cbt for family and marital problems 2 (2)

7/28/2019 CBT for Family and Marital Problems 2 (2)

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Dr.Abdelaziz Elfaki

University of Dammam


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Outlines:

Definition

The Basic Model

The Role of Neurobiological

Processes

Development of Behavior Disorders

The Mechanics of Change with

Couples and Families

Assessment

Therapy Techniques

Treatment of Sexual D sfunction


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Definition

Cognitive-behavioral marriage and family therapy(CBFT) is a therapeutic approach intended to

help couples and families experiencing difficulties

with their relationships.

CBFT looks at individual behaviors, thought

patterns, emotions, beliefs and perceptions and

the effect that these have on the functioning of

the couple or family as a whole.

CBFT is concerned with current interactions

between the members of the couple or family

system, and the meaning that is derived from

these interactions.


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BackgroundWhen they first working with

families, behavior therapists

applied learning theory to train

parents in behavior modification

and teach couplescommunication skills


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Pavolve:

Watson:

Wolpe:

Skinner:

Richard

Stuart (1969):

Classical Conditioningused classical conditioning to experimentally

induce a phobia in "Little Albert

Systematic DesensitizationAnxiety is response of the autonomic nervous

system acquired through classical conditioning.

Systematic desensitization deconditions anxiety

through reciprocal inhibition by pairing responsesincompatible with anxiety

Operant Conditioning Responses that are positively reinforcement will

repeat more frequently; those that punished orignored will be extinguished.

Contingence ContractingFocused on how the exchange of positive

behavior could be maximized using


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During '70s, behavioral family therapyevolved into 3 major packages :

Parent Training Couples Therapy Sex

Therapy

By the end of '70s, there has been a

rapprochement between behavioralmodels and cognitive theories.


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The Basic Model The central premise of behavior therapy is :

o Behavior is maintained by its consequences.

Consequences that increase behavior are calledreinforcers; those that decrease behavior are

known aspunishers.

o Extinction occurs when no reinforcement follow a

response.


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The Basic Model

The central premise of cognitive therapy is:

o Our interpretation of other people's behavior

affects the way we respond to them.

o

Among the most troublesome of automaticthoughts are those based on arbitrary inference,distorted conclusions shaped by a person`sschemas ,or core belief about the world and how

it functions.

o What makes these underlying beliefs problematic

is that although they are generally not conscious

,they bias how we respond to everything and

everyone.


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The Basic Model

Theory of Social Exchange (Thibaut and Kelley's ):

People strive to maximize rewards and minimize

costs in relationships.

In a successful relationship, partners work tomaximize mutual rewards. By contrast, in

unsuccessful relationship, the partners are too

busy trying to protect themselves from getting

hurt to consider ways to make each other happy.

Behavior exchanges follow a norm of reciprocity,

that means aversive or positive stimulation from

one person tends to produce reciprocal behavior

from the others. Kindness begets kindness, andthe o osite is also true.


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The Role of Neurobiological Processes

Recently, increasing attention has been paid to

the effects of

genetics and neurobiology on interpersonalrelationships.

The emerging field of neuropsychobiology

provides us with

new insights into how emotional and behavioralpatterns

develop in intimate relationships.


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The Role of Neurobiological

Processes

Louann Brizendine (2006) cites research

showing that

women use both hemispheres of their brainsto respond

to emotional experiences, whereas men use

only one

hemisphere (Wagner & Phan, 2003).


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The Role of Neurobiological Processes

It was also determined that the connections

between the

emotional centers of the brain are moreactive and

extensive in women (Cahill, 2003). This likely

explains

why women typically remember emotionalevents, such

as arguments, more vividly and retain them

longer than


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The Role of the Amygdala

Such subcortical structures as the amygdalaare

believed to operate quickly and automatically,so

that certain triggered features, such as when

the

whites of our eyes widen in a fearfulexpression, are

relatively unfiltered and always evoke

responses,

such as flight, that may be important for


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Normal Family Development

According to behavior exchange theory

(Thibaut and Kelley's,1959) ,a good

relationship is one in which giving and getting

are balanced.

Wills , Weiss, and Patterson (1978) found thatunpleasant behavior reduced marital satisfaction

more than pleasant behavior increased it . Healthy families arent problems free, but they

have ability to cope with problems when they

arise

Gottman & Krokoff,1989


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Development of Behavior

Disorders

Behaviorists view symptoms as learned

responses. The don`t look for underlying motives.

At first glance it would seem puzzling that family

members reinforce undesirable behavior.

Parents usually respond to misbehavior in their

children by scolding and lecturing .These

reactions may seem like punishment ,but theymay in fact be reinforcing ,because attention

even from a critical parent-is a powerful social

reinforcer.


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Disorders

The use of aversive control ,nagging ,crying

,withdrawingis

often sited as a major determinant of marital

unhappiness.

