Case Study Question from Chapter 11: Emily was sick of her husband, Ralph, coming home at night and immediately starting to watch
Case Study Question from Chapter 11:
“Emily was sick of her husband, Ralph, coming home at night and immediately starting to watch television. He expected her to serve him dinner- a meat and two veggies- and to be quiet so he could watch his shows” (Gladding, 2019, p. 255). One day Emily casually askes her husband if he would consider attending couple’s counseling. He reluctantly consents, as an act to please his wife. If you were this couple’s therapist, which techniques of Behavioral and Cognitive-Behavioral Family Counseling would you consider and why?
Chapter 11
- Behavioral and cognitive-behavioral family therapy do not focus on the affective domain. How does this limit the usefulness of the approach? How would you work with a client who focuses primarily in the affective domain?
Chapter 12
- Discuss Carl Whitaker’s statement “experience, not education . . . changes families.” What evidence is there for the effectiveness of Whitaker’s approach? How would you determine when termination is indicated? How would you measure success?
(Equivalent of 1 typed double-spaced page per question)
Behavioral and Cognitive-Behavioral Family Therapies
Chapter 11
Chapter 11
1
Behavioral Family Therapy (B F T)
Fairly recent treatment methodology
Origins in research on modification of children’s actions by parents
Treatment procedures based on social learning theory
Functional Family Therapy – a type of B F T that is basically systemic
Cognitive-behavioral family therapy (C B F T) – cognitive behavioral techniques converted to a family context
Chapter 11
2
Major Theorists
Early Pioneers
John B. Watson
Mary Cover Jones
Ivan Pavlov
B. F. Skinner
First to use the term, behavioral therapy
Originator and proponent of operant conditioning
Chapter 11
3
Gerald Patterson
Credited with being the primary theorist who began the practice of applying behavioral theory to family problems
Instrumental in writing programmed workbooks for parents to employ in helping their children
Played a critical role in the extension of learning principles and techniques to family and marital problems
Has influenced other behaviorists to work from a systemic perspective in dealing with families
Chapter 11
4
Neil Jacobson
Found that 20% of male batterers, have lower hear rates during times of physical assault
Found that acceptance, or loving one’s partner as a complete person and not focusing on differences, may lead to an ability to overcome fights that continually focus on the same topic
Challenged marriage and family therapy practitioners to be more innovative and reflective in their work
Chapter 11
5
Premises of the Theory
Based on the theoretical foundations of behavioral therapy, particularly operant and classical conditioning
Maladaptive behaviors and not underlying causes should be the targets of change
Not everyone in the family has to be treated for change to occur
Emphasizes the major techniques of behavioral theory, such as stimulus, reinforcement, shaping, and modeling
Many behavioral therapists also emphasize cognitive aspects of treatment
Chapter 11
6
Behavioral Parent Training
Four styles of parenting have been identified:
Authoritative Parenting
Authoritarian Parenting
Permissive Parenting
Neglectful Parenting
One of the main tasks is to define a specific problem behavior
Parents are trained in social learning theory
Behavioral approaches with parents are known as parent-skills training and parent therapies
One example is parent-child interaction therapy
Chapter 11
7
Functional Family Therapy
Family-based, empirically supported treatment for behavioral problems, especially with adolescents
Based on the idea that all behaviors are adaptive and serve a function
Behaviors represent an effort by the family to meet needs in personal and interpersonal relationships
Relationships help family members achieve one of three interpersonal states
Contact/closeness (merging)
Distance/independence (separating)
A combination of states 1 and 2 (midpointing)
Chapter 11
8
Functional Family Therapy
Three-stage process of Functional Family Therapy:
Assessment – focus is on the function that the behavioral sequences serve
Change – purpose is to help the family become more functional
Maintenance – focus is on educating the family and training them in skills that will be useful in dealing with future difficulties
Chapter 11
9
Behavioral Treatment of Sexual Dysfunctions
Masters and Johnson (1970) pioneered the cognitive-behavior approach to working with couples in the late 1960s with the publication of Human Sexual Response.
Four phases of sexual responsiveness
Excitement
Plateau
Orgasm
Resolution
Chapter 11
10
P L I S S I T
A clinically relevant model for sexuality counseling:
P – Permission to talk about sexuality and sexual issues
L I – Limited information about the prevalence and etiology of problems
S S – Specific suggestions
I T – Intensive therapy
Chapter 11
11
Commonalities of Behavioral Approaches to Sex Therapy
Reduction of performance anxiety
Sex education
Skill training in communications
Attitude change methodologies
Overall, behavior-oriented therapy for sexual dysfunctions has been found to produce excellent outcomes
Chapter 11
12
Cognitive-Behavioral Family Therapy (C B F T)
Heavy emphasis placed on modifying personal or collective core beliefs, or schemas.
Important to help change stable, entrenched, and long-standing beliefs that family members have about family life
Teach families to think for themselves and think differently when it is helpful
Chapter 11
13
Cognitive-Behavioral Family Therapy (C B F T)
Behavioral component of C B F T focuses on the following actions:
“Excess negative interaction and deficits in pleasing behaviors exchanged by family members
Expressive and listening skills used in communication
Problem solving skills
Negotiation and behavior change skills”
(Dattilio, 2001, p. 11)
Chapter 11
14
General Treatment Techniques
Education
Communication and problem-solving strategies
Operant conditioning
Contracting
Chapter 11
15
Specific Treatment Techniques
Classical conditioning
Coaching
Contingency contracting
Extinction
Positive reinforcement
Quid pro quo
Reciprocity
Shaping
Systematic desensitization
Time-Out
Chapter 11
16
Specific Treatment Techniques
Job Card Grounding
Grounding
Charting
Premack Principle
Disputing irrational thoughts
Thought stopping
Self-instructional training
Modeling and role playing
Chapter 11
17
Role of the Therapist
Expert
Teacher
Collaborator
Coach
Therapists help families to set up behavioral and cognitive-behavioral management programs
Behavioral and C B T family therapists must learn to play man roles and to be flexible.
