Accentuate the positive

6th April 2007 at 01:00
A short journey of self-discovery can be a lifeline for troubled pupils, says Kairen Cullen

Cognitive behavioural therapy or CBT is the current mental health favourite when it comes to cheering people up. The evidence shows it works with a range of psychological problems, such as anxiety, depression, post-traumatic stress disorder and obsessive compulsive disorder (Beck et.

al., 2006).

Its use with children and young people is less well researched, although there is some evidence of short-term gains where there are clear-cut difficulties (Stallard, 2005).

So what are its key ideas? A core notion is that each aspect of how we behave, think and feel, physically and emotionally, is interlinked. In other words, if one aspect changes, everything changes.

CBT uses a clear framework and a range of systematic behavioural and cognitive techniques to help people explore what is going on and develop new skills to help themselves. Based on a collaboration between client and therapist, it can be seen as a personal project of self-discovery and learning, which is time-limited and usually relatively brief.

The following examples (names and some details have changed) illustrate the opportunities and issues it can present. Sam and Beth were bright Year 8 pupils who had been doing well until they started at their secondary schools. After that, they had become increasingly disaffected and unhappy.

Sam, a former primary school football star, started to miss lessons and opt out from social and sporting activities. Similarly, Beth, after joining every club and team possible in Year 7 and excelling in her studies, started to truant and to appear very lethargic and sad when she did attend.

School staff were at a loss and the parents were worried sick so I was asked, as educational psychologist for the schools, to become involved.

Sam, encouraged by his tutor, was happy to talk to me about possible ways of making some changes. He liked what I had to say about CBT so I arranged sessions with a therapist for eight weeks.

Put simply, he had found the transition to secondary school very difficult.

He had moved with his family from another part of the country so he had to say goodbye to a particularly close-knit social group and his place in the football team. This, added to the stresses of a new, very different secondary school, had resulted in a severe loss of confidence.

He had developed an unhelpful view of himself as a member of a group and therefore increasingly shunned social situations, not risking rejection by groups like his new school's sports teams or clubs.

With the help of his therapist, he started to recognise, examine and challenge his negative assumptions and substitute more constructive ideas and behaviour. The result was improvement all round.

But with Beth, CBT worked less well. She had managed the secondary transition quite well but was opting out of school so she could stay at home with her depressed mother. The only way she would attend therapy sessions, albeit half-heartedly, was if her mother brought her.

After only three sessions, Beth stopped attending. She found it hard to do the between-session "homework" tasks and the situation had become worse with a sibling leaving home. Although she started to gain more understanding of what was driving her choices about school attendance and social development, it became clear she was unlikely to make progress until her mother received mental help.

Beth's case offers a stark reminder that staff should consult with qualified colleagues (usually the school's educational psychologist) if they are concerned about the possibility of mental health problems. It also shows that cognitive behavioural therapy has its limitations. However, the approach has a lot to offer as a way of understanding and supporting people. Educational psychologists can help teachers use CBT ideas in more preventative and less individualised work with groups or whole classes Kairen Cullen is a chartered educational psychologist.


Butler, AC, Chapman, JE, Forman, EM and Beck, AT (2006) The empirical status of cognitive-behavioural therapy: A review of meta-analyses Clinical Psychology Review Vol. 26, Issue 1, January 2006, Pages 17-31 Stallard, P (2005) A Clinician's Guide to Think Good Feel Good: The Use of CBT With Children and Young People (John Wiley, Winchester)

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