08 Self Affirmation

Protocol Guide

Cognitive Change Doing

CBT#01 – Perceiving Reflex Thoughts CBT#27 – Motivation & Goal Setting
CBT#32 – The Pathological Critic CBT#12 – Getting Mobilized
CBT#02 – Altering Limited Thinking Patterns Modified
CBT#03 – Changing Distressing Thoughts
CBT#06 – Thought Stopping
CBT#21 – Self Verbalization Training
CBT#23 – Assertiveness Training
CBT#09 – Coping Imagery
CBT#30 – Anchoring

Confirmation

Social Learning Family Intervention

The final selection and sequencing of techniques is ultimately the responsibility of the clinical supervisor. However, this protocol identifies a process and selection that can be used to guide those decisions.

INTRODUCTION

One of the main factors differentiating humans from other animals is the awareness of self: the ability to form an identity and then attach a value to it. In other words, you have the capacity to define who you are and then decide if you like that identity or not. A positive and realistic self appraisal is essential for psychological survival. When you reject parts of yourself, you greatly damage the psychological structures that literally keep you alive.

In the same way that one would favor and protect a physical wound, a person with negative self appraisal finds him/herself avoiding things that might aggravate the pain of self rejection in any way. S/he takes fewer social, academic and career risks. This limits the ability to open him/herself up with others, ask for help, or solve problems.

Studies of young children clearly show that the parents’ style of child management during the first three or four years of life determines the amount of self esteem that a child starts with. This is because the parents supply many of the mental representations that make up the child’s theory of meaning about self, others and future prospects. It should be noted, however, that the process is interactive and the child may interpret the parents communication negatively, positively or realistically. There is the classic ‘chicken and egg’ problem here: your self esteem grows out of your circumstances in life and your circumstances in life are strongly influenced by your judgements about yourself.

The fact is that self esteem and personal circumstances are only indirectly related. The other intervening factor that determines self esteem is your thoughts, particularly the attributions that you make about why things happen. Attribution theory is concerned with analyzing the cognitive processes that underlie causal explanations. It is a theory of the ways people try to ‘make sense of’ events by setting them in a causal framework.

When individuals engage in an activity, they may attribute their outcomes to the operation of one or more causal factors. A growing body of research has focused on the conditions that influence the tendency to ascribe responsibility to personal forces (e.g., ability and effort) or to impersonal forces over which the individual has little control (e.g., situation and bad luck). When an individual externalizes the cause for success and/or failure, they reduce themselves to an object of the process, not in control. If this object orientation becomes too generalized, the view of oneself as a ‘victim’ of circumstances, rather than as the master of one’s fate, become a character trait.

There are, thus, two kinds of self affirmation problems: situational and characterological. Negative self appraisal that is situational tends to show up only in specific areas. For example, a person might have confidence in him/herself in some areas of life, but not in others. “I read well, but cannot do math.” Characterological self rejection, often having roots in early experiences of abuse or abandonment, derives from a basic identity statement: a feeling of being bad. While both can be addressed through cognitive behavior management, the first is usually addressed predominantly through cognitive error correction while the second may require a deeper cognitive restructuring. Both, however, are enhanced by a process of doing.

…what produces self-esteem and a sense of competence and protects against depression is not the absolute quality of experience but the perception that one’s own actions controlled the experience. Seligman

Seligman goes on to point out that by emphasizing how a child feels, at the expense of what a child does – mastery, persistence, overcoming frustration and boredom and meeting challenge – parent and teachers are making this generation of children more vulnerable to depression.

Thus, addressing self esteem requires at least two functions: the first is getting the child going, doing things and having experiences. A feature of the affirmation problem is the expectancies of the individual. Since s/he sees him/herself as having little or no control over the outcome of endeavors, s/he expects to be unsuccessful. And as Henry Ford is said to have stated: “If you believe you can or you believe you can’t – you are right!”

The second function is concerned with interpreting [judging, appraising] the experience and the reasons for the outcomes of those experiences differently. William James, the father of modern psychology, had a formula for it: Self Esteem = Success

Pretensions

The more success achieved and the lower the expectations, the higher the self esteem. We can feel better about ourselves either by succeeding more in the world or by downsizing our hopes. It seems that too often we opt for lowering expectations to the point that children are praised for not accomplishing anything and that responses to failure are catastrophic. Both unearned praise and catastrophic responses to failure are distortions of reality. The ‘everyone is special’ focus, of course, makes no one special.