People in distressed relationships also show poor

problem-

solving skills .


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Disorders

According to cognitive behaviorists ,the schemathat plague

relationships are learned in the process of

growing up.

These schemas are the underlying basis of the

shoulds ,self-

fulfilling prophesies ,mind reading ,jealousy ,andbad faith

that poison relationships by distorting family

members`

responses to each other`s actual behavior.


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The Mechanics of Change with Couples and

Families

Cognitive Processes :

Expectations and Standards :

Cognitive processes are the backbone of thecognitive

-behavioral approach to relationship dysfunction.

Baucom,

Epstein, Sayers, and Sher (1989) developed atypology of

cognitions that frequently surface during the

course of

relationship distress. These processes include:

e ec an cs o ange w


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e ec an cs o ange wCouples and Expectations and

Standards-Families

1. Selective attention. The individuals tendency

to notice only certain aspects of the events

occurring in relationships and to overlook others

(e.g., focusing on the partners words andignoring his or her actions).

2.Attributions. Inferences about the factors that

have influenced a

partners actions (e.g., concluding that a partner

failed to respond to a question because he or she

wants to control the relationship).


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The Mechanics of Change with Couples and

Expectations and Standards-Families

3. Expectancies. Predictions about the likelihoodthat particular events

will occur in the relationship (e.g., that expressing

feelings to ones partner will result in the partners

getting angry).

4.Assumptions. Beliefs about the general

characteristics of people andrelationships (e.g., a

wifes assumption that men dont need emotional

attachment).

5. Standards. Beliefs about the characteristics

that people and relationships "should have (e.g.,

that partners should have no boundaries betweenthem, sharin all of their thou hts and emotions

ommon ogn ve s or ons w


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ommon ogn ve s or ons wCouples

and Families

1. Arbitrary inference. Conclusions are made inthe absence of

substantiatingevidence, for example, parentswhose

teenager arrives home a half hour beyond her

curfew

conclude, Shes up to no good again.2. Selective abstractions. Information is taken

out of context,

and certain details are highlighted while other

important



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and Families

3. Overgeneralization. An isolated incident or twois allowed to

serve as a representation of all similar situations,

related or unrelated. For example, when a parent

declines a childs request to go out with hisfriends, the child concludes, You never let me do

anything.

4. Magnification and minimization. A situationis perceived as more or less significant than is

appropriate. For example, an angry husband

blows his top upon discovering that the

checkbook isnt balanced and says to his wife,

Were in big trouble.



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and Families

5. Personalization. External events are attributedto oneself when

insufficient evidence exists to render a

conclusion. For example, a woman who finds her

husband adding more salt to her meal assumes,He hates my cooking.

6. Dichotomous thinking. Experiences arecodified as either blackor white, a complete

success or a total failure. This is otherwise known

aspolarized thinking. For example, when a

husband is reorganizing a closet and his wife

questions the positioning of one of the items, the

husband thinks to himself, Shes never happy



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and Families

7. Labeling and mislabeling. Ones identity isportrayed on the basis ofimperfections and

mistakes made in the past, and these are allowed

to define oneself. For example, subsequent to

continual mistakes in meal preparation, a wifethinks, 1 am worthless, as opposed to

recognizing her error as being minor.

8.Tunnel vision. Sometimes mates see only

what they want to see orwhat fits their currentstate of mind. A man who believes that his wife

does whatever she wants anyway may accuse

her of making a choice based purely on selfish

reasons.



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and Families

9. Biased explanations. This is a type of thinkingthat partners develop during times of distress,

automatically assuming that a spouse has a

negative alternative motive behind his or her

intent. For example, a woman tells herself, Hesacting real lovey-dovey because he wants a

favor from me. Hes setting me up.

10. Mind reading. Some spouses end up

ascribing unworthy intentions to each other. Forexample, a man thinks to himself, I know what is

going through her mind; she thinks that I am

naive about what shes

doing.


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Attachment and Affect

Models of Attachment and the SecureEmotional Connection :

Bowlby (1979) believed that human attachment

patterns

noted in infantcaregiver interactions went on to

play a vital

role in human development from the cradle to

the grave

Research has supported a positive correlation

between adult

attachment and relationship satisfaction

(Mikulincer et al., 2002). When both partners in a


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Attachment Styles

Bartholomew and Horowitz (1991) furtherexpanded this

concept into four styles of attachment:

1. Securethe view of oneself as worthy and

others as trustworthy,

allowing one to be comfortable with intimacy and

autonomy.

2. Preoccupiedmaintaining a negative view ofoneself, yet a positive

view of others, causing one to become

overinvolved in close relationships

and depending on others for a sense of self-


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Attachment Styles

3. Fearfulavoidanta negative view of both

oneself and others,

causingone to be fearful of intimacy and

avoiding

relationships with other people.

