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Dr.

Abdelaziz Elfaki University of Dammam

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 Dysfunction

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.

Background
 When they first working with

families, behavior therapists applied learning theory to train parents in behavior modification and teach couples communication skills

Systematic desensitization deconditions anxiety through reciprocal inhibition by pairing responses  Skinner: incompatible with anxiety Operant Conditioning • Responses that are positively reinforcement will repeat more frequently. those that punished or ignored will be extinguished. Pavolve: Classical Conditioning  Watson: used classical conditioning to experimentally induce a phobia in "Little Albert― Systematic Desensitization • Anxiety is response of the autonomic nervous system acquired through classical conditioning.  Richard Stuart (1969):Contingence Contracting •Focused on how the exchange of positive behavior could be maximized using  Wolpe: .

. there has been a rapprochement between behavioral models and cognitive theories. During '70s. behavioral family therapy evolved into 3 major packages : Parent Training Therapy Couples Therapy Sex  By the end of '70s.

The Basic Model  The central premise of behavior therapy is : o Behavior is maintained by its consequences. Consequences that increase behavior are called reinforcers. o Extinction occurs when no reinforcement follow a response. those that decrease behavior are known as punishers. .

they bias how we respond to everything and everyone. .or core belief about the world and how it functions.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 automatic thoughts are those based on arbitrary inference . o What makes these underlying beliefs problematic is that although they are generally not conscious .distorted conclusions shaped by a person`s schemas .

By contrast.  Behavior exchanges follow a norm of reciprocity.The Basic Model  Theory of Social Exchange (Thibaut and Kelley's ):  People strive to maximize rewards and minimize costs in relationships. and the opposite is also true. in unsuccessful relationship. the partners are too busy trying to protect themselves from getting hurt to consider ways to make each other happy. partners work to maximize mutual rewards.  In a successful relationship. Kindness begets kindness. that means aversive or positive stimulation from one person tends to produce reciprocal behavior from the others. .

The emerging field of neuropsychobiology  provides us with new insights into how emotional and behavioral  patterns develop in intimate relationships.  .The Role of Neurobiological Processes Recently. increasing attention has been paid to  the effects of genetics and neurobiology on interpersonal  relationships.

2003).  . whereas men use  only one hemisphere (Wagner & Phan.The Role of Neurobiological Processes Louann Brizendine (2006) cites research  showing that women use both hemispheres of their brains  to respond to emotional experiences.

2003).The Role of Neurobiological Processes It was also determined that the connections  between the emotional centers of the brain are more  active and extensive in women (Cahill. This likely  explains why women typically remember emotional  events. such as arguments. more vividly and retain them  longer than .

are relatively unfiltered and always evoke  responses.  so that certain triggered features. that may be important for  . such as flight.The Role of the Amygdala Such subcortical structures as the amygdala  are believed to operate quickly and automatically. such as when  the whites of our eyes widen in a fearful  expression.

but they have ability to cope with problems when they arise  ―Gottman & Krokoff. and Patterson (1978) found that unpleasant behavior reduced marital satisfaction more than pleasant behavior increased it . Weiss.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.  Healthy families aren‘t problems free.1989‖ . Wills .

Parents usually respond to misbehavior in their  children by scolding and lecturing .Development of Behavior Disorders Behaviorists view symptoms as learned  responses.because attention – even from a critical parent-is a powerful social reinforcer.These reactions may seem like punishment . .but they may in fact be reinforcing . The don`t look for underlying motives. At first glance it would seem puzzling that family  members reinforce undesirable behavior.

nagging .withdrawing –is often sited as a major determinant of marital  unhappiness.Development of Behavior Disorders The use of aversive control .crying  .  . People in distressed relationships also show poor  problemsolving skills .

and  bad faith that poison relationships by distorting family  members` responses to each other`s actual behavior.the schema  that plague relationships are learned in the process of  growing up.jealousy .mind reading .selffulfilling prophesies .  .Development of Behavior Disorders According to cognitive behaviorists . These schemas are the underlying basis of the  ―shoulds‖ .

Sayers. Epstein.  Baucom. These processes include:  . and Sher (1989) developed a  typology of cognitions that frequently surface during the  course of relationship distress.The Mechanics of Change with Couples and Families Cognitive Processes :  Expectations and Standards :  Cognitive processes are the backbone of the  cognitive -behavioral approach to relationship dysfunction.

