Adapting CBT for Children, Adolescents, and their Parents: Our Ten Best Tips

Adapting CBT for Children, Adolescents, and their Parents: Our Ten Best Tips

IN THIS VIDEO:

Jill Levitt: Hi, everyone.

Welcome to our webinar this morning on Adapting CBT to Children, Adolescents, and Their Parents, Our 10 Best Tips. My name is Jill Levitt, although it says Maor Katz on my screen. I apologize for that. Maor Katz is the director of Feeling Good Institute and runs some of our webinars. But I'm Jill Levitt, and I'm the director of training at the Feeling Good Institute. And I'm here with Drs. Taylor Chesney and Lindsy Koroly, who will be presenting to you guys today. I'm just going to say a few things administratively before we start the content of the presentation. Number one is if you are attending and you're hoping to get continuing education credit, you do need to be present for the whole presentation. GoToWebinar takes attendance, and so we're aware of who's here and when you leave, and we're only permitted to give you credit if you're here for the whole presentation. So please make sure that you stay till the very end. In addition, what will happen is within about 24 hours, you'll get an email from our admin at Feeling Good Institute with a survey that you'll need to complete online. And once you complete the survey, you'll get the certificate of completion. And lastly, there's just a few things to orient you to on the GoToWebinar control panel. That is if you see kind of about halfway down, depending on what format you're using, but you'll see a question box. If you click on that little carrot next to questions, there's a place where you can enter a question. So you can type a question in and hit enter, and Taylor and Lindsy will see your question. Lindsy might even respond to you via the chat box or the question answer box, and Taylor will take breaks throughout and attempt to answer some of the questions that you send in to her. Also, I just want to let people know that you're welcome to download the presentation. So we've shared it with you. And the way that you would do that is kind of at the bottom, you might see a little caret that says handouts. So go ahead and take a look for that now. A lot of people forget and then ask later, how do we get the handout? So go down and find the little carrot that says handouts, one of five, and you'll see an orange P with our presentation, and you can click on it and download it. So I think that's about it. I'm going to take myself off the screen and turn you guys over to Lindsy and Taylor, and I'll see you again at the end of the presentation.

Taylor Chesney: Thanks, Jill, for the introduction. As Jill said, I'm Taylor Chesney. I'm a level five certified team therapist and the director of the Feeling Good Institute here in New York City. I'm excited to be here with you all today at the Feeling Good Institute in New York City. We're a thriving center for both treatment and training of therapists. We offer low fee therapy services, regular therapy services, intensive therapy services, which I'll speak about in a little bit, as well as some wonderful trainings for therapists. So I wanted to thank everyone for being here today and helping us to create this webinar. This webinar was developed with all of you in mind who sent in dozens of support emails, who answered questions about what they would like included. So thank you so much for being here and for creating this with us. We hope that it'll be helpful and enjoyable for you all. And as Jill said, if you have any questions, please feel free to type them in, and we'll stop throughout the webinar to answer them. And if we miss any of them, feel free to email either me or Lindsy, and we'll get back to you.

So the Feeling Good Institute, just to give you a little background of who we are, we train therapists in advanced cognitive behavioral therapy tools and techniques. We have a certification program for therapists in TEAM CBT, which was developed by Dr. David Burns at Stanford University. We have treatment centers here in New York City, as well as in Mountain View, California. And we offer both online therapy and in-person therapy. Online therapy is in many United States, as well as Canada. We've developed tools for electronic medical records, as well as tracking patient symptoms in treatment. So we're going to start off today with a poll, because I want to get to know our audience. It's funny for me to be talking to myself and not being able to see all your faces. So I want to be able to connect with you and get a sense of the question is, what is your level of comfort working with children, adolescents, and parents? And so I'm going to run this poll right now and give you about 10 seconds or so to answer what your current level of comfort working with children, adolescents, and their families are. I'll give you about another 10 seconds. I see most people have chosen and let us know. I'll share the results. Give you about five more seconds. Please go ahead. I'll close the poll. All right. Closing the poll now. And so what I found out from our audience is about 10% of you only work with adults. So it sounds like a lot of people here are familiar working with children and adolescents and learning and looking to get some tools and tips to augment to make that work better. 12% of you only see children and adolescents. 67% only work with children and adolescents. 8% have tried to work with this population and have not been particularly successful. And 16% would like to start working with this population. So it's good to get some information about where our audience is coming from. So Lindsy is going to get us started with our first tip.

