Cognitive-Behavioral Family Therapy EPSY 6393 Dr. Sparrow.

Cognitive-Cognitive-Behavioral Family Behavioral Family

TherapyTherapy

Cognitive-Cognitive-Behavioral Family Behavioral Family

TherapyTherapy

EPSY 6393 Dr. SparrowEPSY 6393 Dr. SparrowEPSY 6393 Dr. SparrowEPSY 6393 Dr. Sparrow

First, our goalFirst, our goalFirst, our goalFirst, our goal

To incorporate principles and To incorporate principles and

practices derived from schools of practices derived from schools of

family therapy that, in themselves, family therapy that, in themselves,

may not offer a complete may not offer a complete

approach to an eclectically approach to an eclectically

oriented practicioner.oriented practicioner.

The Essential Principles of The Essential Principles of BehaviorismBehaviorism

The Essential Principles of The Essential Principles of BehaviorismBehaviorism

Whatever is rewarded is repeatedWhatever is rewarded is repeated

We are often unaware of how we reward undesirable We are often unaware of how we reward undesirable

behaviors behaviors

Change cannot come until...Change cannot come until...

we become aware of the relationship between what we we become aware of the relationship between what we

are doing and undesirable behaviorsare doing and undesirable behaviors

we cease rewarding the behaviorswe cease rewarding the behaviors

we begin to reward the behaviors that we want to we begin to reward the behaviors that we want to

seesee

Types of Behavior Types of Behavior ParadigmsParadigms

Types of Behavior Types of Behavior ParadigmsParadigms

Classical conditioning: Unconditional Stimulus (i.e. food) Classical conditioning: Unconditional Stimulus (i.e. food)

paired with a conditional stimulus (i.e. bell) results in a paired with a conditional stimulus (i.e. bell) results in a

conditioned response (i.e. salivation).conditioned response (i.e. salivation).

Operant Conditioning: Behavior that is rewarded is increased, Operant Conditioning: Behavior that is rewarded is increased,

behavior that is not rewarded or punished is decreased behavior that is not rewarded or punished is decreased

important in family therapy because parents have control important in family therapy because parents have control

of rewards and punishmentsof rewards and punishments

important in marital therapy because spouses can become important in marital therapy because spouses can become

aware of how they have not been rewarding each others’ aware of how they have not been rewarding each others’

desirable behaviors.desirable behaviors.

Overall ApproachOverall ApproachOverall ApproachOverall Approach

Functional Analysis of Behavior––careful Functional Analysis of Behavior––careful

observation to determine the contingencies of observation to determine the contingencies of

reinforcement; that is, how particular reinforcement; that is, how particular

undesirable or desirable behaviors are undesirable or desirable behaviors are currentlycurrently

being reinforced in the family system.being reinforced in the family system.

Then therapist works with parents to stop Then therapist works with parents to stop

reinforcing undesirable behavior, and to begin reinforcing undesirable behavior, and to begin

rewarding desirable behaviors.rewarding desirable behaviors.


In most cases, behavior therapy focuses on In most cases, behavior therapy focuses on

ignoring negative behaviors, and rewarding ignoring negative behaviors, and rewarding

positive behaviors on an intermittent positive behaviors on an intermittent

reinforcement schedule.reinforcement schedule.

Important principle: Behavior doesn’t immediately cease Important principle: Behavior doesn’t immediately cease

(extinguish), because it has been previously reinforced (extinguish), because it has been previously reinforced

intermittently, so children are still expecting to be intermittently, so children are still expecting to be

eventually rewarded. (e.g. mom who gives in after eventually rewarded. (e.g. mom who gives in after

resisting)resisting)

I call this “changeback behavior.” I will discuss it in class.I call this “changeback behavior.” I will discuss it in class.


The exception to the usual approach of ignoring The exception to the usual approach of ignoring

negative behavior as the way to extinguish it, negative behavior as the way to extinguish it,

is when children are engaging in antisocial is when children are engaging in antisocial

behaviors. Punishment is often necessary in behaviors. Punishment is often necessary in

these situations.these situations.

