23 Feb Case Study: The Power of Using Cognitive Restructuring (CR) in Your Therapeutic Practice with Children
Alex, a 9-year-old boy, was referred to therapy due to severe anxiety about school and school refusal behaviors. He risks being held back due to his poor academic outcomes. During his session, the therapist identifies a narrative of feeling left out or different. He often expressed fears like, “I’m too dumb to do my homework,” or “Everyone thinks I’m weird.” These thoughts severely impacted his confidence and willingness to engage in classroom activities.
Step 1: Identification
The therapist helped Alex externalize his internal thoughts by engaging Alex through drawing activities where he illustrated scenes that make him anxious.
Step 2: Examination
Alex and his therapist reviewed his drawings together and discussed the events depicted to pinpoint moments when his negative thoughts began.
Step 3: Challenging
Thought Bubbles: Alex was given a comic strip template where he drew himself in various school situations. For each panel, he filled in “thought bubbles” with what he was thinking in those situations. The therapist then helped him question the validity of these thoughts.
Avoiding Absolutes: The therapist noticed Alex often used absolute terms like “always” or “never.” They played a game where Alex would catch himself using these words and rephrase the sentence to include “sometimes” or “maybe,” making his statements less definitive and more accurate.
Role-play: The therapist modeled conversations between Alex and other students or teachers, first showing poor and then improved interactions. Alex then practiced these role-plays, learning to assert himself and express his feelings without fear.
Step 4: Replacement
The therapist helped Alex to develop a list of more constructive and positive thoughts:
Instead of “I’m too dumb to do my homework,” Alex learned to think, “Homework can be tough, but I can ask for help when I need it.”
Replacing “Everyone thinks I’m weird,” he practiced thinking, “We all have our quirks, and I have friends who like me for who I am.”
Encouraging Practice
Emphasizing the importance of practicing these skills in therapy sessions, encouraging Alex to use these new strategies daily, and discussing progress in subsequent sessions promotes success. CBT also supports the use of a “thought diary” to record successes in challenging negative thoughts outside the therapy room.
Outcome
Over several months, Alex’s school anxiety decreased noticeably. He became more engaged in class and reported feeling happier at school. His parents observed a marked improvement in his mood and willingness to attend school, reflecting the effective adaptation of cognitive restructuring techniques tailored to a child’s needs.