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Abuse-Focused Cognitive Behavioral Therapy for Child Physical Abuse

Series: Issue Briefs

Author(s):   Child Welfare Information Gateway

Year Published:  2007

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You are in section: Table of Contents 1. What Makes AF-CBT Unique 2. Key Components 3. Target Population 4. Effectiveness of AF-CBT 5. What to Look for in a Therapist 6. Conclusion 7. Resources for More Information

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1. What Makes AF-CBT Unique

The families in which physical child abuse occurs have often experienced stressful life events that may lead parents to maintain negative perceptions or attributions of their children, heightened anger or hostility, coercive family interactions, and harsh or punitive parenting practices. As a result, abused children from these families may experience aggression, behavioral problems, trauma-related emotional symptoms, poor social and relationship skills, and cognitive impairment.

AF-CBT addresses both the risk factors and the consequences of physical abuse in a comprehensive manner. This approach draws from a variety of therapeutic approaches and implements procedures that have been successful in improving positive family relations and reducing family conflict in diverse populations of parents, children, and families.

Reflects a Comprehensive Treatment Strategy

The diversity of family circumstances and individual problems associated with physical abuse points to the need for a comprehensive treatment strategy that targets both the contributors to abusive behavior and children's subsequent behavioral and emotional adjustment (Chadwick Center, 2004). Treatment approaches that focus on several aspects of the problem (for example, a caretaker's parenting skills, a child's anger, family coercion) may have a greater likelihood of reducing re-abuse and more fully remediating any mental health problems (Kolko & Swenson, 2002). Therefore, AF-CBT adopts a comprehensive treatment strategy that addresses the complexity of the issues more completely.

Integrates Several Therapeutic Approaches

AF-CBT combines elements drawn from:

• Cognitive therapy, which aims to change behavior by addressing a person's thoughts or perceptions, particularly those thinking patterns that create distorted views
• Behavioral and learning therapy, which focuses on modifying habitual responses (e.g., anger, fear) to identified situations or stimuli
• Family therapy, which examines patterns of interactions among family members to identify and alleviate problems
• Developmental victimology, which describes processes involved in the onset and maintenance of abusive behavior, and how the specific sequelae of the abusive experience may vary for children at different developmental stages and across the lifespan

AF-CBT pulls together many techniques currently used by practitioners, such as behavior and anger management, problem solving, social skills training, and cognitive restructuring. The advantage of this program is that all of these techniques, relevant handouts, training examples, and outcome measures are integrated in a structured approach that practitioners and supervisors can easily access and use.

Treats Children and Parents Simultaneously

During AF-CBT, school-aged children and parents (or caretakers) participate in separate but coordinated therapy sessions, often using somewhat parallel treatment materials. In addition, children and parents attend joint sessions together at various times throughout treatment. This approach seeks to address individual and parent-child issues in an integrated fashion.

Discourages Aggressive or Violent Behavior

The AF-CBT approach is designed to promote appropriate and prosocial behavior, while discouraging coercive, aggressive, or violent behavior. Consistent with cognitive-behavioral approaches, AF-CBT includes procedures that target three related ways in which people respond to different circumstances:

• Cognition (thinking)
• Affect (feeling)
• Behavior (doing)

AF-CBT includes training in various psychological skills in each of these channels that are designed to promote self-control and to enhance interpersonal effectiveness.

Tailors Treatment to Meet Specific Needs and Circumstances

Child maltreatment research has documented a variety of risk factors and consequences of physical abuse, and this variability requires treatment that can be adapted for different needs. So, for example, the treatment needs of a suicidal teen abused by an alcoholic father may differ from those of a child reported to be aggressive at school and hostile toward a mother who is also a victim of violence.

AF-CBT begins with a multisource assessment to identify the nature of the problems the child is experiencing, specific parental and family difficulties that may be contributing to the risk of abuse, and the child's and family's strengths that may help influence change. Tailoring the treatment to the family's specific strengths and challenges is key to efficient outcomes (Kolko & Swenson, 2002).

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You are in section: Table of Contents 1. What Makes AF-CBT Unique 2. Key Components 3. Target Population 4. Effectiveness of AF-CBT 5. What to Look for in a Therapist 6. Conclusion 7. Resources for More Information

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Updated on March 1, 2010