CBT for Anxiety in Children and Adolescents

Dr. Taylor Chesney presents CBT for Anxiety in Children and Adolescents at Feeling Good Institute.

This Cognitive Behavioral Therapy (CBT) webinar shares techniques for working with children and adolescents. The webinar was presented by three experts in the field: Taylor, Todd, and Jill Levitt, who shared valuable insights and practical methods for therapists and mental health professionals.

CBT techniques tailored specifically for children and adolescents include the use of the Daily Mood Log, the Double Standard method, and the Examination of Evidence technique. These methods are designed to help young individuals identify and address negative thoughts, emotions, and behaviors, empowering them to manage their mental health effectively.

Throughout the webinar, the presenters emphasized the importance of playfulness, motivation, curiosity, and affirmation when working on CBT for kids and teens. They also discussed strategies for engaging reluctant patients and navigating complex family dynamics, such as divorced parents.

Overall, Dr. Taylor Chesney provides a comprehensive overview of cognitive-behavioral therapy for anxiety disorders in youth, offering valuable guidance for mental health professionals seeking to better support children and adolescents in managing their mental well-being.

IN THIS VIDEO:

Jill: Welcome everyone to our one-hour presentation. Today, we're excited to have you joining us, the topic of our presentation is going to be CBT for anxiety in children and adolescents presented mainly by Taylor Chesney and she'll also be joined by My Tu and Todd Daly and I will introduce them all to you.

If you can move to the next slide Taylor, so let me tell you a little bit about the presenters today. So, join me in welcoming our featured presenter Dr. Taylor Chesney and Dr. Chesney is a licensed clinical psychologist and also the director of training at the Feeling Good Institute, New York City and Dr. Chesney has over 15 years of experience working with children and adolescents. She studied with Dr. Burns at Stanford University and has extensive teaching experience with grad students, medical students and therapists. She's a certified level five Master therapist and trainer in team CBT. And, Dr Chesney is particularly passionate about combining both her extensive clinical experience and her first-hand knowledge of being a parent to four little kids. She looks forward to sharing her expertise and enthusiasm for working with children and adolescents with you all here today.

Our next presenter My Ty, LMFT is a Vietnamese bilingual clinician at the Feeling Good Institute, who also works a lot with kids and teens. Her background includes working with youth and families across diverse backgrounds and acuity levels and prior to joining Feeling Good Institute, she provided therapy in community-based agencies in her last position. She was the manager of the county's largest youth mobile crisis department and her role also included giving presentations and training for the police department county Mental Health Services and school districts on how to help youth in distress. And, since joining Feeling Good Institute, My continues working with kids and teens and is quite creative in personalizing the team CBT methods in child-friendly ways. So, she's here today to share with you all just how she does that.

And, finally join me in welcoming Todd Daly, LMFT, who is a licensed marriage and family therapist, a licensed educational psychologist and a level four team CBT therapist at the Feeling Good Institute in Mountain View. And, Todd has over 20 years of experience as both a school psychologist and licensed therapist working with adolescents and adults. He's also trained with several beloved members of our local CBT community including Dr. David Burns. Todd’s also been completing psycho-educational assessments for children and adolescents at private and public schools for over 15 years and he also looks forward to sharing his unique knowledge with you here today.

Let's move on to the next slide. So, let me tell you just a little bit about Feeling Good Institute and then I'm going to pass the reigns over to Taylor and the rest of the team.

So, our mission at the Feeling Good Institute is to alleviate suffering by elevating the practice of therapy and so to that end, we have kind of two arms. One is a training arm and a training and certification arm and one is a treatment arm. Feeling Good Institute was started by a group of clinicians mentored by David Burns at Stanford University and our goal is to train and certify therapists in the processes of evidence-based CBT that are known to be most effective including the use of measurement, empathy skills, addressing motivation and resistance and lots and lots of CBT skills, which we'll be focusing on some of them today.

The therapists who work with a Feeling Good Institute are highly skilled and vetted and we also all engage in a weekly system of continuous Improvement using deliberate practice so, that we're practising and learning and growing week over week. We have flexible services to meet client's needs and that is both video-based therapy across the US and Canada as well as in-person treatment centres in New York in Mountain View, in Canada and in Israel. And, we engage in traditional sort of outpatient weekly therapy 50-minute sessions as well as intensive therapy where patients will fly in from out of town or do video-based intensive therapy where we do many hours a day, many days a week in order to help patients more efficiently. And, we also have lower-fee options for patients who need lower-fee therapy.

Okay so, now I'm gonna pass things over to you Taylor.

Taylor: Great, I'm so glad we're all here today learning about how to improve our skills working with children and adolescents that are suffering with anxiety. Thank you, Jill for our introduction then I'll spend some time. I'm talking a little bit about why this is important and how to set up treatment to be successful then we'll spend about 10 minutes talking about how to explain cognitive distortions in language that's helpful and accessible to children and teens then we'll cover several methods and then explain how to adapt them more creatively to be effective with children and adolescence and then we'll have 15 minutes of Q&A. So, if you have questions throughout the talk, please put them in the chat to Jill who will gather them and we'll cover them towards the end.

