Development and Cognitive Therapy

Abstract

Some years ago, developmentally oriented clinicians and researchers began to consider the impact of cognitive development on the process and outcome of psychotherapy with children and adolescents (Durlak, Fuhrman, & Lampman, 1991; Shirk, 1988a). It was noted that children enter therapy with abilities that often differ markedly from their adult counterparts. As Shirk (1988a) observed, "child psychotherapy is embedded in, and at times, constrained by the course of cognitive development" (p. 331). Put simply, cognitive developmental level represents a potentially important moderator of treatment effectiveness (Shirk, 1999). This perspective is supported by a recent, comprehensive meta-analysis of child and adolescent psychotherapy (Weisz, Weiss, Han, Granger, & Morton, 1995). Findings indicate that across all therapies, the effects of treatment are significantly larger for adolescents (ages 12 and older) than for children, even after controlling for problem type and gender. Similarly, meta-analytic reviews of cognitive-behavioral therapy (CBT) for children and adolescents have revealed a positive association between age and treatment effects (Durlak et al., 1991; Dush, Hirt, & Schroeder, 1989). With increasing age, and presumably with more advanced cognitive capacities, children appear to attain larger benefits from cognitively based therapies. Could it be that younger children lack the conceptual platform for processing the cognitive components of these interventions? In the articles that follow, the potential impact of cognitive developmental level on the application of cognitive therapy to different childhood disorders is considered and adaptations of technique are proposed. Although consideration of cognitive development seems central to therapies that emphasize cognitive change mechanisms, the authors do not restrict their comments to cognitive processes. Instead, they highlight a range of developmental processes that distinguish cognitive therapy with youth from adult cognitive therapy. A second, and equally important, theme across these articles involves consideration of cognitive processes that contribute to different childhood disorders. As is evident from these articles, simple unitary models that emphasize a one-to-one correspondence between manifest symptoms and underlying pathogenic process are rejected in favor of multivariate models with complex causal pathways. In turn, child cognitive therapy is inherently integrative with an equal emphasis on cognitive, behavioral, and interpersonal factors. As Krain and Kendall (1999) have observed, "the theoretical model that guides CBT is interactional, considering both the internal and external environments surrounding the child" (p. 121). In this connection, each article considers both internal cognitive processes and contextual processes, especially interactions within the family. The fact that most children and adolescents are part of a family system, and that the family system has an ongoing impact on their functioning, broadens the scope of CBT with youth. In this respect, the dual focus on internal cognitive processes and ongoing family interactions, and the targeting of both for intervention, may distinguish cognitive therapy with youth from typical adult cognitive therapy. DEVELOPMENT AND TREATMENT PROCESS The articles in this special issue draw attention to four major developmental factors that merit careful consideration in the delivery of cognitive interventions with youth. These include: the intersection of cognitive capacity with the cognitive demands of therapy, the importance of considering both the child's and the parents' cognitions as targets for intervention, the role of the family in facilitating or undermining individual interventions, and processes that impact children's motivation for treatment participation. Cognitive Development and the Tasks of Cognitive Therapy A core task of cognitive therapy is the identification of maladaptive thoughts that contribute to emotion dysregulation. …