Cognitive–behavioural therapy (CBT) is fundamentally a collaborative, empirical process of shared discovery (Salkovskis, 2002) in which client and therapist together derive a hypothesis, the ‘formulation’ (Persons, 1989), about the aetiology and maintenance of the client's problem. This formulation encompasses the unique predicament and response of the client in their particular present and past life contexts. This hypothesis is continuously refined in therapy as the client tests its validity against their experience and uses it to select cognitive and behavioural interventions. Instead of giving solutions, the therapist's emphasis is on guided discovery using Socratic dialogue (Padesky & Greenberger, 1995) and systematic use of case-specific and standardised ratings to promote self-help and problem-solving. Failure to appreciate that therapy is explicitly based on a shared formulation, rather than being a collection of techniques, has resulted in a disparate range of interventions being used as ‘CBT for children’ (Stallard, 2002). There is now widespread appreciation of the need to define CBT for children, young people and families and, in particular, to ensure that interventions are formulation based (an opinion confirmed at the inaugural meeting of the Child and Adolescent Special Interest Branch of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) in 2001).

By ‘children and young people’ we mean individuals up to the age of 18. For conciseness in this chapter we refer to them simply as children.

The evidence base

A significant body of evidence supports the use of CBT to treat a wide range of child and adolescent mental health problems such as depression (Harrington et al, 1998; March et al, 2004), generalised anxiety (Barrett et al, 2001), conduct disorder (White et al, 2003), interpersonal problems (Spence & Donovan, 1998), phobias (Silverman et al, 1999), social phobia (Spence et al, 2000), school refusal (King et al, 1998), sexual abuse (Jones & Ramchandani, 1999), pain management (Sanders et al, 1994), eating disorders (Schmidt, 1998), post-traumatic stress disorder (Smith et al, 1998) and obsessive–compulsive disorder (Barrett et al, 2005).