Chap 11 - Behavioral and CBFT

Question 1

Behavioral Family Therapy (BFT)

Answer 1

• Is a fairly recent treatment methodology that had its origins in research involving the modification of children’s actions by parents.
• Treatment procedures based on Social Learning Theory (Bandura & Walters)
• Stresses the importance of modeling new behaviors
• Initially structure had a linear nature (A caused B)
• Grew to embrace a more interactional style treating family behavioral problems
• A type of BFT that is systemic is Functional Family Therapy

Question 2

Initial work was conducted at the Oregon Social Learning Center w/Gerald Patterson and John Reid in the mid-1960’s

Answer 2

BFT

Question 3

Involved training parents and significant adults to be agents of change in their children’s lives

Answer 3

BFT

• a

Question 4

BFT techniques include:

Answer 4

1. Rewards (candy, eventually used points instead)
2. Modeling
3. Time-out
4. Contingent attention

Question 5

Cognitive-Behavioral Family Therapy (CBFT)

Answer 5

• Is fairly new; involves cognitive restructuring including behavioral change.
• CB Theorists irrational beliefs cause, or at least maintain maladaptive behaviors and disorders
• Cognitions which perpetuate maladaptive behavior may include:
  • Irrational beliefs
  • Arbitrary inference
  • Dichotomous reasoning
  • Overgeneralization
• CBT was first applied to couples and families in the 1970s.

Question 6

Major Theorists

Answer 6

John Watson, Mary Cover Jones, Ivan Pavlov…

Question 7

BF Skinner

Answer 7

• brought Behavioral therapy to the a national spotlight
• First to use the term Behavior Therapy
  • Argued convincingly that behavior problems can be dealt with directly, not just as symptoms of underlying conflict.
• Originator and proponent of operant conditioning
  • Text: Science and Human Behavior (1955)
• Much of BFT and CBFT are built on Skinner’s work

Question 8

Operant Conditioning

Answer 8

The belief that people learn through rewards and punishments to respond to their environments in certain ways

Question 9

Gerald Patterson

Answer 9

credited as being the primary theorist who began the practice of applying behavioral theory to family problems in the 60s

Question 10

o Work at the Oregon Social Learning Center led to the identification of a number of behavior problems and corrective interventions.
• Especially training parents to act as agents of change in their children’s environment

Answer 10

Gerald Patterson

Question 11

Patterson and associates developed a family observational coding system to use…

Answer 11

in assessing dysfunctional behaviors through their observations of parents and children in labs and natural environments

Question 12

Neil Jacobson

Answer 12

• his practice helped refine his theoretical contributions to behavioral marital therapy and domestic violence
• Found the accountability, empiricism, and methodologies of behaviorism very appealing
• Was on the leading edge of family therapy until his death in ‘99

Question 13

Neil Jacobson discovered that male batterers

Answer 13

(Type I’s or Cobras) had lower (decelerated) heart rates during times of physical assault
- People previously believed that it was higher (accelerated)

Question 14

Neil Jacobson found that acceptance, which is…

Answer 14

loving your partner as a complete person and not focusing on differences – may lead to the ability to overcome fights that continuously focus on the same topic
o Jacobson’s findings challenged M&FTists to be more innovative and effective

Question 15

John Gottman

Answer 15

• known for his expertise on marital stability and divorce prediction
• He and his wife have turned their attention to couples who are expecting their first baby

Question 16

If you feel like your partner respects you, is interested in you, and turns toward you, then…

Answer 16

you will have a positive sentiment override for the negatives that may be in your relationship.