So glad, that you're all here today, passionate about providing therapy for children and adolescents, struggling with anxiety. We promise to deliver more than the learning objectives but at a minimum at the end of this talk. You'll be able to explain the idea of cognitive distortions to children in language that they can understand and be able to describe many techniques but specifically the double standard in language that's helpful for children and that they can really learn and understand and we'll also provide some clinical examples, how we've done that.

It is amazing to be here with so many therapists and people invested in improving the lives of today's youth. There's a mental health crisis affecting our youth as a mother of four young children 9, 7, 5 and five months, I feel incredibly passionate about teaching on this topic as well as arming parents and therapists with the best tools possible to help our children.

In the fall of 2021, the American Academy of Pediatrics along with the American Academy of Children and Adolescent Psychiatry declared a National Emergency in Child and Adolescent health. Anxiety is the most prevalent childhood mental disorder affecting roughly between 15 and 20% of children. That's really a staggering statistic. Untreated anxiety significantly impacts many domains of functioning and follows a chronic course into adulthood. But luckily there is an effective treatment, CBT is a gold standard treatment for anxiety and leads to Improvement across multiple domains of functioning. While we know that some fears and anxiety can be adaptive and developmentally appropriate clinical levels of fear and anxiety can cause significant distress in children and their families and are also likely to interfere with their academic and social functioning which is so important for children as they're growing up.

While anxiety does help kids in many ways, helps them prepare for exams, some levels of anxiety, help them succeed in sporting events and could even help them stay safe when there's a danger. But it also causes harm too much anxiety is not a good thing and this was the case even before the COVID-19 pandemic but this rate has reached a staggering statistic now affecting about 20.5% of our youth worldwide. These kids aren't okay and so I'm all glad we're here today to learn effective methods to better help them and to turn down their anxiety so they can go on to living happy and effective lives.

Later in this presentation, I'm going to talk about methods and tools and tricks to help treat anxiety but to start I want to talk about how we can set up therapy for success.

When I start with a family, they often and I'm sure very similar to many of you want just the tips and tricks and tools and methods of how to be a more effective therapist. I want that as well but what I found is that setting up therapy for success, at the start is even more important than having the best methods, right?

I hate to see kids suffer but we can't just throw methods and techniques and tools at them. What I've learned over the years is that unless we set up treatment to be successful, even if we have the best methods we will fail. We need to make sure that our patients are willing to do the work that it takes to improve and that we're helping them with the things that they see as problems. I accomplish a lot of this in my intake and I encourage you to as well. So, that we can make sure we're helping children and teens with the things that they want help with.

I adapt my intake based on the work of Dr. Jacob Towery, he's an amazing Child and Adolescent psychiatrist at Stanford in the Bay area and I was lucky enough to be supervised when I was first starting out so I want to give him credit for that. And, in my intake, I do a four-session intake this is before I accept any patients into therapy. So, during this process, I'll do two sessions with the child or teen. One session with the parent and then a wrapup session altogether and I'll talk more specifically on the next slide about what goes into each of those sessions. But I only will accept patients into treatment that actively want to work on their anxiety and make sure the anxiety is a problem for the child, not just a problem for the parent or the school, right?

So, as we know anxiety helps in many ways but they need to be willing to overcome it and work hard to change it. So, before we move on to any helping I want to make sure that the child, the parent everyone that's involved in the system is in agreement with what they want help with and willing to do the hard work to change.

I wish it was just a magic button that you could push and they would get better. But unfortunately, it's not. So, we need to make sure that we're not just throwing methods at kids before they really want help. And, I do want to share a quick story that my 9-year-old son told me, I should share with all of you to illustrate, why this is really important and how the setup of therapy is super important.

This weekend, we were at the beach and there was this gross seaweed in the ocean or as he called it weed seed. It was gross and dark and green and very different than it usually was and he totally flipped out because he felt super weird about it and it looked gross. I didn't really like it either, to be honest, and I think a pretty common parenting reaction, when you're in public and your kids freaking out is “Oh don't worry about it” or “It can't hurt you” or “It's not really that gross”, right?

And he wanted to run out of the ocean so I kind of asked him for a quick second I asked him if I could talk to him for a minute about what was going on or if he just wanted to scream and do his own thing. And, he said, he was kind of interested in hearing what I had to say.

So, I told him we're having a fun time and the seaweed is gross but if you run away from it you won't have the chance to see if it's okay. Your brain is trying to trick you into thinking it's something you need to run from but if you stay you may learn something about the situation. You may learn, it's really gross and you actually don't like it, you may learn it's gross and that, you can still have fun or you may learn that it's not bad at all.

