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ISSUE BRIEFS | JANUARY 2013
Alternatives for Families:
A Cognitive-Behavioral
Therapy (AF-CBT)
Families that experience conflict, coercion, WHAT'S INSIDE
and/or physical abuse create substantial
risk to children for the development of What makes AF-CBT unique
significant psychiatric, behavioral, and
adjustment difficulties, including aggression,
poor interpersonal skills/functioning, and Treatment phases and key components
emotional reactivity. Caregivers in such
families often report punitive or excessive
parenting practices, frequent anger and Target population
hyperarousal, and negative child attributions,
among other stressful conditions. During the Effectiveness of AF-CBT
past four decades, research has documented
the effectiveness of several behavioral and
cognitive-behavioral methods, many of which What to look for in a therapist
have been incorporated in alternatives for
families: a cognitive-behavioral therapy (AF-
CBT). Conclusion
Resources for more information
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov
1
AF-CBT is an evidence-supported WHAT MAKES AF-CBT UNIQUE
intervention that targets (1) diverse individual
child and caregiver characteristics related AF-CBT is designed to intervene with families
referred for conflict or coercion, verbal or
to conflict and intimidation in the home and
physical aggression by caregivers (including
(2) the family context in which aggression or
abuse may occur. This approach emphasizes the use of excessive physical force or threats),
training in intra- and interpersonal skills behavior problems in children/adolescents, or
designed to enhance self-control and reduce child physical abuse. The treatment program
violent behavior. AF-CBT has been found has been expanded to accommodate children
to improve functioning in school-aged and adolescents with physical abuse or
discipline-related trauma symptoms, such as
children, their parents (caregivers), and their
posttraumatic stress disorder (PTSD).
families following a referral for concerns
about parenting practices, including child AF-CBT addresses both the risk factors and
physical abuse (Kolko, 1996a; Kolko, 1996b; the consequences of physical, emotional,
Kolko, Iselin, & Gully, 2011), as well as a child's and verbal aggression in a comprehensive
behavior problems (Kolko, et al., 2009; Kolko, manner. Thus, AF-CBT seeks to address
Hoagwood, & Springgate, 2010; Kolko, Campo, specific clinical targets among caregivers
Kilbourne, & Kelleher, 2012). that include heightened anger or hostility,
This issue brief is intended to build a better negative perceptions or attributions of their
understanding of the characteristics and children, and difficulties in the appropriate
and effective use of parenting practices,
benefits of AF-CBT, formerly known as abuse-
such as ineffective or punitive parenting
focused cognitive behavioral therapy (Kolko,
practices. Likewise, AF-CBT targets children’s
2004). It was written primarily to help child
difficulties with anger or anxiety, trauma-
welfare caseworkers and other professionals
related emotional symptoms, poor social
who work with at-risk families make more
and relationship skills, behavioral problems
informed decisions about when to refer
children and their parents and caregivers that include aggression, and dysfunctional
to AF-CBT programs. This information also attributions. At the family level, AF-CBT
addresses coercive family interactions by
may help parents, foster parents, and other
teaching skills to improve positive family
caregivers understand what they and their
relations and reduce family conflict.
children can gain from AF-CBT and what to
expect during treatment. In addition, this
issue brief may be useful to others with an
interest in implementing or participating
in effective strategies for the treatment of
family conflict, child physical abuse, coercive
1
parenting, and children with externalizing
behavior problems.
¹ Coercive parenting refers to parenting by domination, intimidation, or
humiliation to force children to behave according to (often unrealistic) norms
set by parents.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 2
REFLECTS A COMPREHENSIVE TREATMENT Developmental victimology, which
STRATEGY describes how the specific effects
The diversity of family circumstances of exposure to traumatic or abusive
and individual problems associated with experiences may vary for children at
family conflict points to the need for a different developmental stages and across
comprehensive treatment strategy that the life span
targets both the contributors to caregivers' Psychology of aggression, which describes
behavior and children’s subsequent behavioral the processes by which aggression and
and emotional adjustment (Chadwick Center, coercion develop and are maintained,
2004). Treatment approaches that focus on which can help to understand one’s history
several aspects of the problem (for example, as both a contributor to and victim of
a caregiver's parenting skills, a child's aggressive behavior
anger, family coercion) may have a greater AF-CBT pulls together many techniques
likelihood of reducing re-abuse and more fully currently used by practitioners, such as
remediating mental health problems (Kolko behavior and anger management, affect
& Swenson, 2002). Therefore, AF-CBT adopts regulation, problem-solving, social skills
a comprehensive treatment strategy that training, cognitive restructuring, and
addresses the complexity of the issues more communication. The advantage of this
completely. program is that all of these techniques,
INTEGRATES SEVERAL THERAPEUTIC relevant handouts, training examples, and
APPROACHES outcome measures are integrated in a
AF-CBT combines elements drawn from the structured approach that practitioners and
following: supervisors can easily access and use.
Cognitive therapy, which aims to change TREATS CHILDREN AND PARENTS
behavior by addressing a person's thoughts SIMULTANEOUSLY
or perceptions, particularly those thinking During AF-CBT, school-aged children (5-15
patterns that create distorted views years) and their caregivers participate in
Behavioral and learning theory, which separate but coordinated therapy sessions,
focuses on modifying habitual responses often using somewhat parallel treatment
(e.g., anger, fear) to identified situations or materials. In addition, children and parents
stimuli attend joint sessions together at various times
Family therapy, which examines patterns throughout treatment. This approach seeks to
of interactions among family members to address individual and parent-child issues in
identify and alleviate problems, and offers an integrated fashion.
strategies to help reframe how problems
are viewed
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 3
DISCOURAGES AGGRESSIVE OR VIOLENT TREATMENT PHASES AND KEY
BEHAVIOR COMPONENTS
The AF-CBT approach is designed to promote AF-CBT is a short-term treatment typically
appropriate and prosocial behavior, while provided once or twice a week, which may
discouraging coercive, aggressive, or violent require 18 to 24 hours of service (or longer,
behavior from caregivers as well as children. based on individual needs) over 4 to 12 months
Consistent with cognitive-behavioral (although treatment may last as long as
approaches, AF-CBT includes procedures that determined necessary). Treatment includes
target three related ways in which people separate individual sessions with the child and
respond to different circumstances: caregiver/parent and joint sessions with at
Cognition (thinking) least both of them. Where necessary, family
Affect (feeling) interventions may be applied before, during,
or after the individual services. The treatment
Behavior (doing) program for children, caregivers, and families
AF-CBT includes training in various incorporates the use of specific skills, role-
psychological skills in each of these response playing exercises, performance feedback, and
channels that are designed to promote home practice exercises.
self-control and to enhance interpersonal Generally, the following are the goals of AF-
effectiveness. CBT treatment
TAILORS TREATMENT TO MEET SPECIFIC Reduce conflict and increase cohesion in
NEEDS AND CIRCUMSTANCES family
AF-CBT begins with a multisource assessment Reduce use of coercion (hostility, anger,
to identify the nature of the problems the verbal aggression, threats) by the caregiver
child is experiencing, specific parental and and other family members
family difficulties that may be contributing Reduce use of physical force (aggressive
to family conflict, and the child's and family's behavior) by the caregiver, child, and, as
strengths that may help influence change. relevant, other family members
Tailoring the treatment to the family’s specific Promote nonaggressive (alternative)
strengths and challenges is key to efficient discipline and interactions
outcomes (Kolko & Swenson, 2002).
Reduce child physical abuse risk or
recidivism (prevention of child welfare
system involvement or repeated reports/
allegations)
Improve the level of child’s safety/welfare
and family functioning
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 4
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