C B T family therapists concentrate on modifying or changing family members’ cognitions as well as their interactions.
Chapter 11
18
Process and Outcome
If successful:
Family members learn to modify, change, or increase certain behaviors to function better
Family members learn how to eliminate or decrease maladaptive or undesirable behaviors and/or dysfunctional thoughts.
Focuses on increasing parenting skills, facilitating positive family interactions, and improving sexual behaviors
C B F T helps families deal with stress, addiction, and adult sexual dysfunctions
Chapter 11
19
Unique Aspects of B F T and C B F T
The theory behind the approaches
The research
Their continued evolution
Their short term treatment
Their rejection of the medical model of abnormal behavior
Chapter 11
20
,
Experiential Family Therapy
CHAPTER 12
Chapter 12
1
Experiential Family Therapy
Emerged out of the humanistic-existential psychology movement in the 1960s
Influenced heavily by Gestalt therapy, psychodrama, client-centered therapy, and the encounter group movement
Emphasizes affect.
A healthy family is one in which people openly experience life with each other in a lively manner
Chapter 12
2
Major Theorists
David Kantor
Frank Duhl
Bunny Duhl
Virginia Satir
Carl Whitaker
Chapter 12
3
Major Theorists
Bernard Guerney
Walter Kempler
Augustus Napier
Leslie Greenberg
David Keith
Chapter 12
4
Virginia Satir
Published her first book, Conjoint Family Therapy, in 1964
Described as a master of communication and originator of the family communications theory
Worked with more than 5,000 families, often in group family therapy
Her model of counseling is referred to as the human validation process model
Chapter 12
5
Carl Whitaker
Innovative, spontaneous, and unstructured
Main contribution was that of helping families get in contact with their absurdity
Challenged people to examine their view of reality
Since 1988, his approach has been called experiential symbolic family therapy
Chapter 12
6
Premises of the Theory
Families are not aware of their emotions or, if aware, they suppress them
Lack of emotional awareness and express leads to emotional deadness
The resolution is to emphasize sensitivity and feeling expression among family members
Emotional expressivity can be verbal but it often is manifested affectively or behaviorally
Emphasis placed on the present
Humanistic and phenomenological in origin, and also influenced by attachment theory
Chapter 12
7
Treatment Techniques
Therapists Who Use Few Techniques (e.g., Carl Whitaker):
Redefine symptoms as efforts for growth
Model fantasy alternatives to real-life stress
Separate interpersonal stress and intrapersonal stress
Add practical bits of intervention
Augment the despair of a family member
Promote affective confrontation
Treat children like children and not like peers
Chapter 12
8
Treatment Techniques
Therapists who use structured techniques (e.g., Virginia Satir)
Modeling of effective communication
Using “I” messages – involve the expression of feelings in a personal and responsible way and encourage others to express their opinions)
Leveling – congruent communication, in which straight, genuine, and real expressions of one’s feelings and wishes are made in an appropriate context
Chapter 12
9
Treatment Techniques
When leveling does not occur, people adopt four other roles:
Blamer: individual who attempts to place the focus on others and not take responsibility for what is happening
Placater: individual who avoids conflict at the cost of his or her integrity
Distractor: individual who says and makes irrelevant statements that divert attention from pertinent issues
Computer: rational analyzer who interacts only on a cognitive or intellectual level and acts in a “super-reasonable way
Chapter 12
10
Treatment Techniques
Sculpting:
Setting the scene: therapist helps the sculptor to identify a scene to explore
Choosing rule players: individuals are chosen to portray family members
Creating a sculpture: sculptor places each person in a specific metaphorical position spatially
Processing the sculpture: sculptor and other participants de-role and debrief about experiences and insights acquired through engaging in this exercise
Chapter 12
11
Treatment Techniques
Structured Techniques:
Choreography
Humor
Touch
Props
Family Reconstruction
Star or explorer and Guide
Tools for family reconstruction
Family map
Family life fact chronology
Wheel or circle of influence
Chapter 12
12
Other Experiential Techniques
Play Therapy
Filial Therapy
Family Drawings
Conjoint family drawing
Symbolic drawing of family life space
Puppet Interviews
Chapter 12
13
Role of the Therapist
Participate actively (less structured)
Facilitate or provide resources (structured)
Assist family members to discover their individuality and fid fulfilling rules for themselves
Establish an environment that communicates warmth, acceptance, respect, and hope
Help family members to clarify goals and to use their natural abilities
Likely to behave as real, authentic people
Chapter 12
14
Process and Outcome
Family members gain awareness of their needs and feelings and share them with others
Families members become more capable of autonomy and real intimacy through awareness of feelings
Helps family members fulfill roles for themselves without an overriding concern for the needs of the family as a whole
Chapter 12
15
Process and Outcome
The process differs for each experiential family therapist
Whitaker
Engagement
Involvement
Satir
Making contact
Chaos
Integration
Chapter 12
16
Unique Aspects of Experiential Family Therapy
Training Programs
Research
Length of treatment
Attention to emphasizing people as well as structures within the change process
Chapter 12
17
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