CC-CBT TEEN TREATMENT MENU NAME OF SESSION OBJECTIVE

CC-CBT TEEN TREATMENT MENU

NAME OF SESSION OBJECTIVE

Problem-Solving Learn how to generate and evaluate options to problems, and

identify the most effective solution

Thinking Patterns Become aware of the link between thoughts and feelings, learn to identify untrue and unhelpful thoughts that cause negative emotions, and learn how to develop true and helpful thoughts

Affect Management Become aware of signs in one’s body, mind, and behavior that signal that one’s emotions are getting too intense, and develop a coping plan to calm emotions

Coping with Intense Urges and Emotions

Develop safe and effective coping skills to help tolerate situations that lead to significant negative emotions and urges

Improving Sleep Enhance sleep and develop healthy sleep habits to help improve mood and speed of recovery

Diet and Pleasant Activities

Increase behaviors that make teenagers feel better and improve their health, such as diet and pleasant activities

Assertive Communication Learn how to effectively communicate with others, including how to best express feelings, ask for what one needs, and say no in situations that are not healthy in a way that others will listen

Increasing Social Support

Learn how to increase the number of people who provide positive and healthy social support

Motivational Enhancement

Learn a structured way to evaluate the benefits and consequences of unhealthy behavior and decisions

Chain Analysis Identify and address the sequence of thoughts, feelings, and behaviors that lead to risky behaviors and choices that go against one’s values or beliefs

Facing Your Fears Become aware of triggers for anxiety, identify skills to help manage it effectively, and practice exposures in session

CC-CBT PARENT TREATMENT MENU NAME OF SESSION OBJECTIVE

Problem-Solving Learn how to generate and evaluate options to difficult parent

situations and identify the most effective solution

Thinking Patterns Become aware of the link between thoughts and feelings, learn to identify untrue and unhelpful thoughts that cause parenting stress, and learn how to develop true and helpful thoughts

Affect Management Become aware of signs in one’s body, mind, and behavior that signal that emotions are getting too intense, and develop a coping plan to calm emotions and maintain positive parenting

Parental Monitoring Learn how to monitor teen behaviors, activities, and friends to help teen avoid risky situations, intense negative moods, and dangerous behaviors

Positive Parenting

Recognize and praise teen for good behavior as well as identify and respond empathically to teen’s feelings

Limit Setting and Contracting

Identify appropriate limits and set up rewards and consequences to promote positive and healthy teen behavior

FAMILY TREATMENT MENU NAME OF SESSION OBJECTIVE Introduction to Treatment Learn about treatment program, identify values, and set goals.

This session also includes a suicide risk assessment, safety planning, and information on how to keep the teenager safe at home for those teenagers who enter treatment with suicidal thinking or behavior.

Family Connectedness Identify family strengths and further strengthen family bonds

Family Problem-Solving Learn how to generate and evaluate options to family problems and identify the most effective solution

Family Communication Learn and practice positive family communication skills

Relapse Prevention Review treatment progress, create a plan to maintain health, and conclude treatment

Suicide Risk Assessment and Safety Planning

Suicide risk assessment, safety planning and education, and determination of disposition.

CC-CBT SUPPLEMENTAL TRAUMA TREATMENT MENU NAME OF SESSION OBJECTIVE Trauma Education (Family Session)

Learn about traumatic events and symptoms of posttraumatic stress and begin to identify trauma reminders

Talking About Trauma (Teen Session)

Develop a trauma narrative to process the trauma

Sharing with Parent I (Parent Session)

Improve parental understanding and processing of the traumatic experience(s) and ability to respond supportively

Sharing with Parent II (Family Session)

Allow further processing of the traumatic experience(s) and sharing of the trauma narrative between teen and parent

Promoting Safety (Teen Session)

Learn assertive communication and safety skills

Pseudoname:_Allie

Screening Results

Problem Area Screener Clinically Significant?

