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Child and Adolescent Therapy


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Table of Contents

Preface: The Therapist's Challenge xi

Acknowledgments xiii

Part I The Tools Of The Therapist 1 Therapy Fundamentals 3

The Therapeutic Orientation Toward Clients 4

Getting Started 8

Basic Child Therapy Skills 13

Overcoming Obstacles to Client Engagement 25

Simple Therapeutic Interventions 33

Therapeutic Collaborations 37

Termination 39

Summary 41

2 Behavior Therapy 43

Learning Theory 44

Assessment and Case Formulation 50

Change Processes 54

Outcome Research 55

The Therapist's Style 58

Exposure 59

Contingency Contracting 60

Relaxation Training 67

Social Skills Training 69

Summary 73

3 Cognitive Therapy 75

Cognitive Theory 76

Assessment and Case Formulation 82

Change Processes 86

Outcome Research 87

The Therapist's Style 89

Self-Monitoring 91

Self-Instruction 93

Self-Reinforcement 94

Socratic Questioning 96

Cognitive Restructuring 98

Tests of Evidence 100

Personal Experiments 103

Using Spectra to Develop Moderation 104

Summary 108

4 Mindfulness-Based Cognitive-Behavioral Therapies 110

Mindfulness and Psychotherapy 111

What Causes Mental Health Problems? 115

Assessment and Case Formulation 117

Change Processes 121

Outcome Research 124

The Therapist's Style 127

Mindfulness Training Exercises 128

Implementation of Dialectical Behavior Therapy 132

Implementation of Acceptance and Commitment Therapy 141

Summary 147

5 Psychodynamic Therapy 149

Psychoanalytic Theory 150

Assessment and Case Formulation 161

Change Processes 163

Outcome Research 168

The Therapist's Style 170

Facilitating Expression of Material 171

Interpretation and Insight 172

Dynamic Psychoeducation 176

Corrective Emotional Experience 179

Summary 181

6 Constructivism: Solution-Focused and Narrative Therapy 184

Postmodernism and the Social Construction of Reality 185

Assessment and Case Formulation 189

Change Processes 192

Outcome Research 196

The Therapist's Style 198

Solution-Focused Techniques 199

Narrative Therapy Techniques 208

Summary 215

7 Family Systems Therapy 218

Systems Theory 219

Assessment and Case Formulation 227

Change Processes 230

Outcome Research 233

The Therapist's Style 234

Combining Family and Individual Modalities 235

Facilitating Communication 235

Systemic Insight 237

Reframing 238

Treating Enmeshment and Disengagement 242

Therapist Directives 243

Treating Positive Feedback Loops 245

Summary 250

8 Atheoretical and Transtheoretical Techniques 253

Miscellaneous Techniques 254

Parent Counseling 259

Balance Between Extremes 261

Psychoeducation 265

Values in Psychotherapy 272

Incorporating Experiences Into New Structures of Meaning 277

Overcoming Fear of Failure 288

Summary 293

Part II The Needs Of Clients 9 Cultural Factors in Therapy 297

The Role of Culture in Psychotherapy 298

Assessment and Case Formulation 307

The Therapist's Style 314

Connecting the Cultures of Therapy and Client 315

Conflicts Between Client Cultures and the Predominant Culture 318

Addressing Prejudice and Discrimination 319

Culturally Specific Adaptations of Therapeutic Approaches 320

Bringing Spirituality Into Therapy 321

Summary 324

10 Disruptive Behavior in Children 326

Diagnoses Treated in This Chapter 327

Clinical Presentation and Etiology 327

Assessment 332

Treatment Planning 333

Behavioral-Systemic Parent Training 339

Collaborative Problem Solving 352

Individual CBT With the Child 355

Psychodynamic Therapy 358

Summary 359

11 Disruptive Behavior in Adolescents 362

Diagnoses Treated in This Chapter 363

Clinical Presentation and Etiology 363

Assessment 369

Treatment Planning 370

Behavioral-Systemic Therapy 374

Psychodynamic Therapy 391

Parent Counseling 393

Summary 394

12 Aggression and Violence 396

Diagnoses Treated in This Chapter 397

Clinical Presentation and Etiology 397

Assessment 402

Treatment Planning 403

Addressing Decisions About Fighting 406

Cognitive-Behavioral Therapy 410

Psychodynamic Therapy 426

Systems-Oriented Intervention 427

Summary 428

13 Anxiety 430

Diagnoses Treated in This Chapter 431

Clinical Presentation and Etiology 432

Assessment 438

Treatment Planning 440

Cognitive-Behavioral Therapy 443

Psychodynamic Therapy 453

Parent-Child Work 458

Summary 461

14 Depression 463

Diagnoses Treated in This Chapter 464

Clinical Presentation and Etiology 465

Assessment 471

Treatment Planning 472

Special Topic: Suicide Risk 476

Cognitive-Behavioral Therapy 479

Psychodynamic Therapy 489

Systemic Intervention 493

Summary 494

15 Stress and Trauma 497

Diagnoses Treated in This Chapter 498

Clinical Presentation and Etiology 498

Assessment 504

Treatment Planning 506

Cognitive-Behavioral Therapy 509

Coaching Clients in Coping 515

Psychodynamic Therapy 518

Constructivist Therapy 518

Systems-Oriented Intervention 519

Therapy for Parental Divorce 520

Therapy for Bereavement 522

Therapy for Sexual Abuse 525

Summary 530

Afterword: The Therapist's Experience 533

References 537

Author Index 613

Subject Index 635

About the Author

