Preface: The Therapist’s Challenge xi

Acknowledgments xiii

Abbreviations Used in Multiple Chapters xv

Introduction: Integrating Science and Art in Therapy xvii

About the Companion Website xxv

Part I The Tools of the Therapist

1 Therapy Fundamentals 3

The Therapeutic Orientation Toward Clients 4

Getting Started 8

Basic Child Therapy Skills 12

Overcoming Obstacles to Client Engagement 24

Motivational Interviewing 28

Simple Therapeutic Interventions 32

Therapeutic Collaborations 35

Termination 38

Summary 39

2 Behavior Therapy 41

Learning Theory 42

Assessment and Case Formulation 48

Change Processes 52

Outcome Research 53

The Therapist’s Style 56

Exposure 56

Contingency Contracting 58

Relaxation Training 65

Social Skills Training 67

Summary 71

3 Cognitive Therapy 73

Cognitive Theory 74

Assessment and Case Formulation 80

Change Processes 84

Outcome Research 86

The Therapist’s Style 87

Self- Monitoring 88

Self- Instruction 89

Self- Reinforcement 91

Socratic Questioning 93

Cognitive Restructuring 94

Tests of Evidence 97

Personal Experiments 100

Using Spectrums to Develop Moderation 101

Summary 104

4 Mindfulness- Based Cognitive- Behavioral Therapies 107

Mindfulness and Psychotherapy 108

Assessment and Case Formulation 114

Change Processes 117

Outcome Research 121

The Therapist’s Style 123

Mindfulness Training Exercises 124

Dialectical Behavior Therapy Implementation 127

Acceptance and Commitment Therapy Implementation 135

Summary 140

5 Psychodynamic Therapy 143

Psychoanalytic Theory 144

Assessment and Case Formulation 155

Change Processes 158

Outcome Research 163

The Therapist’s Style 164

Facilitating the Expression of Material 165

Interpretation and Insight 166

Dynamic Psychoeducation 169

Corrective Emotional Experience 172

Summary 174

6 Constructivism: Solution-Focused and Narrative Therapy 177

Postmodernism and the Social Construction of Reality 178

Assessment and Case Formulation 182

Change Processes 185

Outcome Research 189

The Therapist’s Style 191

Solution- Focused Techniques 192

Narrative Therapy Techniques 200

Summary 207

7 Family Systems Therapy 211

Systems Theory 212

Assessment and Case Formulation 219

Change Processes 223

Outcome Research 225

The Therapist’s Style 227

Combining Family and Individual Modalities 227

Facilitating Communication 228

Systemic Insight 229

Reframing 231

Treating Enmeshment and Disengagement 234

Therapist Directives 235

Treating Positive Feedback Loops 236

Summary 242

8 Atheoretical and Transtheoretical Techniques 245

Miscellaneous Techniques 246

Parent Counseling 251

Balance Between Extremes 253

Psychoeducation 257

Values in Psychotherapy 264

Incorporating Experiences into New Structures of Meaning 268

Overcoming Fear of Failure 278

Summary 281

Part II The Needs of Clients

9 Cultural Factors in Therapy 285

The Role of Culture in Psychotherapy 286

Assessment 296

Treatment Planning 300

The Therapist’s Style 302

Connecting the Cultures of Therapy and Client 304

Managing Conflicts Between Client Cultures and the Predominant Culture 307

Addressing Prejudice and Discrimination 309

Bringing Spirituality into Therapy 310

Summary 313

10 Disruptive Behavior in Children 315

Diagnoses Treated in This Chapter 316

Clinical Presentation and Etiology 317

Assessment 321

Treatment Planning 322

Behavioral- Systemic Parent Training 328

Collaborative Problem- Solving 342

Individual CBT With the Child 344

Psychodynamic Therapy 346

Summary 348

11 Disruptive Behavior in Adolescents 351

Diagnoses Treated in This Chapter 352

Clinical Presentation and Etiology 352

Assessment 357

Treatment Planning 359

Behavioral- Systemic Therapy 362

Psychodynamic Therapy 380

Parent Counseling 381

Summary 382

12 Aggression and Violence 385

Diagnoses Treated in This Chapter 386

Clinical Presentation and Etiology 386

Assessment 391

Treatment Planning 392

Addressing Decisions About Fighting 395

Violent and Peaceful Foundations of Self-Esteem 397

Bullying 398

Cognitive- Behavioral Therapy 399