So, for now, we can feel the fear and do it anyway. So, he decided to stay and he said it was really helpful to learn about this trick. He decided to stick it out and he learned that he did not like weed seed as he would call it but he could have fun anyway. I share the story to highlight the importance of a kid wanting to work on something and to get help with a specific problem. If they want to work with it and their mind is open to it then, they will be on board with doing the work that it takes to improve.

So, back to my intake and what I did in the four sessions. In the first session, I start by connecting with the child or the teen, it's a general getting-to-know-you session. I want to know about their friends their hobbies, their interest, etc. It's totally non-clinical really connecting. It's so important that children and teens feel as though you understand them and get them before you're going to be able to get to any clinical material.

The next session two is Diagnostic. In this session, we see what they see as the problem, get a sense of their overall functioning and I also assess in this session their motivation to change and what they're willing to work on.

In the third session, is the parent intake, they get to know the family, learn about the child through the parent's eyes, and connect with the parent. Because if we're going to work with parents it's really important that we have a collaborative open relationship. And, then I figure out if this parent is willing to be engaged in the therapy in a way that's really helpful and effective and that they're on their child's team.

After I meet with all the players, on the team, the parents and the child, we do a wrap-up fourth session and depending on the age of the child either part of that session or not. And, this is where we discuss what it will take to improve. What homework would be required, what exercises both the child and the parent would have to do to improve and what workbooks would be helpful or what resources I would recommend? And, if at that point we're all in agreement then we can work on making change and so now I'll talk about how we make change and what tools I use with children and teens.

At this point, I'm sorry these are some resources that I would generally share for anxiety in that wrapup session and you guys should all have a copy of the slides so I'm not going to go through these but I just wanted to provide you with some of the ideas and resource that I use. So, at this point, we have a road map together and we move forward to help.

So, this is the daily mood log, it's a tool that I introduced early on in the treatment. This is where a child will write their anxious thoughts or feelings this particular daily mood log was developed by David Burns and is adapted into more child, kid-friendly language. So, if any of you are familiar with David's mood log, this is a version that has simpler language that's helpful for children. So, here we look at a specific moment in time when they're feeling anxious. I teach children that their thoughts not the facts of their life determine, how they feel.

So, for example, I teach them that it's not a test that's making them anxious, it's their thoughts about the test. Something like I will fail, everyone else will do better, I should to get the highest grade, that is what determines how they feel. Two kids can take the same exact test and feel vastly different. So, there's nothing inherently threatening or scary about the exam, right?

But rather, what they tell themselves about it. I'll teach kids how to generate negative thoughts and identify thinking errors or distortions in their thoughts. My will provide in a few minutes some examples of how she adapts and teaches the thinking errors.

So, here we break down what the thoughts are that the child is having, how strong they're feeling those thoughts and what they're telling them about the situation. So, this is a really awesome tool to kind of orient, our children to that thought process of cognitive behavioural therapy, how our thoughts impact our feelings. And, now I'm going to turn it over to My.

My Tu: Alright, Hi everyone, my name is My and I've been working with teens and kids for many years and I love them, they are my humble teachers because they put me in a position where I have to break down complex ideas and techniques in a way that they can understand. And, I like to use it in their own words and I like to think like how can I say less.

So today, I'm going to share a case example of one of my clients, she's a very smart 12-year-old girl with social anxiety. Her name is Jamie. Now Jamie was volunt told by her mom to start therapy which is pretty classic right and she was struggling with social anxiety. Now, she didn't say to me I want to improve my social anxiety. She said it'd be nice to feel better. You see Jamie had experienced a lot of bullying and isolation and elementary school and she finally made some friends in middle school but then she suddenly started to feel very anxious around her peers at school. At first, she would sit in front of me in session eyes down doodling, fidgeting with squishy toys that I had out. But one day, after about a month she looked up with a sad expression and started telling me how she was sitting by herself at lunch. And, she said I was walking up to some friends but then I saw them laughing. I just saw a memo that someone can't hear me, Is my audio okay?

Jill: Your audio is okay, it's a little quiet. We can definitely hear you but I'm not sure if your mic is being blocked. You're just a little soft.

My: Okay, hold it a little bit closer. Mic check, is that okay?

Jill: Yeah, the yes, it's just a little quiet but we can hear you. Just if you can talk as loud as you can, that'd be great.

My: Alright, okay. So, Jamie said to me that I was walking up to some friends but then I saw them laughing and talking to Chloe and it made me feel bad and they looked over at me weirdly like they didn't want me there and I figured they liked her more. So, I didn't want to interrupt them and I walked away. So, in that moment I thought oh what a great opportunity to go over some cognitive distortions. And, after giving her a lot of empathy and support of course, I asked. Jamie, you said it made you feel bad, what were those bad feelings and she was able to name worried, anxious, jealous, self-conscious.

I then asked, where do you think feelings come from? And, she shrugged your brain. I said, yeah kind of I want to show you something and I whipped out something like. This little triangle image here and I said to her you know when something whenever something happens there's the thing that happens and then there's our experience of the thing that happened. And, is it okay to use this example and take a closer look to see if we can find out a way to help you feel better?

