Running head: FAMILY COUNSELING APPROACH RESEARCH
Family Counseling Approach Research – a Cognitive Behavior approach
Abstract
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FAMILY COUNSELING APPROACH RESEARCH
Family counseling can provide help and guidance to family members to restore couples
suffering from distress in their relationship to a better level of functioning.
Whether a couple struggling to connect with each other, or a child or teenager in the family that
has developed behavioral problems,each situation is delicate and variable in its own way. During
those times of turmoil, one can utilize family counseling as a tool to restore order in a family
searching for a source of guidance, reason, and love. In general, people prefer to assign meaning
to life events. This meaning isnot always helpful or consistent with reality. As a result, irrational
thoughts may arise and to lead to uncontrollable emotions, attitudes, and behaviors that may
impact family life, social, and professional relationships. This paper will discusses Cognitive-
Behavioral Therapy (CBT) as one approach to family counseling. In additon, integrating
Christian beliefs into CBT will be also discussed.
Introduction
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Family is the most important social group of all the social groups because it influences
and shapes the personalities of each member. In family counseling problems do not belong to one
person. They are an expression of the current communication strife and relationships inside the
family system. Among the numerous varieties of family counseling approaches, the Behavioral
and Conitive Behavioral approach seems to have a “significant impact in distinct areas such as
behavioral couples therapy, behavioral parent training, functional family counseling, and the
conjoint treat- ment of sexual dysfunction” (Goldenberg et al., 2017, p. 343).
The cognitive approach describes how people’s thoughts and perceptions influence their
lives. Stressful life events can alter people’s perceptions andlead to unhealthy emotions and
behaviors. Cognitive-Behavioral Therapy (CBT) can help individuals learn to identify and
evaluate their automatic irrational thoughts and replace them with healthier ones. A cognitive
model is at the core of CBT, and it plays an important role in helping therapists use gentle
Socratic questioning to develop treatment (Beckinstitute, 2019).
In a national survey conducted by the American Association for Marriage and Family
Therapy (AAMFT), marriage and family therapists report cognitive-behavioral family therapy as
their primary treatment modality out of the 27 different modalities mentioned (Dattilio, 2010).
Cognitive-Behavioral Therapy (CBT) is the focus of this paper, emphasizing the importance
of cognitive and behavior interactions among the family members. Through the help of CBT,
irrational thoughts and beliefs are replaced with healthier ones, aiding family members to live
happier, healthier lives and create healthier environments.
The basic principle of CBT refers to the negative emotional states such as depression,
anxiety, panic, irritation, and misadaptative behaviors based on the distorted way in which people
think about themselves, the world, and the future. The therapeutic approach focuses on
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restructuring techniques, using the learning principles to achieve desired behavioral changes.
Cognitive-behavioral therapists attempt to increase positive interaction between family members,
emphasizing the importance of self-regulation and self-direction in altering behavior.
(Goldenberg et al., 2017, p.343).
Part I
Leading Figures
Goldenberg et al., 2017 mentions that behavioral models of family therapy attempt to
bring a scientific method to bear upon the therapeutic process by developing consistently
monitored, data-based intervention procedures (Goldenberg et al., 2017, p.343). CBT begins with
the idea that the way we think determines how we think and feel and the resultant behavior we
adopt. Distortions of thought cause behavioral and emotional disorders. CBT was developed
through the combination of two major forms of the psychotherapeutic models,behavioral and
cognitive. Related behavioral therapy, Jones & Butman (2012) mentions that the tools of
scientific psychology or the laws of learning, behavioral therapy attempts to define a set of
problematic behaviors such as thoughts and emotions, to determine circumstances that can cause
the problem behavior to occur. Interference, elimination, or decrease in the occurrence of those
problem behaviors is the most efficient and effective way possible, all using the tools of
“scientific psychology” or the “laws of learning.” (Jones & Butman, 2012, p.166). Regarding
Cognitive therapy, Jones & Butman (2012), mentions that it may help people gain perspective
and control over negative patterns of thought so they can also have greater flexibility with their
feelings and behaviors (Jones & Butman, 2012, p.202).
The application of behavioral and cognitive-behavioral psychotherapeutic models into
family therapy, is fairly new, and it was developed only within the last 30 or so (Goldenberg et
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al., 2017,p. 314). Leading figure heads that first addressed specific behavioral problems in
families such as poor communication between spouses, acting-out behavior in children and
adolescents, identified in a family assessment process, not comprehensive family dynamics, was
social worker Richard Stuart, psychologist Gerald Patterson and psychiatrist Robert Liberman.