Seligman suggests that there is no effective technology for teaching feeling good that does not first teach doing well. Feelings of self esteem in particular, and happiness in general, develop as side effects of mastering challenges, working successfully, overcoming frustration and boredom, and winning. The feeling of self esteem is a by product of doing well.

Seligman thus reiterates the ‘chicken and egg’ theme. There is a paradox here. Negative self affirmation which is based on distorted thoughts about self and others and a process of correcting these distorted thoughts, and thereby enhancing the child’s feelings about him/herself, creates the basis for success. There is a part of this reorientation process where the individual must acknowledge that there is a realistic basic worthiness to simply being human. But this is only the baseline affirmation. From there, the child must begin to see that how s/he thinks affects how s/he behaves and how s/he behaves affects how people respond, and how people respond reinforces the self appraisal – good or bad.

So the first step in doing is to take the responsibility to examine oneself rationally and accurately. We are recommending a protocol to address the feelings of self affirmation with full recognition that lowering standards is not effective except as a developmental step in the continuous quality improvement process. We are not suggesting that having the child simply tell him/herself and having others tell him/her good things is sufficient. Saying does not make it so – it only makes it possible to be so. We are not limiting expectations that the child will perform competently.

We are urging an increase in expectation of the child. Placing mastery expectations sends a message to the child that s/he is worthy. Mastery performance is focused on improving one’s own performance regardless of how that performance compares to the performance of other people. It is not as important that you be the best mathematician in class, but that you improve your own performance in math.

At the same time, since even the inhibition to doing is based on cognitive expectancies, we are urging a cognitive process to help the child interpret his/her experiences differently. We will emphasize in this protocol, not positive self statement or praise from parents and teachers, but rather, accurate and realistic statements. We will urge the use of positive internal attributions, which define the child in new positive ways – I know that you will pass this test because you have worked very hard!’. Giving the child a reason that is realistic and self controlled places responsibility, gives a role, and creates a personhood.

The crisis of self affirmation stems not from an inaccurate self appraisal [the appraisal may very well be accurate in that the child is performing poorly], but an unrealistic one. If the child does not study, it is unlikely that s/he could realistically expect to pass. One must interpret him/herself realistically, and that may mean that s/he is not as ‘good’ as many of his/her peers in many things. But this does not mean that s/he must be pessimistic and catastrophic about such an interpretation. Such thoughts distort reality.

Things turn out best for those who make the best of the way things turn out. | Art Linkletter

Self esteem is probably an inappropriate label. While esteem comes from the same root as estimate and originally meant ‘to evaluate’, it has acquired a meaning according to Funk & Wagnall of “favorable estimation on the basis of worth, especially that based on moral characteristics: respect, regard”. What we are really concerned with is self affirmation – “to declare or state positively” that we are who we are and, in that affirmation, become constantly eager to better ourselves. To declare that we are OKAY. Like Popeye, ‘I yam what I yam’. I can accept and affirm that. But beyond Popeye, I strive to be better.

A few years back, ‘Corky’, a character who was played by an actor with mental retardation, epitomized this form of self affirmation. He stated affirmatively that he understood his limitations as a person with mental retardation, but that he sought to be the best person with mental retardation he could be. He affirmed himself – declaring positively that he was capable of growth and development despite his deficits.

We make the best of who we are. Two steps are required for the client, the first is to be ‘mindful’ of his/her thoughts and the second is to act toward improving his/her performance mastery. Mastery is an important linguistic component. We are identifying personal mastery, improving personal performance. We are not focused on competing with, or being better than, others. Rather, we compete with our present self, we strive to improve our own competence. The concept of continuous quality improvement come to mind, as we seek to improve our own personal performance continuously.

Remembering that we seek to help the child think differently about him/herself as one step in the process of doing better through the identification of goals and implementation plans that will enhance performance competence, this Protocol is oriented primarily toward the process of changing thought.

