Cognitive behavioral family therapy
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Cognitive-Behavioral Family Therapy. Nichols, M. P. & Schwartz, R. C. (2001). Cognitive-behavioral family therapy. In M. P. Nichols & R. C. Schwartz, Family therapy: Concepts and methods (5th ed., pp. 265-305). Boston: Allyn and Bacon. Sketches of Leading Figures.

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Cognitive-Behavioral Family Therapy

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Cognitive behavioral family therapy

Cognitive-Behavioral Family Therapy

Nichols, M. P. & Schwartz, R. C. (2001). Cognitive-behavioral family therapy. In M. P. Nichols & R. C. Schwartz, Family therapy: Concepts and methods (5th ed., pp. 265-305). Boston: Allyn and Bacon.


Sketches of leading figures

Sketches of Leading Figures

  • Gerald Patterson at the Oregon Social Learning Institute has been a pioneer in the development of behavioral parent training.

  • Robert Liberman described an operant learning framework for couple and family therapy. It included

    • contingency management

    • role rehearsal

    • modeling

Dr. Ronald Werner-Wilson


Sketches of leading figures1

Sketches of Leading Figures

  • Richard Stuart introduced contingency contracting that featured reciprocal reinforcement. Couples were taught to

    • list behaviors that they desired from each other

    • record frequency of behavior demonstrated by partner

    • identify exchanges for desired behaviors.

  • John Gottman: leading figure in research on marriage.

Dr. Ronald Werner-Wilson


Theoretical formulations

Theoretical Formulations

  • Central Premise: behavior is maintained by its consequences.

  • Reinforcements: consequences that affect rate of behavior.

    • Positive reinforcement: rewarding consequences.

    • Negative reinforcement: aversive consequences.

  • Reinforcement Schedule: describes intervals associated with reinforcement.

  • Punishment: not the same as negative reinforcement.

    • aversive control (e.g., yelling, spanking)

    • withdrawl of positive consequences

Dr. Ronald Werner-Wilson


Theoretical formulations cont

Theoretical Formulations (cont).

  • Extinction: behavior ends because of lack of reinforcement. “Inattention … is often the best response to behavior you don’t like” (p. 269).

  • Teaching Complex Behavior

    • Shaping: process of rewarding behaviors in successive approximations.

    • Modeling: people learn by emulating others.

Dr. Ronald Werner-Wilson


Normal family development

Normal Family Development

  • Satisfying relationships: balance between giving and getting. There is “a high ratio of benefits relative to costs” (p. 271).

  • Critical influences on relationship satisfaction:

    • affection

    • communication

    • child care

  • Conflict resolution seems to be one of the most critical skills associated with family harmony.

Dr. Ronald Werner-Wilson


Development of behavior disorders

Development of Behavior Disorders

  • Symptoms are thought of “as learned responses, involuntarily acquired and reinforced” (p. 272).

    • People may inadvertently reinforce problematic behavior.

    • Punishments often have the opposite effect of their intention. Attention (even from someone who is angry) is a powerful social reinforcer.

  • Behavior problems may be maintained because of inconsistent responses.

Dr. Ronald Werner-Wilson


Development of behavior disorders cont

Development of Behavior Disorders (cont.)

  • Cause of Marital Discord (based on Azrin, Naster, & Jones, 1973; listed on p. 274 of text):

    • Receiving too little reinforcement from the marriage.

    • Two few needs given marital reinforcement.

    • Marital reinforcement no longer provides satisfaction.

    • New behaviors are not reinforced.

    • One spouse gives more reinforcement than he or she receives.

    • Marriage interferes with extramarital sources of satisfaction.

    • Communication about potential sources of satisfaction is not adequate.

    • Aversive control (nagging, crying, withdrawing, or threatening) predominates over positive reinforcement.

Dr. Ronald Werner-Wilson


Development of behavior disorders cont1

Development of Behavior Disorders (cont.)