Liberman and Stuart. They were early proponents of behavioral couples therapy. Based on
operant conditioning, they discovered that by selectively rewarding certain responses, these
responses can be strengthened. Therefore, future responses will occur more frequently than other
reponses that have or have not been rewarded (Goldenberg et al., 2017, p.315).Starting in late
1970’s, behaviorists realized that cognitive factors such as attitudes, thoughts, beliefs, and
attributions or expectations also impact the individual’s behavior.
Two important figures in the development and use of CBT within intimate couple
relationships, is the psychiatrist Aaron Beck, and the psychologist Albert Ellis (Goldenberg et al.,
2017, p.317). Albert Ellis developed the A-B-C theory of dysfunctional behavior, stating that
disturbing life events are provided by an unrealistic interpretation people give to events, or their
irrational beliefs about what has taken place that cause them difficulties (Goldenberg et al., 2017,
p.317). Ellis argued that cognitive restructuring would help an individual to modify thier
perceptions and allow them to produce new self-statements (Goldenberg et al., 2017, p.317).
Beck’s approach regarding family therapy, more consistent with the systems perspective, is
attending in greater depth to family interaction patterns. Therefore, family relationships,
cognitions, emotions, and interactive behavior are all seen as reciprocally influencing one
another (Goldenberg et al., 2017, p.317). Beck discovered that through research with depressed
patients unfortunate personal and interpersonal experiences, the subjects developed negative
schemas that were reactivated every time a new situation resembled conditions similar where
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they learned the schema (Goldenberg et al., 2017, p.317). Becks viewed family schemas as a
shared belief about what is occurring within the family and open to errors, distortions, and
omissions impacting how family members respond, emotionally and behaviorally, to one another.
Becks envisioned the therapeutical process as helping families to restructure the family’s
dysfunctional beliefs and to helping adjust their behavioral patterns (Goldenberg et al., 2017,
p.317). Goldenberg et al., 2017, mentioned that Cognitive-behavioral family therapy is directed
at restructuring the schemas learned early in life from the family of origin, cultural traditions, the
mass media, relationship experiences, and a couple’s relationship. In turn, these schemas affect
automatic thoughts and emotional responses to others (Goldenberg et al., 2017, p.324). Although
family schemas typically represent shared beliefs about mostly family phenomena, such as the
day-to-day dilemmas and interactions, they may also pertain to nonfamily phenomena as well,
such as cultural, political, or spiritual issues (Dattilio, 2005).
Concepts and Techniques
Dattilio (2010) mentions that a cognitive-behavioral approach with families involves the
direct teaching of skills for dealing with problems and differences (Dattilio, 2010, p.144).
Moreover, Dattilio (2010) mentions that improving family members’ skills for expressing
thoughts and emotions, as well as listening effectively to each other, is one of the most common
forms of intervention found with various approaches to therapy (Dattilio, 2010, p.123).
Cognitive Therapy is seen mostly as a theory of psychological dysfunction. It originated
within the theory of depression and tends to focus on psychological maladjustment than on
healthy functioning (Murdock, 2017). It is characterized as constructivist because of the
objective and subjective realities it assumes. Cognitive Therapy takes a neutral approach, seeing
humans as simply adapting to the environment around them, and surviving. Human behavior is
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motiviated by survival and conservation and also focuses on expansion and reproduction
(Murdock, 2017).
The role of counselor in Cognitive Therapy is a techer that is an expert, teaching a client
on Cognitive Therapy techniques (Murdock, 2017). A counselor has the duty to encourage
behavior change in a client and play an active role in that change. In the role play, the client is a
student, collaborating with the therapist on how Cognitive Therapy is applied to them (Murdock,
2017).
CBT uses techniques of both Cognitive Therapy and Behavioral Therapy. According with
Leichsenring et al., 2006, CBT represents “a unique category of psychological interventions
based on scientific models of human behavior, cognition, and emotion” (Leichsenring et al.,
2006). The National Alliance for Mental Illness mentions that studies of CBT have shown it to be
an effective treatment for a wide variety of mental illnesses, including depression, anxiety
disorders, bipolar disorder, eating disorders and schizophrenia (NAMI, 2019).
Aaron Beck identifies some discrepancies between the behavioral and cognitive
approach. He applies the principles of the cognitive theory to account for the mechanisms of
action of systematic desensitization, a behavioral therapy. He goes on to conclude that the
cognitive model provides a greater range of concepts for explaining psychopathology as well as
the mode of action of therapy. Therefore, Beck makes a distinction between the nature of the
therapeutic interventions (i.e., cognitive vs. behavioral) and working mechanisms in providing a
cognitive account of the effects of a behavioral intervention (Lorenzo-Luaces et al., 2016).
