Clinician Spotlight

AF-CBT is practiced by a wide variety of dedicated professionals, and we thought that the best way to show that would be to feature just a few of those people on this website.

Barbara Baumann

Who do you train to implement AF-CBT?

I really enjoy meeting clinicians from around the United States and around the world who are working to help families to highlight their strengths and develop skills to improve their family functioning. In the past year, I’ve traveled to California, New York, and Indiana to conduct trainings, as well as hosting several trainings in Pittsburgh. We have been fortunate to have clinicians from outside the United States attend our last 2 Pittsburgh trainings. This included a group of clinicians from Seoul, South Korea who are helping us to translate our AF-CBT materials and determine how to deliver the model appropriately in Korea.

What is your therapeutic background?

I began my career with children and families as a camp counselor and then as a research assistant on a federally funded grant for children with ADHD. That then led to an initial therapy career working with children with ADHD and their caregivers and schools. I learned a lot about behavior management and family systems through this work. It served as a foundation as I moved on to work with children who set fires, juvenile sex offenders, and then families involved with child protection services. Throughout this work I developed a strong background in CBT and adolescent-parent communication. I’m thrilled to be able to now combine much of my background in teaching and consulting on AF-CBT.

What do you do for fun in your spare time? Have your hobbies influenced how you approach treatment?

In my spare time I’m a mom to 3 kids, ages 11, 14, and 16. Parenting them has definitely influenced how I approach treatment. I notice that I’m more hesitant to recommend positive behavior charts with more than a few behaviors on them. I know firsthand how hard it is to keep track of kids’ behaviors and remember to reward them consistently. I also use a lot of the techniques we teach in AF-CBT when I’m at home. I find myself taking a lot of deep breaths and using positive self-statements when the house gets too chaotic. I often use these experiences when I’m working with parents and therapists on implementing AF-CBT.

Naomi Perry

Who do you use AF-CBT with?

AF-CBT is applied with caregivers who have abused their child or are in conflict due to poor parenting skills. The referrals are sent to us by CPS social workers and family attorneys. The majority of referrals are court ordered with a mandate to attend treatment in lien of incarnation or permanent loss of their children. My focus in using AF-CBT is directed towards helping families to resolve their conflicts and to restore equilibrium. Children love their parents and truly do want to return home but they also want to return to a better environment. My goal is to help a child and parent to achieve their goals of being reunited by enhancing a parents’ ability to learn positive parenting strategies and in enhancing child compliance through the application of those positive parenting strategies.

What sort of setting do you use AF-CBT in?

Harborview Medical Center is located in the central district of Seattle, Washington. Services are provided in a regular mental health clinic setting.

What is your therapeutic background?

I am trained in several evidenced based interventions: Parent-Child Interaction Therapy (PCIT); Alternative for Families: Cognitive Behavioral Therapy (AF-CBT); Trauma Focused Cognitive Behavioral Therapy: (TF-CBT); Cognitive Processing Therapy (CPT); Cognitive Behavioral therapy; CETA and Motivational Interviewing (MI), CBT for depression, and CBT for anxiety.

What do you do for fun in your spare time? Have your hobbies influenced how you approach treatment?

I have grandchildren that I enjoy taking on family vacations and gathering them all together for family dinner celebrations. I enjoy outdoor fun that always includes a trip to the beach, planting a garden and a traditional summer gathering to pick wild blackberries. I have learned to sit with them either collectively or individually without judgement and sometimes to hear difficult things that make me want to say “you did what”? If I show my disapproval, I know that I will lose them. So I have learned to control my emotions, bite my tongue, avoid opinions and watch my facial expressions and to tread gently. I show the same regard towards an AF-CBT family. While I work towards restoring unity within the family, I teach, I listen and I try to make suggestions that lead my families away from abusive patterns and ultimately into a space where enjoyment of each other’s company becomes their primary focus.

When you were first learning AF-CBT, what was the hardest thing to adjust to?

I have worked with victims my entire career and when I started using the AF-CBT model, my primary focus shifted to working primarily with caregivers who were the instigators of violence/aggression in their behaviors towards their children. It was challenging to suddenly be in the role of having to work so closely with the legal system and the attorneys involved with a caregiver who had been accused of the abuse. Advocating for the person who harmed the child was new to me and it was hard to do when I first started the therapy but it proved to be a necessary part of the therapy if others were to fully understand the impact and the power of the treatment in changing negative behaviors into positive outcomes.

What is something you learned through AF-CBT training that you have come to apply elsewhere in your life?

My assumptions about caregivers who physically abused their children have shifted since providing AF-CBT. I have a deeper understanding and appreciation of the dynamics, circumstances and other factors that can lead to physical aggression and poor parenting. I have learned that if a parent is motivated to change their behavior, significant changes can occur and parent-child relationships can drastically improve. I am less judgmental and I always try to look beyond what the naked eye can see to try to gain a better understanding of why a parent came into the system and into therapy in the first place.