Question 17

Premise of BFT

Answer 17

• Based on Behavioral Therapy – especially classical and operant conditioning
  • Behavior is learned; people – including families – act according to how they have been previously reinforced
  • Behavior is maintained by its consequences and will continue unless more rewarding consequences result from new behavior
• Maladaptive behaviors (and not underlying causes) should be the targets of change
  • Ineffective behaviors can be extinguished and replaced with new sequences of behavior patterns
• Not everyone in the family has to be treated for change to occur
• Focuses on identifiable, overt behavioral changes
  • Not usually be considered a systemic but does share an emphasis on the importance of “family rules and patterned communication processes…”
• Emphasizes the major techniques within a behavioral theory approach
  • Stimulus
  • Reinforcement
  • Shaping
  • modeling
• Has more specific forms of treatment than any other form of family (with the exception of Strategic Family Therapy)

Question 18

Premise of CBFT

Answer 18

• The relationship-related cognitions individuals hold, shape how they think, feel and behave in couple and family relationships
• Also emphasize cognitive aspects of treatment
  • Attention focuses on what family members are thinking as well as how they are feeling and behaving
• CBFT therapists believe it’s important to gain insight into how cognitions influence a problem
• Utilizes health-promoting, relationship-related cognitions that promote growth and negative - relationship-related cognitions that lead to distress and conflict
• Therapists must deal with irrational beliefs on the part of resistant family members

Question 19

Four Most Prevelant Forms of Behavioral and CBFT

Answer 19

1. Behavioral parent training and Parent therapies
2. Functional family therapy
3. Behavioral treatment of sexual dysfunctions
4. Cognitive-behavioral family therapy

Question 20

Behavioral parent training and Parent therapies

Answer 20

• The therapist serves as a social learning educator whose prime responsibility is to change parents’ responses to a child or children, both through thoughts and actions
• By effecting change in the parents, children’s behavior is altered
• This treatment has a linear structure
• Therapists must be precise and direct in following a set procedure
• This approach attempts to improve the reactions, self-esteem, perceived support, and well-being of parents as a goal itself
• In Parent Therapies, parents are considered clients in their own right; this approach attempts to improve the reactions, self-esteem, perceived support, and well-being of parents as a goal all its own
• In either approach, one of the initial and main tasks of the therapist is to define a specific problem behavior, monitor that behavior (A, B, C) and then trained in social learning theory; usually include verbal and performance methods; may involve role-playing, modeling, behavioral rehearsal, and prompting; performance is charted
• A psychoeducational parenting program is essentially Cognitive-Behavioral is particularly effective for at-risk parenting behavior; significant gains with low SES parents
• In parent therapies, parent variables are considered as important as child variables; the goal is to improve parental feelings; provides nonviolent resistance training

Question 21

Functional family therapy

Answer 21

• Is family-based, empirically supported treatment for behavioral problems, especially with adolescents
• It is a multisystemic approach focusing on relevant systems at several levels (individual, family, and community) and all domains of client experience (biological, behavioral, affective, cognitive, cultural, and relational)
• It integrates different theoretical backgrounds from behavioral, systemic, cognitive, and intrapsychic therapies
• All behavior is adaptive and serves a function
• Behaviors represent an effort by the family to meet needs in personal and interpersonal relationships.
• Behaviors help family members achieve one of three interpersonal states
• Functional family therapy is a systemic, three stage process

Question 22

In Functional Family Therapy, behaviors help family members achieve one of three interpersonal states, which are:

Answer 22

i. Contact/closeness (merging) – members are drawn together
ii. Distance/independence (separating) – members learn to step away from each other
iii. A combination of I and II (midpointing) – members fluctuate in their emotional reactions, individuals are both drawn in and repelled from each other

Question 23

Functional family therapy systemic; three stage process:

Answer 23

PHASE I – Assessment: what is the function of the behavioral sequences? Do they promote closeness? Create distance? Or help the family achieve a task? The answer is found through direct questioning and observing

PHASE II – Change: help the family become more functional through:

 1. Clarifying relationships
 2. Interrelating thoughts, feelings, and behaviors of family members
 3. Interpreting the functions of current family behavior
 4. Relabeling behavior so as to alleviate blame
 5. Discussing how the removal of a behavior will affect the family 
 6. Shifting the treatment from one individual to the entire family

PHASE III – Maintenance: focuses on educating the family and training them in skills that will be useful in dealing with future conflict; specific skills taught are those dealing with effective communication, team building, and behavioral management (eg contracting)

