Discuss the relative merits of cognitive-behavioral AND systemic approaches to working with children. In 2018, the Mental Health Foundation reported that about 1 in 10 children are affected by psychological problems such as conduct disorders, anxiety and depression. Mental health conditions experienced by children are often caused by what happened in their life. At the same time, the interaction between a child’s thoughts, behaviors and feelings also play a significant role on a child’s mental health condition. Psychotherapy is a form of treatment, which is widely used with children. Cognitive behavioural and systemic approaches are two important psychotherapeutic treatments that are considered to be effective in the treatment of various mental health conditions experienced by children. The following essay will discuss the relative merits of cognitive behavior and systemic approaches working with children.
Relatives Merits Of the Cognitive Behavioral Approach For Children Becks developed the Cognitive Bevioural approach in 1960. This approach focuses on teaching the clients how to recognize and change their maladaptive thought patterns and behavior. CBT breaks the cycle of dysfunctional habitual behaviors as well as make an improvement on how the patient can handle worries and feelings. With the help of this perspective, children become able to see the link between what they think, what they tell themselves, and the feelings and actions that follow. Children’s developmental and learning processes in perceiving or adapting new experiences are related to their mental health conditions (Kurniawan, n.d.).
In recent years CBT become the most popular treatment, and many meta-analytic studies have proved the efficiency of CBT on the treatment of psychological condition in children. The idea behind CBT is that individual’s cognitive processes affect their behavior and feelings. CBT believes unrealistic and negative thoughts cause mental problems (Cartwright-Hatton et al., 2004). According to Brewin, (1996) feelings and behaviors are controlled by thoughts, and any distortion in cognition processes can cause distress, which can result in mental problems. For instance, children with a high level of anxiety often perceive situations as skewed, because of experiencing irrational thoughts. This causes damage impact on decisions and actions taken by children. These irrational thoughts often appear automatically and children may not even aware of having these irrational thoughts (Seligman & Ollendick, 2011).
CBT differs from other therapies; CBT is a more focused and more structured therapy that examines the patient’s negative thoughts to understand the cause of the presenting problem (Seligman & Ollendick, 2011). According to Seligman and Ollendick (2011), the method used in CBT focuses on the factors that maintain the condition, rather than what underlies the problem. For instance, rather than focusing on the past interactions, the therapist may want to know the reaction of the parent on child’s attempts at avoidance. With the knowledge of this, the therapist can decide whether collaboratively work with the parents in order to develop a new approach to an altered learning experience for the child (Seligman and Ollendick, 2011).
Cognitive Behavioural Therapy is a very educative and skills-based approach that teaches adaptive behaviors, problem solving skills and strategies to children, parents and teachers, in order to combat a child’s distorted thoughts. According to the behavioral theory, teachers (teaching methods) or family (parenting styles) are the contributing factors to the mental disorder which the child experiences (Bradley, 2001). For this reason, new adaptive skills are introduced by CBT to parents, teachers or sometimes-even siblings/peers, in order to increase the efficiency of the treatment. Parent and the teachers can become major agents to help children to gain new skills and adaptive behaviors. In point of fact, teachers and/or parents are often requested to become a trainer and are asked to change their behaviors or approaches in order to respond to a child’s mental condition and ability to complete his or her homework tasks or apply skills into everyday situations (Seligman and Ollendick, 2011).
Moreover, very empowering strategies used in CBT encourage patients to play a role in the recovery process. Through these strategies, patients learn rational self-counseling skills. At the beginning of the therapy, to be able to identify patients disturbing cognitive processes as well as assisting and giving the formulation of the presenting problems, therapist involves the clients actively during the therapy (Kurniawan, n.d.).
In CBT there are some limitations to be considered when working with children. Children can be identified their distorted cognition with the help of CBT’s restructuring step. At this stage, the map the disturbing feelings and thoughts need to be known by the therapist in a detailed way. Aims of this strategy reduce the negative talk, which causes automatic thinking, which also leads disturbing feelings and behaviors. Nevertheless, children, especially those still developing phase of language, have difficulties in formulating or expressing their feelings and experiences because of limitations in metacognition, lack of emotional vocabulary and inability to label feelings. During the therapy session, due to these difficulties therapist may have limitations in identifying faulty beliefs’ evidence, following instructions or understanding the formulation presented. In fact, Scheeringa et al., (2007) found that, since the young children’s cognitive immaturity restricts the use of some traditional CBT strategies, CBT’s treatment approach for children needs external support.
