Cognitive-Behavioral Family Therapy

1
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.

2
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

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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.

4
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

5
Theoretical Formulations (cont).

• Extinction behavior ends because of lack of
  reinforcement. Inattention is often the best
  response to behavior you dont like (p. 269).
• Teaching Complex Behavior
• Shaping process of rewarding behaviors in
  successive approximations.
• Modeling people learn by emulating others.

6
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.

7
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.

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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.

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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.

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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.

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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).

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Techniques

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

13
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.

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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
• Jacobsons 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

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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.

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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

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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

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Evaluating Therapy Theory Results

• Behavior therapy is the most carefully studied
  form of family therapy.
• Improvement in communication is commonly
  associated with relationship improvement