1. Alternatives for Families: Cognitive Behavioral Therapy

Alternatives for Families: Cognitive Behavioral Therapy

Program Goals

Alternatives for Families: Cognitive Behavioral Therapy (AF–CBT; formally Abuse-Focused Cognitive Behavioral Therapy) is a comprehensive approach to dealing with the effects of child physical abuse, exposure to related abuse, child or family aggression, and hostile family environments by reducing risk factors for future abuse while also helping the affected individual to recover from the effects of past abuse. AF–CBT teaches parents and children intrapersonal and interpersonal skills to enhance self-control, promote positive family relations, and reduce violent behavior.


Target Population

Traditionally, AF–CBT is meant for children exhibiting behavioral or emotional dysfunction because of exposure to a hostile or physically aggressive family life. It can also be used for children with behavioral disorders such as Conduct Disorder and Oppositional Defiant Disorder even without the presence of violent relationships.


Program Components

Previous versions of AF–CBT conducted the individual therapy session separate from the family sessions. Known as Individual Child and Parent cognitive behavioral treatment (CBT), the sessions for the parent and child were conducted separately—using parallel protocols. The joint Family Therapy (FT) sessions were introduced and included components for improving family functioning and relationships.


Currently, AF–CBT consists of 3 phases of treatment and 18 session components. Phase 1 concentrates on introduction to and engagement in treatment, psychoeducation, feeling identification, and abuse discussion. Phase 2 teaches new ways of thinking, emotional and behavior management, and how to get along with others. Phase 3 prepares the parents and child for program completion by holding a clarification meeting and teaching problem-solving techniques to use in future situations.

Intervention ID

6 to 13


Study 1

Violent Behavior and Child Abuse Risk

Kolko (1996) found that parents reported significantly less child-to-parent and parent-to-child violence over time in the Cognitive Behavioral Therapy (CBT) and Family Therapy (FT) groups, compared with the routine community service (RCS) group. Though both treatment groups showed a consistent reduction in child abuse risk potential, this only approached significance. In comparison, the RCS group had a small drop and then a large increase in risk potential. CBT parents reported thinking of using physical force or discipline significantly less from pretreatment to posttreatment and at the 1 year follow-up than those in the RCS group. FT parents thought significantly less about using force from pretreatment to posttreatment only.


Children reported a significant reduction over time in parental anger and reported lower ratings of serious family problems over time for the treatment groups. However, there was no significant change in the number of threats or acts involving physical force.



There was no statistically significant difference between the groups on child reabuse. There were 7 case records from the county child abuse agency for the 47 records they received (14.9 percent). One of the seven cases was for physical abuse; the other six were for maltreatment.


Child Behavior and Adjustment

Children in the both treatment groups reported significant reductions over time for internalizing and externalizing symptoms. There was no effect found for social skills. Scores on depression were generally low and did not differ significantly between groups. Parents reported significant reduction over time in levels of externalizing symptoms. Children from the CBT group showed the greatest initial change, and those from the FT group showed the greatest change at follow-up, compared with the RCS children.


Parenting Skills and Family Functioning

CBT and FT parents reported significant reductions in belief in the need for physical punishment. There was a weak significant increase in level of discipline and in child acceptance.


Parents and children reported a significant increase in cohesion scores for the CBT and FT families. Children noted a significant decrease in conflict scores for the FT group as well. There was a significant reduction in the level of family conflict over time as reported by the parents in both treatment groups; conversely, the RCS group saw a significant increase.

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