What games or activities have you added to enhance AF-CBT?

I don’t usually provide a lot of extras. I may use a different worksheet to make a point clearer or provide a toy of no real importance to give the child something else to focus on while they talk about difficult subjects or the toy can serve as a center point if it’s a joint session and the child is in the session with the person who hurt them. I may ask the child to write a narrative of the events of the abuse and reward them with their favorite snack or an end of the session computer game for their efforts in writing a sentence or two. To enhance the relationship between the parent and child, I may provide a board game or toys for fun to support the parent and child in a fun activity together to demonstrate what it means to engage in playtime with a child. I will give an older child and a parent a topic to discuss and assess how well they are able to communicate and resolve the problem without getting into a major conflict.

What is it about AF-CBT that you think helps families succeed?

The AF-CBT manual is laid out in a manner that is easy to follow and is caregiver focused with a non-judgmental approach. It acknowledges and validates the difficulties of being a parent while teaching and holding each family member to a certain level of accountability. The clarification session is very powerful. This is the session where the caregiver, (who may have initially adamantly denied any involvement in abusing their child) acknowledges full responsibility for their actions and apologizes to the child. Children benefit from hearing their parents apologize and then benefit from hearing their parents tell them what they have learned in the therapy that will support making their lives better together. The children, having also experienced the changes in the caregiver behaviors, can see that the learned positive parenting skills are being used on a regular basis. The children’s behaviors also significantly improve through this process.

What do you think are 2 or 3 attributes of a successful AF-CBT practitioner?

To be respectful and present, demonstrate objectivity and to show genuine regard for the family one is working with.

What advice would you offer to someone pursuing AF-CBT training?

It’s a great intervention and well worth the investment of getting trained. You may not see the full reward of the therapy until you have gone the full course with a family but it’s so worth it to know that you have been a part of a life changing intervention that teaches lifetime skills and reunites a child back into, not just a home, but a healthy home environment.

Patrice Rotolo

Who do you use AF-CBT with?

Our program implements AF-CBT with families referred from Child Protective Services that have had an allegation, incident or risk of physical abuse in the home. The children may or may not be currently residing with the offending caregiver. We include multiple caregivers and all the children that live in the home whenever possible.

What sort of setting do you use AF-CBT in?

Our therapists are fully community based meaning that all therapeutic sessions are held either in the home, the school or a community location such as a park or library. Office space is available for more sensitive topics such as imaginal exposure.

What do you do for fun in your spare time? Have your hobbies influenced how you approach treatment?

I enjoy the outdoors. Simple things like taking a walk in the park help center me and remind me that some of the horrible things we see and hear at work do not define the world.

When you were first learning AF-CBT, what was the hardest thing to adjust to?

The manual! I quickly took to the structure, theoretical background and rationale for each topic. However, following the manual in session was a difficult adjustment. I now feel more comfortable relying on it as a tool and find that following the outline helps me to implement the topics more efficiently.

What is something you learned through AF-CBT training that you have come to apply elsewhere in your life?

Focusing on the function of a child’s behavior; what is this child trying to communicate to me? This gets incorporated into my other clinical trainings as well as my experiences with my own family. When a baby cries, we learn to distinguish between the types of cries. Is this a hungry cry, a scared cry, a cry for attention? We don’t yell at the baby for crying or get angry at the baby for needing attention. When does that change? At what age do we forget that our children are still just trying to communicate something to us and it is our responsibility as parents to figure out what type of “cry” this is?

What games or activities have you added to enhance AF-CBT?

I include and encourage my staff to include body safety education. In addition to the body safety education workbooks, we also have a multitude of therapeutic games including some based on the movie “Inside Out.”

What is it about AF-CBT that you think helps families succeed?

We acknowledge how difficult parenting is and there is no cookie cutter model of parenting. Building on the strengths, values and traditions of the caregiver leads to increased engagement and motivation. We are very clear that we are not trying to repeat what other practitioners have done with them. We strive to understand what they want their family life to look like and build on those ideas.

What do you think are 2 or 3 attributes of a successful AF-CBT practitioner?

I think that it is important for an AF-CBT practitioner to subscribe to a systemic approach and value the role of the caregivers as leaders within their home. There are no bad children and there are no bad parents. We are all individuals doing the best we can in the circumstances given. Remembering that and including that idea in all aspects of your work with families will help to truly explore and understand the values of the caregiver as well as see the child’s behavior more objectively as a response to their environment.

What advice would you offer to someone pursuing AF-CBT training?

Trust the process. The structure and order is there for a reason. When in doubt, return to the book. It is easy to get lost in the sea of needs that the clients present. The family needs focus, as does the practitioner. The structure and order of the topics provides that.