Addressing Motivation in CBT with Kids and Teens

I remember leaving a session with a 10-year-old girl named Josie last year, wondering why I could not get her to complete her homework, why our work on her procrastination was not successful, despite her seeming to want to get the work done.

When working with children it’s important to remember that parents often bring their children to therapy in order to change things in their children that are bothersome to the parent, but NOT bothersome to the child. In these situations we can work with the parents to give them skills to be more effective at parenting.  We can talk to them about having appropriate expectations for their children.  We can work with the parents on their own anxieties about their children or their child’s behavior. However, unless the child has good reasons to work hard to change his own habits, it’s unlikely he will improve. Instead of trying to help kids to change against their will, we can attempt to create a strong therapeutic alliance with our patients using the 5 Secrets of Effective Communication, and other important rapport-building techniques. Once the child is convinced that we are on her team, and that we see the world through her eyes, then we can clearly identify and work through the motivational issues which will improve our chances of success. If we can develop a warm and collaborative relationship — and set goals for therapy with total “buy-in” from the child—amazing results are possible!

In Josie’s case, the mother was inadvertently CREATING resistance in her daughter by forcing Josie to complete her homework exactly when THE MOTHER thought it was necessary. Initially, I too fell into the same trap. But once I reflected on the reasons our therapy was stuck, using Dr. Burns’ TEAM Therapy approach to CBT, I was able to see my error and instead of hitting a dead end (e.g., trying to convince Josie to do her homework on her mother’s time-line), I was able to connect with Josie about her frustration with the limits her mother was putting on her, and then turn the focus of the work to improving communication between mother and daughter. Paradoxically, once Josie felt understood and accepted, and once her mother stopped pressuring her to do her homework at a particular time each day, Josie became much more motivated to get her homework done.

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