She quietly really agreed and followed along I said so when you saw your friends laughing sitting talking with Chloe, that's a fact right, that's the thing that happened. Then you said you had thoughts they're looking at me weird like they didn't want me there like they like her more and I don't want to interrupt them. And, those thoughts left you feeling anxious, worried, jealous, self-conscious and as a result you walked away, right? Now, what do you think you would have done if your thoughts in that moment was “oh looks, like they're having fun I can't wait to hear what they're talking about” and she responded so bluntly and obviously I just joined them. I said, yeah, isn't it interesting how your thoughts really can affect your feelings and behaviours thoughts are powerful.

Now, we all have a bunch of thoughts going on all the time but it's the ones that we listen to that we choose to listen to that gives it power. And, our thoughts can be tricky though and this happens to everyone. We sometimes fall into what's called Thinking Traps, then I whip something else out.

But before, I show you that, here's a typical list of cognitive distortions at the bottom of our daily mood log tool with kid-friendly examples. Now depending on the age things like visuals, emojis, cards are a great way to teach the different types of distortions so something like this.

Alright and with Jamie she always had her phone on her so I prompted her to take out her phone and Google cognitive distortions emojis. And, you'll see all kinds of fun images. I went over each one with her to teach her and for example, I'll be like do you ever do something like this? And, like generalizations, this one is my favourite Distortion because I always do it and shoulds.

This one is a crowd favourite you know there's the saying you shouldn't should on yourself. And, I got a couple of smiles and chuckles from her and all this is to normalize the distortions. Then we looked at each of her negative thoughts to see which type it fell under and in a way this is externalizing the thoughts from her as a person. I said to her Jamie that thought you had of they're looking at me weird they didn't want me there, what type of thinking traps might that be?

And, we were able to identify it as mind reading and emotional reasoning where she thought her feelings were facts. And kids respond really well to learning through storytelling metaphors and sensory applications. So, the more senses you can stack on when you're teaching them something or trying to get them to do something differently, the more senses you can stack on the better. Such as hearing visuals, speaking tactile touch, writing the deeper the impact and personal examples resonate better. Just like today, I shared with you about one of my clients rather than just talking about social anxiety and interventions, in general. Makes it more meaningful, doesn't it?

Jill: My, Do you want to say something about this slide or should we move on to Taylor?

My: Oh no, we're ready to move on. This is just descriptions of some examples.

Jill: Okay, awesome. Thank you so much My, that was really great and fun too and now back to you Taylor, I think you're muted. Yeah, you need to unmute yourself.

Taylor: Yeah, sorry I was trying to avoid making noise while My was presenting. Great job My, thank you.

Now, I'm going to share a clinical example to bring two methods to life. I'll be talking about Jessica throughout both of these examples, Jessica is a 10-year-old patient of mine in the past. Jessica had social anxiety and a situation that she felt anxious about that we worked on. While she was feeling anxious about her first day at a new school.

So, September I know on the East Coast beginning of school I know other parts of the country have started sooner but I'm sure many here have patients or kids that could kind of relate to this, right, starting at a new school whether you know people are not definitely a situation where you would feel anxious.

Jessica was feeling anxious, worried and self-conscious and some of the thoughts that she wanted help with were no one will talk to me, everyone else has a lot of friends, people will be mean to me and people will think I'm weird.

So, I wanted to introduce all of you to the method Examine the Evidence that I used with Jessica and we'll be working on the thought “no one will talk to me on the first day of school.

In examining the evidence, I just kind of teaching the method in general before I dive into some adaptations for children and teens. In examining the evidence, we teach that feelings are not facts just because you think or feel something doesn't mean it is true and I'll break this down a little bit, how I teach this for children. But in in general the method we want to look at evidence for and against the statement, we want to look specifically at what are the facts what do they suggest and then we wrap up by asking which side of the argument would win in court.

So, children like to make it a little bit more playful when I work on this. So, I generally start by explaining the idea that feelings are not facts in language that's more accessible to them so I use an example I'll say something like it's the beginning of school I want to do a mental exercise with you I want you to think really really hard, I want you to feel really really hard that your teacher should not give you homework for the rest of the school year.

So, I want you to spend as much time as you need right now. I want you to manifest all your best feelings and thoughts right because we really want to do a good job changing this, right? So, I want you to thank and close your eyes and maybe you and the audience want to try to help Jessica do this too try to get them to think really hard about how your teacher shouldn't give you any homework.

And, then I say alright and now your homework for me, you didn't wish and you didn't get homework from me is to go to school and see that you have no homework, right? That's how it works.

If we feel something really strongly and if we think something really strongly, we could change the facts right. It'll instantaneously change that you have no homework and you know most kids find that somewhat funny I'm not the funniest person in the world but you know in general that's just trying to highlight the fact that even if you think something or feel it it's really not going to change the facts and that's a really important cognitive behavioural technique for kids to understand that they have big feelings a lot, kids have feelings a lot but feelings are very different than facts.