COGNITIVE CHANGE

The Process

1. The best place to begin is with the child’s thoughts. Ask what s/he was thinking during a recent episode of self reproach [See CBT#01 – Perceiving Reflex Thoughts]. Get as much detail as you can about the critical self-talk and then:
2. Introduce the concept of the pathological Critic [CBT# 32 – The Pathological Critic].
   1. Personify the Critic [by naming] to help the client externalize the self accusing voice.
   2. Introduce the child to his/her ‘healthy’ voice. The healthy voice is the client’s ability to think realistically. By emphasizing and strengthening this ability you are positioning the child to begin talking back to the Critic. Name the healthy voice. By creating this dichotomy between the critical voice and the healthy voice, you can encourage the client to conform the critic.
   3. Identify the main function of the client’s Critic. The critical voice is being reinforced because it serves some positive function – to promote desired behavior, paradoxically to protect self-worth, or to control painful feelings. Learning the Critic’s function sometimes requires an exhaustive inquiry, You have to explain that every thought, no matter how painful, exists because it is rewarded in some way. Ask: “What would you be forced to feel or be aware of if the Critic weren’t attacking you? How does the Critic help you here? What are you afraid you might do or fail to do without the Critic in this situation”. You may want to suggest the major function you see the Critic serving.
   4. Identifying what reinforces the Critic is half the battle. In addition, the client must learn that the important needs the Critic helps meet can be met in healthier ways. The Critic is not the only way to deal with the fear of failure, the fear of rejection, guilt, etc. New, nontoxic strategies must be devised.
3. Identify distortions in thinking that contribute to lower self appraisal. Identifying and confronting these distortions is a major component of the intervention. Defining the distortion is also defining the task. When identifying distortions, it is important to focus on the most significant ones and don’t overload the child. Three or four self critical cognitions and the commonality among them is important.
4. Start teaching the child to substitute accurate, realistic language for the toxic beliefs [See CBT#02 Altering Limited thinking Patterns &/or CBT#03 Changing Distressing Thoughts]. The best technique for arriving at a more accurate statement is in Socratic questioning. This is the method that Socrates used to expose logical inconsistencies in the arguments of his students. There are three main lines of questioning to use:
   1. Questions that expose overgeneralization. “Is it true that you always screw up? Every single task? You do nothing right?”
   2. Questions that expose faulty labeling. “Is it true that getting a B means that you’re screwing up?”
   3. Questions that expose the lack of evidence. “What evidence do you have that people think you are screwing up?”
5. Refuting the Critic is the objective. Develop specific rebuttals that the child can write down and use for each critical attack. The rebuttals are created through dialogues between the Critic and the Healthy Voice, through the Socratic Questioning, and through the three column technique. Over time you can evaluate and modify the rebuttals until they are believable and effective.
6. Thought stopping [See CBT#06 Thought Stopping]. The internal Critic is often so insistent and so caustic that there is literally no room for the healthy voice. Use Howitzer Mantras or Asking the Price [which requires the client to refocus on the cost of listening to the Critic, rather than to the critical message itself].
7. Identifying strengths. Concurrent with working to defeat the Critic must be a program to bolster the child’s awareness of genuine strengths and assets. ‘Accurate Self Assessment’ is a detailed procedure for doing this. At minimum:
   1. create a list of genuine strengths and assets
   2. identify his/her most troubling weaknesses
   3. revise the weaknesses from pejorative language to accurate, nonjudging descriptions
   4. use affirmations taken from the strengths list to make affirmative signs for displayFrom the strengths list, select two to four qualities that you genuinely appreciate in the child and work them into every session. The repetition of strengths is a must. It takes a great deal of repetition by an authority figure to undo the child’s negative programming. However, attempting to praise too many of the child’s strengths dilutes the attention give to any one of them.
8. Self acceptance. Self esteem is an attitude of acceptance and nonjudgement toward self and others. Use specific exercises to develop a forgiving, noncritical inner voice. Create a mantra of acceptance that is repeated over and over until a new attitude begins to sink in [See CBT#21 Self Verbalization Training].
9. Special focus on problems. There are four special problems that impact negatively on self esteem: 1) inflexible rules and shoulds, 2) perfectionism, 3) extreme vulnerability to criticism, and 4) nonassertiveness [See CBT#23 Assertiveness Training]. When any of these are present to a significant extent, they should be treated very specifically.
10. Reinforcing the Healthy Voice. There are several interventions you can use:
    1. Teach coping statements. These can be in the form of affirmations or specific rebuttals to Critic attacks.
    2. Visualization [See CBT#09 Coping Imagery]. These techniques will allow the child to begin seeing him/herself as confident, socially comfortable and competent. Visualization facilitates a more rapid shift in self concept because the client literally sees his/her body and behavior differently.
    3. Anchoring [See CBT#30 Anchoring]. A technique for retrieving feelings of confidence from times in the past and bringing them into the present. An ability to access positive feelings at will has a significant strengthening effect on the healthy voice.

