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 ). 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 ):
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