? I thought you said one boy did sit with you? If you saw a kid sitting alone during lunch, would you think he was worthless or a loser?” The goal of therapy is not to teach clients to think positively but rather to help them see themselves, others, and the world more realistically rather than in a biased or distorted fashion (Kendall, 2018).
A cognitive therapist would focus her attention on the thoughts associated with Anna’s bingeing and purging. Anna might feel lonely and think to herself, “I’m worthless. No one likes me.” The therapist might help Anna challenge this belief to determine whether it is true or whether it is a cognitive distortion. For example, the therapist might ask Anna, “What’s the evidence that no one likes you? Can you identify any friends who’d be willing to talk with you if you texted or called them when you’re feeling lonely?”
Anna might also think, “If I called someone and said that I was lonely and wanted to do something, they would probably laugh at me and say I was a loser.” The therapist might challenge Anna’s distorted belief by asking, “If another girl from school called you and said that she was feeling lonely and wanted to spend time together, would you make fun of her? Isn’t it more likely that you would help her and try to cheer her up? Don’t you think that your friends would do the same thing for you if you asked?”
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