DOING

Concurrent to the cognitive approaches or at a time scheduled by the clinical supervisor, the child should be addressing the issues identified in CBT#12 – Getting Mobilized. Although this technique is written from a focus on depression as the focus, the same process, in modified form, can be helpful to the child whose self appraisal needs to be addressed. Using this technique for self affirmation requires a focus on performance mastery more than pleasure. We tend to enjoy succeeding and, therefore, the achievement of mastery is self fulfilling.

Wilmore has suggested that goals should be behind every performance if maximum performance parameters are to be stimulated. There is a reserve in work output above a predetermined capacity that needs to be stimulated by goal setting. Physical performance without set goals will not produce the best form of physical response. Coaches who disregard the value of this simple manipulation will not stimulate the best form of training in athletes. As has been demonstrated by champion athletes, every task of training and competition must be oriented to some particular explicit goal that will focus the athlete on functioning with the greatest efficiency in performance. A physical activity at training without a goal orientation is a wasted opportunity for improvement.

There is no reason to believe that this same impact does not exist in other [cognitive, behavioral] performance arenas. Therefore, the changeworker will need to help the child identify mastery goals both in the beginning and throughout the process.

Motivation relates to the sustained interest or involvement in a goal oriented task. It is important that the child define goals, and the use of CBT#27 – Motivation and Goal Setting can be considered before, after or as an integrated feature with Getting Mobilized.

The technique of Goal Setting is a cognitive restructuring process, which is built upon the following principles:

• create the future [self-fulfilling prophecies] – A Self Fulfilling Prophecy is said to occur when one’s belief concerning the occurrence of some future event…makes one behave in a manner…that increases the likelihood that the expected event will occur….
• reframing [negative to positive] – The goal should not be related to ‘I’m too fat and must lose weight’, but rather to ‘I am thin’.
• present time perspective – The present tense time technique assists in visualizing a goal as if it already exists. A goal stated in future time is likely to always remain in the future.
• cognitive errors [shoulds] – When you have a list of ironclad rules about how you and other people “should” act, this generally means that the goals operate within the “shoulds”.
• visualization [attainment] – You can learn new behavior sequences by imagining yourself performing the desired behavior successfully. Called covert modeling, it enables a person to identify, refine, and practice in his/her mind the necessary steps for completing a desired behavior.
• intentionality – It is expectancy in the sense of that which the expecter believes is likely to occur, rather than that which a person believes ought to occur, that leads to the behavior that fulfills the prophecy.

The purpose of this technique is to assist a child with problems in living in obtaining absolute clarity on what s/he wants in every area of his/her life. If s/he is interested in improving the quality of day-to-day experiences, then s/he must define a richer, fuller, more satisfying life. S/he must face what s/he wants. This technique is designed to be a tool to determine and clarify all of the child’s personal desires, wants, and dreams; becoming aware of what they are, assessing them and making them real by acting on them.

The Process

1. Monitoring and Recording Weekly Activities

This process will start with the Weekly Activity Schedule [CBT#12-001]. Each box on the schedule represents an hour of time. Throughout the next week have the child record his/her main activity or activities during each hour. Whatever s/he is doing, just have him/her write it down. The reason you’re having the child keep detailed accounts of activities is to establish an activity baseline that will help you and the child recognize progress in the weeks ahead. One of the things you are looking for in this baseline is ‘what does the child avoid doing because s/he has an expectation of failure, but may, in fact, want to do.

2. Identifying and Rating Mastery Activities

While the child is recording the first week’s activities, s/he will need to pay attention to mastery. Mastery has a slightly different meaning in the context of this technique, but this can be adjusted and used effectively in the context identified here. What will be required in this shift is that the changeworker identify specific performance activities that the child must do [schoolwork] or would like to do, but is afraid of failure. These activities must be defined in a way that performance can be measured and tracked. Picture, for example, a child who wants to learn to play basketball. S/he will identify the baseline number of foul shots s/he can make out of ten. S/he may record this over five sets of ten shots each. S/he, with your encouragement and support, will then set a mastery task of increasing the average number of shots made in five sets over time. This process should be done in very limited increments. If /he started with only one of ten, the immediate goal is to make two of ten. It does not matter if other children are making eight or nine of ten. The sense of progress, which is being tracked, should also increase the sense of pleasure in the activity.