Furthermore, CBT fails to provide help to children those live in a collectivist culture. Hofmann et al (2010) said that morality and group harmony highly valued to maintain social harmony and is considered as a standard competency, in some cultures. Cognitive approaches can be perceived as judgmental by children morality and attribute children’s distorted thinking to a basic fault in their selves. For this reason, children with the moral model can perceived the CBT diagnosis as confused. For instance, in the case where children suffers from social anxiety disorder. Certain behavior such as shyness and embarrassment are the maintaining factors in social anxiety. Kevin et al., (2011) said that these factors occur in relation to cultural beliefs or social norms learned to respect group harmony. According to Singelis et al, (1995), children who live in collectivist cultures have more rules for proper social behaviors than children from individualist culture, which may lead children in collective culture to be looked embarrassed. Whence, when working with children who live in various cultural backgrounds it is important to address cross-cultural understanding and culturally adapted CBT.
Merits Relatives Of Systemic Approach For ChildrenSystemic approach is a frequently used form of psychotherapy. In order to understand the children’s problem, the systemic approach focuses the contextual framework, and understand and shifting the current dynamics of the relationships, in families. Systemic therapy takes into account the broad contexts children function in, and their entire family, in order to help children (Margoies, 2018). Long-term positive changes and improvements for both families and children can occur by strengthening the entire system in which the child operates (Pointon, 2006). The emotional, behavioral, and physical changes in children’s growth and development stages may cause problems within themselves as well as with others around them by lead to confusions, conflict and adjustment difficulties. This therapy is beneficial to address developmental changes and conflicts those experienced by children (Turner, 2005). At the same time, system therapy helps parents/relatives better understand children, to support families during these transition periods and to recognizes the tensions that may be associated with changes in life cycle. The difficulties they may have in the future are mitigated by timely interventions (Pointon, 2006).
The systemic approach describes the development of problems by reciprocal interpersonal interactions. Symptoms of external situations, and avoidance of these experiences, or particular internal experiences can characterize all of these. Because just focusing on children can treat the symptoms but leave the underlying problem untreated. For instance, children may present some behaviors, which may be seen as problematic by parents, in order to meet their needs or cope with the family environment. Within systemic therapy, parents can be involved with the treatment and can understand the reason for these problematic behaviors (Carr, 2009). Systemic therapy addresses diverse forms of difficulties experienced by the child and the associated challenges parents have suffered. This therapy aims to solve the problem of the child through a therapeutic process by engaging with the member of the family and the wider network of the family. Evidence showed that systemic therapy improves child’s school and community based problems. For instance difficulties in learning and reading, bullying, children sleeping and attachment problems, also range of mental disorders and it’s associated symptoms (Carr, 2009). Strategies used in systemic approach help children develop management skills, for example, and using social support, cognitive coping, relaxation. Also, these strategies help parents/relatives learn to reward their children’s use of problem management skills, manage their own problems/symptoms, ignore their avoidant or problem behavior. In addition to that, in order to enhance the parent-child interaction quality, develops communication and problem solving skills (Barrett & Shortt, 2003).
Especially, the systemic approach is also effective for comorbid conditions such as academic as well as problems in relationships and emotional, and in the long term to adult adjustment difficulties (Burke et al., 2002). These co morbid conditions are also relatively common. School refusal and/or problem in academic performance are usually occurring due to the child’s mental condition (Loeber et al., 2000). Systemic therapy starts with a careful systemic assessment, which allow therapist to identify triggers of the problem, and obstacles to problem control and school attendance or academic life of the child (Heyne & King, 2004). In order to increase school performance, system therapy enables parents, teachers, and children to work collaboratively and develop strategies such as the coaching child in relaxation, social and coping skills to help the child to deal with the problem triggers. Then teachers and parents encourage and support the child to use management and social skills in order o help child to deal with the challenges faced throughout returning back to the regular school routine (Elliott, 1999; King and Bernstein, 2001).
However, there are some limitations need to be considered. In system therapy, the participation of more than one individual in the therapy and the creation of systemic treatments in the context of the child-family, cause dilemmas as to which outcome needs to evaluated as the result of the treatment (Cotrell, et al., 2002). Furthermore, in some cases, considering the child’s past history may be crucial to reaching a solution, but systemic therapy neglects the past perspective of the child when addressing issues.