Inferences about the factors that  have influenced a partner‘s actions (e.The Mechanics of Change with Couples and Expectations and Families-Standards 1. .. The individual’s tendency  to notice only certain aspects of the events occurring in relationships and to overlook others (e.. Selective attention.g. focusing on the partner‘s words and ignoring his or her actions). Attributions.g. concluding that a partner  failed to respond to a question because he or she wants to control the relationship). 2.

that expressing  feelings to one‘s partner will result in the partner‘s getting angry). Assumptions... that partners should have no boundaries between them.The Mechanics of Change with Couples and Families-Expectations and Standards 3. Expectancies.g. Predictions about the likelihood that particular events will occur in the relationship (e. a wife‘s assumption that men don‘t need emotional attachment).g.g. 4.. 5. Beliefs about the characteristics  that people and relationships "should‖ have (e. Beliefs about the general  characteristics of people and relationships (e. sharing all of their thoughts and emotions . Standards.

Conclusions are made in  the absence of substantiating evidence. ―She‘s up to no good again. Selective abstractions. and certain details are highlighted while other  important . parents  whose teenager arrives home a half hour beyond her  curfew conclude. Arbitrary inference.‖  2. for example. Information is taken  out of context.Common Cognitive Distortions with Couples and Families 1.

when a parent declines a child‘s request to go out with his friends. For example. Magnification and minimization.Common Cognitive Distortions with Couples and Families 3. an angry husband blows his top upon discovering that the checkbook isn‘t balanced and says to his wife.‖ . An isolated incident or two is allowed to serve as a representation of all similar situations. For example. A situation  is perceived as more or less significant than is appropriate. Overgeneralization. related or unrelated.‖ 4. ―You never let me do anything. the child concludes. ―We‘re in big trouble.

Dichotomous thinking. Personalization. when a husband is reorganizing a closet and his wife questions the positioning of one of the items. External events are attributed to oneself when insufficient evidence exists to render a  conclusion. a complete success or a total failure. the husband thinks to himself. ―She‘s never happy . For example.‖ 6. Experiences are  codified as either black or white. This is otherwise known as polarized thinking. ―He hates my cooking. For example.Common Cognitive Distortions with Couples and Families 5. a woman who finds her husband adding more salt to her meal assumes.

For example. subsequent to continual mistakes in meal preparation. One’s identity is portrayed on the basis of imperfections and mistakes made in the past.‖ as opposed to recognizing her error as being minor. Sometimes mates see only  what they want to see or what fits their current state of mind. and these are allowed to define oneself. Labeling and mislabeling. A man who believes that his wife ―does whatever she wants anyway‖ may accuse her of making a choice based purely on selfish reasons. a wife thinks.Common Cognitive Distortions with Couples and Families 7. . ―1 am worthless. 8. Tunnel vision.

she thinks that I am naive about what she‘s doing. For example. ―I know what is going through her mind. This is a type of thinking  that partners develop during times of distress. a woman tells herself. For example. a man thinks to himself. automatically assuming that a spouse has a negative alternative motive behind his or her intent. ―He‘s acting real ‗lovey-dovey‘ because he wants a favor from me. Biased explanations. He‘s setting me up. Mind reading. Some spouses end up  ascribing unworthy intentions to each other.‖ 10.‖  .Common Cognitive Distortions with Couples and Families 9.

When both partners in a .Attachment and Affect Models of Attachment and the Secure Emotional Connection : Bowlby (1979) believed that human attachment  patterns noted in infant–caregiver 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).

yet a positive view of others.Attachment Styles Bartholomew and Horowitz (1991) further  expanded this concept into four styles of attachment:  1. . Secure—the view of oneself as worthy and  others as trustworthy. allowing one to be comfortable with intimacy and  autonomy. 2. Preoccupied—maintaining a negative view of  oneself. causing one to become  overinvolved in close relationships and depending on others for a sense of self.

 4. causing one to be fearful of intimacy and  avoiding relationships with other people. Fearful–avoidant—a negative view of both  oneself and others.Attachment Styles 3. but a negative view of others. Dismissing—maintaining a positive view of  oneself. preferring to remain independent  and shying . causing one to avoid  relationships with others.