T Depression PHQ9-A YES

P Depression SMFQ YES

T Mania ASMRS No

T General Anxiety SCARED-GAD scale No

P General Anxiety SCARED-GAD scale YES

T Social Anxiety SCARED-Social scale YES

P Social Anxiety SCARED-Social scale YES

T Panic SCARED-Panic scale No

P Panic SCARED-Panic scale No

T Separation Anxiety SCARED-Separation scale No

P Separation Anxiety SCARED-Separation scale No

T School Avoidance SCARED-School scale No

P School Avoidance SCARED-School scale No

T PTSD SCARED-PTSD scale YES

T OCD Spence OCD scale YES

P OCD Spence OCD scale YES

T Attention PSC17-Y No

P Attention PSC17 No

T Externalizing PSC17-Y Ext scale No

P Externalizing PSC17 Ext scale No

T Alcohol/Drugs CRAFFT 2.0 No

T Eating ChEAT YES

Problem Area Screener History / Last Time

T Suicidal Ideation C-SSRS-SR YES No / Passive once per

week

T Suicide Attempt C-SSRS-SR Yes No /

T Non-Suicidal Self-Injury C-SSRS-SR Yes No /

T = Teen Report, P = Parent Report

Other Notable Concerns (e.g., Psychosis, Aggressive, etc.):_ Family Conflict

Pseudoname:_Enrique

Screening Results



P Depression SMFQ No

T Mania ASMRS No


P General Anxiety SCARED-GAD scale No

T Social Anxiety SCARED-Social scale No

P Social Anxiety SCARED-Social scale No





T School Avoidance SCARED-School scale No

P School Avoidance SCARED-School scale No

T PTSD SCARED-PTSD scale No

T OCD Spence OCD scale No

P OCD Spence OCD scale No




P Externalizing PSC17 Ext scale YES

T Alcohol/Drugs CRAFFT 2.0 YES

T Eating ChEAT No


T Suicidal Ideation C-SSRS-SR Yes No / Last month

T Suicide Attempt C-SSRS-SR Yes No / 2 years ago



Other Notable Concerns (e.g., Psychosis, Aggressive, etc.):_Significant family conflict, dad

emotionally abuse and unaccepting of sexual orientation, acculturation differences

between parent and teen

CC CBT CASE CONCEPTUALIZATION WORKSHEET (Page 1) Presenting Problem

Pseudoname: Enrique Mom brought him to treatment after getting caught with pot at school.

Age Sex & Gender Sexual Orientation

Race & Ethnicity

SES Living Situation

Family Country of Origin / Immigration / Acculturation / Cultural Practices

16

Male, Cisgender

bisexual Hispanic Low Lives with dad, mom,

younger sister (age 10), and

paternal grandmother.

Enrique is first gen, immigrated from Mexico, speaks Spanish, and embraces customs/vales from his home country.

Enrique has adopted Westernized customs/values. Dad is Catholic and very religious. Enrique is agnostic and refuses

to attend church with his dad. Family Relationships Peer Relationships Academic History/School Functioning

Enrique and dad do not get along. He has a good relationship with his mom. Dad and

mom both work minimum wage jobs for the same restaurant and are rarely home. When

dad is home, he and Enrique argue. Dad does not accept Enrique’s sexual orientation

or his friends. Mom accepts his sexual orientation but not his friends. Dad believes

Enrique’s duty is to home and family but Enrique wants to spend all his time with friends. Enrique gets along well with his

little sister.

Enrique has a group of friends that he spends time with both in and outside of

school. They all use marijuana.

Enrique had good grades when he was in elementary and middle school

(mostly As and Bs). When he started high school, he met a new peer group

and his grades have dropped to Cs and Ds.

Mental Health/Substance Use & Treatment History (client)

Mental Health/Substance Use History (family)

Medical & Developmental History (include sleep & eating)

Inpatient treatment for 1 week at age 14. They did not follow through on outpatient treatment because they could not afford it. He was referred for treatment by his school

after getting caught with pot. He has a

Biological mother and grandmother had a history of untreated depression.