In conclusion, it has been proven CBT and systemic therapy are scientifically effective treatments or the common mental problems in children. With the help of the CBT, children and parents learn formulation of how the cognitive process of the individual links to their emotion and behavior and how the presenting problems are developed and maintained. This feature of CBT is very advantageous and very educative. Nevertheless, the developmentally appropriate practice of CBT for children’s needs to be considered by the therapist, as well as put more attention to emotional cultural and social issues. On the other hand, systemic approach takes into account the conceptual framework of a child, in order to make sense of these problems and treat their underlying problem. This therapy works as systematic in collaboratively with relatives by developing coping and social skills for both child and parents/relatives. It not just improves child emotional state, also improves child- parent/relatives relationship, and all the areas child performance, such as school.
Clinical Psychologist B. Perim Secmen
Barrett, P. and Shortt, A. (2003) Parental involvement in the treatment of anxious children. In
A. Kazdin and J. Weisz (eds) Evidence Based Psychotherapies for Children and Adolescents (pp.
101–119). New York: Guilford Press.
Bradley, S.J. (2001). Anxiety and mood disorders in children and adolescents: A practice update.
Pediatric and Child Health, 6(7), 459-463.
Brewin, C. R. (1996). Theoretical foundations of cognitive-behavioral therapy for anxiety and
depression. Annual Review of Psychology, 47, 33-57.
Burke, J., Loeber, R. and Birmaher, B. (2002) Oppositional defiant disorder and conduct disorder: a
review of the past 10 years, part II. Journal of the American Academy of Child and Adolescent
Psychiatry, 41: 1275–1293.
Carr, A. (2009). The effectiveness of family therapy and systemic interventions for child‐ focused
problems. Journal of family therapy, 31(1), 3-45.
Cartwright-Hatton, S., Roberts, C., Chitsabesan, P., Fothergill., C & Harrington, R. (2004)
Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent
anxiety disorders. British Journal of Clinical Psychology, 43, pp. 421–436.
Cotrell, D., & Boston, P. (2002). Practioner review: The effectiveness of systemic family therapy
for children and adolescents. Journal of Child Psychology and Psychiatry, 43, 573– 586
Heyne, D. and King, N. (2004) Treatment of school refusal. In P. Barrett and T. Ollendick (eds)
Handbook of Interventions that Work with Children and Adolescents: Prevention and Treatment (pp.
243–272). Chichester: Wiley.
Hofmann, S. G., Asnaani, A., & Hinton, D. F. (2010). Cultural aspects in social anxiety and social
anxiety disorder. Depression and Anxiety, 27, 1117-1127
Kevin J. Ashworth, K.J., Randall, J., Millen, A & Rosqvist, J. (2011). Culturally Competent CBT:
Treating SAD in a Korean Immigrant—A Single Case Analysis. Clinical Case Studies, 10(6) 449 –465.
King, N. and Bernstein, G. (2001) School refusal in children and adolescents: a review of the past
10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 40: 197–205.
Kurniawan, A. P. Cognitive Behavioural Therapy for Children: Strengths and Limitations.
Loeber, R., Burke, J., Lahey, B., Winters, A. and Zera, M. (2000) Oppositional defiant and conduct
disorder: a review of the past 10 years, Part I. Journal of the American Academy of Child and
Adolescent Psychiatry, 39: 1468–1484.
Margolies, L. (2018). Understanding Different Approaches to Psychotherapy | Psych Central. [online]
Psych Central. Available at: https://psychcentral.com/lib/understanding-
different-approaches-to-psychotherapy/ [Accessed 26 Mar. 2018].
Mental Health Foundation. (2018). Children and young people. [online] Available at:
https://www.mentalhealth.org.uk/a-to-z/c/children-and-young-people [Accessed 26 Mar. 2018].
Scheeringa, M.S., Salloum, A., Arnberger, R.A., Weems, C.F., Amaya-Jackson, L & Cohen,
J.A. (2007). Feasibility and effectiveness of cognitive-behavioural therapy for post-traumatic
stress disorder in preschool children: Two case reports. Journal of Traumatic Stress, 20, 631– 636
Sein, E. P., Fundudis, T., & Kolvin, I. (1987). A behavioural and systems approach to family
therapy: a position paper. Journal of family therapy, 9(4), 339-353.
Seligman, L. D & Ollendick, T.H. (2011). “Cognitive-Behavioral Therapy for Anxiety Disorders in
Youth”. Child and Adolescent Psychiatric Clinics of North America 20 (2): 217– 38.
Singelis, T. M., & Sharkey, W. F. (1995). Culture, self-construal, and embarrassability.
Journal of Cross- Cultural Psychology, 26, 622-644.
Turner,J. (2005) A family affair. The Guardian. Accessed on 10/12/2012:
Pointon, C. (2006) Systemic resources. Therapy Today, 17 (19) (9):
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