Not only are they a source of information about  the members‘ memories and opinions concerning  characteristics and events in their relationships. conjoint  interviews also give the therapist an opportunity to observe the family  .Assessment 1-Initial Joint Interviews :  Joint interviews with a couple or a family are an  important source of information about past and current functioning.

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.  .

 Each person‘s perspective on those concerns. the therapist asks  each member of the family about:  His or her reasons for seeking assistance.  Any changes that each member thinks would  make family life more satisfying. .Assessment 2 -Gathering Background Information :  During the initial joint interview.

such as blaming others for family problems and presenting themselves in a socially desirable way. Naturally.Assessment 3 . .Inventories and Questionnaires :  A therapist often asks couples and family  members to complete questionnaires before the intake interviews. individuals‘ reports on questionnaires are subject to bias. so that he or she can ask for additional  information about the questionnaire responses during the initial interviews.

Assessment A variety of measures have been developed to  provide an overview of key areas of couple and family  functioning. decision making. and level of  conflict .  communication quality. cohesion. such as overall satisfaction. . values.

1985). 1999). Marital Satisfaction Inventory—Revised (Snyder & Aikman. Family Assessment Device (Epstein. Hampson. 1986). Baldwin. & Hulgus. 1976).Inventories and Questionnaires Dyadic Adjustment Scale (Spanier. . 1983). Family Environment Scale (Moos & Moos. & Bishop. Self-Report Family Inventory (Beavers.

especially if serious  psychopathology is suspected in spouses or family members.  The Minnesota Multiphasic Personality Inventory–  2 (MMPI2) and the Millon Clinical Multiaxial Inventory  (MCMI) are two of the more popular instruments for  determining levels . the need may arise for more  specific assessment.Additional Psychological Testing and Appraisals Occasionally.

Educating and Socializing Couples and  Family Members about the Cognitive-Behavioral  Model .Addressing Schemas and Schema  Restructuring.Cognitive-Behavioral Techniques 1. 2-Identifying Automatic Thoughts and  Associated Emotions and Behavior.  3.  .

Accept silence. Ask meaningful questions.Communication Training :  Strategies for the Speaker  1.Behavioral Techniques 1.   .  3. Speak attentively  2. Do not overspeak. Avoid cross-examining.  5.  4.

 . Do not interrupt.  3. Reflect on what you hear. Clarify what you hear.  5.Behavioral Techniques Strategies for the Listener  1.  4. Listen attentively  2. Summarize  Conveying Empathy  Validation.

Behavioral Techniques Techniques for Modifying and Reducing Interruptions in Communication The Pad-and-Pencil Technique.   .

Behavioral Techniques Problem-Solving Strategies: • Define the problem in specific behavioral terms. • Select a feasible solution.  • Evaluate the advantages and disadvantages of  each solution.  Compare perceptions and arrive at an agreeable description of the problem.  • Generate a possible set of solutions.  • Implement the chosen solution and evaluate its  effectiveness  .

Record the frequency of the targeted behavior  on a chart.Behavioral Techniques Behavioral Exchange Agreements Contingency Contracts :  Stuart outlined a four-step process of employing  this strategy: 1. 3. 4.  2. . Have each spouse or family member initiate  changes in his or her own behavior first. Have each spouse or family member sign a  written contract for a series of exchanges of desired behaviors. Identify a rationale for mutual change.

Behavioral Techniques Assertiveness Training  Deescalation and Time Out  Behavioral Rehearsal  Role Reversal  Acquiring Relationship Skills  Homework Assignments  Bibliotherapy Assignments  Audiotaping or Videotaping Interactions at  Home .

Behavioral Techniques Activity Scheduling  Self-Monitoring  Testing Predictions with Behavioral  Experiments Behavioral Techniques and Parental Control  .

Cognitive-Behavioral Techniques Addressing the Potential for Relapse  Partners’ 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 changed  Differences in Agendas  Anxiety about Changing Existing Patterns in  the Relationship .

Roadblocks Therapist Roadblocks Unrealistic Expectations  Cultural Obstacles  Racial Issues  Environmental Forces  Psychopathology  Low Intellectual and Cognitive Functioning Effects of Previous Treatment Inoculation against Backsliding .