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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

  1. 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

  1. 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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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)

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General Treatment Techniques

Education

Communication and problem-solving strategies

Operant conditioning

Contracting

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Specific Treatment Techniques

Classical conditioning

Coaching

Contingency contracting

Extinction

Positive reinforcement

Quid pro quo

Reciprocity

Shaping

Systematic desensitization

Time-Out

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Specific Treatment Techniques

Job Card Grounding

Grounding

Charting

Premack Principle

Disputing irrational thoughts

Thought stopping

Self-instructional training

Modeling and role playing

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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.

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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

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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

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Experiential Family Therapy

CHAPTER 12

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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

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Major Theorists

David Kantor

Frank Duhl

Bunny Duhl

Virginia Satir

Carl Whitaker

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Major Theorists

Bernard Guerney

Walter Kempler

Augustus Napier

Leslie Greenberg

David Keith

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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

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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

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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

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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

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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

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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

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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

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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

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Other Experiential Techniques

Play Therapy

Filial Therapy

Family Drawings

Conjoint family drawing

Symbolic drawing of family life space

Puppet Interviews

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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

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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

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Process and Outcome

The process differs for each experiential family therapist

Whitaker

Engagement

Involvement

Satir

Making contact

Chaos

Integration

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Unique Aspects of Experiential Family Therapy

Training Programs

Research

Length of treatment

Attention to emphasizing people as well as structures within the change process

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