Family Therapy
As behavior therapists shifted their attention from individuals to family relationships, they came to rely on Thibaut and Kelley's (1959) theory of social exchange, according to which people strive to maximize rewards and minimize costs in relationships. In a successful relationship partners work to maximize mutual rewards. In unsuccessful relationships the partners are too busy protecting themselves from getting hurt to consider how to make each other happy.
In time all couples run into conflict and, therefore, a critical skill in maintaining family harmony is conflict resolution (Gottman & Krokoff, 1989). Healthy families aren't problem free, but they have the ability to resolve conflicts when they arise. They focus on issues and keep them in perspective, and they discuss specific behaviors of concern to them. They describe their own feelings and request changes in the behavior of others, rather than just criticizing and complaining.
Successful couples…expand their reinforcement power by frequently acquiring new domains for positive exchange. Spouses who depend on a limited quantity and variety of reinforcers are bound to suffer the ill effects of satiation. As a result, over time their interaction becomes depleted of its prior reinforcement value. Successful couples cope with this inevitable reinforcement erosion by varying their shared activities, developing new common interests, expanding their sexual repertoires, and developing their communication to the point where they continue to interest one another.
The use of aversive control—crying, nagging, withdrawing—is a major determinant of marital unhappiness (Stuart, 1975). Spouses tend to reciprocate their partners' use of aversive behavior, and a vicious cycle develops (Patterson & Reid, 1970).
Sometimes it may be necessary to redefine a family's goal of decreasing negative behavior in terms of increasing incompatible, positive responses (Umana, Gross, & McConville, 1980). Couples, for example, often state their goals negatively: "I wish he wouldn't always argue with me" or "She nags too much." Most people have difficulty describing behavior that they want their mates to accelerate. To help them do so, some therapists (Azrin, Naster, & Jones, 1973) ask couples to make a list of pleasing things their partners do during the week. Reviewing these lists in the following session provides an opportunity to emphasize the importance of positive feedback.
For preadolescent children, the most widely used punishment is time-out. Time-out involves removal to a boring place for five minutes…When a child refuses to go to time-out, parents are taught to add additional time, up to a ten-minute maximum. If the child continues to refuse, a privilege is removed. When parents are consistent, children soon learn to go to time-out rather than lose the opportunity to watch TV or use the computer.
Simply repeating commands to children is the most ineffective way to change their behavior (Forehand, Roberts, Doleys, Hobbs, & Resnick, 1976).
The importance of immediate proximity is what makes time-out such an effective punishment and grounding such an ineffective one.
With teenagers, contingency contracting (Alexander & Parsons, 1973; Rinn, 1978) is more widely used. Contracting is introduced as a way for everybody in the family to get something by compromising. Parents and teenagers are asked to specify what behavior they'd like each other to change. These requests form the nucleus of an initial contract. In order to help family members arrive at contracts, the therapist encouraged: (1) clear communication of wished and feelings, (2) clear presentation of requests, leading to (3) negotiation, with each person receiving something in exchange for some concession.
Richard Stuart (1975) lists five strategies that summarize the behavioral approach to troubled marriages:
- Couples are taught to express themselves in clear, behavioral descriptions, rather than in vague complaints.
- Couples are taught new behavior exchange procedures, emphasizing positive control in place of aversive control.
- Couples are helped to improve their communication.
- Couples are encouraged to establish clear and effective means of sharing power and making decisions.
- Couples are taught strategies for solving future problems as a means to maintain and extend gains initiated in therapy
The goals of a cognitive-behavioral assessment are to (1) identify strengths and problems in individuals, the couple or family, and the environment; (2) place individual and family functioning in the context of developmental stages; and (3) identify cognitive, emotional, and behavioral aspects of family interaction that might be targeted for intervention.
Among the family patterns of interaction therapists look for are the style and degree to which family members express their thoughts and feelings to each other, who interrupts whom, and who speaks for whom.
Epstein and Schlesinger (1996) cite four means by which family members' cognitions, behavior, and emotions may contribute to spirals of conflict:
- The individual's own cognitions, behavior, and emotions regarding family interactions (e.g., the person who notices himself or herself withdrawing from the rest of the family)
- The actions of individual family members toward him or her
- The combined (and not always consistent) reactions several family members have toward him or her
- The characteristics of the relationships among other family members (e.g., noticing that two other family members usually are supportive of each other's opinions)
The following questions may be asked to help family members examine their thoughts:
"Based on your past experiences or events in your life, what evidence exists that supports the thoughts you just shared? How could you obtain additional information to better help you assess whether your thought is accurate?"
"Could you consider an alternative explanation that might explain your partner's (or child's or sibling's) behavior?"
"Referring to the list of cognitive distortions, which cognitive distortion, if any, do you view your automatic thoughts applying to?"
In addressing the schemas in this family, the therapist followed a series of eight steps to uncover and reexamine them:
- Identify family schemas and highlight those areas of conflict that are fueled by them (e.g., "We have to walk on eggshells with mom. If we show any signs of weakness, she flips out."). Schemas are uncovered by probing automatic thoughts through techniques such as the downward arrow. Once schemas have been identified, verification should be made by obtaining agreement from other family members.
- Trace the origin of family schemas and how they evolved to become an ingrained mechanism in the family process. This is done by exploring the parents' backgrounds. Similarities and differences between the parents' upbringings should be highlighted to help them understand areas of agreement and conflict…
- Point out the need for change, indicating how the restructuring of schemas may facilitate more adaptive and harmonious family interaction…
- Elicit acknowledgment of the need to change or modify existing dysfunctional schemas. This step paves the way for collaborative efforts to change. When family members have different goals, the therapist's job is to help them find common ground.
- Assess the family's ability to make changes, and plan strategies for facilitating them…
- Implement change…
- Enact new behaviors. This step involves trying out changes and seeing how they work. Family members were asked to select an alternative behavior consistent with the modified schema and to see how acting on it affected the family…
- Solidify changes. This step involves establishing the new schema and its associated behavior as a permanent pattern in the family. Family members were urged to remain flexible about the possible need for future reevaluations…Dattilio notes that this process is similar to reframing but with an important difference: In cognitive-behavior therapy, family members are asked to gather data and weigh the evidence in favor of changing their thinking, rather than merely accept the therapist's alternative explanations.
Frank Dattilio (1999) introduced the "pad-and-pencil" technique to help family members overcome the annoying habit of interrupting each other. Family members are given a pad and pencil and asked to record the automatic thoughts that go through their minds when someone else in the family is talking.