Cognitive AspectsCognitive AspectsCognitive AspectsCognitive Aspects

Schemas are core beliefs about the way Schemas are core beliefs about the way

the world functions, and they determine the world functions, and they determine

how people interpret behavior.how people interpret behavior.

Schemas determine how we arbitrarily Schemas determine how we arbitrarily

and automatically infer certain things and automatically infer certain things

about other people’s behaviors. (e.g. about other people’s behaviors. (e.g.

“When he says no, it’s because I am “When he says no, it’s because I am

unattractive to him.)unattractive to him.)

Cognitive AspectsCognitive AspectsCognitive AspectsCognitive Aspects

The theory of social exchangeThe theory of social exchange

We try to maximize rewards and minimize costs in our We try to maximize rewards and minimize costs in our

relationships.relationships.

This theory implies that when something positive isn’t This theory implies that when something positive isn’t

happening between people (e.g. lovemaking), then happening between people (e.g. lovemaking), then

the costs (e.g. unpleasant consequences that may the costs (e.g. unpleasant consequences that may

accompany intimacy, such as perceived pressure or accompany intimacy, such as perceived pressure or

perceived rejection) are too high. I say “perceived,” perceived rejection) are too high. I say “perceived,”

because the schemas affect our interpretation of the because the schemas affect our interpretation of the

exchange. exchange.

CommunicationCommunicationCommunicationCommunication

An essential part of healthy relationships is a general An essential part of healthy relationships is a general

climate of positive reinforcement.climate of positive reinforcement.

All families and couples experience conflict, and it is All families and couples experience conflict, and it is

important to learn to resolve the conflict with the important to learn to resolve the conflict with the

maximum benefit and minimum cost (social learning maximum benefit and minimum cost (social learning

theory.)theory.)

Unfortunately, couples who engage in “unfair fighting” Unfortunately, couples who engage in “unfair fighting”

do not reap the positive benefits of conflict, and end up do not reap the positive benefits of conflict, and end up

creating distance because the costs (punishments) creating distance because the costs (punishments)

involved in conflict are too great. involved in conflict are too great.

CommunicationCommunicationCommunicationCommunication

Important for couples to learn conflict resolution Important for couples to learn conflict resolution

skillsskills

Discuss feelingsDiscuss feelings

specific behavior concerns of othersspecific behavior concerns of others

request behavior changesrequest behavior changes

avoid criticism and complaintavoid criticism and complaint

Symptom EtiologySymptom EtiologySymptom EtiologySymptom Etiology

Symptoms are learnedSymptoms are learned

Symptoms are rewarded through inadvertent responses Symptoms are rewarded through inadvertent responses

that strengthen undesirable behaviorsthat strengthen undesirable behaviors

Example: Pressuring spouse to show affection drives Example: Pressuring spouse to show affection drives

him/her away, resulting in less affection.him/her away, resulting in less affection.

Example: Whining child eventually gets what he wants Example: Whining child eventually gets what he wants

because parent wants peace, or feels guiltybecause parent wants peace, or feels guilty

Example: Dad finally pays attention to junior when he Example: Dad finally pays attention to junior when he

acts out.acts out.

Symptom EtiologySymptom EtiologySymptom EtiologySymptom Etiology

Important concept that relates to systems theory is Important concept that relates to systems theory is

reciprocal reinforcement.reciprocal reinforcement. Remember that the fundamental Remember that the fundamental

tenet of systems theory is that tenet of systems theory is that reciprocity is the governing reciprocity is the governing

principle of relationships. principle of relationships.

This means that symptoms are mutually reinforcing. This means that symptoms are mutually reinforcing.

(Example: Mom is relieved when she finally gives in to (Example: Mom is relieved when she finally gives in to

junior’s pleading. Thus, both parties are “rewarded” when junior’s pleading. Thus, both parties are “rewarded” when

she gives in.she gives in.

Aversive control (Example: Husband who threatens to kill Aversive control (Example: Husband who threatens to kill

himself if wife leaves him, or wife who cries to get himself if wife leaves him, or wife who cries to get

husband to soften his approach to her.) husband to soften his approach to her.)

