Robert D. Friedberg

Integrating Psychotherapeutic Processes with Cognitive Behavioral Procedures

There has been a recent focus on the processes that underlie intervention delivery for children and adolescents throughout the Cognitive-Behavioral Therapy (CBT) literature. Certain process variables have been associated with treatment outcome among youth receiving CBT. Data for these process variables including: the therapeutic alliance or therapeutic relationship, child and parent involvement, other child and therapist variables, and issues of diversity, are reviewed. Based on this data, specific clinical recommendations are made. The treatment relationship as a very important process (VIP), and the facilitation of CBT so that it is real and relevant to youth are emphatically discussed. Process issues in modular CBT are identified. Ultimately, genuine collaborative empiricism and guided discovery preserve the therapeutic relationship as a VIP, and foster the customization of therapeutic tools and the treatment trajectory.

Training psychologists for cognitive-behavioral therapy in the raw world: a rubric for supervisors.

Empirically supported treatments (EST) hold much promise in relieving psychological distress and dysfunction. However, various obstacles to effective training and clinical practice have truncated dissemination efforts. One such obstacle is the perceived applicability of EST procedures to raw world clinical practice. This article proposes a rubric for supervision that emphasizes case conceptualization, the use of immediacy in session, tolerating negative affect, harvesting open attitudes, cultural responsiveness, and technical proficiency. Several specific training strategies and supervisory processes are recommended.

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.

CDI Scores in Pediatric Psychiatric Inpatients: A Brief Retrospective Static Group Comparison.

The Childrens Depression Inventory is a widely researched and clinically useful measurement tool. However, research on the CDI is limited by an overreliance on outpatient samples. This is unfortunate because the CDI holds potential for use in inpatient settings. Method. This retrospective static group comparison examined the CDI total scores contained in 69 pediatric psychiatric inpatients treated at a large academic medical center. Patients were sorted into static groups (depressive spectrum, nondepressive spectrum) based on their diagnoses at admission. Results. Independent t-tests revealed that the CDI total scores discriminated between patients presenting with depressive spectrum disorders and youngsters admitted with non-depressive disorders. Conclusion. The results suggested that the CDI is a rather dimensional measure, which reflects broad negative affectivity as well as particular depressive symptoms in pediatric psychiatric inpatients.

Core Principles in Cognitive Therapy with Youth

Cognitive therapy (CT) is increasingly being adopted by child psychiatrists for a variety of clinical problems. This article explains the cardinal principles, practices, and processes associated with this approach. More specifically, a brief overview of the treatment model is offered along with an emphasis on case conceptualization and modular format for treatment. The value of collaboration, guided discovery, establishing a good therapeutic alliance, empiricism, and transparency in clinical work, as well as bringing the head and heart to consensus, is explained. Finally, the hallmark session structure that characterizes CT is delineated.

Training Methods in Cognitive Behavioral Therapy: Tradition and Invention

Cognitive behavioral supervisors influence new generations of clients and clinicians. Accordingly, the task is meaningful, rewarding, challenging, and critically important. This article describes traditional and unconventional approaches to supervising clinicians in cognitive behavioral therapy (CBT). Traditional methods such as the use of the Cognitive Therapy Rating Scale, videotape/audiotape review, live supervision, and cotherapy are reviewed. Further, inventive procedures for teaching supervisees cognitive flexibility, empathy, tolerance for ambiguity, and remaining steadfast when faced with negative emotional arousal are explained. Popular media, improvisation and acting exercises, and working with professional actors as teaching methods are explained.

Using Cognitive Behavioral Interventions to Help Children Cope with Parental Military Deployments

Wars in Afghanistan and Iraq are associated with more deployments than in previous years. Recent estimates show 1.2 million school children have a parent that is serving in the active military. Family stress increases proportionately to the length of deployment and the perception of danger. In a recent study, twenty percent of children whose parent was being deployed were identified as “high risk” for psychosocial disturbances. A deployed parent represents a stressor reflecting ambiguous loss which prompts emotional distress. Cognitive behaviorally based prevention and intervention efforts have shown considerable promise with children experiencing a variety of disorders who do not necessarily have a deployed parent. For instance the Penn Resiliency Program has enjoyed considerable empirical support. It seems quite reasonable that these favorable results would generalize to a population of military children. This paper will briefly review the extant literature on the effects of parental deployment on children’s emotional well-being and then recommend a variety of cognitive behavioral interventions to enhance their psychological welfare.

Religious and Spiritual Issues: Family Therapy Approaches with Military Families Coping with Deployment

Exploring religious and spiritual issues in family therapy has become more commonplace over the past decade (Walsh, Spiritual resources in family therapy, 2009), but understanding how religion and spirituality evolve within military families is unclear. Further, the stressors that family members face in the midst of a deployment are paramount, for which many individuals use a variety of coping skills. In this paper we explore these links further by reviewing the scant literature focused on military families and religious and spiritual coping. This literature review is followed by a description of strategies to understand family members’ religious and spiritual lives related to family functioning and military deployment. Finally, strategies to enhance family functioning through both an integration of secular, religious, and spiritual pathways in a family therapy setting are discussed.

Training Psychiatrists in Cognitive Behavioral Psychotherapy: Current Status and Horizons

The Residency Requirements Committee of the ACGME recommends that psychiatric residents receive training in cognitive behavioral psychotherapy (CBP). Despite these recommendations, some training programs are slow to implement these requirements and many struggle to develop didactic and clinical curricula to meet these criteria. This article provides a model for training psychiatry residents in cognitive behavioral therapy based on the extant literature. Literature on training psychiatrists and other mental health professionals in CBT is reviewed. A conceptual template representing declarative, procedural, and self-reflective knowledge domains is also presented. Characteristics of good candidates for CBP training are described. Ways of assessing competencies and training outcomes are discussed. Finally, the article concludes with the presentation of a training paradigm in CBP for psychiatrists.

Procedures and processes in cognitive behavior therapy with children and adolescents

Development and empirical testing of innovative procedures has a long tradition within cognitive behavioral therapy. However, the discussion of psychotherapeutic processes and their integration with established procedures is a relatively neglected area. This article seeks to remedy this state of affairs and ideally stimulate further dialogue regarding the integration of processes and procedures. This article begins with a brief theoretical introduction and then includes sections on integrating psychotherapy processes with session structure, self-instruction, and rational analysis. Several techniques are described and numerous methods for working with young patients are recommended Development and empirical testing of innovative procedures has a long tradition within cognitive behavioral therapy. However, the discussion of psychotherapeutic processes and their integration with established procedures is a relatively neglected area. This article seeks to remedy this state of affairs and ideally stimulate further dialogue regarding the integration of processes and procedures. This article begins with a brief theoretical introduction and then includes sections on integrating psychotherapy processes with session structure, self-instruction, and rational analysis. Several techniques are described and numerous methods for working with young patients are recommended