Preparing for the Introduction of Cognitive Therapy treatment model.

Laying the foundations for self-awareness, and assuming the inevitable need for therapy.

It is very likely that my son will at some time in his life benefit from Cognitive Therapy (CT), therefore it seems logical to begin establishing the underlying principals now.
Rationalizing the practices of introducing the CT treatment model to an adult or an adolescent would require the use of different approaches. There is a need for some creativity when to introducing the idea to a younger child. Just as considering the client’s developmental levels and their diagnosis (DX) is important when relating the treatment model, the language and props used for a adolescent would be considerably different when helping a child of Kindergarten age.
Friedburg describes the first steps of introducing the CT model pointing out that a younger child may lack experience in articulating their emotional state, and recommends teaching children how to report their mood prior to beginning cognitive interventions. Once a range of emotions is easily identified, the work of rating intensity begins.

We began the process of identifying and labeling emotions in our family a before my son entered preschool. Once there, emotions were explored by use of positive modeling in class, a variety of books, and Second Step, a violence prevention curriculum. Second Step uses puppets to describe emotions such as “Glad, Mad, Sad and Scared’. And is very dependant on the skills of those who deliver the program. The puppets can be difficult for children on the Autism Spectrum to related to. My son related better to representations and descriptions of emotions in books such as “How are you peeling? Foods with moods”. We also found that using social stories or scripts to help both our children gain a better understanding of feelings. Recently we have started to relate a typical situation where one of us would display and identify a feeling, and narrate or interpret ‘in-the-moment’ event to explain what circumstance may produce feeling in each of us. For example-: “When mummy rushes around she might be worried and anxious about being late”. The ‘real-time’ example would be “I am getting worried about being late. Please get dressed so we can get ready to go because I am anxious about being late”.
My son can identify and label a variety of feelings and emotions and using the social stories or narrative interpretation can increase his emotional vocabulary. He learns well by associating one emotion to another in a context that he is failure with and I can introduce the concept of rating with the appropriateness of the words I use. For example, I combine ‘worried’ with ‘anxious’, but would avoid saying I ‘hate’ that TV show. At age 3 he struggled to get beyond ‘mad’ and ‘glad’. Now at the age of 5 he can identify excited, frustrated, mad, worried, scared, jealous, calm, sad, relaxed, disappointed, bored, upset, distracted and more. He can be extremely kind and thoughtful but a bit of a sore looser at times so we have begun to discuss those qualities and how when he behaves in a certain way it can effect how others feel. He is learning rapidly to identify and name his own emotions. He will spontaneously state how he feels, and how others’ actions made him feel, or how certain events made him feel. Sometime he seems to be confused and will make statements such as “Waiting ‘till my birthday will be just too boring!” I believe that “boring” is not the feeling that he is describing as his vocal tone suggests something more intense, so I reply. “Maybe boring is not quite what you mean. Perhaps you feel a little frustrated, or a bit impatient.” He replies that he is both frustrated and impatient. I say that I understand and we count the days until his birthday. I distract him with a discussion of what gifts he would like to receive.

Intensity teaching.
It seems more natural to combine recognizing feelings and emotions with some references to intensity. At this time, we have yet to establish a rating scale with more that 3 degrees. For example, yesterday my son was waiting for me to play “Go- Fish” with him. He had waited too long, and he came to protest. I asked “ When mommy takes too long at the computer, does that make you a little bit mad, are you very mad, or is it the end of the world (an idiom well used and accepted as an over statement) Of course he chose ‘the end of the world’. He had been waiting a very long time.

He is learning how to use his voice and his tone will change with intensity although he often uses impatient sounding voice. His use body language to enhance his communication is emerging and he is able to exaggerate his body movement in order to make is reason or justification more compelling. His ability to read others emotions seems to be improving but he frequently objects to any exaggerated body gestures that we use in an attempt to give him clues as to our emotional states. Because his sense of and control over his own body language is still emerging using ‘the body read’ to understand his responses to particular questions or circumstances may be difficult.

How to show a 5-year-old that feelings, thoughts, behavior, and health are all connected and all happening within environment.

I showed my son a picture of four gears and asked him what would happen to all the gears if we moved just one of them. “They all move.” He stated immediately.
A person’s acceptance of the principles that CT is based upon is critical for the success of the treatment and relating to their special interest can help the process. What better visual representation to use for a child who fixates on turning wheels that interlocking gears. Each of the four gears has removable and replaceable labels that are written or visual representations of feelings, thoughts, behaviors, and physiology or health. The gear model will work for my son. His passion for inanimate objects and the stimulation he receives when he is control is intense. My daughter may be happier with the balloon model, and another child I know would love to see 4 stunt kites all connected.
It might be challenging to for both my children to accept that they have varying degrees of control over what each individual gear or balloon represents. The use of social stories and appropriately selected picture story-books can help to promote the idea that we all have some influence over our thoughts, but no control of our feelings. They may struggle more with the fact that we all can learn to control our behavior and yet our reaction to the events in any one circumstances are part of whom we are. Currently I would say of my children that they have little way of separating their behavior from their emotional state and may not understand their own physiology or why they react in certain ways. It is often the behavior that they are ether reprimanded or praised for and little attention is given to the cognitive elements. Perhaps an earlier introduction of CT in their daily learning would promote an advanced level of maturity and an overall better outcome. I predict that for my son the ability to understand and control his thoughts and behavior will make a huge difference to him, and I hope that we can set him on an earlier path of discovery. A thought record may work well for him, as currently the way we modify and implement social stories is equivalent to a thought record without the word ‘sometimes’. Although there is no directive in the thought record, there is an objective in the treatment environment that thought records are completed within, and therefore there is a desired positive outcome.

In the absence of a formal treatment environment, I use our numerous games of ‘Go Fish’ and ‘Uno’ to create an episode of treatment. My son focuses on the game and I ask him about events of the day and what when through his mind. He asks me to stop talking and play the game. I create an event by challenging his play, or deviating from his interpretation of the rules. He responds predictably and gets a little mad at me. We identify his feelings and agree upon a rating. We investigate what worked, and what didn’t work. Generally, what works is sticking to the rules of the game or playing a different game. We decide that what does not work would be when someone refuses to play anymore, or becomes very mad at loosing. I judge just how much of the ‘Family Therapy’ he can tolerate and we get on with the game. He normally wins.