Cognitive-behavioral family therapy derives from the general foundation of cognitive-behavioral therapy (CBT) basic strategies. According to Wenzel (2017), CBT possesses four distinctive features: customization, therapist’s collaboration with the patient, a direct movement towards the treatment goal, and control through the entire therapy process. Therefore, CBT strategies can be defined as patient-focused, targeted, and, ultimately, efficient. In turn, the fundament of CBT is based upon an underlying causal relationship between cognitions, actions, and emotions. The cognitive mediation model proposed by Beck (1976) presumes that understanding cognitions makes it possible to identify factors, serving as triggers for dysfunctional emotional and behavioral patterns (as cited in Nichols & Davis, 2017). Consequently, it also becomes possible to reshape a patient’s behavior by addressing the triggers which cause dysfunctional patterns.
The CBT approach was eventually applied to the family life domain, which led to the emergence of several concepts related to marital experience. For instance, multiple scholars attempted to define normal family functioning (Nichols & Davis, 2017). Wills et al. (1974) claimed that unpleasant behavior reduces martial satisfaction more than positive behavior increases it (as cited in Nichols & Davis, 2017). Gottman and Krokoff (1989) found that healthy families possess conflict resolution skills which lead to desired changes in behavior instead of complaints and criticism (as cited in Nichols & Davis, 2017). Additionally, aversive behaviors, such as crying, nagging, and withdrawal, were found detrimental to marital happiness (Stuart, 1975, as cited in Nichols & Davis, 2017). Overall, cognitive-behavioral family therapy focuses on mitigating aversive behaviors in parents and children and reinforcing positive alternatives. The CBT-based family therapy emphasizes increasing the frequency of healthy behaviors and shapes them into practice with the inclusion of all family members in the treatment process.
Assessment of Primary Presenting Problem
The information present in the case description allows concluding that the family in question is affected by several problems. Mary and Jim, who have been married for ten years, constantly argue and fight about money. Sometimes, their arguments were so heated that the neighbor had to call the police. The couple’s three children — Mark (10), Elizabeth (8), and Joshua (4), are seemingly affected by these arguments. Mark and Elizabeth get involved in school fights almost daily, while Joshua always cries when Mary or Jim pick him up from the daycare. In addition, the parents are frustrated with the kids because of their troubling behavior.
Mary and Jim may be seeking counseling since they want Mark, Elizabeth, and Joshua to behave well. In this regard, cognitive-behavioral family therapy would uncover the triggering factors that lead to aggressive and capricious behavioral patterns in children. However, cognitive-behavioral family therapy would also require the whole family’s involvement. According to the information presented in the case, children’s aversive behaviors are likely induced by the parents’ example. For instance, Mark and Elizabeth might have learned that verbal aggression is acceptable for resolving conflicts and carried that behavior to school. Therefore, an initial assessment of all family members’ strengths would be necessary for developing an appropriate set of interventions.
Strength assessment can be performed via multiple purpose integration tools, representing both child’s and caregiver’s perspectives. For instance, the Child and Adolescent Needs and Strengths (CANS) questionnaire includes a section dedicated to evaluating caregiver strengths and needs (New Jersey Department of Children and Families, 2016). Given the information from the case, Jim and Mary are likely to score worrying grades in supervision (caregiver’s ability to monitor and discipline youth) and family stress. Consequently, these problematic patterns of interpersonal interaction within the family should be considered the primary presenting problem. Mary and Jim have to learn and reinforce behaviors that facilitate constructive resolution of conflicts. Otherwise, their children will live in a violent and stressful environment that contributes to aversive behaviors at school and daycare.
Goals and Intervention
Given the circumstances highlighted in the case assessment section, the ultimate goal of the therapy would be resolving the arguments between the parents. At the end of the treatment, Mary and Jim will abandon the practice of violent arguments at home. Instead of this, parents will become capable of showing their children that conflicts can and should be resolved in a civil manner. Consequently, Mark and Elizabeth will act less violently and eventually stop fighting at school, and little Joshua will become less stressed.
These goals can be achieved through several therapeutic techniques focused on the interpersonal interactions within the family. Most importantly, the therapy must address existing inaccurate schemas that affect behavior in a family setting. These schemas are often reflected by so-called automatic thoughts that flash through an individual’s mind (Nichols & Davis, 2017). For example, Mary and Jim tend to argue about money — the downward arrow technique may reveal their money-related schemas and harmful automatic thoughts. In addition, Mark and Elizabeth are old enough to provide similar information about their violent behavior at school.
After the downward arrow technique allows to trace the origins of family schemas, it would become possible to point out the need for change. For instance, Mary and Jim may be convinced that their arguments negatively influence children’s behavior, as they adopt parents’ violent demeanor. The next step of the intervention would be discussing positive alternatives to aggression and rewards for polite and composed behavior in conflict situations. Once this step is done, the new positive schema will become solidified in interpersonal interaction within the family setting. In the end, peaceful and constructive parents’ behavior would show a good example to Mark, Elizabeth, and Joshua, making them less violent and capricious.
New Jersey Department of Children and Families. (2016). Children’s system of care: Strengths and needs assessment.
Nichols, M. P., & Davis, S. D. (2017). Family therapy: Concepts and methods (11th ed.). Pearson.
Wenzel, A. (2017). Basic strategies of cognitive behavioral therapy. Psychiatric Clinics, 40(4), 597-609.