Lindsy Koroly: Awesome. So our first tip is to make weekly assessment fun and interactive. And we really cannot stress enough the importance of monitoring patient's progress. And so we like to do that at the beginning and the end of every session. So checking in on their mood and their symptoms. And just as we wouldn't really go to a doctor's office without them taking our temperature, taking our blood pressure, it doesn't seem sensible to us to see our patients without monitoring their progress on a session-to-session basis to see what's working, what's not working, and how they're feeling. And so we use David Burns's pre- and post-session scales. It's called the BMS, or the Brief Mood Survey, to get a sense of patients' depression symptoms, anxiety, anger, positive feelings, relationships, satisfaction. And in order to make this more kid-friendly and fun, there's also a child version of that scale. If having the child fill out a scale doesn't work for you or your setting, you can also assess verbally. So you could ask the person on a scale from 0 to 10. If 10 is the worst you've ever felt, and 0 is not feeling depressed at all, how's your mood today? And with kids, especially with young children, you can do that more collaboratively. So it might be difficult for a very young child to fill out a form on their own. So I might just sit next to a 7- or 8-year-old client in the therapy office, then go through it question by question with them. And not only is this an information-gathering tool, but it's also an empathy-building tool. So it's really helpful for a child to feel like you really are genuinely interested in how they're feeling and what's going on for them that day when they come to see you in the office. So it's also a great way of making them feel empathized with and building rapport.

Jill Levitt: Taylor, you're muted. We couldn't hear you since Lindsy spoke.

Taylor Chesney: Okay. Thank you. Okay. I'm going to redo that on tip number two. Thanks, Jill. We want to encourage you to use tons of disarming and I-feel statements to build your relationship. And this is sort of team therapy lingo. So what this really means is using many statements that show you get what they're saying and you agree with what they're saying. And also I-feel statements which share how you're feeling hearing what they're saying. So I-feel statements really help to aid communication and connection with children and adolescents. A really important thing that I find in my work is to show children and adolescents that you remember being a kid, that you get the unique frustrations. And as therapists, we really need to come from a place of understanding that children and adolescents will usually just see us as another adult that does not understand them, that doesn't get them, that's sort of on their parent's side, unless you prove that you listen and show understanding in a way that's unique and that you really get their perspective. And so I want to bring this to life with a case example of a 12-year-old boy who comes in. I wonder if anyone has had a 12-year-old boy that comes in and shares something similar. So kind of in the question box, you're definitely welcome to kind of type in and let me know if you've ever heard a 12-year-old boy say something or any patient that you're seeing come in and say something like, there's nothing wrong with me. It's all my parents. I don't want to be here. They expect too much of me. I hear that all the time. And so how we can use disarming and I-feel statements to connect with them is to say something along the lines of you're right, your parents expect a lot from you. It's really too much. It makes sense you don't want to be here. I hate when people force me to do something I don't want to do and don't see things the way I do. It makes me super frustrated and even angry.

And so what we're not conveying is that the parent's going to change based on us agreeing with the child, but it conveys that we understand what they're saying. One common thing that I hear in my training groups that people are afraid of with disarming is, is it okay to disarm even if they're totally wrong? And what I say is absolutely disarm away. I rarely find that it's fueled to their fire. Usually by agreeing, it actually takes away some of their intensity and some of their commitment to believing their side of it. And in preparing for this webinar, I was trying to think of, as I was home one day with my kids, I was trying to think of how can I bring this to life? And I was sitting at the table with two of my kids, Alon and Sloan, and my oldest one grabs a cookie and Alon says, Sloan's cookie has so many more M&Ms than mine. And he's four years old. So he starts screaming and crying, kind of throws himself on the ground. I want you guys to kind of type in if you want how you might respond. And it's definitely not easy to respond in a disarming way, but I was like, I'm going to use my techniques. And so I just said to him, I was like, I'll see how this goes. And I said, you're right, Alon, Sloan has so many more than yours. That's not fair. And then he got up and he was kind of like, let's go count our M&Ms. These cookies are so good. And so instead of, and the truth was that their cookies had the same amount of M&Ms, but it wasn't about that. It was about just kind of saying you're right. And that was enough to decrease his reaction and his commitment to believing this. So I think these, a lot of questions I always get are how young can you use that? And so my son's four. I use it with three-year-olds too. And so I think it can be applied to really young children as well as adolescents. Another example is a 10-year-old boy that came to my office and said something like, I work so hard at school and deserve technology time after. If my mom would just give it to me, we wouldn't be here. And so even with the mother in the room, I said, you're so right. You work hard at school and no one is understanding your needs and how you're feeling. And all of a sudden he started to cry and the anger really disappeared. And he, all of a sudden, he started to share a little bit more about what he was feeling. And lastly, we don't just need to use disarming and I feel statements in person with parents and children and adolescents, but I find that it really aids my communication and building a relationship with a parent, which is so important, even through email. So a particularly fine email to a parent without these communication tools might read something like, dear Mrs. Smith, let's find time to set up a session to discuss the technology battle that's going on. And then with using some of our communication tools that I teach in a lot of my classes, using the skill of disarming, which is finding some truth in what they're saying. I feel statements sharing how we're feeling and stroking, saying something positive about them.

