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Behavioral and Cognitive Behavioral Family Therapy Models
Jane Doe
School of Behavioral Sciences, Liberty University
Author Note
Jane Doe
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Kelsey Walters
Email: jdoe@liberty.edu
Address: 1971 University Blvd Lynchburg, VA 24515
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Abstract
Behavior and Cognitive Behavioral Therapy and family models are discussed, compared,
and contrasted. The following research paper includes three parts: research, personal integration,
and personal reflection on a SYMBIS assessment the student took with her spouse. The student
presents pertinent historical events to encompass a complete understanding of cognitive
behavioral therapeutic interventions. Provided is an explanation of theory philosophies, key
concepts, and techniques. Similarities and differences between cognitive behavioral therapy,
reality therapy and dialectical behavioral therapy are compared. The student personally integrates
CBT and biblical principles and explores her personal SYMBIS assessment results.
Keywords: behavior therapy, cognitive behavioral therapy, CBT, biblical principles, SYMBIS
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Behavioral and Cognitive Behavioral Family Therapy Models
Part I
Cognitive Behavioral Therapy (CBT) is recognized as one of the leading and primary
treatment modalities used in marriage and family therapy and made its first entry into the therapy
world during the 1960’s (Dattilio, 2014) Today, CBT is used to treat anxiety, panic disorder,
depression, obsessive compulsive disorder, phobias, eating disorders, substance abuse, PTSD,
and relational problems (Department of Health & Human Services, 2007). The main objective of
CBT is to address problem behaviors and emotions by teaching clients how to break thought
distortions that lead to negative outcomes (Corey, 2021). CBT is useful to treat various mental
disorders for both individual and family therapies, but is also a complimentary therapeutic
intervention that may integrate the Christian faith as it compliments biblical concepts.
Leading Figures
Aaron Beck is the first leading figure in Cognitive Behavioral Therapy who contributed
research which led to the discovery of schemas (Goldenberg & Stanton, 2017). Concerning
family systems, Beck realized that families may have shared core beliefs and attitudes. Beck
drew the connection between schemes and dysfunctional behavior, leading him to value the
therapeutic alliance. Beck also conducted research which included depressed patients and led to
the discovery of automatic thoughts. Beck observed that these automatic thoughts drove negative
feelings and behaviors.
Albert Ellis is another leading figure in Cognitive Behavioral Therapy and family
systems (Goldenberg & Stanton, 2017). Albert Ellis is known for Rational Emotive Behavioral
Therapy, and for discovering cognitive restructuring, which teaches clients to correct and replace
thoughts and perceptions. During the 1960’s Albert Ellis also wrote about the role cognition
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plays in marital issues and proposed that relational problems stem from couples internalizing
irrational beliefs about their partners and form negative assumptions when their partner or
marriage fails to meet unrealistic expectations (Dattilio, 2014). Ellis’s greatest contribution is his
ABC model, A (Activating event), B (Belief), C (Consequence) , which increased client
awareness of belief patterns and teaches them to restructure them (Selva, 2022).
Other behavioral therapists like, Robert Liberman and Robert Stuart, are known for their
step-by-step interventions used to condition marital relationships by reinforcement (Goldenberg
& Stanton, 2017). Liberman believed that families and therapists did not need to understand
family dynamics to change the family system. Instead, Liberman saw behavioral analysis as the
only necessary intervention (Dattilio, 2014)
Development of the Theory/ Historical Events
In the early 1900s, it was understood by behavior therapists like Skinner, Pavlov, and
Watson, that behavior could be measured, modelled, and changed (Dattilio, 2014). It wasn’t until
the 1960’s that cognitive psychotherapy was introduced by Aaron Beck and Albert Ellis’s work.
By the late 1970’s, cognitions were finally accepted as treatment for behavioral therapy,
and former behavior therapists who initially found cognitive techniques useless swiftly changed
as success in couple counseling increased with the integration of CBT (Dattilio, 2014). In the
1980’s, there was an uprising in discovery of CBT as cognitive factors became the center focus
of research for behavioral therapists. By the 1990’s, behavior interventions for clients were
including family member’s cognitions about each other and Cognitive Behavioral Family
Therapy (CBFT) rapidly expanded its territory. Today, CBT is a mainstream therapeutic
approach often applied in family and couples counseling (Dattilio, 2014).
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Basic Assumptions and Key Philosophy
Cognitive Behavioral Family Therapy (CBFT) treats the family as a system by assuming
that family relationships, cognitions, behaviors, and emotions depend on and influence one
another. Each person’s behavior may affect another person, but also the family as a unit. CBFT
seeks to focus on present issues and guide families towards developing preventative skills.
CBFT additionally believes that maladaptive behavior comes from maladaptive thoughts,
therefore by altering irrational beliefs, feelings and behaviors will also change (Hutcheson,
2019).
