CHAPTER 11: Behavioral and Cognitive-Behavioral Family Therapies Family Therapy: History, Theory, and Practice 6th Edition Samuel T. Gladding Developed by Nathaniel N. Ivers, Wake Forest University © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved

Overview Behavioral Family Therapy (BFT) Functional Family Therapy Cognitive-Behavioral Family Therapy (CFBT) Major theorists Premises Techniques Roles of the therapist Processes and Outcomes Unique Aspects of BFT and CBFT

Behavioral Family Therapy (BFT) 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 Cognitive-behavioral family therapy (CBFT)

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

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

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

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

Types of BFT and CFBT Therapies Behavioral Parent Training 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

Types of BFT and CFBT Therapies Functional Family Therapy 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)

Functional Family Therapy Continued Three-stage process of Functional Family Therapy: Assessment Change Maintenance

Types of BFT and CFBT Therapies Behavioral Treatment of Sexual Dysfunctions Four phases of sexual responsiveness Excitement Plateau Orgasm Resolution Model for Sexuality PLISSIT

PLISSIT P – Permission to talk about sexuality and sexual issues LI limited information about the prevalence and etiology of problems SS – specific suggestions IT – intensive therapy

Types of BFT and CFBT Therapies 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

CBFT Continued Behavioral component of CBFT 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)

BFT: Treatment Techniques General BFT and CBFT techniques: Education Communication and problem-solving strategies Operant conditioning Contracting

BFT Treatment Techniques Specific behavioral and cognitive-behavioral techniques Classical conditioning Coaching Contingency contracting Extinction Positive reinforcement Quid pro quo Reciprocity

Specific BFT and CBFT Techniques Continued Reciprocity Shaping Systematic desensitization Timeout Job Card Grounding Grounding Charting Premack Principle

Specific BFT and CBFT Techniques Continued Disputing irrational thoughts Thought stopping Self-instructional training Modeling and role playing

Role of the Therapist Expert Teacher Collaborator Coach Helps families to set up behavioral and cognitive-behavioral management programs Behavioral and CBT family therapists must learn to play man roles and to be flexible. CBT family therapists concentrate on modifying or changing family members’ cognitions as well as their interactions.

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 CBFT helps families deal with stress, addiction, and adult sexual dysfunctions

Unique Aspects of BFT and CBFT The theory behind the approaches The research Their continued evolution Their short term treatment Their rejection of the medical model of abnormal behavior