Enrique was a healthy child. He met his developmental milestones on time. His mother had a normal,

substance free pregnancy. Enrique does not have any medical conditions

history of depression, that started at age 14. He made a suicide attempt this past

summer after a blowout with his dad. He has been using marijuana for the last year

and drinks occasionally.

or hospitalizations. He only gets about 6 hours of sleep a night b/c he stays up late talking with friends. He does

not have much of an appetite.

Trauma History (include oppression / discrimination / racism) Family Discipline Practices Parents faced discrimination when they arrived to the US but moved to a more accepting neighborhood with a large Hispanic population where things are better. When Enrique was younger, kids made fun of him because of the way he dressed. His family could not afford to buy him new clothes so he tended to wear the same clothes a lot and they were worn.

Dad tries to invoke fear and threatens Enrique (e.g., I am going to kick you out of this house!) when upset with him but does not follow through with his threats. Dad tries to ground him but is not home enough to enforce the grounding. The grandmother does not engage in parenting.

CASE CONCEPTUALIZATION WORKSHEET (Page 2)

Diagnosis or Problem Behavior

Automatic Thoughts or Core Beliefs

Feelings Behaviors Physiological Symptoms

Depression

I am never going to be accepted. I am worthless.

Sadness, Irritability Withdrawal from family Not doing schoolwork Using drugs to numb

Loss of appetite

Triggers: What things lead client to feel this way? Conflict with dad, failure at school

Response: How do others respond when client feels/does this? Dad yells and threatens him




Suicide attempt

No one understands me. I am a failure.

Anger, Despair, Hopeless Took mom’s depression medications, did not tell anyone, grandmother found him unconscious, called 911

Agitation, Anxious

Triggers: What things lead client to feel this way? Big fight with dad, dad telling him to get the hell out of the house, that he is worthless, and that he won’t have a son who is a “queer” or “pot head.” Also said he is going to burn in hell.

Response: How do others respond when client feels/does this? Dad was kind for about a month after the hospitalization.




Marijuana Use

I need to escape. I can’t stand the way I feel.

Sad, hopeless Uses pot alone and with friends. Does not do homework when high.

Agitation, tension

Triggers: What things lead client to feel this way? Conflict with dad, academic failure

Response: How do others respond when client feels/does this? Conflict at home with both dad and mom, teachers give failing grades

Pseudoname:_Karina

Screening Results



P Depression SMFQ No

T Mania ASMRS No


P General Anxiety SCARED-GAD scale Yes

T Social Anxiety SCARED-Social scale Yes

P Social Anxiety SCARED-Social scale Yes





T School Avoidance SCARED-School scale Yes

P School Avoidance SCARED-School scale Yes

T PTSD SCARED-PTSD scale No

T OCD Spence OCD scale No

P OCD Spence OCD scale No




P Externalizing PSC17 Ext scale No

T Alcohol/Drugs CRAFFT 2.0 No

T Eating ChEAT No


T Suicidal Ideation C-SSRS-SR Yes No / Last month

T Suicide Attempt C-SSRS-SR Yes No / 2 years ago



Other Notable Concerns (e.g., Psychosis, Aggressive, etc.):_ acculturation differences

between parent and teen

CC CBT CASE CONCEPTUALIZATION WORKSHEET (Page 1) Presenting Problem

Pseudoname: Karina Nervous about school; logs in but won’t turn on camera or participate in class; worry thoughts about teachers and peers judging her; grades have started slipping; has stopped face timing with friends and refuses to meet up with them outside; teachers have expressed concern that they have “lost track of her” and don’t know what is happening with her