And, when we get really anxious and worried we often get really over overwhelmed by our feelings. But we do have to teach them how to reason from facts and data and evidence rather than feelings. So, I use a courtroom example to adapt this method to be more kid-friendly. I try to make it into a roleplay so it's not quite as dry and in some ways in which I do this the first step is I'll say to my patient.

In this case, Jessica the thought no one the thought no one will talk to me on the first day of school is on trial. I say imagine you're in a courtroom, you're an attorney fighting the charges brought against you.

First, be a detective and gather evidence to prove each side of the case and write it down in two columns. Then, we'll roleplay the argument the therapist can be the prosecutor, the patient can be the client and I always change my degree of playfulness based on the child's interests.

So, we'll both be involved in this we're kind of collaborating to gather the data and evidence for their case in court. We could also do what we call role rehearsals If the child wants to be a different a different player in this, right?

We switch roles, we could get dressed up sometimes in my office. I'll have like a gavel so they could pretend to be the judge. Really in these types of methods with children if they can act it if they can feel it if they can live it they can really start to internalize some of these ideas.

So, after we gather all our data and evidence I'll ask them which side is stronger which is more true, which is more convincing, and then I'll have them put those thoughts that are more convincing on a mood log or a piece of paper and ask them who has won.

So, this is an example of the sort of after both sides have weighed in I'll have them now that I do a lot of my therapy virtually I'll take out a Google document and type this in I'll ask them to print it out.

So, some evidence that Jessica gathered for the thought no one will talk to me is “I don't have a lot of friends” and “I sometimes keep quiet”. And, then evidence against no one will talk to me is kids have generally been kind to me, I have made new friends before, the teacher will likely encourage us to get to know one another, we sit at tables with small groups of kids so it'll be easier to talk to at least someone. And, then the last thing that she came up with is I might recognize someone that lives near me or that I've seen at soccer.

So, this can be a totally collaborative experience If the child is able to do this completely independently. You can you know scaffold it less sometimes kids need help gathering the evidence. And, kids have a lot of fun with this and again I tight traded the playfulness based on their interests and how much they're they're getting into it some kids that are really into acting, really kind of take to bringing this to life the idea is basically we want to teach them how to think through both sides of the argument.

And then lastly, how I make sure that it follows with them, it isn't just like a fun example or role play we do in the session is I'll if I'm in person with them I'll print it out for them, if we're virtual I'll ask them to print it out and then we'll talk together through where they might be when they're worried about this thought. Is it in their bed, Is it while they're brushing up for bed, Is it in their locker when they get to school and I'll ask them to actually hang it up there, right?

Because we want the methods and the things that we work on in session to generalize to the real world and outside of our office.

The next technique, I want to talk about is the Double Standard. In this method, you talk to yourself in the same kind of compassionate way, you might talk to a dear friend or a clone of yours. The therapist describes to the patient a situation or an event and the feelings and emotions and thoughts that they're having and then asks the patient what they think about the negative thought and if it's true.

So, in this way we're using the same thought no one will talk to me and we would be asking them what they think about that as a dear friend or a clone that was coming to them.

But if it's sounding a little confusing as I'm saying it now it does often sound somewhat confusing to children so I found some clever ways to kind of break it down for children.

Definitely, using simpler language so I'll ask them if your sibling or friend is worried over the same problem what would you tell them when they're worried about that? So, we want to make it simpler and more accessible but kids are really good at giving advice I know, when I have conversations with my kids or my patients they're experts in what other people should do, right?

But sometimes and I'm sure all of us are too as adults but sometimes when we're emotional and thinking about these things the same sort of good advice or thoughts or how we would handle the situation don't really sync in. So, we employ friends as helpful.

I'll get to a dialogue on how I'll handle that in a second but in this role-play what I'll say is I'll ask them if your friend or sibling is worried over the same problem, if your friend or sibling was worried about their first day at school and making friends, what would you tell them?

So, this is sort of how it played out with Jessica, using Jessica from before. So, the therapist or myself would say something along the lines of “I'll play the role of your best friend and remind me who you are” so I just want to check that the child understands who they are in this roleplay and that I'm the person asking for advice and so then the child says I am me so then sometimes I'll have them pick up a phone or texting, right. We want to be realistic about how kids are giving advice these days.

So, I've even had kids do this in text messages to you know just to kind of simulate the way that they communicate with their friends but for this role-play, the phone rings “Hi Jessica, it's me, Taylor, do you have a few minutes to talk to me? I miss you so much since you moved schools and as you know I'm starting a new school tomorrow. I'm so nervous I can't go to sleep, no one will talk to me. Everyone else knows each other people will think, I'm weird. I can't go to school tomorrow. My mom said you might have some advice to help me”

And, then in this role play the child responds and we kind of she came up with this on her own which I thought was really awesome she said “That's tough, it might be hard but remember everyone is nervous for the first day. You don't have to make best friends on the first day, you can just try to talk to one or two people and start slowly. You're super kind and people always like you” and therapist says “That's super helpful but are you telling me that just to cheer me up or do you actually believe that, would that be the same for you then?”.

