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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

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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