Age Sex & Gender Sexual Orientation

Race & Ethnicity

SES Living Situation

Family Country of Origin / Immigration / Acculturation / Cultural Practices

15

Female/woman/cisgender Heterosexual white and Korean

Middle income

Mom, Dad, and Younger Sister (age

12)

Dad immigrated from Korea to U. S. as a teen; Mom grew up in the U. S. and is

white. Dad tends to prefer more traditional Korean values about

parenting and teen behavior; Mom is more flexible but tries to stay “on the

same page as Dad”. Family Relationships Peer Relationships Academic History/School Functioning

Karina has typically had low conflict with her parents. She states that this is because she feels like she cannot

disagree with her parents. Lately they have been fighting more. Her father does not want her to watch certain tv shows that her friends are allowed to watch or to start dating until she is 18; she is starting to feel frustrated by this. She is not allowed to be on social

media but her friends are allowed to have social media accounts.

Karina has always had a few close friends but has never had a large friend

group. She feels more disconnected from friends during the pandemic

because they are connecting on social media and she is not allowed to have

social media accounts.

Has always done well in school; Has become more and more hesitant

to participate so her grades are starting to slip.

Mental Health/Substance Use & Treatment History (client)

Mental Health/Substance Use History (family)

Medical & Developmental History (include sleep & eating)

Has never tried alcohol or illegal drugs; Has always been anxious and “introverted” but used to

socialize more. World has been “shrinking” since the pandemic started. Has never been in mental health

treatment before.

Karina’s family has never been in mental health treatment before. Her parents occasionally drink socially but

do not use other substances.

Typical developmental history; eats regularly; no problems with weight;

no major medical problems; She reports sleeping regularly about 7-9

hours a night.

Trauma History (include oppression / discrimination / racism) Family Discipline Practices Karina states that people who don’t know her well make assumptions about her because she is Asian-American; members of her Korean church make stereotypes about Mom because she is white; the family doesn’t go to the church very much anymore because of this.

Parents try very hard to stay on the same page but sometimes disagree about what is appropriate/ok for teens. Family has used grounding as a consequence in the past.

CASE CONCEPTUALIZATION WORKSHEET (Page 2)




Social Anxiety/Social Phobia

“They are judging me” “Everyone will stare at my face on the camera and see blemishes” “I’ll say something stupid” “I’ll look ridiculous if I try to talk too much on zoom” “We’ve lost touch so much that they probably hate me by now – there’s no point in trying to reach out.”

Anxiety/fear Camera turned off; avoidance of talking; avoidance of friends; does not respond to texts; Has not turned in all her school work;

Breathing fast when thinking about school; heart racing when gets a phone call;




Potential Depression

“No one cares if I’m participating or not.” “No one cares if I’m on the group chat or not”

Sadness; feels like it is so much effort to try to do anything outside

Withdrawal; not responding to invitations.

More tired than usual

CC CBT TREATMENT PLANNING WORKSHEET

Please check those that apply to your case. You can add checks as treatment progresses.

TEEN SESSIONS DESCRIPTION OF SKILL

Problem-Solving Poor decision making when faced with triggers/stressors/problems?

Thinking Patterns Untrue or unhelpful beliefs that drive negative feelings and behavior?

Affect Management Difficulty regulating negative affect or uncomfortable physiological symptoms?

Coping w/Urges or Intense Emotion

Urges to engage in maladaptive behavior or strong emotions that drive maladaptive behavior (cutting, drinking, hitting, etc.)?

Diet & Pleasant Activities

Poor eating habits or low healthy pleasant activities on a regular basis?

Improving Sleep Inadequate sleep (<8 hours) or trouble falling/staying asleep?

Assertive Communication

Conflictual relationships or trouble communicating wants/needs?

Chain Analysis Repeated patterns of high risk behavior (suicide attempts, non-suicidal self-injury, substance use, running away, etc.)?

Facing Fears Significant anxiety and/or avoidance of situations that trigger anxiety?

Increasing Support

Poor prosocial peer/other supports or lack of activities with peers outside of school?