I might write something along the lines of, dear Mrs. Smith, I love working with Johnny. He's super sweet and fun to get to know. He's working really hard. It makes sense. You're feeling frustrated about the technology battle going on. I'd love to find time to figure out a plan of how I can best support you and bring more peace and harmony to your home. What are some options that work for you? So I think both emails are perfectly fine, but one really aids our communication with our parent, which is really important for success.

Jill Levitt: Taylor, I hate to interrupt you, but right now we can see Lindsy, but we can't see your camera. I have no idea.

Taylor Chesney: I know. I just noticed that.

Jill Levitt: Let's just one second to see if you can share your webcam again. And if Lindsay either stay on screen, Lindsay, or you can black out your screen, either one.

Taylor Chesney: I can go back. We can share my webcam now. There we go.

Jill Levitt: So we can see you, but now you've got to share your presentation.

Taylor Chesney: Oh, gosh. Okay. Are we better now?

Jill Levitt: Perfect.

Taylor Chesney: Okay. Not sure how that disappeared. Okay, cool. Back and running. Okay, here we go. So tip number three is leave plenty of time to get to know their world. So this means the parents, the child, their adolescent. And it's so important that we connect with our patients, especially as children and adolescents, really, I find is what helps us to be super successful with them. So at the Feeling Good Institute here in New York, we do a four session intake. And I want to thank one of my mentors, Dr. Jacob Towery, and one of his mentors, Dr. Tom Tarshis, who kind of gave us this model. But what this model is, is a four session intake. And the first session is entirely committed to getting to know the child or adolescent, nothing clinical. And we're going to be so tempted to go in for symptoms. Often what I hear, I'll speak to a parent on the phone, they'll say something like, my daughter is really anxious. She's having tons of test anxiety. Can you help her? And they'll expect relief from day one. And really what I set up is this four session intake, where one session, I'm alone with both parents. And it's super important that they're both physically present. Often I'll hear, oh, my husband's traveling for work, or the mom has a work meeting, or some reason that they can't be here. What I find is if everyone can't be here together for one session, it's so hard to get everyone on the same page and set therapy up for success. So we really want to set therapy up with children and adolescents from the beginning. And it's so hard to do therapy with children and adolescents in some ways, because we're not just dealing with the patient, but we're also dealing with their parents.

And I view us as like a coach, right, or someone that has to organize all these different players. And this four session intake really helps to do that. And so we have one session, as I said, with both parents, then two sessions alone with a child and adolescent. The first one of those is purely getting to know the child or adolescent, and I'll give you some tips about how to connect with them. And then the second one of those is about much more clinical diagnostic information. And then in the wrap-up session, we get a chance to kind of be all together and present our treatment recommendations. So this is a really great way to involve the parents and to be able to hear what their goals are, what they're hoping to get out of therapy, hearing what the child's or adolescent's goals are, and then figuring out, is there something we can help them away with? In leaving plenty of time to get to know their world, we want to ask them specific questions. And some of those questions are, what do you do in your free time? What is your favorite music? If you don't know a lot of the child-adolescent music now, listen to the radio. Know some of the top songs. The more that you know, the more you can aid your connection, which is so important with this age group. You might want to ask them, what Netflix show do you watch? Who's your favorite YouTuber and why? Where do you hang out after school? What are your favorite video games? What gaming console do you use? I think also asking about video games and technology, which is kind of a taboo subject then, right? Everyone wants to kind of eliminate technology and all of that, kind of shows that you get their world. And if you don't know something, ask, right? Don't be afraid to ask, but do it in sort of a curious, nonjudgmental way. And also, if you want to know more, ask more. So for example, we could ask something like, wow, your favorite show is Mofi, which stands for Modern Family, if you don't know. Which character do you like best? I might share something that I feel like, oh, I love Phil.

