WELCOME TO
Addressing Juvenile Substance
Abuse and Behavior Problems
using CBT Theories & Approaches
to Change
Pamela Morgan, BS/CADC-M
Key Insights, LLC
P.O. Box 760502
Lathrup Village, MI 48076
(313) 610-4626
Co-Facilitator: Karrie McCrary, MSW / MAFE
MODULE I
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Training Objective
Introduction- What is Cognitive Behavior Therapy
Objectives of CBT
Characteristics of CBT
Training Objective:
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To enhance the Participant’s ability to utilize
Cognitive Behavior Therapy to assist substance
abusing juveniles and juveniles with behavior
problems in making life altering changes, thereby
reducing the recidivism rate.
Participants will be provided with user friendly
assignments to address the juvenile’s belief
system, identify the current stage of change and
interventions needed to motivate the adolescent to
the next stage.
INTRODUCTION-What is Cognitive
Behavior Therapy (CBT)?
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CBT Is an Umbrella. CBT is a very general term for a
classification or families of psychotherapies with
similarities.
CBT is a combination of cognitive therapy and
behavior therapy. It works with the thoughts of youth
(what are they thinking about just before they start to
use drugs, while they are using and after they finish
using) and how those thoughts influence their
behaviors.
Problems addressed by CBT
Criminal Behavior, Extreme Anger, Various Addictions
– (Sexual, Drug Addiction, Overeating, Cigarette
Smoking & other addictions)
– Violent Behavior
OBJECTIVE OF CBT
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To identify & Monitor thoughts, assumptions, beliefs
and behaviors related to debilitating, negative actions
and dysfunctional displays of emotions
To replace irrational thoughts with more realistic and
useful ones
To assist in Group, Family, and Individual Therapy
Characteristics: CBT is…
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…based on Cognitive Model of Emotional Response.
…briefer and time-limited.
…does not focus on the therapeutic relationship
…a collaborative effort between therapist and the
client.
…does not tell people how to feel
…uses Questions
… is structured and direct
… is based on an educational model-teaching to
unlearn-learned behaviors
…relies on homework as a central feature
…deals with thinking based on fact
Module II
Rational Emotive TherapyAlbert Ellis/ – 1955
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Focuses on Beliefs and Perspective
Confronts irrational core beliefs (handout)
Replaces irrational core beliefs with
rational ones
Suggests that Emotions and Behaviors
result from the cognitive process/thinking
process
Foundational Work
Preparing the Client for Therapy
Work on building trust
 disclosure
 education
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Explain to client the basics of REBT to elicit
confidence in the possibility for change
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THERAPY BEGINS
Identify the Problem – GAINS Assessment
(client Hx)
Assess clients feelings about the problem
Identify causal factors (from Hx )
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Factors attributing to clients beliefs about self,
others and the world
Reflect on past long enough to establish causal
effect (how the past has effected client’s beliefs)
Causation Approach
(ABC Theory-Albert Ellis)
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STIMULUS ITSELF DOES NOT ELICITS AN
EMOTIONAL RESPONSE DIRECTLY
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CLIENT’S EVALUATION OF OR THOUGHT ABOUT
THAT STIMULUS ELICITS THEIR RESPONSE.
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THE COGNITIVE THERAPIST ASSUMS:
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1) THE CLIENT IS CAPABLE OF BECOMING AWARE OF
THEIR OWN THOUGHTS AND OF CHANGING THEM
2) CLIENT’S PERCEPTION OF REALITY MAY BE
DISTORTED BY STIMULI.
REBT deals with
CORE BELIEFS
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(see worksheet pg. 1,2,3)
The long-standing views that we hold about
ourselves, others, the world and the future.
Usually formed during childhood or other
important times in our lives
We filter our experiences through core
beliefs
Core Beliefs form PET PEEVES
A-B-C Method
(developed by Albert Ellis)
(see worksheet pg. 4)
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Activating event
Belief system
Consequential Response to Activating event
Disputing (irrational core beliefs)
Effects of Alternative Thinking
Module III
Stages of Change
(DiClemente/ Prochaska’s Model of Change)
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Pre-Contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
SELF-EFFICACY
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Prerequisites to Change
Goals must be realistic to the client
Client’s evaluation of current behaviors
and current conditions must indicate new
behavior is needed if new conditions are
to be expected.
Client must believe there are optional
behaviors available and attainable
Therapist must determine readiness to
change and counsel at that stage
Pre-contemplation Stage
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Defining –
Individuals are either
unconvinced that
they have a problem
or are unwilling to
consider changes
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Approach to Facilitate
Change
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Weigh Good/Bad
Ask questions
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Raise Awareness
Use Assessments
Highlight
inconsistencies
Contemplation Stage-ambivalence
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Defining –
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Individual is
considering the
possibility of change
Evaluating options
having mixed
feelings
Doubts self, fears
failing
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Approach to
Facilitate Change
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Explore benefits of
change
Scenarios / Role
Play
Projection – life
without the behavior
Preparation Stage
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Defining –
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Individuals make a
commitment as well
as initial plans to
change behavior
No longer justifying
behavior
Becomes agreeable
vs. arguementative
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Approach to Facilitate
Change
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Structure plan of action
Identify & Reduce
barriers/ assess
environmental
risks/self-defeating
behaviors
Identify people who will
assist
SELF - EFFICACY
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Defining –
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One’s judgment or
belief about one’s
ability to deal with
challenging high risk
situations
competently based
on development and
commitment to
coping skills
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About Self-Efficacy
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Facilitates courage to
move forward
Without Self-Efficacy,
change rarely occurs
It is not Self-Will
Must be contingent on
a foundation of coping
skills
Case Study
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Break into groups-Designate spokes person
to report clinical insight
Review Case Study/ Add variables to the
client’s life.
Using the CBT Technique discussed in
today’s training, develop a treatment plan to
assist the client in meeting the identified
goal(s).
Report clinical insight