So, we really want to kind of take it home for them, we want to make the jump for them that here's advice you would give to your friend but now that you have this great advice, are you able to use that for yourself?

And, so, then based on that response hopefully they say yes otherwise we'll you know kind of keep talking through and working why that wouldn't work or trying a different method if this method isn't effective. But really this is a very helpful method for kids and then similarly to examine the evidence I'll have them write out exactly the advice their friend gave them and have them practice telling themselves that advice and then hanging it up somewhere if this was a method. That was really helpful for them so that they have that on their first day of school now.

Now, Todd is going to review one last method, the Reattribution method with us.

Todd: Yeah, thank you, Taylor. It's awesome to be here, thank you, Jill, for that intro a little while ago but yeah I know we've thrown a lot of different techniques at you and this is the bonus technique it's called Reattribution. It's not as popular some of the other ones but man it is an awesome technique to work with kids.

And, just to bring it to life, here's another example of a child named we call him Billy, he's a 12-year-old and just like Taylor and My, kind of queued us up with a daily mood log the specific moment that he wanted to work on, was this upcoming science test along the theme of seaweed that also we talked about upcoming science test. Predictably, there was feelings of worry and nervous and anxiety and feeling anxious. And with the daily mood log some of the specific thoughts that he had come up with I think I heard this a little bit earlier with test anxiety is pretty common, my friends are going to do better than me, I'm gonna fail, I should be the best and then maybe just moving on to the next slide.

For Reattribution, what's so cool about this technique, it's just another way it's just another tool to look at how you could look at a situation in a different way. This is the actual kind of blank form that's part of the online tool kit and if we move on to the next one.

Again not to go over too much of this in detail but these were some of the ideas that we came up with and on a bigger level what I think I heard a theme about being playful and being fun, absolutely. And, so that's definitely what I try to do, I also try to motivate I think I heard that as a key thing from the onset.

But then the other is I try to be curious and I try to be you know affirming and I try to just like kind of lay it out like “Hey Billy I have this awesome technique” that could be a helpful way to you know look at this problem that we're been talking about.

And, it's possible it could help you know feel better and calm and as we lead up to this test I'm wondering if you'd be open to trying this technique.

Because he was motivated, he was all in and I was like awesome and then I also try to say you know like the two different areas then I say is like what are things that are under your control when we think about this test?

And, then we just kind of thought for a moment, I try to pause and right away he said sleep and he's like I could control how much sleep I get and then I think David Burns talks about this like there's like this synergy and there's like this change at the gut level.

But you know, there is a little bit of momentum and then that's when I really lean into what he's saying I try to be affirming, I try to be curious and I go, yes, exactly.

Sleep is like important and you can control it. Tell me how it's important to you and he went on and talked a little bit about that and as you could see there's a few other areas that he kind of touched on, he could control how much he studied, he could study, he could control his own reactions and his overall attitude.

And, as he's saying these things, you could just visibly see him changing and feeling relieved and being able to kind of just approach this test in a different light. What was also helpful and kind of like Examine the Evidence. There's like the two columns and then so the other column is now what are some things that are out of your control.

I think Taylor mentioned 15 to 20% of kids have anxiety you know again such a cool technique to try and control is such an important theme and he right away said he can't, he's like my teacher she grades it in this different way but I can't really control that. And that seemed to give him some peace.

He also talked about I can't really control like how other people actually do on the test and I also can't control their reactions.

And, you know again this is just another technique it's the bonus technique. I called it maybe if we move on to the next slide, there are a couple of I know I went fairly quickly but just a couple of the key highlights for reattribution is again, just be curious. I think have fun with this you know we working with kids, you know we try to be humble sometimes it's unpredictable just like the doodling on our slides today you know sometimes things happen session that it's hard to predict and that's what I love about kids but also be affirming and really lean into their responses.

The other key takeaway is what you know what are things that they could control and what are the things that are potentially out of their control? Sounds so simple but it could be extremely helpful.

And, then the other thing I just kind of will throw out there is you know sometimes depending on when you get to this method in your session I try to you know with that theme of like synergy and momentum with my clients if we didn't quite get to all the different reasons and all the different ways that you could control and not control. I'll say hey maybe it's part of our action plan or your homework what if you try to come up with even more ways that are under your control and come up with ways that are also out of your control? You know send it back to me, I'll take a look at it and then we'll be on our way.

So, that's Reattribution and I’m gonna hand it back off, I think we're going to do a little bit of Q&A, right now.

Jill: Thank you so much, Todd, that was great and something that really comes across with all three of your presentations is just how much you love working with kids and it's really kind of fun to hear you guys talking, getting lots of great positive comments in the chat box. So, the presenters can breathe a sigh of relief you're doing a great job and I'm excited because we're actually on time as well which is never the case but always awesome so that leaves us lots of time for Q&A.

