What Format and Content Are Used in AF-CBT?

Treatment includes separate individual sessions with the child and caregiver/parent, and joint sessions with at least both of them.  Where necessary, family interventions may be applied before, during, or after the individual services. Treatment incorporates the use of specific skills, role-playing exercises, performance feedback, and home practice exercises. The techniques, relevant handouts, training examples, and outcome measures are integrated in a structured approach designed to enhance accessibility to practitioners and supervisors.

AF-CBT includes three treatment phases designed for both the caregiver and child:

• Engagement and Psychoeducation
• Individual Skill-Building
• Family Applications  

The sequence for conducting the treatment proceeds from teaching intrapersonal skills first (e.g., cognitive, affective), followed by interpersonal skills (e.g., behavioral). Topics/sessions can be flexibly delivered (adapted, abbreviated, or repeated) based on the family’s progress and treatment goals.  Although AF-CBT has primarily been used in outpatient and home settings, the treatment has been more recently delivered in inpatient and residential settings when there is some ongoing or potential contact between the caregiver and the child.  The primary content in each topic noted below is organized into three phases and is reflected in the acronym, A-L-T-E-R-N-A-T-I-V-E-S.

PHASE I: ENGAGEMENT and PSYCHOEDUCATION

• TOPIC 1: Orientation–Caregiver and Child
• TOPIC 2: Alliance Building and Engagement–Caregiver
• TOPIC 3: Learning about Feelings and Family Experiences–Child
• TOPIC 4: Talking about Family Experiences and Psychoeducation–Caregiver

PHASE II: INDIVIDUAL SKILL-BUILDING (Skills Training)

• TOPIC 5: Emotion Regulation–Caregiver
• TOPIC 6: Emotion Regulation–Child
• TOPIC 7: Restructuring Thoughts–Caregiver
• TOPIC 8: Restructuring Thoughts–Child
• TOPIC 9: Noticing Positive Behavior–Caregiver
• TOPIC 10: Assertiveness and Social Skills–Child
• TOPIC 11: Techniques for Managing Behavior–Caregiver
• OPTIONAL TOPIC 12: Imaginal Exposure–Child
• TOPIC 13: Preparation for Clarification–Caregiver

PHASE III: FAMILY APPLICATIONS

• TOPIC 14: Verbalizing Healthy Communication–Caregiver and Child
• TOPIC 15: Enhancing Safety through Clarification–Caregiver and Child
• TOPIC 16: Solving Family Problems–Caregiver and Child
• TOPIC 17: Graduation-Caregiver and Child