Download Nichols, MP & Schwartz, RC

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
 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 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
 Central Premise: behavior is maintained by its
consequences.
 Reinforcements: consequences that affect rate of
behavior.
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Positive reinforcement: rewarding consequences.
Negative reinforcement: aversive consequences.
 Reinforcement Schedule: describes intervals
associated with reinforcement.
 Punishment: not the same as negative
reinforcement.
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aversive control (e.g., yelling, spanking)
withdrawl of positive consequences
Dr. Ronald Werner-Wilson
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
 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
 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.)
 Cause of Marital Discord (based on Azrin, Naster,
& Jones, 1973; listed on p. 274 of text):
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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 (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
 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
 Behavior will change when reinforcement
contingencies are changes. Significant others are
trained to use contingency management
techniques.
 Hallmarks of Therapy:
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Careful and detailed assessment to
 determine baseline frequence of problem behavior,
 guide therapy,
 provide accurate feedback about effectiveness.
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Design specific strategies to modify reinforcement
contingencies.
 Therapists might need to work on family
members’ attributions (beliefs about others).
Dr. Ronald Werner-Wilson
Techniques
Caveat: although the principles of
behavior therapy are simple, the
practice is not.
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
 Begins with an elaborate, structured assessment to
identify specific strengths and weaknesses.
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Clinical interviews
Ratings of specific target behaviors
Standard marital assessment questionnaires
 Jacobson’s Pretreatment Assessment of Marital
Therapy (Table 9.1, pp. 286-287):
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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.)
 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
 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
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to evaluate one another
the emotionsand behaviors generated in responses to
the evaluations
Dr. Ronald Werner-Wilson
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
 Behavior therapy is the most carefully
studied form of family therapy.
 Improvement in communication is
commonly associated with relationship
improvement
Dr. Ronald Werner-Wilson