So, I have been getting a lot of questions already, I've been trying to organize them on my screen and so we're going to spend maybe 10 minutes because we have some wrap-up points and things at the end. We want to make sure people are in time for their one o'clock appointments here in Pacific time.

So, let me go through some questions I'll kind of throw them out to the three of you and I think kind of My and Todd feel free to jump in and then you know Taylor will also do that but don't be shy.

So, starting out, we started out with some questions about the evaluation process maybe Taylor if you want to comment on these and let's try to be sort of brief in our responses knowing just that we have a lot of questions.

So, one question was how do you conduct that intake session with divorced parents, Taylor do you do it the same way? That was a question that came up.

Taylor: Great question! I absolutely do, I find that's very tricky but that if divorced parents aren't able to come together for their child's mental health and well-being that it gets really ticky and really difficult to have one meeting with this person and tell them one thing and a meeting with another so I really try to stay as far away from separate meetings as possible I really think using kind of a medical model if there was a medical issue with their child they would show up to an appointment together so I really think that it's very important even for divorced parents to to be together and it's also super informative to see how they interact.

Jill: Awesome, a couple of other questions about the evaluation I'll ask you quickly and then we'll move on to some other topics. Someone said, do folks really accept a four-session intake? I do a 90-minute intake with family so I think the answer is yes. Because this is the way that you do it but maybe you could just speak briefly to that.

Taylor: Yes, parents do. As I mentioned many parents want methods very quickly but I am very firm in setting up the importance of doing the four-session intake and in my mind, if we set it up there be successfully it will save them lots of money down the line because we'll be able to get to the crux of things more quickly and make sure that working together is a good fit rather than doing a super quick intake and then finding out that it's not a good fit to work together.

Jill: And then I don't know if you have an answer to this but some questions about how does that work with insurance like do you know, how do you build for it, how does that work if you have a comment about that.

Taylor: I mean, I don't take insurance but I submit a super bill so I use the code for the psychiatric diagnostic evaluation and it's on four separate occasions so I'm very upfront with my fees and that services may or may not be covered so I encourage patients to always check with their insurance before getting started if they have concerns.

Jill: Okay, so one more question about that which is what recommendations or interventions do you have for parents and kids who don't meet that motivational level needed to proceed with treatment, what happens then?

Taylor: Yeah, great question! I often encourage them to reevaluate it later in time so that's if the child's not willing to do the work. I often also offer parenting help how to help the parents help their child and then if a higher level of care is needed and I can't provide it then I might make a recommendation for a higher level of care but I've never been successful in convincing kids to work on something that they're not willing to work on.

So, a lot of times I'll say the last quick thing because I know we want to be brief is as an example if like the school has made a complaint and they're being very disruptive I may say something to them like I can't force you to come to therapy and I definitely don't want to force you to come to therapy if you don't see your you know behavioural outburst at school as being an issue but what I do know is that your school is having issues with it and complaining and if things don't change there's going to be consequences from the school and from your parents but if we work together and you're willing to work on these things then we do have some control over the consequences and how your behaviour improves.

So, I try to dingle the carrot in terms of getting them to want to work together and why working together would be better than not but I will not convince a child to work with me that isn't willing to engage in the treatment.

Jill: Great, so let me ask My or Todd maybe you guys could answer this question what do you do when a child or adolescent has a hard time identifying their thoughts, any kind of pointers or tricks for that?

My: So, for myself when working with kids and they're having a hard time identifying thoughts I ask more open-ended questions like how is this a problem for you like, what is important about this, it could be like this feeling that you're having like you were so worried about what your friends think about you, why is this important to you and then sometimes times by uncovering like deeper thoughts they just start talking and then I'll pick upon it and I'll hear something and I'll reflect it back to them or as with kids and teens especially teens they like to correct you.

So, sometimes I'll just make like a bunch of guesses and assumptions I'm like is it this or is it this and they'll be like "no not that" it's more of this and then they'll start talking so you kind of give them throw them something to latch on to and then they can elaborate usually pretty well. Tod, I wonder if you had any response to that.

Todd: I don't know if I have much to add but I guess maybe something I learned probably from Jill was you know from the daily mood blog you know I guess two things one is like I'll try to be specific with the emotion and it's like when you're feeling anxious what were you telling yourself or maybe like what would like a friend think about if they're taking this science test and it's like when you stop talking about them and it's about like someone else it's like oh they may be telling themselves that they're not going to do very well on this test or it's like exactly.

So, it's such an important question because kids do get stuck on this very thing.

Jill: Yeah and then I would just add to those things like thought bubbles you know I mean these are actually things I sometimes do with adults too stick figures, thought bubbles you know cartoon characters like what would you imagine would be going through this person's head, what might they thinking to themselves stuff like that.

Let me see I think is a good question about a method I mean there are so many questions I can't get to all of them but so regarding the double standard technique, someone says I use this a lot but I find there's sometimes a point out which young people recognize that they do have a double standard of how they talk to them friends versus how they think about themselves and they just accept that as fact, sort of what do you do in that situation. Any tricks for moving through that?

