Cognitions, emotions, and behaviors of one family member affect the entire family system adversely or positively. The statement is a core strength of the cognitive-behavioral family therapy (CBFT) which encourages a therapist to determine how family members influence each other during interactions, applying various concepts of the family systems theory to understand the source of tension and the ideal path of change (American Psychological Association, 2023). This paper describes the model in detail, focusing on its link to systems theory, founders, role of the therapist, assumptions, goals, course of treatment, relevant interventions., and limitations. The theory is also applied on a case study involving a family involved in conflict over a mother’s habit of hoarding and shopping. It is affirmed that cognitive and behavioral family therapy is effective in resolving issues affecting a family system because it addresses dysfunctional emotions, thoughts, and behaviors and proposes effective interventions useful in creating sustainable changes.
Describing The Theory
Foundation
Taking shape in the 1970s, cognitive behavioral family therapy has become widely accepted as a model to help families to restructure maladaptive thinking and dysfunctional behavioral patterns. It posits that family members influence one another’s thoughts, emotions, and behaviors, and hence, assessing such factors is critical in determining the source of conflict or tensions in interactions (Lan & Sher, 2019). The model also integrates the family systems theory approach, focusing on ways in which subsystems, boundaries, hierarchies and other concepts influence cognitions and behavior. Other approaches using the cognitive behavioral theory include functional family therapy and integrative behavioral couples therapy.
Remarkably, three individuals popularized the behavioral family therapy in the 1970s. One of them was Gerald Patterson, who integrated in behavioral family therapy with the social learning theory (Cluxton-Keller, 2011). The second person was Robert Liberman wrote materials on how behavioral techniques can be used in therapy. Third, Richard Stuart, a social worker, laid emphasis on encouraging positive behavior in therapy as opposed to reducing undesired behaviors. It is also notable that the work of B.F. skinner was instrumental in the development of behavioral therapy, where the examination of operant conditioning revealed that rewards and punishment were vital in promoting behavioral change. Related principles used at the time included behavioral parent training, modeling, role rehearsals, and contingency contracting.
The concept of cognition was included in the behavioral family therapy in the 1980s. Notable figures in the development are Albert Ellis and Albert Beck. They emphasized on attitudinal change to sustain behavioral modifications. Albert Ellis stated that unrealistic patterns of expectations led to conflict in couples (Cluxton-Keller, 2011). The theorist further created rational emotive behavioral therapy to help couples address irrational cognitions. His work on ABCs of behavior lays a foundation for many CBFT approaches today. Specifically, psychologists examine the activating event, beliefs, and consequences to determine the source of conflict and possible solutions.
Based on the work of Frank Datillio, CBFT id regarded as a systems-based model because it integrates related concepts to assess interactions in a family setting. Circular causality and the role of emotions can be examined to explain why family member’s cognitions, emotions, and behaviors are mutually influential. Family members often influence and are being influenced by one another, implying that they are a part of system (Dishion et al., 2016). The concept of family schemas is also used to explain the systematic foundation of the model. Schemas are developed from the family of origin, and are pivotal in determining how individuals make sense of their world (Hutcheson, 2019). Couples combine schemas from their family of origin to create a functional or dysfunctional family. Even further, the aspects of attachment and affect ped the model to the systems theory. Secure or insecure attachments during childhood development can be assessed to determine the cause of conflict in relationships. Attachment issues are addressed by considering the maladaptive schemas in couples.
The ideal illustration for the systematic foundation of CBFT is conflict over parenting style in a family-one parent opines that time-out and reasoning with a child is affecting, while the other believes that spanking is the only way to discipline children. It is arguable that the different approaches are based on schemas, where one parent views spanking as a rational process of disciplining children because it was endorsed in the family of origin. The other parent feels that talking to the child, as well as time-outs, is sufficient based on their upbringing. Both parents make sense of their world as a result of the systematic foundation in their family of origin. Unrealistic and unproductive assumptions must be addressed to resolve the conflict in the family system.