I think he's so funny. What do you like about this show? So we really want to engage with them. It might seem silly, like they're here because they have anxiety and I should be talking about anxiety, but really spending that 50-minute session talking about things besides their diagnosis really goes a long way. And if you don't know something, you could say something like, I have to admit, I'm a little embarrassed, but I'm not so familiar with Harry Potter. I'd love for you to tell me about your favorite character or which in the series do you like the best? Alicia Beja, who's an awesome therapist at the Feeling Good Institute in California, also suggests to use lots of positive reinforcement, show lots of warmth, compassion, and genuine interest in them and their worlds. And I think she's right on, that really aids in that connection. Some other ways to help connect and get to know their world is to get down to their level. And I mean that in a literal way, right? With children and adolescents, we might need to sit on the floor with them, play some games as we're talking, or depending on their level of comfort, sitting on the couch next to them, right? For some people, this is definitely not comfortable and not something they're willing to do, but I think we need to kind of check in with the child and get a sense of what they're comfortable with, as well as what you're comfortable with. And you can use their language. I know when I first started working with adolescents, I'm not someone that curses, and it was super uncomfortable when I would hear them curse. And then I really kind of discovered it was kind of fun to curse with them, and it actually kind of aided my connection with them. I don't generally curse, but if I notice an adolescent is cursing a lot, I may kind of join in with them, and I think they find that that gives me some, like, street credit that I'm on their level. We want to invite them also to show us their hobbies in session. Five minutes on their Instagram page can really go a long way. One thing that I really like that Lindsy here at the Feeling Good Institute in New York does is that she establishes a routine for wrapping up each session, right? They can let them spend, like, three or five minutes showing her a YouTube video or a song, right? That small amount of time really goes a long way. And for those that aren't super comfortable interacting with children or adolescents or feel like they don't get a chance to do it enough, do it when you're out of session. A few weeks ago, I just got back from Disney with my friend, with my family, and I was chatting up a little eight-year-old girl on the bus with my kids, and I was learning about her hobbies and interests. I learned about a new show for girls called SciGirls that she really loved, and then she was talking to my daughter about no longer being afraid of the flu shot.

So I think it's really important to kind of get comfortable, not just in your session, but using life in general as a way to build your comfort level connecting with children and adolescents. And if this isn't something that comes naturally to use, really use any opportunity to connect with the children or adolescents. Think of, like, family members that have kids, friends with kids, and so forth. Ask questions and be curious. For example, I was at a family birthday party last weekend, and my cousin has an adolescent son, and so I kind of just asked her, you know, I'm curious about learning more about how you guys are dealing with technology and how kids are wanting to use so much technology. How do you set that limit with them? And we just kind of got talking, so it was helping me gather information about different views on technology.

Tip number four is teach communication using empathy techniques. David Burns developed the five secrets of effective communication, which I cover in my 12-week course in depth. We spend like two or three weeks on it, but I want to kind of share a little bit here about how I use it to help stand up to bullies at school, to help build friendships, and how to teach social skills. I feel so sad for kids sometimes that socializing is such an important part of their life, and they're not taught this in school. They're taught math and reading and science and all these kind of book things, but they're not really taught this one thing that is so important, and it's not natural at all. So we use the five secrets to kind of teach communication skills, and I'll just give an example.