Key Concepts
Key components of CBT include information processing, schemas, and social learning
theory (Hutcheson, 2019). Information processing focuses on the relationship between thoughts,
emotions, and behaviors based on individual interpretation of events. CBT therapists believe that
information processing can be biased or distorted, therefore triggering negative emotions and
behaviors. Schemas are the underlying cognitive structure built overtime based on experience,
core beliefs, and cultural environment (Corey, 2021). Schemas are automatic thoughts
developed in childhood that determine perception, interpretation, and how one reacts to new
information. Schemas shape thoughts, feelings, and behavior. Lastly, social learning theory is the
concept that behavior is influenced by environment, and that behavior may be observed and
imitated (Corey, 2021). Therefore, social environments may contribute to emotional and
behavioral issues.
Techniques
CBT therapists collaborate with their clients and use techniques like thought stopping and
reframing, guided association, direct disputation, exposure therapy, role playing, examining
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alternatives, and setting SMART goals (Tan, 2011). Therapists also rely on teaching clients deep
breathing and relaxation exercises and giving them take-home assignments like thought logs or
journal writing (Pientrangelo, 2019)
Similarities and Dissimilarities
Like CBT, Reality Therapy focuses on behavioral outcomes and evaluates the
relationship between client emotions, behavior, and positive and negative consequences (Corey,
2021). However, CBT relies more on suggestion whereas Reality Therapy uses challenging to
determine if client needs are being met. Different from CBT, is that Reality Therapy treats
behavior as a choice. CBT instead treats behavior by closely examining thoughts and emotions.
CBT therapists will explore the unconscious mind, trauma history, early childhood events, and
dreams, where Reality Therapy primarily focuses on guiding clients to taking responsibility for
behavior and seeking ways to change (Corey, 2021).
Dialectical Behavioral Therapy (DBT) is a branch of CBT and may also be compared.
DBT and CBT are alike in how they both address irrational thinking patterns and aim to help
clients change behavior (Corey, 2021). However, the two approaches are very different and
useful for different treatment purposes. DBT specifically is the leading treatment for borderline
personality disorder and is predominantly used for suicide ideation, self-harm, and PTSD
(Peprah & Argáez, 2017). DBT and CBT share different principles and philosophies. While CBT
focuses more on thought processes than the traumatic events that lead to irrational thinking, DBT
focuses on accepting the reality of negative emotions stemmed from trauma before working
through them (Corey, 2021). CBT also prioritizes challenging irrational beliefs whereas DBT
prioritizes mindfulness.
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New Knowledge Acquired
One new piece of knowledge I acquired through this assignment, is that the therapeutic
relationship is important in CBT, whereas before I thought that the therapeutic relationship was
primarily valued by other theories. It is apparent, that through the development of CBT
collaboration and relationship with clients has become of stronger value. Tan (2011) asserts that
the therapeutic relationship is not crucial in CBT, however in newer articles the therapeutic
relationship is discussed as pivotal. Proven, is that client outcomes and success rates are
dependent on a positive therapeutic relationship, therefore the relationship between counselor
and client is a powerful tool that creates change (Dobson, 2022; Pipkin, 2021; Young, 2021).
A second new piece of knowledge I acquired through this assignment is the mark in
history CBT has made and its precedence as a reliable and successful therapy intervention. CBT
is a proven theory that helps clients and treats various conditions and may be used for individual,
couples, or family counseling. But, in my past experience, I was trained to use CBT at my job
working with children, therefore I thought it was only useful for children.
Part II
Personal Integration
Clinical mental health counseling is more than a vocation, but a personal calling. Like
Eckert (2006), writes, “I believe I am living out God’s unique call on my life to work with people
toward healing and wholeness” (p.51). As a counselor and a Christian, I believe I am expected to
meet a biblical standard when bridging the gap between my faith and vocation. One way of
doing this, is by choosing a therapeutic approach that compliments my faith. Hawkins & Clinton
(2015) discuss that “genuine change requires attention to the whole spirit, the entire soul, and the
whole body – no dimension of the person can be overlooked” (p.32; English Standard Version
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Bible Online, 1 Thess. 5:23). Cognitive Behavioral Therapy reflects the biblical concept of
treating the whole person by treating thoughts, feelings, and behaviors. CBT also accentuates the
biblical notions of sowing and reaping, safeguarding the mind, and having self-control.
Scripture teaches us that what we sow, we will also reap, and CBT believes that negative
or positive thoughts, feelings, and behavior lead to negative or positive consequences (English
Standard Version Bible Online, Galatians 6:7; 2 Cor. 9:6; Luke 6:38) Christianity often focuses
on sowing out of benevolence, obedience, faithfulness, etc., but it is also understood that there is
a battle for our mind. In Romans, Paul writes a letter urging us to resist thinking like the world
does and to instead submit ourselves to transformation by God, signified by the renewing of our
minds (English Standard Version Bible Online, Romans 12:2). Thus, we are to put on the mind of
Christ. Paul also warns us to meditate on heavenly things and disregard earthly matters and
asserts that we fight against principalities (English Standard Version Bible Online, Colossians
3:2; Ephesians 6:12). Paul understood that there are negative forces that may influence our
thinking and behavior, especially through temptation, trial, and tribulation. We know that we
must renew our minds, because without a vision the people will perish (English Standard
Version Bible Online, Proverbs 29:18). This asserts that having a positive outlook of the future
will lead us to positive outcomes, but to have negative thoughts of the future can lead to a
person’s demise.