JEREMY P. SHAPIRO, PHD, is a Clinical Child Psychologist and an Adjunct Faculty Member of the Psychology Department and Mandel School of Applied Social Sciences at Case Western Reserve University.


"This book is by far the most comprehensive and useful child therapy text. Amazingly well-written, it is both supremely helpful for new clinical graduate students and an outstanding, sophisticated review for clinicians and researchers. The second edition of this book is even more useful than the original text! The first edition filled a key gap by providing a broad array of useful and evidence based information to new child clinicians learning to conduct therapy with kids and teens. Because of its currency and clinical sophistication, it is also suited to busy practitioners who are looking for practical ways to integrate new, clinically relevant evidence and ideas. The writing engages the reader with a crisp style and clear real-world examples showing a deep understanding of evidenced based work with youth. The revised edition adds new material on mindfulness-based cognitive-behavioral therapies and motivational interviewing, and it weaves recent neuroscience research into discussions of clinical topics. To a unique degree, this book articulates the thought process of an experienced therapist as he or she integrates outcome research and clinical considerations to plan treatment strategy and decide what to do and say in work with clients. We use this textbook in our didactic practicum with new clinical graduate students at the University of North Carolina, and each fall, the students and I enjoy reading the combination of a broad perspective, specific techniques and logistical implementation ideas, as well as up to date references. Child and Adolescent Therapy: Science and Art is a helpful and detailed yet fun read for new and seasoned clinicians!" Jen Kogos Youngstrom, PhD, Professor of Clinical Psychology, Director of Child and Family Services and Assessment Clinic The University of North Carolina at Chapel Hill "This book combines clear, insightful explanations of the major theoretical orientations, rigorous summaries of outcome research, and the clinical wisdom of an experienced therapist in a unique synthesis that shows readers how to plan treatment and decide what to say when with clients. My graduate students loved the first edition of this book there's nothing like it. The broad array of theoretical approaches that are covered helps to develop a comprehensive understanding of intervention approaches and provides a very solid foundation in child and adolescent therapy. This new edition has added an excellent chapter on mindfulness-based therapies and has infused a sophisticated neuroscience framework throughout the book. I highly recommend this text to mental health professionals working with young people and to graduate students beginning their work in child and adolescent therapy." Sandra W. Russ, Distinguished University Professor Case Western Reserve University "As a researcher, clinician, and instructor in a school psychology graduate program, I appreciate books that offer breadth of content but also sufficient depth in evidence-based practices in order to best prepare future youth mental health professionals. After switching from other texts that were either overly broad and historical or too narrow, I adopted the first edition of this book as the required text for my introductory course in counseling and psychotherapeutic interventions. My graduate students and I have given this book the highest praise. We appreciate the clear, insightful explanations of theory and research and the detailed, vivid instructions for implementation that make the process of therapy come alive. Unlike edited books with chapters by different authors, this text presents psychotherapy as an integrated whole. The chapters cross-reference each other frequently to identify connections and contrasts among the major theories and to show how elements of different approaches can be woven together in customized therapy for each client. My students are particularly thankful for the numerous vignettes and example scripts that illustrate best practices and provide detailed demonstrations of effective therapy." Shannon Suldo, Professor, University of South Florida "This book is essential for courses covering child and family therapy. It is comprehensive, well-written, engaging, well-organized, and informative. When I used the first edition, my students told me they looked forward to reading each week's assignment and that this is the book they return to again and again throughout their career as a resource for the most up-to-date information on interventions for various disorders. The author not only provides background information about the theory and evidence base behind interventions but also practical illustrations for how to implement interventions effectively and stylistic suggestions that demonstrate the art of conducting therapy. This book is a wonderful addition to any therapist's library, whether a therapist in training or an experienced therapist who wants to stay current." Amy Przeworski, Ph.D. Assistant Professor Case Western Reserve University

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