Alternatives for Families: A Cognitive-Behavioral Therapy

Domain II · Behavioural & cognitive · Kolko, Brown, Shaver · 1985 · Pittsburgh

What it is

AF-CBT is a trauma-informed family treatment for children aged 5 to 17 and their caregivers. It targets family conflict, anger and verbal aggression (emotional abuse included), harsh or coercive physical discipline, child physical abuse, child behaviour problems and aggression, and the child's…

Format

• Format. Phases I and II are mainly separate individual sessions with the caregiver and with the child; Phase III is joint caregiver–child sessions. Caregivers can get a brief check-in after child sessions. Any adult caregiver (birth, foster, adoptive, kinship), whether or not they used force, can…
• Dose. Sources disagree. CEBC gives weekly 1–2 hour sessions, usually 20–24 hours of direct service or more over 6–9 months, with no fixed length. NCTSN (2026) gives 18–24 sessions of 30–120 minutes. Allegheny County gives 18–24 hours over 4–12 months. The 2012 NCTSN sheet gives about 20 sessions of…

Who practises it, and how they are trained or regulated

• AF-CBT is a trauma-informed family treatment for children aged 5 to 17 and their caregivers. It targets family conflict, anger and verbal aggression (emotional abuse included), harsh or coercive physical discipline, child physical abuse, child behaviour problems and aggression, and the child's trauma symptoms that follow these. It combines learning and behavioural theory, cognitive therapy, family systems,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Rewards that get withheld for unrelated misbehaviour.
• Commands creeping back in. Working: the child seeks out the caregiver.
• Question-commands, strings of several commands, and shouting from another room.
• Safety plans that exist only on paper. Working: incidents fall on the Weekly Safety Check-in.
• The praise-to-criticism ratio rises at CA$H, and the caregiver reports fewer power struggles.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.