Child and Adolescence Problems

The framework, set out in Figure 1 outlines the stages of brief CBT with children and adolescents from the initial receiving of a referral letter to the point where the case is closed. In the first stage a plan for conducting the intake interview is made. The second stage is concerned with the processes of engagement, alliance building, assessment and formulation. In the third stage, the therapeutic contract, the completion of a therapy plan and the management of resistance are the primary issues addressed. In the final stage, disengagement or recontracting for a further episode of intervention occurs. Within the context of this stage-based model of consultation, brief CBT is usefully conceptualized as a developmental and recursive process. At each developmental stage, key tasks must be completed before progression to the next stage. Failure to complete the tasks of a given stage before progressing to the next stage may jeopardize the consultation process and lengthen treatment unnecessarily. For example, attempting to conduct an assessment without first contracting for assessment may lead to co-operation difficulties if the child or parents find the assessment procedures arduous. Brief CBT is an episodic and recursive process insofar as it is possible to move from the final stage of one episode of brief CBT to the first stage of the next.