For example, the girl with social anxiety might misperceive her classmates’ giggles during her speech as a sign of criticism. She might think, “They’re laughing at me. They think I’m stupid.” These distorted thoughts, in turn, might interfere with her ability to give a good presentation and lead to actual criticism from others, thus confirming her expectations. Similarly, the boy with depression might misperceive the fact that few friends sat with him during lunch as a sign that he is worthless. He might think, “No one likes me. I’m such a loser.” His distorted thoughts, in turn, might cause him to act mopey or avoid others, thus leading his classmates to reject him and confirming his negative view of himself (DiGiuseppe, David, & Venezia, 2018).
An initial goal of cognitive therapy is to help clients recognize the close connection between our thoughts, feelings, and actions. Although we usually have little direct control over our feelings, we can control what we think or do. If we change the way we think or act, we can often improve the way we feel. The From Science to Practice section demonstrates one way a cognitive therapist might teach the relationship between thoughts, feelings, and actions to a child (Beidel & Reinecke, 2016).
Cognitive therapists help clients identify and challenge biases and distortions and adopt more accurate ways of thinking. A primary technique in cognitive therapy involves asking clients for evidence to support their beliefs. For example, a therapist might ask the girl with anxiety, “How do you know that your classmates think you are stupid? What evidence do you have to support your belief? Is there any evidence to the contrary, that maybe they actually liked your presentation?” Similarly, a therapist might ask the boy with depression, “What’s the evidence that no one wanted to sit with you during lunch? I thought you said one boy did sit with you? If you saw a kid sitting alone during lunch, would you think he was worthless or a loser?” The goal of therapy is not to teach clients to think positively but rather to help them see themselves, others, and the world more realistically rather than in a biased or distorted fashion (Kendall, 2018).
A cognitive therapist would focus her attention on the thoughts associated with Anna’s bingeing and purging. Anna might feel lonely and think to herself, “I’m worthless. No one likes me.” The therapist might help Anna challenge this belief to determine whether it is true or whether it is a cognitive distortion. For example, the therapist might ask Anna, “What’s the evidence that no one likes you? Can you identify any friends who’d be willing to talk with you if you texted or called them when you’re feeling lonely?”
Anna might also think, “If I called someone and said that I was lonely and wanted to do something, they would probably laugh at me and say I was a loser.” The therapist might challenge Anna’s distorted belief by asking, “If another girl from school called you and said that she was feeling lonely and wanted to spend time together, would you make fun of her? Isn’t it more likely that you would help her and try to cheer her up? Don’t you think that your friends would do the same thing for you if you asked?”
Cognitive therapy emphasizes the connection between thoughts, feelings, and actions. As clients learn to think in more realistic, flexible ways, they may experience fewer negative emotions and behave in a more adaptive and flexible manner. Usually, cognitive therapists incorporate elements of behavior therapy into their treatments. Cognitive–behavioral therapy (CBT) refers to the integrated use of cognitive and behavioral approaches to treatment (Beidel & Reinecke, 2016).
Interpersonal Therapy
Interpersonal therapy focuses primarily on the quality of clients’ relationships with others and their ability to cope with changes in those relationships over time. The therapy was originally developed by Gerald Klerman and Myrna Weissman as a treatment for depression (Weissman, 2020). It is based on the theories of John Bowlby and Harry Stack Sullivan. Recall that Bowlby (1969, 1973) believed that people form internal working models of caregivers and other significant individuals in their lives. Internal working models built on trust and expectations for care promote later social–emotional competence. However, models based on mistrust and inconsistent care can interfere with the development of future relationships. Sullivan (1953) believed that interpersonal relationships are essential for mental health. Friendships in childhood help youngsters develop a sense of identity and self-worth and form the basis for more intimate relationships in adulthood. Problems in interpersonal relationships can interfere with social–emotional functioning and self-concept.
Interpersonal therapists believe that problems occur when people experience disruptions in their relationships (Weissman, Markowitz, & Klerman, 2018). Four types of disruptions are especially important. First, interpersonal relationships can be disrupted due to death or loss of a loved one. Second, relationship problems can arise when a person experiences an interpersonal transition or change in social roles (e.g., problems adjusting from middle school to high school). Third, problems can occur when a person experiences an interpersonal dispute—that is, when her social role conflicts with the expectations of others (e.g., parents and adolescents disagree about dating or the importance of attending college). Finally, problems can occur when an individual has interpersonal deficits that interfere with his ability to make and keep friends (e.g., excessive shyness or lack of social skills).
An interpersonal therapist attempts to identify and correct relationship difficulties that might contribute to the child’s presenting problem. The strategies that the therapist selects depend on the nature of the client’s interpersonal disruption. For example, a therapist might help an adolescent cope with the death of a parent by giving her time to mourn during the therapy session. Then, the therapist might help the client find ways to cope with the absence of the parent in her life. Alternatively, a therapist might help an excessively shy adolescent develop social skills so that he can expand his peer network and social support system (Lipsitz & Markowitz, 2018).
An interpersonal therapist might notice that Anna’s eating problems occurred shortly after her father changed jobs and the family moved to a new neighborhood and school district. The therapist might interpret Anna’s eating disorder as a maladaptive attempt to lose weight, appear attractive to others, and gain acceptance by peers at her new school. Her rigid eating could also be seen as a way for Anna to take control of her life despite the changes occurring in her relationships. Through a combination of support and suggestions, the therapist would help Anna grieve the loss of her old neighborhood and friends, cope with her move to a new school, and find more effective ways to build new relationships in her current setting (Rudolph, Lansford, & Rodkin, 2016).
Family Systems Therapy
Family systems therapy seeks to improve patterns of communication and the quality of interaction among family members (Bitter, 2013). Although there are many types of family therapies, all family therapists view the family as a system—that is, a network of connected individuals who influence and partially direct each other’s behavior. Viewing the family as a system has several implications for therapy. First, no member of the family can be understood in isolation. A family member’s behavior is best understood in the context of all other members of the family. Second, family therapists see the entire family as their “client,” not just the person with the identified problem. Finally, a systems approach to treatment assumes that change in one member of the family will necessarily affect all members of the family. Consequently, family therapists believe that helping one or two family members improve their functioning can lead to symptom reduction in the family member with the identified problem (Kerig, 2016).
The family therapist Salvador Minuchin (1974) developed structural family therapy. Structural family therapists are chiefly concerned with the structure of the relationships between family members and between the family and the outside world. In healthy families, parents form strong social–emotional bonds, or alliances, with each other that are based on mutual respect and open lines of communication. Furthermore, in healthy families, parents form boundaries between themselves and their children. Specifically, parents respect children’s developing autonomy and provide for their social–emotional needs, but they also remain figures of authority.
In unhealthy families, alliances are formed between one parent and the children,