This is how I'll help a child learn to not focus on themself as much. I'm sure a lot of people that work with the 10-11 year olds are very familiar that they tend to focus on themselves a lot. They have some low self-esteem sometimes, so they want to make themselves feel better by talking about what they're really good at, and it kind of misses the mark on building friendships and getting closer to people. So an example that I worked on in session with an 11-year-old who was texting with a friend after school. This is sort of before she learned any of these skills, and it makes me cringe a little bit to say that this conversation was via text message, but that's sort of my attempt to kind of meet children where they're at sometimes. While I prefer that they're talking on the phone and in person, a lot of these relationships now are on the cell phone, and it's sad, but I find that we kind of have to roll with it. So she says to her friend, text her, I just got home from soccer practice. I made the travel team. Very focused on herself. Her friend just says, cool. Then she says, my parents are getting me awesome cleats, and her friend says, cool. She says, I'm going to Delaware this weekend, and the friend isn't interested and doesn't respond. So then we kind of worked in session of how to role play this and talked about what are some ways where you can ask open-ended questions, what we call inquiry, or how you could do something called stroking, right? Say something positive about the other person. I know I like it when people say nice things about me, but children like it even more. So if we can teach our child and adolescent patients to do that, it really aids in their communication. And so how this re-edited conversation went where we, and then we imagine sort of what her friend would say, and she went home and tried it. So she says, I just got home from soccer practice. What are you up to? So we call that inquiry, asking a question, taking pictures to post to my Instagram account. And then she says, that's so cool. You're such a talented photographer. Can I see some? So then she takes the picture and sends them to her. That's sweet. Thanks. Do you have any fun plans this weekend? I'm not sure. Her friend says, oh, cool. Well, it's always fun to be with you. Would you want to hang? And she says, yeah, let's hang tomorrow. So you could see by asking questions, by stroking, it really opens up the conversation and aids their communication. So tip number five, and then we're going to take a little break for some questions. Tip number five is practice what you preach. So a lot of the things that I teach and work with children and adolescents on is around their own anxieties, feelings of sadness. A common problem is overuse of social media, unhealthy lifestyles, poor sleep hygiene, and procrastination. So feel free to type in the questions if you're someone that doesn't have a problem in any one of these areas. I have so much admiration for you if you do not struggle in any of these areas. But what I think is really important is if we're working with children and adolescents to improve in these areas, it would be in our best interest to get in touch with what it's like to improve in those areas. Of course, we don't have a parent on our back making us do it, but I think kind of talking about our own struggles and how we're working to improve gives us some credit, especially with our adolescent patients. So an example would be when I was younger, I was nervous around people too. It wasn't easy, but the more I practiced talking to others, the better I got. The next one is something that's true for me.

I'm working on going to sleep earlier, and I have to say it's been really tough. The first two weeks, I only went to bed earlier one time, but I'm going to keep working on it. So we're showing partial successes, the fact that we can work on something and it doesn't come easy, but we could continue doing it. And the last one, which has been the hardest for me, is that I just recently realized on social media too much. So I deleted Instagram and Facebook off my phone. And it's been a really hard habit to break, but I'm really excited that I'm doing it and trying it. I'm reading a lot more books and enjoying the company of my kids and friends a lot more. So we're going to stop for about four to five minutes now. I'm going to take a look at some of the questions. A lot of these are.

Jill Levitt: Hey, Taylor. I was thinking I'll read one I saw that was about the evaluation, a question. Would it be helpful if I read what I thought was.

Taylor Chesney: Yeah, that would be helpful. It's hard to kind of.

Jill Levitt: Yeah. There's sort of comments and questions combined. So someone asked, let's see, Angela asked, so the first session is just with parents, not the adolescent or all three? So maybe just a quick review of how you were describing. Of course, different therapists will do it differently, but what your typical assessment is. And I think Angela also asked later on to sort of confuse like if the kid is not present for one of the sessions, do they sit in the waiting room? How do you handle that?

Taylor Chesney: Great. So I usually don't have anyone waiting in the waiting room. So I'll answer that part of it first. Whoever the session is for generally is who I'll meet with. Of course, if it's a child, the parent always in the waiting room, but the child won't come to that parent session. So for adolescents, I sometimes I tend to let the adolescent meet with me first. I think of letting them kind of get first crack at me so that they, it kind of conveys like I want to hear you and get your perspective. Generally for children who might not be as verbal or might not be able to present that much information, I generally meet with the parents first. So what it looks like is parent session generally first, then the getting to know you session with the child or adolescent, then the clinical session with the child or adolescent, and then the wrap up session. And so with adolescents, one and two can be flipped, meaning I can do the get to know you first and then the parent session.

Jill Levitt: Great. And then Kim asked, if you have the first session with the adolescent, do you ask them, why are you coming in? Why are your parents wanting you to come in if that's the case, or do you just get to know them? And I think you explained that you do one getting to know you session where you're not actually asking about clinical material.

Taylor Chesney: Right.

Jill Levitt: And then maybe Kim is asking when you start that getting the clinical session, are you asking them what, why are you here? What do you want to work on? What do your parents want you to work on?

