Cognitive based behavioral charts

Will Davidson, LMHC

How to create and score the chart

• Collaborate with client and parent to identify up to 5 behaviors to work on.

• Include a behavior or behaviors that the client is already good at doing.

• Scoring: each visit, collaborate with client and parent to score each behavior on a 0-5 scale.– Never score zero. 1’s and 2’s should be rare.– Stay positive!– Use visual aids as needed.

Why use a cognitive behavioral chart?

• Documents client progress• Reinforces good behavior• Identifies areas needing improvement• Identifies relapse• Combats parent black and white thinking• Combats client black and white thinking• Motivates client for treatment• Increases perception of Self-efficacy

Documents client progress

“Mother disclosed that client tantrummed yesterday and broke a lamp.”Mother, client and I scored his/her behavioral chart. Client received the following scores:5/5 Keep room clean3/5 be kind to siblings2/5 Anger management3/5 Listen to momTotal = 13/20”

Reinforces good behavior

“I praised the client for his high score and encouraged him to bring up his low scores so that he can beat his previous total score.” I pointed out to the client that he had done really well keeping his room clean for 4 days in a row.”“I suggested to the client that he is really good at accomplishing things and his chart is proof of that.”Praise high scores. Treat low scores as opportunities for learning and achieving. Stress the process. Remind client that he was not initially good at (playing video games, riding a bike etc.), but that he kept trying and was eventually able to succeed.

Identifies areas needing improvement

“Client and I collaborated on making a list of ways to be kind to his siblings. Client and I discussed why it is a good idea to listen to mom.”

Identifies relapse“Client and I discussed why his anger management score went down when he had been doing very well for over a week. Client disclosed that he received a phone call from his father and this upset him.”“I suggested to client that nobody is perfect and that we all make mistakes. When we make a mistake we should just pick ourselves up and keep trying to do better. I expressed confidence that client could raise his anger management score. Client and I collaborated on making a plan for increasing his anger management score. Client and I reviewed coping tools for anger and attitudes about his father.”

Combats black and white thinking

• Black and white thinking is a Cognitive distortion• Black and white thinking in the child:

– Black and white thinking is static and does not take into account the process of improvement.

– Child is apt to see any setback as evidence of total failure instead of a partial success.

– We learn more from losing than we do from winning

• Black and white thinking in parents:– Only remember the negative– Conveys disappointment to child

Increases perception of self-efficacy

• Bandura, social learning theory– Definition: the extent or strength of one's belief in

one's own ability to complete tasks and reach goals.

• Increasing perception of self-efficacy is better than trying to increase self-esteem.

• A perception of high self-efficacy is something the child can use in any challenging situation.

Increases motivation for treatment

• The behavioral chart is a positive reinforcer that highlights the child’s successes and provides a plan for improving areas of struggle.

• If you are doing it right, the child should look forward to the scoring.

• Increasing perception of self-efficacy increases the child’s perception that he/she can improve and do better.

Tools that augment cognitive behavioral chart

• Collaborate with the child in making a list of things that the child is good at doing and add to the list periodically.

• Board games can be used to increase perception of self-efficacy, teach the process of learning and teach cognitive coping skills.