Cognitive Cognitive DistortionsDistortionsCognitive Cognitive

DistortionsDistortionsSchemas learned early in life that underlie Schemas learned early in life that underlie biased assumptions about roles and behaviors.biased assumptions about roles and behaviors.

Arbitrary inference (narrative fallacy)Arbitrary inference (narrative fallacy)

Selective abstractionSelective abstraction

OvergeneralizationOvergeneralization

Exaggeration and minimalizationExaggeration and minimalization

Personalization (delusions of reference)Personalization (delusions of reference)

Dichotomous thinkingDichotomous thinking

LabelingLabeling

Mind readingMind reading

Therapeutic ObjectivesTherapeutic ObjectivesTherapeutic ObjectivesTherapeutic Objectives

Extinguish undesirable behaviorExtinguish undesirable behavior

Reinforce positive alternativesReinforce positive alternatives

Educate clients in three areas:Educate clients in three areas:

communicationcommunication

problem-solving problem-solving

negotiation (accommodation)negotiation (accommodation)

Conditions for Conditions for ChangeChange


Just as the SFT therapist considers the Just as the SFT therapist considers the

alteration of structure the essential alteration of structure the essential

objective of family therapy, the cognitive-objective of family therapy, the cognitive-

behaviorist considers the behaviorist considers the alteration of alteration of

reinforcement contingenciesreinforcement contingencies necessary necessary

and sufficient to bring about therapeutic and sufficient to bring about therapeutic

change.change.Consider the possibility that theseConsider the possibility that theseare quite similar, if not the same, in are quite similar, if not the same, in

practice.practice.



For example consider triangulation: You are the For example consider triangulation: You are the

substitute for someone’s spouse, and to the extent that substitute for someone’s spouse, and to the extent that

you listen and sympathize, a negative behavior is you listen and sympathize, a negative behavior is

rewarded. De-triangulation, through a variety of rewarded. De-triangulation, through a variety of

remedies that we have studied, all bring about a remedies that we have studied, all bring about a

cessation of reward, and begin to reward constructive cessation of reward, and begin to reward constructive

behavior (direct, honest communication.) The language behavior (direct, honest communication.) The language

you use to describe this process reflects your paradigm, you use to describe this process reflects your paradigm,

but the remedies are quite similar regardless of your but the remedies are quite similar regardless of your

model.model.

Consider the possibility that theseConsider the possibility that theseare quite similar, if not the same, in are quite similar, if not the same, in

practice.practice.

Points of InterestPoints of InterestPoints of InterestPoints of Interest

Cognitive-behavioral therapists focus on changing Cognitive-behavioral therapists focus on changing

dyadic interactive patterns, similar to the early family dyadic interactive patterns, similar to the early family

therapists (cyberneticists), but does not focus on therapists (cyberneticists), but does not focus on

triadic interactions, which are more characteristic of triadic interactions, which are more characteristic of

modern systemic approaches, such as SFT.modern systemic approaches, such as SFT.

Positive reinforcement, rather than punishment, is Positive reinforcement, rather than punishment, is

widely used today in behavioral family therapy. It is widely used today in behavioral family therapy. It is

widely believed that parents have already resorted to widely believed that parents have already resorted to

punishment and have failed. Further, therapists want to punishment and have failed. Further, therapists want to

avoid introducing coercive control wherever possible.avoid introducing coercive control wherever possible.

Therapeutic TechniquesTherapeutic TechniquesTherapeutic TechniquesTherapeutic Techniques

The most commonly used approach in The most commonly used approach in

treating children with behavior problems treating children with behavior problems

is to introduce reinforcers that areis to introduce reinforcers that are

tangible (candy, TV, video games)tangible (candy, TV, video games)

social (praise, time out)social (praise, time out)

Therapeutic TechniquesTherapeutic TechniquesTherapeutic TechniquesTherapeutic Techniques

Shaping––reinforcing change in small stepsShaping––reinforcing change in small steps

token economies––uses points, stars, or stickers token economies––uses points, stars, or stickers

for rewardfor reward

contingency contracting––If you will do x, we will contingency contracting––If you will do x, we will

do ydo y

contingency management––giving and taking contingency management––giving and taking

away rewardsaway rewards

time-outtime-out

Couples TherapyCouples TherapyCouples TherapyCouples Therapy

Dr. Sparrow’s approach to contingency contracting:Dr. Sparrow’s approach to contingency contracting:

Take turns listing verbally specific changes in the spouse’s Take turns listing verbally specific changes in the spouse’s behavior in positive terms. (e.g. Come home early enough behavior in positive terms. (e.g. Come home early enough to spend time together vs. Don’t stay at work too late.to spend time together vs. Don’t stay at work too late.

