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 Dr. Ronald Werner-Wilson

3. 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

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 Dr. Ronald Werner-Wilson

5. 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

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. Dr. Ronald Werner-Wilson

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. Dr. Ronald Werner-Wilson

8. 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

9. 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

10. 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

11. 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

12. 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. Dr. Ronald Werner-Wilson

14. 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

15. 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

16. 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

17. 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

18. 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