In response to many of these questions, I must encourage families to re-assess their therapy if it’s not working. The first thing you want to ask in these cases is, “is my therapist truly behavioral?” In order for our approach to work, the therapist has to be willing and prepared to enact behavioral exercises IN SESSION. We can’t just count on designing a hierarchy and a reward plan and expect the school and families to implement this on their own. At our clinic we do active exposures IN SESSION. So, if a child has fears of speaking in public (as a relatively simple example), we arrange a series of social exposures in therapy. That can include giving speeches in front of a group at the clinic, it can include wandering around on campus and starting up conversations with novel college students, it could mean calling up a fellow classmate from the therapy room. Don’t underestimate the power of these simple experiments. Giving the youth practice at tolerating distress in session makes it more likely they will try these assignments at home. Ask yourself – does my therapist ever leave the therapy room with my child? Do they ever involve other people to make the exercises more “real?” If not, they may not be enacting exercises that are “real enough.”

Another great website for more information on evidence-based treatments (like cognitive behavioral therapy) is http://www.effectivechildtherapy.com.

It is the official website of the Division of Child and Adolescent Clinical Psychology of APA and gives lots of great education about a variety of childhood problems and effective treatments.