4. Dismissingmaintaining a positive view of

oneself, but anegative view of others, causing one to avoid

relationships

with others, preferring to remain independent

and shying


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Assessment

1-Initial Joint Interviews :

Joint interviews with a couple or a family are an

important source of information about past and

current functioning.

Not only are they a source of information about

the

members memories and opinions concerningcharacteristics

and events in their relationships, conjoint

interviews also give

the therapist an opportunity to observe the family


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Assessment

Cognitive-behavioral therapists approach

assessment in an

empirical manner, using initial impressions to form

hypotheses that must be tested by gathering

additional information in subsequent sessions.


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Assessment

2 -Gathering Background Information :

During the initial joint interview, the therapist asks

each

member of the family about:

His or herreasons for seeking assistance,

Each persons perspective on those concerns,

Any changes that each member thinks wouldmake family life more satisfying.


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Assessment

3 - Inventories and Questionnaires :

A therapist often asks couples and family

members to complete questionnaires before the

intake interviews,

so that he or she can ask for additional

information about the questionnaire responses

during the initial interviews. Naturally, individualsreports on questionnaires are subject to bias,

such as blaming others for family problems and

presenting themselves in a socially desirable way.


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Assessment

A variety of measures have been developed to

provide an

overview of key areas of couple and family

functioning, such

as overall satisfaction, cohesion,communication quality,

decision making, values, and level ofconflict .

I t i d


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Inventories and

Questionnaires

Dyadic Adjustment Scale (Spanier, 1976),Marital Satisfaction InventoryRevised (Snyder

& Aikman, 1999),

Family Environment Scale (Moos & Moos, 1986),

Family Assessment Device (Epstein, Baldwin, &

Bishop, 1983),

Self-Report Family Inventory (Beavers,

Hampson, & Hulgus, 1985).


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Additional Psychological Testing and

Appraisals

Occasionally, the need may arise for more

specific

assessment, especially ifserious

psychopathology is

suspected in spouses or family members.

The Minnesota Multiphasic Personality Inventory

2 (MMPI-2) and the Millon Clinical Multiaxial Inventory

(MCMI) are

two of the more popular instruments for

determining levels

C iti B h i l


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Cognitive-Behavioral

Techniques

1-Educating and Socializing Couples and

Family

Members about the Cognitive-Behavioral

Model .

2-Identifying Automatic Thoughts and

Associated

Emotions and Behavior.3- Addressing Schemas and Schema

Restructuring.


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Behavioral Techniques

1- Communication Training :

Strategies for the Speaker

1. Speak attentively2.Ask meaningful questions.

3. Do not overspeak.

4.Accept silence.

5.Avoid cross-examining.


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Strategies for the Listener

1. Listen attentively

2. Do not interrupt.3. Clarify what you hear.

4. Reflect on what you hear.

5. Summarize

Conveying Empathy

Validation.


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Techniques for Modifying and Reducing

Interruptions in Communication

The Pad-and-Pencil Technique.


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Problem-Solving Strategies: Define the problem in specific behavioral terms.

Compare

perceptions and arrive at an agreeable

description of the

problem.

Generate a possible set of solutions.

Evaluate the advantages and disadvantages ofeach solution.

Select a feasible solution.

Implement the chosen solution and evaluate its

effectiveness


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Behavioral Exchange AgreementsContingency Contracts :

Stuart outlined a four-step process of employing

this strategy:

1. Identify a rationale for mutual change.

2. Have each spouse or family member initiate

changes in his or her own behavior first.

3. Record the frequency of the targeted behavioron a chart.

4. Have each spouse or family member sign a

written contract for a series of exchanges of

desired behaviors.


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Assertiveness Training

Deescalation and Time Out

Behavioral RehearsalRole Reversal

Acquiring Relationship Skills

Homework Assignments

Bibliotherapy Assignments

Audiotaping or Videotaping Interactions at

Home


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Activity Scheduling

Self-Monitoring

Testing Predictions with BehavioralExperiments

Behavioral Techniques and Parental Control

Cognitive Behavioral


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Cognitive-Behavioral

Techniques

Addressing the Potential for RelapsePartners Negativity and Hopelessness about

Change

Negative schemas about the characteristics of

the relationship need to be addressed by having

the clients test the validity of their fixed views and

consider information that suggests that

such views can be changedDifferences in Agendas

Anxiety about Changing Existing Patterns in

the Relationship


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Roadblocks

Therapist RoadblocksUnrealistic Expectations

Cultural Obstacles

Racial IssuesEnvironmental Forces

Psychopathology

Low Intellectual and Cognitive Functioning

Effects of Previous Treatment

Inoculation against Backsliding


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cbt for family and marital problems 2 (2)

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