3. Scheduling Activities

If the child’s expectation was of failure, s/he may have been avoiding shooting foul shots, even though there is a desire to do so. No one wants to look foolish. It’s time to encourage the child to increase performance mastery activities during the week. Have him/her identify at least ten hours on the activity schedule when s/he is engaged in an activity that provides neither pleasure nor a sense of mastery. See if s/he can find one or two of these hours each day. These are two or three hours committed to personal continuous quality improvement in a specific area of interest. This can be in any area of the child’s choice.

You can also try to have him/her add mastery activities. Often these are efforts the child may be avoiding. The Mastery Activities List [CBT#12-003] may or may not be appropriate for consideration. The list indicates some activities that the child might schedule into his/her week, but the choices are really personal.

Make a list of mastery activities that might give the child a feeling of accomplishment. From the list, have him/her select from five [05] to seven [07] to sprinkle through the coming week, in the same fashion as with pleasure activities. Don’t overwhelm the child with too many mastery activities at once. It is important that the measure of performance be specific and identified beforehand. Unfortunately, the intuitive assessments of the average person are not bound by scientific procedures and public information constraints.

Hypotheses that are formed on the basis of one set of results are considered to have been proven by those very same results [Gilovitch]. By retrospectively and selectively perusing the data in this way, people tend to make too much of apparent anomalies and too often end up detecting order where none exists. This is one of the cognitive processes with which the child has made his/her past distorted appraisal of self and others. It is not sufficient, and should not be overly responded to if the child on one set makes eight shots in a row. In fact, you may want to help the child understand that there will probably be a regression to the mean – his/her performance is likely to deteriorate. What does s/he do in a set of five? What is the average for the week? Is the average number of shots made going up or down?

You are attempting to get the child to make the connection between internal forces [persistence, practice] and the outcome [mastery, a higher average of shots made]. This is a conscious process and the praise is for the persistence and practice, not for the outcome. This is based upon the assumption that the outcome performance will improve if the internal force is exercised.

Scientists utilize a set of formal procedures to guard against the source of bias and error such as the generalizations the child is making about his/her comparative worth. They have a set of procedures of which the average person is insufficiently aware, and has not adequately adopted in daily life. Perhaps the most fundamental safeguard is the requirement that the meaning of various outcomes be precisely specified in advance and objectively determined.

This kind of precise specification of what constitutes ‘success’ and ‘failure’ is something we rarely do in everyday life, and consequently our preconceptions often lead us to interpret the meaning of various outcomes in ways that favor our initial expectations. [Gilovitch]

Note that some mastery activities may be too involved to accomplish in an hour, or simply too overwhelming when tackled all at once. It may help to break a mastery activity into smaller steps that can be accomplished in no more than five to fifteen minutes.

Be particularly aware of things the child has been avoiding as a good source of mastery items. If s/he’s been putting off doing homework, have him/her make an appointment with him/herself on the Weekly Activity Schedule to get it done. What are the mastery objectives of the homework? It can vary. It may be a mastery of self discipline and use of time. Therefore, the measurables might be for example: does the child have a scheduled time to do homework, how close to the scheduled time does the child start the work, how continuously does s/he work, how much work is completed in the allotted time, how much of the work is done correctly? One would assume that if the first mastery objectives are met, the fourth would show improvement. Failure of this to happen would indicate that the method of practice is wrong. Practice does not make perfect: right practice makes perfect. If the child disciplines him/herself to do the homework and works consistently and covers the material and does not improve his/her grades, something in the process is being overlooked. As the ‘coach’ in this matter, the worker will need to identify and address this issue. The connection must be that effort equals improved performance.

4. Prediction Ratings

A very important part of planning activities is trying to anticipate how they will make the child feel. Most self rejecting people make very negative predictions about the amount of achievement they will have. They do not believe that this is in their control. It’s OK for the child not to feel hopeful . S/he may anticipate very little in the way of successful outcome from the planned activities. But s/he should do them anyway and evaluate what happens.

Have the child use a modified Weekly Activity Schedule to plan the mastery activities for the coming week. S/he should use the 1-10 scale to predict how much achievement s/he will make, and circle that number on the schedule. For example, the child may predict that s/he will fail a test with a 50% or an F [check with teacher to make sure that you are using the proper measurement technique].

