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. 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

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): 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: 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

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. 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

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 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