Taylor Chesney: So I'll get to this in a little bit of kind of how I start to melt away resistance or challenges even on the first phone call, but it kind of depends what I've covered already on the first phone call. I often ask parents first, like, would your child be willing to call me for an adolescent, not for a child and let me know what they're hoping to accomplish. So I generally try to not ask any of those types of questions. The first time I'm meeting with the adolescent, often I'll do it on the phone. I would have already connected with them. And if I haven't, then I'll wait till the second intake with the adolescent. It's sometimes naturally comes up and then I'll answer the question. Like if a child has a question for me of why they're coming, I'll sort of get a sense of what their, what their thoughts on why they're coming. But I really try to keep that about getting to know them.

Jill Levitt: Okay. And then I think some of the questions that are coming up are questions that you're going to address later. So what if an adolescent isn't as motivated as his parents are to work on the agenda? And someone else is asking, can you get to some CBT techniques? So I think that's all, that's all. Maybe it makes sense to keep going and then we'll see if there are more questions about the content.

Taylor Chesney: Yes. Yeah. Sounds good.

Jill Levitt: Cool.

Taylor Chesney: All right. We'll keep going. So now I'm going to run our, run our next poll. So I want to know, have you had parents request you work on things that you cannot realistically help their child with? And so I'm going to, so just answer yes or no. And this is something like being more respectful or can you motivate them or get them to want to use less technology? So let's see what you guys think. All right. I'll give you another five seconds and then we'll close the poll. All right. So it sounds like the majority of you, about 86% answered yes, that you're in positions where parents call you and ask for help on something you can't help their child with. So, how, how do we work with this? And so we'll cover this, we'll start covering this in tip number six, is to start melting away their resistance to treatment on the phone. So some questions we can, some questions that we can ask is, who is this a problem for? The parent, the child, or both? I always want to know, how much time does your child have to commit to treatment each week? I ask things like, what other commitments do they have? Kind of assuming that they may be, there may be things that get in the way of them being able to do the work that's going to be required for change and for help. I love asking the question, if, if I ask this, both the adolescent or child, as well as to the parent to get a sense of what their, what their take on it is. Is that if the parent is unattached to the child getting treatment, would the child or adolescent still attend? And I think that provides so much information about where their level of motivation is. And then assessing how involved the parent is willing to be. I have plenty of parents who kind of just want to drop their child off and want me to fix them. And I know that I'm not going to be successful unless we're kind of all on the same page. And then if it's an adolescent, also asking, is your adolescent willing to call me and why? And even on the phone, I start asking a parent or the adolescent, if I'm speaking with them, not so much with a child, I ask them straight up, I know that sounds like a weird question, but can you think of some good reasons not to change? What are some reasons you feel like it might be hard for your child to change? Or they may not want to give up their anxiety or depression or separation anxiety. And that really gives me some insight into the family and what it is that we're going to be up against in terms of bringing out change. And I cover a lot of these resistance busting techniques in my 12 week course. I just wanted to kind of give you a teaser for some tips of how I start to address resistance before treatment even begins. And before we get into the tips of how we can help, I want, which Lindsay I'll get to in a second, is I want to work with being comfortable. My tip number seven is being comfortable with not being able to help everyone. I do prefer to help, but I have to take a stance of being unattached to helping.

And Lindsy here suggests that it's important to really be honest with what you can or cannot help with, right? So I often get the question, can you help my child be more respectful or motivated, right? Or a parent of a high school junior called recently and worried because their child is smoking pot and doing poorly in school. And they said, can you make them smoke less pot? And I said, absolutely. If they want that type of help, I have lots of wonderful tools like the habit and addiction log that would be helpful if they want to work on this. I think we can do really great work together. And if the adolescent isn't interested in getting that help, I can also help the parents set limits and increase their effectiveness. But I do know that there's a hundred percent chance that I will not be successful in convincing an adolescent to work on something if they're motivated to continue the behavior.

And this is sort of an additional tip from Dr. Jacob Towery that he always tells the client at the beginning, and I do the same thing, we're currently, this is during the intake, we're currently signed up for me to see you for three total sessions. If after that, you don't want to see me for any reason, I will not meet with you. I only work with people who enthusiastically want to work with me. So even if your parents try to persuade, convince or control me to see you, I will only see you if you genuinely and independently want to work with me. I'm going to turn it over to Lindsy, who's going to give us some tips on maybe understanding how to overcome depression and anxiety again.