Psychodynamic Therapy 415

Systems- Oriented Intervention 416

Summary 416

13 Anxiety 419

Diagnoses Treated in This Chapter 420

Clinical Presentation and Etiology 421

Assessment 427

Treatment Planning 428

Cognitive- Behavioral Therapy 432

Psychodynamic Therapy 442

Parent– Child Work 447

Summary 449

14 Depression 453

Diagnoses Treated in This Chapter 454

Clinical Presentation and Etiology 455

Assessment 460

Treatment Planning 462

Special Topic: Suicide Risk 466

Cognitive- Behavioral Therapy 469

Psychodynamic Therapy 480

Systemic Intervention 483

Summary 484

15 Stress and Trauma 487

Diagnoses Treated in This Chapter 488

Clinical Presentation and Etiology 488

Assessment 493

Treatment Planning 496

Cognitive Behavioral Therapy 500

Coaching Clients in Coping 505

Psychodynamic Therapy 508

Constructivist Therapy 509

Systems- Oriented Intervention 509

Therapy for Parental Divorce 510

Therapy for Bereavement 513

Therapy for Sexual Abuse 516

Summary 521

Afterword: The Therapist’s Experience 523

References 525

Index 595

The most comprehensive textbook on the theory, research, and practice of child and adolescent therapy

Child and Adolescent Therapy: Science and Art is a unique textbook that introduces readers to all the major theoretical orientations (CBT, family systems, etc.) and applies them to the common diagnostic categories (anxiety, disruptive behavior, etc.). Rather than championing one therapeutic approach above the others, it identifies the strengths and applicability of each, with an emphasis on matching strategies to client needs and preferences. The central theme is the integration of outcome research and clinical reasoning to choose techniques and personalize counseling for each client. The vast literature on therapy outcomes is distilled into user-friendly summaries with clear conclusions and implications for treatment planning.

The book models the thought processes of expert clinicians as they integrate theoretical principles, research findings, and observations of clients in real time to conceptualize cases, make clinical decisions, and decide what to say next. Theoretical concepts, empirically supported treatments, and best practices are translated into numerous examples of therapist statements and conversations between counselor and client. Unlike edited books with chapters by different authors, this work is an integrated whole, with connections between chapters, a building block approach to learning, and unifying themes developed throughout the book.

The Third Edition has been thoroughly updated to reflect current research and clinical advances. It features new material on:

• The Internal Family Systems therapeutic model
• Modular psychotherapies
• Transdiagnostic approaches
• Head-to-head comparisons between empirically supported therapies

This textbook offers a thorough and practical introduction for graduate students in psychology, counseling, and social work. It also serves as a valuable resource for practicing mental health professionals who want to fill gaps in their knowledge, catch up with the outcome research, and learn new techniques. Purchasers get access to a companion website where they can download therapy handouts; instructors can also download teaching materials such as questions for discussion and exam questions.

"As an instructor in a graduate level clinical psychology program, I've come to rely on Child and Adolescent Therapy: Science and Art as a truly invaluable resource. It's one of those rare texts that manages to bridge theory and practice in a way that feels both rigorous and relatable. The book neatly weaves together research and real-world clinical expertise, offering a solid guide to evidence-based practices in child and adolescent therapy. It doesn't just outline the major theoretical approaches—it also shows you how to apply them to the kinds of challenges you'll see every day. Additionally, it is challenging to find a text organized by both theoretical approach and by clinical issues. This text does both.