These requests are written down by the therapistThese requests are written down by the therapist

Once both have made their lists, therapist asks each Once both have made their lists, therapist asks each person to what extent he or she believes that each request person to what extent he or she believes that each request would be “good for them” independently of the spouse’s would be “good for them” independently of the spouse’s desires.desires.

Therpist asks each to enter into a “covenant” with Therpist asks each to enter into a “covenant” with themselves or with God or both to abide by this themselves or with God or both to abide by this commitment.commitment.

Couples TherapyCouples TherapyCouples TherapyCouples TherapyDr. Sparrow’s approach to contingency contracting:Dr. Sparrow’s approach to contingency contracting:

By making each person’s commitment to By making each person’s commitment to themselves or to God, the therapist encourages themselves or to God, the therapist encourages each spouse to remain true to their promises each spouse to remain true to their promises independent of what the other person does or independent of what the other person does or does not do.does not do.

Criticism of quid pro quo (I will do x if you will do y) Criticism of quid pro quo (I will do x if you will do y) agreements is that if one person fails, then the agreements is that if one person fails, then the other has an excuse to break the agreement, too.other has an excuse to break the agreement, too.

Covenanting guards against a “three-legged race” Covenanting guards against a “three-legged race” approach in which one person’s positive change is approach in which one person’s positive change is tied to another’s.tied to another’s.

Family therapy a la Family therapy a la EllisEllis

Family therapy a la Family therapy a la EllisEllis

Helps family to see how illogical beliefs Helps family to see how illogical beliefs

serve as foundation for family distress.serve as foundation for family distress.

Taught the ABC theory and encouraged to Taught the ABC theory and encouraged to

challenge irrational beliefs. (e.g. “If junior challenge irrational beliefs. (e.g. “If junior

smokes pot, he is an addict and a failure,” smokes pot, he is an addict and a failure,”

or “If she disagrees with me, then she has or “If she disagrees with me, then she has

no respect for me.”no respect for me.”

Family therapy a la cognitive-Family therapy a la cognitive-behavioral approachbehavioral approach

Family therapy a la cognitive-Family therapy a la cognitive-behavioral approachbehavioral approach

takes a broader view than Ellis and his followers, takes a broader view than Ellis and his followers,

by emphasizing both cognition and behaviorby emphasizing both cognition and behavior

focuses in greater depth on family interactive focuses in greater depth on family interactive

patternspatterns

believes that family members are believes that family members are

simultaneously influencing each other’s simultaneously influencing each other’s

cognitions, emotions, and behaviors, similar to cognitions, emotions, and behaviors, similar to

systems theory.systems theory.

Family therapy a la Family therapy a la BeckBeck


Revolves around clarifying beliefs, Revolves around clarifying beliefs,

expectancies, and attributions through expectancies, and attributions through

analyzing the underlying schemas or “core analyzing the underlying schemas or “core

beliefs.”beliefs.”

schemas relating to family of originschemas relating to family of origin

schemas relating to families in generalschemas relating to families in general



Eight steps:Eight steps:

identify family schemasidentify family schemas

trace origins of family schemastrace origins of family schemas

point out need for changepoint out need for change

elicit acknowledgment of the need to changeelicit acknowledgment of the need to change

assess family’s ability to make changesassess family’s ability to make changes

implement changeimplement change

enact new behaviorsenact new behaviors

solidify changessolidify changes

This is similar to This is similar to reframing, except that reframing, except that the therapist does not the therapist does not impose his or her impose his or her assessment, but gets assessment, but gets the family to do that the family to do that work.work.

Cognitive-Behavioral Family Therapy EPSY 6393 Dr. Sparrow.

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