Taylor: Yeah, I mean sometimes you know sometimes a method isn't helpful right so if someone is attached to their double standard then it might be a different method that's more helpful and I sometimes do work with core values or kind of figuring out why there is that double standard but there's just so many methods that are helpful that attacking their negative thought from a different angle, can be really helpful.

Obviously, if that becomes like a recurring theme and something that they're constantly getting stuck with then we'd want to work on that to address why there is that double standard but there are just so many helpful methods that I think it's important to fail as fast as we can and get to methods that are are really helpful and effective because there's so many of them.

Jill: Yeah and I would also add to that because this is a question not just for kids but for working with adults too. This happens all the time that you discover someone does have a double standard and in fact, they might be damn proud of it because that means that they hold themselves to a higher standard than they hold others to and so actually in team CBT we have this method that's called Positive Reframing which we're not covering today but where we kind of make our patients proud of their symptoms right like what does it show about you that's beautiful and awesome that you hold yourself to a higher standard than you hold other people to maybe we wouldn't want to take that away from you.

So, they can actually kind of feel proud of their double standard and maybe even proud of their suffering you know and then on the other hand it may also just be that this isn't a great method for that person with a double standard.

And then as Taylor said we'd move on to a different method I'll ask you one more methods question and then I want to share some more slides with people and start to kind of wrap up and also we'll tell you about another training we have where you can get more of your questions answered.

So, here's a question do we give out suggestions to the child during examine the evidence or do you just allow them to figure it out for themselves?

Taylor: Depends on how quickly they're getting it. I definitely will let them lead the way I'm not gonna let them kind of flounder and drown. If I think they can't come up with stuff I might prompt them and help them think through that but we want to kind of support their ability to do it them themselves while also offering some suggestions. So, it's definitely collaborative.

So, in the example, that I gave you know no one will talk to me on the first day of school, what's you know I may ask them a question that we scuffled it like have you ever been in a new situation before what happened or what was it like when you met friends for the first time somewhere else or what if someone else was new at your school what would you do and sometimes these questions will help them be able to gather the data and facts.

Jill: Great and I realized there was one more question that came up a few times that was about this child version of the Daily mood log, people are asking where they can get it. Maybe Mike will drop in the chat box a link to some of David's tools but specifically people were saying is that in David Burn’s tool kit where can people find it?

Taylor: It's in his upgrade so if you've gotten the electronic upgrade, it would be in there.

Jill: Okay and you mentioned some books that were helpful do you also have any other work book recommendations?

Taylor: Within that list, there are also workbooks.

Jill: Okay wonderful! So, Taylor will you do me a favor and move I'm going to share a couple more things with you guys. Move to the next slide for me.

So, I just wanted to share with you guys we have lots of other trainings if you liked this one, stay on for the next few minutes because I have a few things I want to share with you guys. But Taylor has an upcoming training that she's offering that's a CBT training for therapists who work with kids and adolescents and it's a 12-week really comprehensive training. You meet weekly on Thursdays for an hour and 45 minutes and it's 21 CES and lots of great content so you can find out more about you know the the weekly plan for that on the Feeling Good Institute website.

And, finally well not finally sorry I have a few more things to say but next we hope that you'll join us every Wednesday the first Wednesday of every month for our training and so we're offering free training the first Wednesday of every month. Some months sorry it will be a drastic like this one which offers continuing education credit some months it will just be a free Q&A that isn't associated with CES but we hope that you'll put it on your calendar and meet with us once a month on Wednesday sat noon.

The next one Mike Christensen is going to be our featured presenter and I will be mcing and that's on harnessing accountability in CBT expert tips techniques and Q&A and that's on October 4th so next month at noon.

And many of you have been wondering how you going to get your CE credit, Mike is dropping a link in the chat box for how you can get your CE credit but right after the webinar log back into the workshop page and Mike puts the link in the chat right now just make sure you complete the CE survey and then you'll automatically get your CE certificate for the one today.

The next slide so yes we'd like to thank you for being present today again if you're interested in doing more training with us or interested in getting certified with us, you can check on the Feeling Good Institute website at www.feelinggoodinstitute.com

You can send any questions about training or certification to certification at feelinggoodinstitute.com and we also hope that you'll think of us as a place to send your patience if you've liked what we had to say, know anyone who could benefit from our services whether that's a friend a family member or a patient. You can see therapists that are available on our website which is feelinggoodinstitute.com

So, I finally want to give a big thank you to Taylor and My and Todd and also thank all of you for being present with us today. It's our commitment to always be helpful to you. We believe in the power of sharing knowledge and building meaningful connections with the community. So, I hope that you've enjoyed this webinar and if you have any other questions or feedback for us, please don't be shy, get in touch with me or send an email to certification@feelinggoodinstitute.com because we're here to support you in any way that we can. So, thank you so much for joining us for this webinar and I hope you all have a great day!