Lindsy Koroly: Yeah, so in tip number eight, we're really talking about how we can take our tried and true CBT methods and make them more kid-friendly and engaging. So we just have a few examples here to illustrate how we might do that. So in our first example, say we have a nine-year-old patient who has the negative thought, I'm ugly and nobody will ever like me. And so in this case, we might want to use a technique called examine the evidence where we're looking at the evidence for and against the validity of this thought. And one way to make it more kid-friendly is to involve props. So even like bringing a magnifying glass to get that visual piece and make it more exciting and assigning them the role of being a detective and figuring out what is the evidence for and against this thought. What distortions might we be able to find in this thought that might show that it's twisted or untrue? So really helping to engage them more by making it more fun. They're no longer just a client in your office. They're a detective trying to really get to the bottom of this. Another example would be, say we have an eight-year-old who's struggling with perfectionism and having the thought, everyone will think I'm dumb if I don't get a hundred on the spelling test. And David Krakowski, who's a wonderful clinician in the New York Feeling Good Institute office, has this great idea of using puppets for what we call the double standard technique. So this is a role play technique in which you challenge the client to fight up against their negative thoughts and to defeat their negative thoughts. And by having puppets, again, we're using props. We're having something visual so that the child can better understand who's playing what role and practice talking back to their negative thoughts in a way that they can understand. And then finally, we have another example of a 10-year-old struggling with anxiety. Maybe she's thinking nobody's going to want to talk to me or hang out with me at the party. So assigning homework in a way that can seem exciting and fun for the kid might be saying, okay, your homework this week is you're going to be a scientist. You're going to conduct an experiment and see if this is really true. See what does happen when you go to the party, gather some data, and then report back to me next week.

So really bringing in that enthusiasm and creativity and catering these methods to be more child and adolescent friendly. And then Alicia Beja, a great clinician in the California FGI office, also brought us this tip of making your office fun and kid-friendly, right? You want to have puzzles, Legos, things to color with, games, and you can be creative in taking those tools and objects and working them into your methods. So for example, UNO can be turned into a coping skills game. I've done a coping skills bingo with a kid, and that can be something that you can work together to make a bingo board or you can set it up on your own. And so just really being a little bit creative can go a long way in making it a lot more interesting for kids. And the more interesting it is for them, the more likely they are to really internalize these methods that we're teaching them.

Taylor Chesney: Great, thanks Lindsy. So tip number nine is assign homework that everyone, the parent and child, feels excited about and can be successful with. If we're working individually with a super motivated child or adolescent, we also want to bring the parent into the treatment. What I love most is working with a super motivated adolescent who does all their homework on their own and updates their parent on what's going on. And it's a great system where they're working on something independent of their parent wanting them to do anything. But I really find it helpful to bring the parent into the homework and integrate them in some small way. So an example of a recent patient that I had would be a 10-year-old boy struggling at night to stay in his bed. And he often goes to check on his parents to make sure that they're okay. He kind of cracks open their door and peeks in. He doesn't really talk to them, but it's super disruptive to their sleep because they hear the door open. And so he had agreed to kind of track his behavior. And then I asked him, what would you deem as success? And he said, if I did not check on their door five out of seven nights of the week. And then I brought the parent in and asked kind of what their take on it was. And this particular parent was super on board with five out of seven. Of course, the goal would be eventually seven out of seven. But an example of a way in which I kind of break down some homework would be making a chart like this. And for this particular boy, kind of getting on the computer with him for the last three minutes of the session and making this chart unique to him by just putting a football on it. He felt really excited about football that week.

The previous week, he wanted a soccer ball on it. And then a way in which I kind of asked him, is there anything you want from your parents to kind of help make this easier? And I didn't mean like a reward, just is there anything your parents could do? And he said, I really like to feel connected to my parents at night. Maybe every night they can write a motivational comment for me. So we kind of ripped off some pieces of paper and stuck it on there. And then we shared with the mom that he would love to see just like, I love you, or you can do it. So each night, it was like a rip off piece of paper. Each night, she wrote a motivational comment to him about being successful with this. And then the chart each day, he wrote what day it was. He checked off, you know, there were nights that sometimes he didn't wake up, but most nights he did. So he would check off the box if he didn't wake up. Then if he woke up and thought of this positive thought that we came up with in session, like the positive thought could be, you know, in this example was, you'll be safe, whether you check or not, you can do it, it might be hard, but just stay, stay in your room, and you'll be able to fall back asleep. So he would check if he thought of that thought and then went back to sleep. Or he would check the last box if he had to open that door and check on his parents. Another example of a homework that also relates to some of the techniques that I'm using in session with a patient is that it's a 13 year old girl who wants help controlling her anger at home and improving her relationship with her parents. And her parents were totally on board with this goal, as you imagine.