Question 24

Behavioral treatment of sexual dysfunctions

Answer 24

• Sexual functioning is more than just having intercourse; it is physical and psychological – comprised of intimacy, relationship satisfaction, self-esteem, and family life
• Masters and Johnson pioneered the cognitive-behavior approach to working with couples in the late 60s and early 70s
• Masters and Johnson delineated four phases of sexual responsiveness:
• Discovered the importance of learning and behavioral techniques in the remediation of sexual dysfunctions• Their work from beginning to end is systemic
• Joseph LoPiccolo and associates have also reported behavioral sex therapy techniques success and that behavioral approaches had common elements:
• Behavioral-oriented therapy for sexual dysfunctions has been found to produce excellent outcomes

Question 25

The common elements found by Joseph LoPiccolo and associates:

Answer 25

i. The reduction of performance anxiety
ii. Sex education including the use of sexual techniques
iii. Skill training in communications
iv. Attitude change methodologies

Question 26

Cognitive-behavioral family therapy

Answer 26

• Same principals as cognitive-behavioral MARITAL therapy (CBMT) are used, only broader and more extensive
• The cognitive piece places a lot of emphasis on modifying personal or collective core beliefs/schema
• It’s particularly important to help change entrenched and long-standing beliefs that family members have about family life, parenting, especially if the beliefs are NOT factual or functional
• A major emphasis in CBFT Is to teach families how to think for themselves and differently when it is helpful
• When the schemas change, the “behavioral component” of CBFT focuses on several aspects of family members’ actions

Question 27

CBFT focuses of family members’ actions:

Answer 27

i. Excess negative interaction and deficits in pleasing behaviors exchanged between family members
ii. Expressive and listening skills used in communication
iii. Problem solving skills
iv. Negotiation and behavior change skills

Question 28

General Behavioral and Cognitive-Behavioral Approaches

Answer 28

As a rule Behavioral AND Cognitive-behavioral family therapists use a variety of learning theory techniques to bring about change in families. These techniques are generally modified from the same techniques used to treat individuals. 
•	Positive reinforcement
•	Extinction
•	Shaping 
•	Desensitization
•	Contingency contracts
•	Cognitive-behavior modification
Techniques are usually applied in combination so that family members learn individually and collectively how to give and receive recognition and approval for desired behaviors.

Question 29

In BFT a relatively small number of interventions tend to form the basis for most therapeutic plans across a broad range of settings:

Answer 29

• Education
• Communication and problem-solving strategies
• Operant conditioning
• Contracting

Question 30

Education

Answer 30

methods intended to help family members learn more about how relationships work; to help them relate to one another better; ie – attend lectures, read books together, view videos as a group, have discussions based on the previous activities

Question 31

Communication and problem-solving strategies

Answer 31

are intended to help families develop mutually enhancing social exhanges; “Instruction, modeling, and positive reinforcement (e.g., praise) are used to enhance communication skills until both the therapist and the family agree that they are competent. Problem solving is directed at the resolution of conflict within a family.

Question 32

Operant conditioning

Answer 32

is employed mostly in parent-child relationships; most common approach involves teaching parents to use shaping and time out procedures to increase desirable behavior.

Question 33

Contracting:

Answer 33

used when family interactions have reached a severe level of hostility; they build rewards for behaving in a certain manner (i.e. token economy, point systems, reinforcing appropriate behavior)

Question 34

Specific Behavioral and Cognitive-Behavioral Techniques

Answer 34

The following are more specific techniques used in behavioral and CBFT approaches. Almost all of these techniques are used frequently. They are all operationally definable, precise, and measureable. They are applicable to psychological and some sexual situations. They are able to bring about a fairly significant change in a relatively short amount of time.