Role Of the Therapist, Key Assumptions, Interventions, Goals, And Length of Treatment
The role of the CBFT therapist is to direct and educate the family to help members explore patterns of cognition, emotion, and behavior that lead to conflict. They must form a therapeutic alliance to attain positive outcomes. American Psychological Association (2023) explains that a such an alliance comprises tasks, bonds and goals. Bonds are determined by core conditions, attitudes, and styles used in therapy, while goals are mutually created and pursued. Tasks are activities that a therapist and the client to create to reach pre-determined goals. A therapist also plays the role of an assessor, conducting extensive research to understand the problem systematically. Areas of assessment are describing the problem, defining the baseline, factors causing the problem, clients’ resources, and how (and if) CBFT can used to address the problem. Bailey (2020) expound that therapists work closely with clients to build communication and problem-solving skills, building upon their strengths and resources to resolve current and future issues in the family system. hence, the therapists are active coaches in ensuring that the clients reach the pre-set goals.
CBFT is based on several assumptions. First, cognitions, emotions, and behaviors are mutually influential in a family setting. (Datillio, 2021). Second, distortions in cognitions are linked to dysfunctional behavior and interactions in a family. Third, people can learn to determine, assess and change their belief system and assumptions. Fourth, reducing negative assumptions and embracing the right perspectives can help families resolve issues in the system. Lan and Sher (2019) clarify that the main underlying assumption is that behaviors of one family member leads to specific cognitions, emotions, and behaviors among other family members. Still, assumptions in CBFT can be evaluated by considering the underlying assumptions in behavioral therapy and cognitive therapy separately. Behavioral therapists assume that human behavior is acquired through the principle of learning (Gallica, 2022). They also state that behavioral disorders equal to learned maladaptive patterns, and that they can be replaced by new behaviors. Cognition therapies assume that cognitive processes create behavior and emotions and that uncovering maladaptive cognitive thoughts, beliefs, and assumptions helps in resolving dysfunctional patterns.
Based on the assumptions, the goal of CBFT is to assist family members to recognize distortions in their thinking and behavior and henceforth offer them resources to restructure their thinking and modify their behavior to create a functional family system. Cluxton-Keller, (2011) explain that the goal is to assess and communicate how each family members construct thoughts based on erroneous information, allowing family members to determine actions, thoughts and emotions that cause conflict in the system. Child Welfare Information Getaway (2013) adds that the goals and objectives of the treatment is to minimize conflict and optimize cohesion in a family, reduce the use of aggressive interactions and forms of discipline, and improve family’s functioning. It is also noteworthy that the course of treatment is short-term, involving 18 to 24 hours. It is administered once of twice per week and can be spread over the course of 4 or 12 months depending on the complexity of the problem (Hutcheson, 2019). The treatment phase may be divided into three: engagement and psychoeducation, individual skill building, and family applications.
Several cognitive processes are known to cause tension and conflict in a family system. first selective abstractions may prevail when a family member focuses on certain details and ignoring others when assessing a problem. It is related to selection attention, where a person attends to certain aspects and ignores others (Cluxton-Keller, 2011). Distress may also be caused by negative or positive attributions as family members give meaning to certain actions. Expectancies also cause dysfunctional family system as the members are disappointed when the expected outcomes do not match the reality. Family members may also conflict because of their underlying assumptions or general beliefs on certain aspects. Standards also explain conflict because family members believe that a person should behave or think in a certain way and as such are disappointed when confronted with different realities. Still, distress occurs because of arbitrary inference or unsupported conclusions. Overgeneralization also define distress since family members assume that specific events represent the whole. Family members may also resort to minimization or maximization of events, where an aspect is overvalued or undervalued.