So I taught the five secrets of effective communication. And that we cover more in the classes, I think, as I was looking through the questions, some people were curious about some resources to learn that. So maybe we'll help connect you with that through some of David Burns's materials on the five secrets of effective communication. But the one that we were focusing on, in this particular scenario, was the disarming technique. And so we were working this week on having this adolescent disarm five things that her parents said this week. So we made this chart, and I had her write down what her parents said, what she said, and then kind of her modified response, which basically just meant what she wished she said, what would be an example of disarming, kind of finding some truth in what her parent was saying. So, for example, this angry 13 year old, her parent or her mom would say, get off your iPad. And she would just lash out and scream, like, I hate you, you don't get it. And so then what she wished she said was, you're right, I really need to get off my iPad, right? And kind of teaching these skills sort of opens up their ideas that there are different ways to communicate. Another example was her dad said, let's go get lunch together. And she said, that's so stupid, leave me alone. And then our what she talked about and what she wished she said is, you're right, it would be nice to get lunch together. So she was motivated to improve her communication. So she was motivated to try these disarming techniques. And then she was able to also for homework involve her parents in the therapy by after she did this, she shared it with them and kind of taught them about the disarming technique. So it's not that she's just working in isolation, but she's also sharing some of these tools. And then the last tip before we move on to questions, which I'm sure you all have some great questions, is, it's awesome to offer short term intensive treatment. So at the Feeling Good Institute in New York, and in California, we offer short term intensive treatment, which means that they can work on specific skills in a short period of time, it's really focused on working hard, and skill acquisition. And I'll share sort of a case of a 16 year old boy recently that I worked with that had social anxiety. And he came to me because he had a crush on a girl, but he was too anxious to talk to her. And as a result, he was avoiding school and becoming depressed because he couldn't talk to girls. And so we worked on some techniques, in 20 hours of therapy over five days, we used a daily mood log to target some of his negative thoughts, which is just a thought log to kind of record what the negative thoughts are, I helped him identify some of his errors in thinking. And then we use methods to fight back against the negative thought, and come up with positive thoughts. So, you know, if his negative thought was no one will like me, I'm such a loser, the positive thought would be, you know, there actually are people that like me. And if I stay home from school, surely no one is going to talk to me. And some techniques we used was smile and hello practice, which is basically I took him out of the office, and we walked around the streets, and we smiled and said hello to people. And this was the first time in months that he felt comfortable smiling and saying hello to people. And what I do in this technique is I do it with the patient. So I'm giving him feedback around about how he's smiling, how he's interacting with people, kind of encouraging him to make good eye contact, to wave, and to say a quick hello. And it really gave him so much confidence to approach people. He's like, Oh, my God, this is actually fun. And we spent two hours just walking the streets of New York City. And I would do it, he would do it, and we kind of go back and forth. Some other things that we were able to do were shame attacking exercises, which basically means doing things that you feel like might embarrass you, or, or, as we said, bring shame, but really, we discover that they can be fun. So on the streets of New York City, we were doing jumping jacks, we started dancing, we invited other people to dance. I remember we walked around with umbrellas, it was the middle of the summer, and it was 85 degrees out and sunny. And we're asking people if they thought it was raining soon. And we had so much fun together and good laughs. But what it really did was gave him the confidence to start talking to people again, and to not worry about being rejected and really have that confidence to approach girls to approach friends. And it was really transformative for him. So I have I think all of you were able to download the handout, so I don't want to spend too much time.

But these are some of the handy learning resources that I use in terms of activities for children in session. I'm gonna just give you a brief information on some upcoming trainings, and then spend about five more minutes taking questions. So you could find more about child and adolescent training by taking one of my 12 week courses, or starting next month, we're going to be running a weekly child and a monthly sorry, child and adolescent consult group online. The first one is January 31st. And then it'll be an hour and 45 minutes to do some didactics, case consultation, and some practice. So I hope you can join us. And Jill, I would love if you would want to help with some of the questions.

Jill Levitt: I would join you on screen and then just read you some of the questions.

Q&A Session