Classical conditioning
Coaching
Contingency contracting
Extinction
Positive Reinforcement
Quid Pro Quo
Reciprocity
Shaping
Systematic desensitization
Time-out
Job Card Grounding
Grounding
Charting
Premack principle
Disputing irrational thoughts
Thought Stopping
Self-instructional training
Modeling and role playing
Shame attack

Question 35

Role of the therapist

Answer 35

The therapist is the expert, teacher, collaborator, and coach
• Helps the families identify dysfunctional behaviors and thoughts and then works with these families to set up behavioral and cognitive-behavioral management programs
• The therapist comes to understand the influence family members have on each other and then works with these families to set up behavioral and cognitive-behavioral management programs that will assist with change
• To be effective, the therapist must learn to play many roles and be flexible
• AIM (see additional vocab)
• Cognitive-behavioral therapists concentrate on modifying family members’ cognitions as well as the interactions
• BOTH mean taking an active part in designing and implementing specific strategies
• BOTH must have persistence, patience, knowledge of learning theory, and specificity in working with family members

Question 36

Process and outcome

Answer 36

• If BFT is successful, family members learn how to modify, change, or increase certain behaviors in order to function better.
• If CBFT is successful, dealing constructively with the cognitions of each family member is crucial
• In BOTH, family members learn how to eliminate or decrease maladaptive or undesirable behaviors
o CBFT- and negative thoughts
• BOTH stress the use of specific techniques aimed at particularly important actions
• BFT focuses in particular on increasing parenting skills, facilitating positive family interactions, and improving sexual behaviors
• CBFT is most powerful in helping families deal with stress, addiction, and adult sexual dysfunctions
• In practice, blending of the two techniques often occurs
• By the end of treatment, couples and individuals should be able to modify their maladaptive behaviors and/or cognitions, lower anxiety, and use relaxation procedures.

Question 37

Unique aspects of Behavioral and Cognitive-behavioral approaches

Answer 37

Both have unique and universal points. Practitioners need to be aware of them so that they can achieve the best possible outcome.

Question 38

Emphasis of Behavioral and CBFT

Answer 38

1. Both utilize the learning theory approach – well formulated, highly researched
   o Learning theory focuses on pinpointing problem behaviors and making use of behavioral and cognitive techniques
   • Contingency contracts
   • Reinforcement
   • Punishment
   • Extinction
2. Both are research based.
3. Both involve continued evolution
   a. BFT
   i. focus on parent management to a focus on the family as a system
   ii. incorporated many ideas from cognitive approaches in its handling of families
   b. because they are flexible, both are able to focus on a variety of problems and concerns
   i. promoting changes from within
   ii. altering family interaction styles
   c. have influenced other approaches
4. Both are short term treatments
   a. processing problems are taken seriously, examined and broken down into definable parts and then, using target strategies, therapists teach skills or extinguish maladaptive behavior
5. Both reject the medical model of abnormal behavior
   a. problems can be addressed directly and effectively without labeling
6. Both can be useful at a number of levels as long as they are used as part of a comprehensive treatment

Question 39

Comparison of Behavioral and CBFT with other theories

Answer 39

Both are less systemic than other theories
• Learning theory is to bring about linear change
o Can prohibit complete family change in the process
• BFT – some therapists do not focus on the affective components of behavior (i.e. feelings)
o Even though the behaviors might change the thoughts and feelings behind the behavior may not change
• Both are precise. The rigidity some therapists use could turn off their patients
• Both of historical data to consider
• Both generally stress family action over family thought
• CBFT – has integrated concepts and methods from so many other approaches

Question 40

Assertiveness

Answer 40

asking for what one wants

Question 41

Desensitization

Answer 41

overcoming unnecessary and debilitating anxiety associated with a particular event

Question 42

Social exchange theory

Answer 42

stresses the rewards and costs of relationships in family life according to a behavioral economy

Question 43

Nonviolent resistance

Answer 43

a sociopolitical model “aimed at helping parents deal effectively with their helplessness, isolation, and escalatory interactions with their children” – in this approach, parents are redirected away from a child’s reactions and toward their own performance. The emphasis is on commitment and acceptance rather than control

Question 44

Baseline

Answer 44

recording of the occurrence of targeted behaviors before an intervention is made.

Question 45

Anatomy of Intervention Model (AIM)

Answer 45

– delineates five phases in therapy
I.	Introduction
II.	Assessment
III.	Motivation
IV.	Behavior change
V.	termination