CBT across the life span: How it works for clients of different ages

In my practice as a psychologist who is certified in cognitive behavioural therapy (CBT), I work with clients varying in age. This includes adults, adolescents and young children. And although CBT has been found to be effective for clients of different ages, there are some commonalities in the way it is used across ages as well as some age-related differences. In the following sections, I will explore these similarities and differences.

Similarities in the use of CBT among different ages

1. The focus is on the connections among thoughts, feelings and behaviours

For clients of all ages, these connections are the essence of CBT. Related to this is the notion that changes in any one of the factors produces changes in the other factors.

For example, people of all ages often seek therapy when there have experienced negative events which have produced a cycle of negativity in their thoughts, feelings and behaviours. CBT works by capitalizing on the fact that making positive changes in any one of these factors will produce positive changes in the other factors.

As the name suggests, CBT helps clients to make deliberate changes in their thinking in order help them feel and behave better as well as facilitating changes in client behaviours to produce positive changes in their thoughts and feelings.

2. A good therapeutic relationship is essential for progress

Regardless of the client’s age, having a positive working relationship with their therapist is essential for progress in CBT. In fact, a positive therapeutic relationship is pivotal for client progress whether CBT or other forms of therapy are used.

3. The therapy is directive, structured, and goal-oriented

For clients of all ages, CBT uses a directive, structured and goal-oriented approach in which the therapist plays an active, guiding role. In that regard, I usually describe my role as that of a coach working in collaboration with the client to help them achieve their goals. I do so by teaching my clients skills and helping them to practise these skills until they have become habits. Each CBT session is structured with an agenda of topics to cover which has been agreed upon by the client and the therapist.

Differences in the use of CBT among different ages

1. The level of complexity differs by age

CBT becomes more complex as the client gets older. The reason is that adults and adolescents have progressed to advanced levels of cognition which allow them to engage in abstract thinking. This makes it possible for more complex CBT skills to be taught to these clients.

An example is the thought record. This skill helps people change their thinking to feel and behave better. It does so by helping clients gather evidence to test the hypothesis that their negative ‘hot thought’ is true.

Not yet having developed abstract thinking, young children cannot engage in hypothesis testing. As a result, the skills to help them change their thinking to feel and behave better are simpler than the thought record. For example, a CBT therapist can instead guide a young child to come up with a helpful thought to replace an unhelpful thought in order to help them feel and behave better. Young children in CBT can also be taught simple coping self-statements such as ‘I can do this’.

2. The methods of therapy differ by age

Adolescents and adults are not only superior cognitively to young children, their verbal abilities are also much better. As a result, the methods used in CBT typically differ across the ages of clients.

Therapists can talk about issues, goals and methods directly with adolescent and adult clients. With young children, non-verbal methods such as play are often used as alternatives which allow for skills to be taught in a different way. This play may involve techniques such as drawing, puppets, dolls and story-telling to help young children benefit from CBT.

3. The degree of involvement of parents in therapy differs by age

Parents typically play a greater role in CBT with clients who are children compared with adult clients. Adults typically seek individual therapy for themselves or come with a partner for couples counselling. In contrast, children are usually brought to therapy by their parents. One reason for this is that, with some exceptions, minors are not allowed legally to consent to therapy. Their parents must provide consent for a therapist to work with their child.

Beyond the consent issue, there are other reasons that parents are more involved when CBT is being taught to a child. One is that, because parents typically have a lot of influence over their children, they often are a valuable source of information in helping the CBT therapist assess the issues with which the child needs help.

Having said that, the CBT therapist typically complements this assessment by getting the child’s perspective. This is especially the case if the child has reached adolescence and is therefore capable of discussing their issues and goals.

Following the assessment stage of CBT therapy, parents continue to be involved as the therapist addresses their child’s issues. For example, parents often help their child practise between sessions the CBT skills which they have learned from the therapist. This between-sessions assistance of the parent is generally more common with young children than with adolescents.

In addition, CBT therapists may work directly with parents to help them make changes which are helpful in addressing their child’s issues. For example, a session with the therapist and the parents may be called for when their child’s issues are being caused or exacerbated by frequent fighting between the parents in front of their child.

In conclusion, whether the client is an adult, an adolescent or a young child, cognitive behavioural therapy is an approach which can help a person to address their issues and achieve their goals.

May you benefit from CBT at any age,

Dr. Pat