Reluctance or resistance toward making changes to get better?

PARENT SESSIONS DESCRIPTION OF SKILL

Problem-Solving Trouble generating good options to manage difficult parenting situations?

Thinking Patterns Untrue/unhelpful beliefs about parenting or child that may drive poor parenting decisions or negative feelings toward child?

Affect Management Difficulty regulating negative affect in parenting situations (yelling, saying hurtful things, etc.)?

Positive Parenting Trouble validating child’s feelings or noticing good things child does? Poor parent-child relationship?

Parental Monitoring Poor knowledge of child’s whereabouts, friends, or what child is doing or child engages in high risk behaviors (substances, sex, etc.)

Limit Setting & Contracting

Difficulty getting child to follow house rules or expected behavior (curfew, homework, abstinence from alcohol or drugs, etc.)


Trouble following through on what is needed to help child get better (therapy attendance, using parenting skills outside of session, etc.)

FAMILY SESSIONS DESCRIPTION OF SKILL

Introduction to Treatment

Complete with all families, first session in treatment

Family Problem-Solving

Difficulty resolving family problems or frequent disagreements among family members?

Family Connectedness

Loss of memory of what family members love about one another or conflictual family relationships?

Family Communication

Poor communication with one another or frequent arguments among family members?

Suicide Supplement

Child reports suicidal thoughts, threats, plans, or behaviors?

Relapse Prevention Complete with all families, termination or discharge session

SELECT ORDER OF TREATMENT TARGETS

1 Use skills to address life threatening behaviors first (e.g., suicide attempt/ideation/threat/plan, non-suicidal self-injury, heavy alcohol use, heavy drug use, running away, etc.)

LIST life threating behaviors (if applicable):

2 Use skills to address disorders/behaviors that cause client most distress or impairment or client chooses to work after you address life threatening behaviors.

LIST disorders/behaviors that cause distress or impairment with rating of distress (1=low to 5=high)

3 Use skills to address therapy interfering behaviors (e.g., no shows, no/poor session participation) as needed.

LIST therapy interfering behaviors (if applicable):

SELECT ORDER OF SKILLS

1 Introduction to Treatment (if client is suicidal will need to use Suicide Supplement Session)

2 Next 3 sessions in order: Problem-Solving, Thinking Patterns, Affect Regulation to address trigger most strongly related to primary treatment target unless need to increase motivation for/address problem preventing change (e.g., motivational enhancement, improving sleep)

3 Use your case conceptualization and weekly assessment to help guide selection of other skills and end treatment with Relapse Prevention as final session.

REMEMBER

Practice skills taught multiple times in relation to new triggers to increase skill generalization. One skill (e.g., sleep) may lead to improvement in multiple areas (depression, anxiety, anger, etc.) Do not begin family sessions until you believe the adolescent and parent(s) are ready.

RECORD ALL COGNITIVE DISTORTIONS AND MIND TRICKS (Black & White Thinking, Predicting the Worst, Missing the Positive, Feelings as Facts, Jumping to

Conclusions, Mind Reading, Expecting Perfection)

RECORD ALL SOCRATIC QUESTIONS

(Is this belief true? Is this belief helpful? What would a friend say if he/she/they heard this belief?)

MIND TRICKS TEEN VERSION

BLACK & WHITE THINKING

Viewing a situation or person as all good or bad, without noticing points in between.

Example: My mom will never understand me.

Dispute: My mom tries and we have had some good talks in the past.

PREDICTING THE WORST

Predicting the future negatively without considering other more likely outcomes.

Example: My depression has been around so long I am never going to feel better.

Dispute: I have to give time for therapy and medication to work. I can get better.

MISSING THE POSITIVE

Focusing on the negatives and failing to recognize positive experiences and qualities.

Example: I failed another math test. I can’t do anything right.

Dispute: There are a lot of things that I do really well.