Personalization can lead to a dysfunctional family system when a person finds an inexistent personal connection to an event. Distress is also related to dichotomous thinking as fail to leave room for ambiguity (Cluxton-Keller, 2011). Labeling and mislabeling is problematic when an identity is built around flaws. Further, tunnel vision causes distress because family members view a problem from pre-existing ideas rather than gathering new information. biased explanations create dysfunction because family members only focus on negative motivations in a situation. Even more, mind reading can explain family distress, where a person purports to know what a person is thinking before hearing from them.
The goals of CBFT can be achieved using various interventions and techniques, attending to the issues in the family system rather than the individual. They can employ education strategy to create an understand on the impact of maladaptive thoughts and behaviors in the system (Lan & Sher, 2019. Coaching is then used to pass skills on new ways of behavior and thinking. Further, therapists can offer problem-solving skills by using techniques such as positive reinforcement, modeling, and reciprocity. Contracting is also used to encourage families and couples to embrace new ways of thinking and behaviors. a formal agreement is created to determine the rewards and punishments of engaging in certain actions. Still, the therapist can assign homework to integrate the principles identified in different sessions. It may involve a range of activities, such as self-monitoring, writing down materials after reflection, and cognitive restructuring.
Additionally, therapists can use point charts and token economies, where parents are trained on using points to reward good behavior. The points are accumulated over time and exchanged for a substantial reward (Cluxton-Keller, 2011). Besides this, therapists can use role play to create an understanding of how one behavior affects an entire system. shaping is used to assist family members arrived at an appropriate behavior over time using different steps. A bar for reinforcement is raised at evert stage of shaping. In disciplining children, time-out can be used to separate them from family members when they engage in undesirable behaviors.
CBFT has its core strength in the fact that therapists are required to gather data and assess a problem from different points of view. It gives room for practical and evidence-based solutions. It also uses multiple interventions and techniques to assist family members (Lan & Sher, 2019. Even more, it addresses cultural diversity issues by challenging families’ patterns of thinking. Beliefs and norms in a culture determine how individuals view the world. Assessing them can reveal the cause of dysfunctional interactions and behavior (Hutcheson, 2019). It means that attaining positive outcomes requires CBFT therapists to assess a problem from a cultural context and adjust their techniques to meet clients’ needs.
Nonetheless, applying cognitive-behavioral family therapy may be challenged by various ethical concerns and limitations. First, the model is difficult to apply when the validity of information is undeterminable (Lan & Sher, 2019). Finding the distortions in thought patterns is challenging in this case. Also, the aspect of informed consent may pose challenges depending on the severity of the condition. Some family member’s cognitions may have been distorted to a degree that they cannot consent to therapeutic processes.
Treatment Plan for A Family
A family has decided to see a therapist after realizing that the mother’s hoarding and shopping behavior is out of control. The family compromise twins, a daughter and son aged 19 years, a Hispanic mother, and a Caucasian father. The middle-aged couple has been married for 20 years, within which time have hosted different family members attending school or work. In the session, one of the relatives, from the mother’s side is present. They indicate that they have had a blessed marriage for the first 16 years, with a stable income that helped them to pay for private schools, live in affluent neighborhoods, and go vacations annually. However, the relationship has been strained for the last four years when the mother started to shop excessively and hoard items. During the therapy, one of the children states that “she started to use different credit cards for shopping and has not stopped since then. Most of the items are stored in the garage since they are unnecessary. Recently, she started to place the hoarded items in our bedroom after we went to college”. The father feels that the problem is straining their finances and may lead to a divorce if she does not stop the habit. On their part, the mother and the hosted relative feel that the problem is being blown out of proportion. She also reveals that the habit is understandable since it helps her cope with the loss of her mother, four years ago.
