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December 8, 2013

Therapists should honor uniqueness of each child in treatment

Dear Doctor,

Recently the school psychologist said we should find a specialist in cognitive behavior therapy for our 10-year-old daughter who has anxiety.

Some time ago you wrote about cognitive behavior therapy. What is this kind of treatment? Does it work? Where do we find a therapist like the one the school psychologist recommended?

Wondering

Dear Wondering,

Let me start with what cognitive behavior therapy is and offer some demystifying thoughts.

Human beings do three things: They behave. They feel. They think. That about wraps up our mental repertoire. Changing what a person thinks and how they behave will, in the opinion of the devotees and theorists of the therapy, change how one feels. It makes good sense, common sense that is. It also is roughly based upon some solid neurological structure. Our fanciest brain is that which thinks, conceptualizes, acts and judges accordingly. Fibers are connected to more affective centers.

To be sure, current literature is alive with “evidence” for the efficacy of CBT.

The main problem with the execution of the technique is how it is implemented. CBT therapist are proponents of “homework,” which is exercises and things to do and think. With a 10-year-old, this might not be an easy sell. I can tell you from experience it is not.

Most therapists who work with children the age of your child use some techniques involving principles of CBT. However, if a child does not relate to the therapist and everything is simply a “technique,” it is not likely to be successful.

Most therapists are “eclectic” and will try whatever works. CBT is one strategy. My own philosophy strongly believes children are people and should be approached with respect and appreciation of individual uniqueness. Something in me bridles at the thought of using a “technique” as a concept in itself.

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Dr. Larry Larsen is an Andover psychologist. Email him questions or comments at lrryllrsn@CS.com.

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