As the performance activities occur, the child should write the actual mastery rating for each new activity. This can be placed right next to the circled prediction. One of the things you and the child are likely to notice is that actual achievement experiences often are better than expected. As noted earlier, negative self appraisal tends to make you pessimistic about achievement. Comparing prediction to the actual mastery levels experienced may help the child recognize how s/he distorts his/her view of things. The fact that the new activities may feel better than anticipated could help the child resist the discouraging inner voice that says, “Don’t bother with anything new; it’s a lot of work and you’ll never succeed.”

SPECIAL CONSIDERATIONS

We do not mean to suggest by the focus of the protocol that confirmation is not important. Generally, an increase in performance mastery will produce social reinforcement or confirmation for others. However, we are dealing here with children, and we had indicated in the introduction the power of the family, particularly before the age of four, on the self affirmation process. The salience of the family culture and its reinforcement or erosion potential cannot be overestimated. Families often initiate and help to maintain the thoughts that their children carry. If, in the mind of the clinical supervisor, the family is maintaining negative self affirmation through the culture of family life, s/he may want to add Social Learning Family Intervention to the protocol.

Among the most well-documented precursors and covariates of cognitive disorders are parent and family characteristics and behaviors, particularly in the area of child management and monitoring. In addition, researchers have convincingly demonstrated that parent and family characteristics such as marital distress, spousal abuse, lack of a supportive partner, maternal depression, poor problem solving skills, and high life stress [socioeconomic disadvantages and a lack of social support for the mother outside the home (e.g., few positive social contacts with family or friends)] are likely to lead to serious defects in child and family management practices. Attempts to address the issues of child management, therefore, cannot be expected to achieve success, unless some of these issues are directly addressed. A Social Learning Family Intervention therefore, is a comprehensive approach that combines training with clinical intervention and enhancement of natural supports. This approach is specifically important for the families of children with Conduct Disorders.

Child Management Training: the parents are taught a step-by-step approach where each newly learned skill forms the foundation for the next skill to be learned. Nine child management practices form the core content components of the program.

• they are taught how to pinpoint problem behaviors of concern and to track them at home [e.g., negative expectancies, avoidance behavior];
• they are taught social and tangible reinforcement techniques [e.g., praise, point systems, privileges, treats]. Over time, the tangible reinforcers are replaced by the parents’ social reinforcement;
• they are taught discipline procedures, focusing on discipline as a noun instead of as a verb. Discipline is seen as a method of teaching the child how to discipline him/herself and take responsibility. When parents see their child behave inappropriately, they learn to apply a mild consequence such as a five-minute time out combined with a learning experience [either written (Individual Behavior Learning Packet), or in discussion about what constitutes appropriate behavior]. Response costs and work chores are advocated for older children;
• they are taught to ‘monitor’ their children, even when the children are away from home. This involves parents knowing where their children are at all times, what they are doing, and who they are with and when they will be home;
• they are taught how to set up a time and area for homework and the best methods to help their children finish homework assignments. They are taught how to contract with the school to receive daily notes regarding assignments and completion;
• they are taught problem solving and negotiation strategies and become increasingly responsible for designing their own programs;
• they are taught how to play with their children in a non-directive way, and how to reward children’s prosocial behaviors through praise and attention. The objective is for parents to learn to break the cycle by increasing social rewards and attention for positive effort and persistence and reducing their commands, questions and criticisms;
• they are taught how to communicate transactionally, adult to adult; and
• they are taught ways to communicate direct, concise and effective directions for mastery.

Training methods include role-playing, modeling and coaching. Homework can be assigned in the form of daily ten minute practice sessions with the child using the strategies learned. After each session, the trainer leads a family discussion of the relevant interactions and encourages parent ideas.

The process takes a minimum of thirty hours with additional time for follow-up and reinforcement.

Specific Clinical Interventions: The literature is clear that families with severe and persistent problems in living have characteristics that need to be addressed and many of these are listed above. Where necessary, individual or family clinical interventions will take place with sufficient intensity to at least prepare the individual and/or family to take the initiative to address the problems on their own. Such interventions will be cognitive behavioral in nature, and consistent with the principles off social learning, teaching the individual specific skills that will enable them to take responsibility for their own lives.

The use of the Social Learning Family Intervention can be shaped by the clinical supervisor to specifically focus on the process that is happening with the child and orienting the family in appropriate supports and responses.