Like CBT, scripture also encourages self-control and appropriate ways of coping. The
Word underlines that free will must be paired with self-control to avoid negative consequences.
This includes self-control of behavior, which Paul describes as works of the flesh (ESV, Gal.
5:19) and control over negative thoughts and feelings which we are instructed to share with God
who is our Mighty Counselor. Prayer is even described as a coping mechanism to give the
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worried believer peace of mind (ESV, Ph. 4:6-7). Lastly, we are taught that self-control is a fruit
of the spirit of God, thus it is a characteristic of positive transformation (English Standard
Version Bible Online, Gal. 5:22-23).
Part III
SYMBIS Facilitator Results
Marriage Mindset
The assessment revealed that my husband and I have differing marriage mindsets. His is
restless, while mine is resolute. I do agree with the results, as my husband and I have discussed
our different views many times, and it always appears to stem from our different childhood
experiences. As I have a resolute mindset and am extremely dedicated, I came from a traditional
home, my parents have been married for 35 years, and we hold close to Italian family values.
While my husband has a restless mindset, he grew up in a divorced home and has a trauma
background, as his mother and stepfather were mutually physically and verbally abusive.
Five Issues in Real Relationships
When it comes to love, the assessment described me as, “kind and supportive to create a
positive environment”. Hearing this is helpful in building my self-esteem. Sometimes, I may not
see myself through the lens, but when taking a step back and reflecting on past circumstances, I
recognize that despite how I may feel, this is true to how I love.
For attitude, I scored as highly resilient with a percentage of 92. Under stress, my
personality is dependable, team player, good-natured, thoughtful, and a good listener. I may be
perceived by my spouse as unconcerned, hesitant, or non-demonstrative. The words
“unconcerned” and “non-demonstrative” spike my interest, as I know that I may be calculatory at
times, but did not realize it may be noticeable to others.
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For communication, the assessment described me as a careful communicator and that I
have the ability to separate my emotions from the facts. I seek to understand, speak clearly, and
support my notions with firm evidence. I may find myself frustrated when my spouse does not
communicate the same as me. I may also be slow to open up and internalize my feelings.
Insightful, was that one of my husband’s desires in communication is that I ask for his opinions
and ideas. From this assessment, I have realized that I can be so deliberate and independent, that
I don’t consult my husband on much. Thought I have a good track record for decision making,
my husband is needed in this way and may feel valued when consulted. Making changes in my
communication could strengthen our marriage and communication in ways I did not see before.
Differences in gender revealed that as a man, my husband needs affection and respect,
and as a woman I need conversation and admiration. From this assessment, I have gained insight
hat if I fill my husband’s cup up, then he will fill mine.
Congruent perspectives of conflict in the home include sleep habits, chores, and money.
For personal conflict, the assessment described that I sometimes fail to project a sense of urgency
in getting things done, which I disagree with. I was surprised to see that in my results, as I am
prompt, on top of things, and get things done quickly.
When it comes to our relationship with God, the assessment showed that we are in
complete agreement. This didn’t surprise me, as I would say being like-minded and in agreement
is one of our greatest marital strengths. My husband were diligent in our dating years to make
sure that we were in unison on an array of topics. It has always been important to me that faith
would not be a conflict in my marriage nor hinder my children from knowing the Lord.
However, three things we can plan to do to make our relationship God-honoring is to pray
together every day, read the Bible together more, and spend more time serving others together.
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The assessment shows that we both value doing these things, but that does not mean we reflect
them in our life together. Life can get so busy that it is easier to do them alone but prioritizing
spirituality in the home is extremely important. Especially as we are trying to conceive, it is
important that we build that foundation now so we may model it to our children.
The assessment is a great tool for both pre-marital counseling and marital counseling. My
husband and I have been married for 6 years, and though we may not see anything wrong with
our relationship, there is always room for improvement. It was helpful to see where we are both
at and it started some conversations that we potentially would not have initiated, nor thought
were necessary without doing the assessment. Marriage is continuous work; You do not merely
mesh your lives in the beginning years of marriage, but continuously are meshing across a
lifetime.
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References
Corey, G. (2021). Theory and Practice of Counseling and Psychotherapy (10th ed.). Cengage
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Dobson, K. S. (2022). Therapeutic relationship. Cognitive and Behavioral Practice, 29(3), 541–
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