The document discusses how cognitive behavioral charts can be used in therapy. It describes how to create and score the charts by collaborating with the client and parents to identify behaviors to work on. The charts document progress, reinforce good behavior, identify areas needing improvement, and combat black and white thinking. They also increase motivation and perception of self-efficacy.

1. Cognitive based behavioral
charts
Will Davidson, LMHC

3. 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.

4. 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

5. 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 clean
3/5 be kind to siblings
2/5 Anger management
3/5 Listen to mom
Total = 13/20”

6. 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.

7. 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.”

8. 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.”

9. 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

10. 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.

11. 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.

12. 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.