Presenting Problem

Youth involvement refers to the child or adolescent’s willingness to engage in treatment by asking and answering questions, completing assigned tasks in and out of session, and becoming familiar with the material discussed in therapy. Youth involvement may account for up to 20% of the variance in CBT outcomes (e.g., Braswell, Kendall, Braith, Carey, & Vye, 1985; Gorin, 1993; Karver, Handelsman, Fields, & Bickman, 2006), such that improved child involvement is associated with better treatment outcomes (e.g., Jungbluth & Shirk, 2009).

Does the Timing of Youth Involvement Matter?

There appear to be two key time points in therapy when youth involvement is most important. First, therapist behavior in the initial session is critical for subsequent youth involvement and motivation in treatment (Jungbluth & Shirk, 2009). Given high dropout rates early in treatment, it is important for the therapist to establish a positive impression within the first few sessions (McLeod et al., 2014). Among adolescents, motivational interviewing (e.g., Tevyaw & Monti, 2004; van Voorhees et al.,

2009) may help foster early engagement. Second, youth involvement at midtreatment (i.e., just prior to beginning exposure tasks) is also crucial for making gains and maximizing treatment outcomes (Chu & Kendall, 2004; Crawford et al., in press; Hudson et al., 2014). Engaging the child or adolescent in treatment is integral to building the therapeutic relationship. Involvement during treatment may be a useful index of change, as well as a predictor of outcome.

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