FEELINGS AS FACTS

Believing something is true just because it is “felt” it so strongly without any evidence.

Example: Things are never going to get better between me and my friend. I just know it.

Dispute: We are in a rough patch. We have made it through tough times before.

JUMPING TO CONCLUSIONS

Deciding that things are bad without any definite evidence.

Example: He did not call me when he said he would. He must not like me anymore.

Dispute: There are many reasons he may not have called, like getting stuck at work.

MIND READING

Assuming that you know what others are thinking without asking.

Example: My teacher must think I am not trying because I forgot my homework again.

Dispute: Teachers know kids do not turn in homework for many reasons. I can tell her mine.

EXPECTING PERFECTION

Expecting that you (or others) should do or say things perfectly.

Example: I can’t believe my dad said that in front of my friends. What is wrong with him?

Dispute: My dad, like me, make mistakes. No one is perfect.

A-B-C-D-E Worksheet 1st Step: Activating Event What negative event happened? _______________________________________________________ 2nd Step: Beliefs (skip 2nd step) What were you thinking that lead you to feel how you described below? 1_________________________________________________________ 2_________________________________________________________ 3_________________________________________________________ 4_________________________________________________________ 3rd Step: Consequences or Feelings (go back to 2nd step) How did you feel after the negative activating event? 1_____________________________ 2____________________________ 4th Step: Disputes Are your beliefs about the negative event really true? Are they helpful? What would you say to someone close to you who had the same belief? 1___________________________________________________________ 2___________________________________________________________ 3___________________________________________________________ 4___________________________________________________________ 5th Step: Effect “I feel better”

HELP WITH DISPUTING BELIEFS 1. Is this belief true? Does it have a Mind Trick? 2. Is this belief helpful? Does it help me feel the way I want? 3. What would you say to a friend or someone you care about who had the same belief?

CHAIN ANALYSIS

VULNERABILITY à TRIGGER à LINKS (BEHAVIORS, THOUGHTS, BODY TALK, FEELINGS) à PROBLEM BEHAVIOR à CONSEQUENCES

WHAT IS THE PROBLEM BEHAVIOR THAT I AM WORKING ON? ______________________________________________________________________________ ______________________________________________________________________________ WHAT THINGS IN MYSELF AND MY SURROUNDINGS MADE ME VULNERABLE? (e.g., poor sleep, skipped meals, physical illness/discomfort, missed medication, isolation, etc.) 1)______________________________________ 2)______________________________________ 3)______________________________________ 4)______________________________________ 5)______________________________________ 6)______________________________________ WHAT TRIGGER STARTED ME ON THE CHAIN TO PROBLEM BEHAVIOR? (e.g., invitation to go out with friends, argument, bullying incident, poor grade, low mood, etc.) ______________________________________________________________________________

CHAIN ANALYSIS LINKS: BEHAVIORS, THOUGHTS, BODY TALK, FEELINGS

List links: Behavior Thought(s) Body Talk Feeling 1st _________________________________________________________________________________________________ 1st (new)____________________________________________________________________________________________ 2nd ________________________________________________________________________________________________ 2nd (new) ___________________________________________________________________________________________ 3rd ________________________________________________________________________________________________ 3rd (new)____________________________________________________________________________________________ 4th ________________________________________________________________________________________________ 4th (new)____________________________________________________________________________________________ 5th ________________________________________________________________________________________________ 10th____5th (new)_____________________________________________________________________________________________

Situations That Trigger Anxiety

Situation Fear Rating

0=Easy to Face 10=Difficult to Face

*Type of Fear

* Examples of types of fear include social, dirt/germs, order, animals, insects, crowds, small spaces, etc.

Fear Ladder for _____________________ (Goal)

Steps Toward This Goal (Easy to Hard) Fear Rating

0 = Easy to Face 10 = Hard to Face

CC-CBT TEEN TREATMENT MENU NAME OF SESSION OBJECTIVE

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