The presenting problem in the case is unresolved trauma, leading to hoarding and excessive shopping. Specifically, the mother’s distorted patterns of thinking and behavior started for failing to address grief after the loss of her mother. Shopping and hoarding are symptoms of the unresolved trauma and should be resolved using different CBFT techniques. Given this, it is vital to assess issues in the system that deterred the healing or coping process and the mutually influential cognitions, emotions, and behaviors. The family’s attitudes toward the behavior seem to reveal that the members cannot connect the issue the grief with the dysfunctional way of thinking and behavior. Assessing the cultural differences in grief, along with individual schemas in the family, can assist the family to understand the issue in a deeper context. All family members must participate in viewing the problem differently, focusing on their individual responsibility in creating dysfunctional interactions.
The treatment plan is summarized in the table below:
| Treatment strategy/technique/ duration | Description and interventions | Goal/ Outcome |
| Introduction phase/ initial assessment (week 1) | The initial stage involves introductions, assessing the presenting problem, and resources among family members.
Family members are given homework to write down their opinions on the reason for family conflict |
Creating a therapeutic alliance sufficient for determining distortions in cognitions, emotions, and behavior in the family system. Assessing family’s strength is necessary for identifying relevant interventions. |
| Working phase (week 2 and three). | Interpreting presented information based on the assumptions and principles of CBFT.
The three major interventions to be used are: role playing, contracting, and psychoeducation. |
Creating an understanding of the reason for distorted patterns of cognition and behavior.
Role playing will help family members understand the problem from different points of view. They can see how their behavior and patterns of thinking influence behavior in the system. The education process helps the family relate the dysfunctional family system with schemas and conditioning aspects. With the contracting intervention, the family members will agree to reward or punish shopping and hoarding behaviors. |
| Closing phase (week 4) | Family members are expected to review the process.
Contracting is used as an intervention to maintain change. |
The therapeutic alliance is terminated at this point. The family members will be requested to draw on their resources to reward and punish the presenting problem. |
Conclusion
Cognitive and behavioral family therapy is effective in resolving family and couples’ issues. It is based on the assumption that addresses dysfunctional emotions, thoughts, and behaviors and proposes interventions can usher in sustainable changes in a family system. It applies the systems theory concepts, including circular causation, to explain dysfunctional cognitions, emotions, and behaviors. A range of concepts are used to explain difficulties in interactions, including attributions, expectancies, attributions, assumptions, standards, overgeneralization and selective abstractions. Therapeutic goals are achieved using interventions such as psychoeducation, behavior exchange and quid pro quo, contingency contracts, communication and problem-solving, and time-out. Nonetheless, the model is daunting to apply if issues of diversity, informed consent, and validity of data are not addressed.
References
American Psychological Association, (2023). Cognitive behavioral family therapy. https://psycnet.apa.org/record/2019-03863-005
American Psychological Association, (2023). Therapeutic alliance. https://dictionary.apa.org/therapeutic-alliance.
Bailey, C. L. (2020). Cognitive-behavioral family therapy. Walden University.
Child Welfare Information Getaway, (2013). Alternative for families: A cognitive behavioral therapy. https://www.childwelfare.gov/pubpdfs/cognitive.pdf
Cluxton-Keller, F. (2011). Cognitive behavioral models of family therapy. In L. Metcalf (Ed.). Marriage and family therapy: A practice-oriented approach (pp. 91-146). New York, NY: Springer Publishing.
Dishion, T., Forgatch, M., Chamberlain, P. & Pelham, W. E. (2016). The Oregon model of behavior family therapy: From intervention design to promoting large-scale system change. Behavior Therapy, 47(6), 812-837.
Gallica, J. (2022). Cognitive behavioral therapy. https://www.theravive.com/research/cognitive-behavioral-therapy#:~:text=The%20three%20common%20assumptions%20of,educator’%20to%20uncover%20maladaptive%20cognitive
Hutcheson, C. L. (2019). Cognitive behavioral family therapy. In L. Metcalf (Ed.), Marriage and Family Therapy: A Practice-Oriented Approach (pp. 95–118). Springer Publishing Company.
Lan, J. & Sher, T. G. (2019). Cognitive behavioral family therapy. Encyclopedia Of Couple and Family Therapy, 497-505.
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