What I love most about this book is how it keeps pace with the latest developments in our field, giving both students and seasoned practitioners fresh, up-to-date strategies for tackling complex clinical issues. I've seen firsthand how much students benefit from the clear, step-by-step explanations that mirror the thought processes of experienced therapists. The detailed examples of therapist-client interactions and specific verbal strategies make it easier to understand how to plan treatment and make sound clinical decisions. Overall, Child and Adolescent Therapy: Science and Art not only deepens one's understanding but also builds confidence in blending the science and art of therapy. I wholeheartedly recommend this book to anyone dedicated to growing in the field of child and adolescent mental health."
—David Sedghi, Adjunct Instructor, Pepperdine University

"This book is by far the most comprehensive and useful child therapy text. Amazingly well-written, it is both supremely helpful for new clinical graduate students and an outstanding, sophisticated review for clinicians and researchers. The second edition of this book is even more useful than the original text! The first edition filled a key gap by providing a broad array of useful and evidence based information to new child clinicians learning to conduct therapy with kids and teens. Because of its currency and clinical sophistication, it is also suited to busy practitioners who are looking for practical ways to integrate new, clinically relevant evidence and ideas. The writing engages the reader with a crisp style and clear real-world examples showing a deep understanding of evidenced based work with youth. The revised edition adds new material on mindfulness-based cognitive-behavioral therapies and motivational interviewing, and it weaves recent neuroscience research into discussions of clinical topics. To a unique degree, this book articulates the thought process of an experienced therapist as he or she integrates outcome research and clinical considerations to plan treatment strategy and decide what to do and say in work with clients. We use this textbook in our didactic practicum with new clinical graduate students at the University of North Carolina, and each fall, the students and I enjoy reading the combination of a broad perspective, specific techniques and logistical implementation ideas, as well as up to date references. Child and Adolescent Therapy: Science and Art is a helpful and detailed yet fun read for new and seasoned clinicians!"
—Jen Kogos Youngstrom, PhD, Professor of Clinical Psychology, Director of Child and Family Services and Assessment Clinic The University of North Carolina at Chapel Hill

"This book combines clear, insightful explanations of the major theoretical orientations, rigorous summaries of outcome research, and the clinical wisdom of an experienced therapist in a unique synthesis that shows readers how to plan treatment and decide what to say when with clients. My graduate students loved the first edition of this book¯there's nothing like it. The broad array of theoretical approaches that are covered helps to develop a comprehensive understanding of intervention approaches and provides a very solid foundation in child and adolescent therapy. This new edition has added an excellent chapter on mindfulness-based therapies and has infused a sophisticated neuroscience framework throughout the book. I highly recommend this text to mental health professionals working with young people and to graduate students beginning their work in child and adolescent therapy."
—Sandra W. Russ, Distinguished University Professor Case Western Reserve University

"As a researcher, clinician, and instructor in a school psychology graduate program, I appreciate books that offer breadth of content but also sufficient depth in evidence-based practices in order to best prepare future youth mental health professionals. After switching from other texts that were either overly broad and historical or too narrow, I adopted the first edition of this book as the required text for my introductory course in counseling and psychotherapeutic interventions. My graduate students and I have given this book the highest praise. We appreciate the clear, insightful explanations of theory and research and the detailed, vivid instructions for implementation that make the process of therapy come alive. Unlike edited books with chapters by different authors, this text presents psychotherapy as an integrated whole. The chapters cross-reference each other frequently to identify connections and contrasts among the major theories and to show how elements of different approaches can be woven together in customized therapy for each client. My students are particularly thankful for the numerous vignettes and example scripts that illustrate best practices and provide detailed demonstrations of effective therapy."
—Shannon Suldo, Professor, University of South Florida

"This book is essential for courses covering child and family therapy. It is comprehensive, well-written, engaging, well-organized, and informative. When I used the first edition, my students told me they looked forward to reading each week's assignment and that this is the book they return to again and again throughout their career as a resource for the most up-to-date information on interventions for various disorders. The author not only provides background information about the theory and evidence base behind interventions but also practical illustrations for how to implement interventions effectively and stylistic suggestions that demonstrate the art of conducting therapy. This book is a wonderful addition to any therapist's library, whether a therapist in training or an experienced therapist who wants to stay current."
—Amy Przeworski, Ph.D. Assistant Professor Case Western Reserve University