Cognitive Behavioral Therapy

This paper will present the cognitive behavioral therapy program at Deer Creek Psychological Associates, and specifically programs at the Hanover, N.H. office of Dr. Raymond Chin PhD, MFA and associates. This paper will present ideas and theories of cognitive behavioral approach and therapies at Deer Creek. Methods and therapy practices will be discussed in detail as implemented by Dr. Chin, for behavioral change among children with, including but not limited to, stress and anxiety disorders, Autism, ADHD, aggressive disorders, and medically related disorders.

Cognitive Behavioral Therapy

“[Cognitive behavioral therapy] encompasses many techniques aimed at curbing problem behaviors, such as interrupting, obsessions, meltdowns or angry outbursts, as well as developing skills like recognizing feelings and coping with anxiety. Cognitive behavior therapy usually focuses on training a child to recognize a troublesome situation – such as a new place or an event with lots of social demands – and then select a specific learned strategy to cope with the situation.” Cognitive behavioral therapy (CBT) is based on ideas that our thoughts, not external things such as people, situations, or events, cause our feelings and behaviors.

Much like behavioral therapy cognitive behavioral therapy focuses on the present situation the client is faced with. Therapy begins with the identification of distorted perceptions or thought patterns which are problematic. Cognitive behavioral therapy is generally a short-term therapy used to change beliefs and perception through instruction, modeling, and by giving individuals the opportunity to rehearse new attitudes and responses as well as practice them in real-life situations. “It’s an intense, short-term treatment that helps you recognize and change harmful thoughts and behaviors.” (Gray, 2008, p. 44) CBT can be used alone or combined with other therapies or medication in changing unwanted or irrational behavior.

Deer Creek Psychological Associates

“Deer Creek Psychological Associates is a multi-disciplinary group practice offering a variety of psychological and medical services to children, adults and families.” (deercreekpsych.com, 2008) Deer Creek Psychological Associates team consists currently of eight Doctors, five of whom hold the PhD title, one MD, two PsyD holders, a business manager, three social workers and a black lab named Plato. Each team member specializes in one or more areas in the field of psychology. Deer Creek offers individual, couples, and family therapy. Clinicians at Deer Creek provide educational, psychological, neuropsychological, neurological, and disability evaluations as well as consultations to parents, allied professionals, schools and other human service agencies.

Dr. Raymond Chin PhD, MAFF

Dr. Raymond Chin PhD, MAFF is a child and family clinical psychologist who specializes in pediatric behavioral medicine. Dr. Chin, also a cognitive behavioral therapist, works mostly with a wide range of children with stress and anxiety disorders, Autism, ADHD, aggressive disorders, or medically related disorders. He uses a proactive approach, stating that, “Pro-action is much harder than reaction, but more effective. We should always reinforce what to do, never what not to do. Reinforcing what to do is teaching and pro-active, whereas reinforcing what not to do is punishing and reactive.” (Chin, CBT seminar, May 21, 2008)

Dr. Chin uses the example of a young child suffering from an anxiety disorder to explain a cognitive behavioral therapy approach he used implementing his pro-active approach. Dr. Chin explained that if a child such as the one he treated where picking his/her fingernails, for example, and if the child was constantly told not to do so, that the behavior would subconsciously worsen. The reasoning, Chin explains, is that the child is subconsciously reminded constantly of the behavior. “Even though the child is thinking `don’t pick he does it automatically, because he is thinking about it. The more you think about a behavior, good or bad, the more you do it” (Chin, personal communication May 21, 2008) Dr. Chin suggested a better way to go about the “picking” behavior is proactively, meaning “Let the child know what he can do. Tell him he can put on gloves. Tell him he can hold his hands apart, one on each side of his desk. Then reward him for doing these things that stop his picking.” (Chin, personal communication May 21, 2008) Dr. Chin has used this and other techniques to reinforce `what to do. Through pro-active reinforcement of preventative behaviors the `good behaviors become learned and automatic. “Now the child is constantly thinking of ways to refrain from picking, and simply does things like holding his hands apart automatically.” (Chin, personal communication May 21, 2008)

Dr. Chin works directly with children individually at his Hanover, N.H. clinic. His specialization being behavioral medicine, he uses the cognitive behavioral therapy more than other types of therapy. Dr. Chin consults area schools and child services organizations. In addition he also teaches seminars on Cognitive Behavioral Therapy.

Dr. Chin expresses how important it is to understand each child’s constraints. As an Example he lists off constraint violations to a diverse group of parents and teachers of children with a wide range of disorders, (including low IQ, to ADHD, obsessive compulsive disorder, various disabilities, and those of the autism spectrum among others) attending one of his seminars on cognitive behavioral therapy. Some examples he uses are: “Do not tell a child with ADHD that he will have extra time for a test. He wants that thing done five minutes ago.” (Chin, CBT seminar, May 21, 2008) The group chuckles and half of them nod in agreement. “Why shouldn’t you ask a child with Asperger Syndrome to tell you how the other guy felt? Simple,” states Dr. Chin, “the child with Asperger’s doesn’t know. Tell that same child I like your vest sarcastically and roll your eyes. He’s going to thank you, because that would be the correct response to `I like your vest`.” (Chin, CBT seminar, May 21, 2008) The second time Dr. Chin said “I like your vest,” he said it nicely as if he meant it as a compliment.

The child with Asperger Syndrome, who cannot identify tone or expression, needs to be taught about sarcasm, according to Dr. Chin. Dr. Chin goes on to explain how much we take for granted. He uses another example of a child with ADHD to get this point across, “The child with ADHD is tapping away with his pen on his leg. The teacher is mad, thinking he is being defiant. But in reality he just has to keep himself busy, `awake. The child is tapping trying to keep his brain awake and stay focused on the lesson. It is very much the same thing when we are driving, and we cannot stay awake. How many of you do the same as me? You roll down the window, crank up the stereo, sing at the top of your lungs and tap to the beat on the steering wheel. When we are tired this is how we stay focused on the driving. A kid with ADHD taps to stay focused on the classroom.” (Chin, CBT seminar, May 21, 2008) Dr. Chin expresses that it is important to understand “intent” rather than outcome.

Conclusion

“Cognitive-Behavioral Therapy is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.” Cognitive Behavioral Therapy as an effective approach to helping has spread to be one of the most frequently used methods around the globe. CBT is individualized to meet the needs of the client. Dr. Chin, a highly praised cognitive behavioral therapist, uses individualized therapies to meet the specific needs of his clients. Dr. Chin has helped many families and many children who claim without his help to never have had the chance to live a fulfilling life.