What is AF-CBT?
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) is an evidence-based treatment (EBT) designed to improve the relationships between children and parents/caregivers in families involved in physical coercion/force and chronic conflict/hostility.
The content of AF-CBT is designed to address concerns about child physical abuse and/or exposure to related circumstances, such as harsh physical discipline/punishment, as well as child/family aggression and family interactions characterized by hostile interactions and conflict.
AF-CBT seeks to both reduce caregiver/family risk factors for physically abusive or coercive behavior and ameliorate the consequences of these experiences for children, at both the individual and family-context levels. It has also been adapted for children diagnosed with behavior problems or disorders, including Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD).
AF-CBT incorporates several behavioral and cognitive-behavioral methods that have been described and examined for use with physically abusive or at-risk families in several studies over the past four decades. To address both individual and family level problems, the approach draws from several conceptual models, including behavioral and learning theory, cognitive therapy, family-systems therapy, and developmental victimology.
AF-CBT emphasizes training in both intrapersonal and interpersonal skills designed to enhance self-control, promote positive family relations, and reduce violent behavior. Its primary techniques include affect regulation, behavior management, social skills training, cognitive restructuring/problem-solving, and communication. Common treatment goals include reducing a caregiver’s level of anger and use of force, promoting non-aggressive (alternative) discipline strategies, minimizing family risks for re-abuse, enhancing a child’s coping skills, and encouraging non-aggressive family problem-solving and communication.
With its integration of both individual and joint sessions, AF-CBT is suitable for application by trained practitioners in individual, parent-child or family, and group sessions across diverse outpatient, residential, and home settings. The techniques, relevant handouts, training examples, and outcome measures are integrated in a structured approach designed to enhance accessibility to practitioners and supervisors.
Formerly known as Abuse-Focused Cognitive Behavioral Therapy, the method was developed by David J. Kolko, Ph.D., ABPP, and updated in collaboration with Amy D. Herschell, Ph.D., Barbara L. Baumann, Ph.D., and Meghan Shaver, M.S.W. AF-CBT was renamed to more clearly reflect its focus on specific skills training in different domains and application to a broader population of families. Specifically, the name was also changed because the term “abuse” applies to a minority of the families who are referred for AF-CBT and, even if applicable, may create treatment engagement obstacles by accentuating client defensiveness and self-perceptions of being stigmatized.