  • Distressed marriages include fewer rewarding exchanges and more punishing exchanges. “Spouses typically reciprocate their partners’ use of punishment, and a vicious cycle develops” (p. 274 of text; based on Patterson & Reid, 1970).

  • Parents who respond aversively to children are likely to have aversive responses reciprocated.

Dr. Ronald Werner-Wilson


Goals of therapy

Goals of Therapy

  • Primary goal: modify specific behavior patterns to reduce symptoms. (Note: symptom change is not thought to lead to symptom substitution.)

  • Help families accelerate positive behavior.

Dr. Ronald Werner-Wilson


Conditions for behavior change

Conditions for Behavior Change

  • Behavior will change when reinforcement contingencies are changes. Significant others are trained to use contingency management techniques.

  • Hallmarks of Therapy:

    • Careful and detailed assessment to

      • determine baseline frequence of problem behavior,

      • guide therapy,

      • provide accurate feedback about effectiveness.

    • Design specific strategies to modify reinforcement contingencies.

  • Therapists might need to work on family members’ attributions (beliefs about others).

Dr. Ronald Werner-Wilson


Techniques

Techniques

Caveat: although the principles of behavior therapy are simple, the practice is not.


Behavioral parent training

Behavioral Parent Training

  • Usually begins with an extensive assessment. SORKC

    • stimulus

    • state of the organism

    • target response

    • KC: nature and contingency of consequences

  • Emphasis on parent education.

  • Encourage families to try behavioral change experiments.

  • Application of operant conditioning that can include social or tangible reinforcers.

Dr. Ronald Werner-Wilson


Behavioral couples therapy

Behavioral Couples Therapy

  • Begins with an elaborate, structured assessment to identify specific strengths and weaknesses.

    • Clinical interviews

    • Ratings of specific target behaviors

    • Standard marital assessment questionnaires

  • Jacobson’s Pretreatment Assessment of Marital Therapy (Table 9.1, pp. 286-287):

    • Strengths and skills of the relationship

    • Presenting Problems

    • Sex and Affection

    • Future Prospects

    • Assessment of Social Environment

    • Individual Functioning of Each Spouse

Dr. Ronald Werner-Wilson


Behavioral couples therapy cont

Behavioral Couples Therapy (cont.)

  • Therapist works with couples to identify “accentuate the positive, striving to maintain positive expectancies” (p. 287).

    • Goal: identify behaviors to accelerate.

    • Establish reinforcement reciprocity.

  • Treatment Strategies:

    • Increase rate of positive control and reduce the rate of aversive control.

    • Improve communication. Help couples learn to make clear, direct requests rather than expecting partner to intuit needs.

    • Constructive conflict engagement is necessary.

Dr. Ronald Werner-Wilson


The cognitive behavioral approach to family therapy

The Cognitive-Behavioral Approach to Family Therapy

  • Premise: members of a family simultaneously influence and are influenced by others. This is consistent and compatible with systems theory.

  • Assessment: investigate schemas (core beliefs) of family members to assess cognitive appraisals.

  • Interventions are directed toward assumptions used by family members

    • to evaluate one another

    • the emotionsand behaviors generated in responses to the evaluations

Dr. Ronald Werner-Wilson


Treatment of sexual dysfunction

Treatment of Sexual Dysfunction

  • Assumption: most sexual problems are the result of conditioned anxiety.

  • Systematic desensitization: guide clients through a progressive series of encounters that lead to more intimate encounters while avoiding thoughts of erection or orgasm. Sensate focus is commonly used in sex therapy.

  • Assertiveness training: socially and sexually inhibited persons are encouraged to accept and express their needs and feelings.

  • Three stages of sexual response (based on Helen Singer Kaplan, 1979) so each can lead to a different difficulty:

    • Desire

    • Arousal

    • orgasm

Dr. Ronald Werner-Wilson


Evaluating therapy theory results

Evaluating Therapy Theory Results

  • Behavior therapy is the most carefully studied form of family therapy.

  • Improvement in communication is commonly associated with relationship improvement

Dr. Ronald Werner-Wilson


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