Alternatives for Families: A Cognitive Behavior Therapy
Family conflict, hostility, and abuse tend to be chronic. This chronic exposure to violence can interfere with children’s emotional, behavioral, academic, and social development. Changing how families interact is hard, and requires caregivers to change their parenting, couples to change how they disagree, and children to manage their anxiety and anger.
Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) (Kolko, Brown, Shaver, Baumann, & Hershell, 2011) was initially used as a therapy for child physical abuse and then expanded to be used for verbal and physical aggression, and family conflict. AF-CBT is designed to address both the key risks for abuse (e.g., coercive parenting practices, anger, hyperarousal, negative child attributions, family conflict) and the consequences of negative parent/caregiver behavior on the child (such as child aggression, poor interpersonal skills/functioning, intense emotional reactions).
AF-CBT uses the ALTERNATIVES acronym to refer to the treatment components:
- Alliance building between the family and therapist
- Learning about trauma and mental health responses through psychoeducation
- Talking about positive and negative family experiences
- Emotional regulation skills to reduce anxiety and anger
- Restructuring inaccurate and unhelpful thoughts
- Noticing positive behavior in children and reinforcing it
- Assertiveness and social skills for children
- Techniques for parent management of child misbehavior
- Imaginal exposure to the trauma
- Verbalizing healthy communication in the family
- Enhancing safety through clarification of the family violence
- Solving family problems without conflict
What Happens in AF-CBT Sessions
AF-CBT is designed to be short-term, typically completed in 6-9 months (24 sessions). Children and caregivers meet separately with the therapist for the psychoeducation, skill-building, parenting, and exposure components of treatment, and then children and caregivers meet together for the family communication, clarification, and problem-solving components of treatment. Sessions include: planning the agenda for the session, home practice review, focus on a specific ALTERNATIVES PRACTICE component, and home practice assignment.
AF-CBT is focused on the parents/caregivers, children, and family as a whole. Caregivers are taught the same coping skills as their children because they may be experiencing their own stress and because of the critical role they play coaching their child in using their skills. Family therapy is used to improve communication, discuss the family conflict, and plan for future safety.
Feedback from Families
victim of child physical abuse
Regina inherited three things from her mother — her eyebrows, a budding dimple, and getting senselessly beaten by her single parent. She is anxious and depressed. At 13, she has joined her first pre-gang for its drinking and fighting — causing even more tension in the home. Her mother is unaware of how her own behavior has influenced Ginny’s emotional and behavioral problems. Child Protective Services recommended the family work with PARTNERS.
PARTNERS went well beyond traditional therapy — learning how to better handle anxiety and anger — to rebuild Ginny’s relationship with her mother. Each wrote a letter: the mother acknowledging her role in the conflict, apologizing for it, and offering a plan to stop the abuse. Ginny wrote a narrative about her trauma and the feelings surrounding it. PARTNERS then brought the two together to read the letters, each allowed into the other’s world through honesty and vulnerability.
Today, Regina’s mother understands her anger and abuse potential, with communication between the two far more open than before. Ginny can look forward to having a daughter herself — with that dimple, not the danger.
victim of teen dating violence
Talisha loves a boy two years older – adores him so much that she sees past the face-slaps and bruises he gives her in his thunderous rages. It’s passion, she tells herself. Almost flattering.
Just like Uncle Von and Aunt Clare and in the movies — violence is a part of life. But it’s getting worse. She’s hurting more than happy, his fuse shorter and shorter. Will he break her arm? Crack her cheekbone? She doesn’t know how to get out — not just physically, but emotionally. Talisha needs help, and fast, to get away and to learn how avoid this happening again.
Outcome / Research Results
In a review of treatments for youth exposed to family violence, Vickerman and Margolin (2007) found AF-CBT to be “well-supported .” In four randomized controlled trials, AF-CBT has been associated with greater improvements in children’s mental health, caregivers’ parenting skills, and family conflict and cohesion. At Child HELP Partnership, we wanted to ensure that our families have the same rates of improvement as those families who participated in the randomized trials.
The chart below presents outcomes at each stage of therapy at Child HELP Partnership.
Percentage of Children with Mental Health Problems at Each Stage of PARTNERS Therapy
No Data Found
As the chart shows, the percentages of children with PTSD, depression, and conduct problems decrease significantly over the course of therapy. Additionally, each phase of AF-CBT is important for recovery. By reducing rates of PTSD, depression, and conduct problems, we are not only easing the current pain of the children served, but preventing the need for long-term, expensive mental health care.