CBT and the Child Client

Case Study: Beth

Beth is an eight-year-old minor who has undergone significant trauma, including sexual abuse. As a child, understanding the significance of the sexual abuse she has suffered at age six at the hands of an acquaintance of her biological father must be viewed in age-appropriate terms. Cognitive behavioral therapy (CBT) is often used to replace irrational versus rational coping mechanisms in both children and adults. Despite the fact that her father Dustin is incarcerated for dealing and using drugs, Beth still desires a relationship with her father. She also blames her mother Tara for depriving her of contact with Dustin, and for perceived and real abandonment, even though Tara is struggling to stay sober.

The counselor must understand the extent to which Beth’s concrete way of looking at the world as a child in black and white terms is normal. From a relational perspective, the counselor should also realize that he or she cannot automatically assuming that Beth will extend trust in an unconditional fashion, given the extent to which she has felt betrayed by the adults in her life. According to Halder & Mahato (2019), while adults who voluntarily come in for counseling usually have an idea of how to prioritize problems, set an agenda, and have goals for treatment, this is not always the case with children. Children often struggle with discussing their concerns and putting their needs into words. Also, in the case of multicultural considerations, the counselor may need to bridge the gap regarding the socio-economic gap between the counselor and Beth.

Beth’s needs pertain to safety and security, as well as gaining a realistic view of both her parents and her experience, without idealizing her father or demonizing her mother. She also needs help in understanding the wrong that was done to her, and understanding her right to physical autonomy and wholeness. Additionally, as an unaccompanied minor, the counselor needs to be concerned about potential negative impacts of either employer policy or other factors which might influence the client’s mental stability. From an advocate’s as well as a social justice concern, the counselor has an additional role to protect the interests of the child, since the adults responsible for Beth have consistently failed to protect her, or are struggling with mental health issues of their own.

Treatment goals may include identifying problems in Beth’s life at home and at school, and identifying negative thought patterns (such as blaming her mother for things her mother cannot control, like the absence of Dustin, or anger and resentment about other issues at work and school). The goal of CBT is to replace these thought patterns with positive ones that affirm her sense of self-worth. Language expression is often one of the most difficult issues in dealing with patients in this age group (Halder & Mahato, 2019). Even though Beth is developmentally normal, being able to express her complicated feelings about her parents may be a challenge, and the majority of her resentment appears to be focused upon her mother.

Setting behavioral goals might also be a challenge, given that her mother is currently struggling with issues of her own, including recovering from substance abuse as well as her own guilt about what happened to her daughter. Particularly for children, consistency in parental response (affirming when a child engages in a desirable behavior and affirming the child’s realistic sense of self-worth) is critical, and Beth’s mother may struggle with such consistency, particularly given the adversarial relationship she has with her daughter.