Regardless of the discussion concerning their active treatment components as well as working
mechanisms, appears so that CBT continue to be the most widely studied and used forms of
therapy (Lorenzo-Luaces et al., 2016).
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Identified Gaps
Regarding a possible gap between the theory and practice in CBT, Reese et al., 2013,
mentions in an article that there is substantial, concerning gap between the theories and
interventions supported by research and those offered to patients in the community. The authors
also mention the concern regarding CBT techniques and procedures that are becoming
increasingly disconnected from underlying theories and offered some solutions in order to close
the gap. (Reese et al., 2013). Therefore, the authors suggested that educating providers in theory
most likely will make beneficial and durable changes in the interventions they deliver.
Moreover, the authors emphasized that without understanding theory, practitioners who apply the
techniques are highly likely to apply the protocol in a recipe book manner, which may have a
negative effects on the outcomes (Reese et al., 2013).
Part II
In an article published in Journal of Pastoral Counseling, an author by the name of
George Nedumaruthumchalil wrote that spirituality is the heart and soul of religion, it is a
dimension of human experience involving transcendent beliefs and practices.
(Nedumaruthumchalil, 2009). The author also mentions that spirituality is personal and can be
experienced outside formal religious structures. Spiritual resources may include practices of
prayer, meditation, or traditional faith, healing rituals, and involvement in a faith community.
Otherwise, many people who do not consider themselves religious may lead deeply spiritual
lives and find spiritual nourishment in diverse ways. Some find renewal and connection through
nature and the creative arts or by servicing others (Nedumaruthumchalil, 2009).
Ripley & Worthington (2014), mentions that taking into consideration a counselor’s role
and the ethics regarding the use of religion or spirituality in counseling, clients must either self-
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select their spiritual practices or seek guidance from a spiritual leader. Taking the role of spiritual
leader as a counselor (unless the counselor is a pastoral counselors as well) can cause confusion
in clients. (Ripley & Worthington, 2014, p. 290)
Regarding my future counseling practice and how I will integrate my own faith and
counseling approach, I am envisioning a CBT approach, including where is agreed, the use of
prayer and Scripture with my Christian clients. McMinn (1996), mentions that prayer is more
than a counseling technique, but growth vehicle in one’s spiritual life (McMinn,1996, p.85). The
authors also mention that prayer appears to be a frequent but not routine part of Christian
counseling and psychotherapy. Prayer is used with some, but not all counseling clients, and
depends on the theoretical orientation of the counselor and the diagnosis of the client
(McMinn,1996, p.85). Worthington (2008) mentions that prayer as an intervention in couple
therapy can add something positive to the relationship, but is not recommended for couples who
do not already employ it, nor as a method that proselytizes couples (Worthington, 2008).
Personally, I strongly believe that the use of prayer and/or Scripture in a counseling
sessison has the potential to create a solid therapeutical relationship. Through prayer both the
client, their family, and the therapist may achieve a peace of mind effect and calming of negative
thought, resulting in an improved general state and a better communication. Consequently, a
client and the therapist may communicate more effectively in finding out those irrational
thoughts that create discomfort and finding new positive ones to replace the irrational ones. This
may result in a an improved general state of hope and optimism.
Tan (2007) published an intersting article related the use of prayer and scripture in CBT,
offering an interesting approach regarding the use of prayer in counseling sessions and more over
its role in CBT. The author mentions that by using prayer and Scripture in counseling sessions
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one may have benefical outcomes. Regarding the use of Scripture in counseling sessions, Tan
wrote that “the appropriate and ethical use of Scripture or the Bible in Christian CBT can be of
significant help to Christian clients who seriously take the Bible to be the inspired Word of God
and their ultimate authority in life” (Tan, 2007, p. 108).
McMinn (1996) mentions that before incorporating the prayer into counseling sessions,
counselors should be mindful regarding the potential effects of various forms of prayer, such
privately praying for clients, and regularly praying aloud in the counseling sessions. The author
mentions that while praying silently for the clients is always useful and praying aloud in
counseling sessions must be always reconsidered due to the eventual harm caused to the clients
McMinn, 1996, p.85). American Association of Christian Counselors (2014) Code of Ethics,
indicates the importance of understanding the client’s belief systems and remaining respectful to
their faith and values (AACC, 2014, p. 25).
Conclusion
Every couple has a unique story. Family therapy can help the couple to build the
relationship the couple needs and wants to build. This therapy will help build in a conscious and
healing way in a relationship that causes suffering. Therefore, the therapist becomes the "voice"
of the relationship, the space between the two partners. Trying to give voice to this space, the
therapist accompanies the partners in construction and reconstruction process so their
relationship matches the wishes and needs of each of the two.
CBT teaches our clients new strategies not only to overcome their current problems, but also to
adapt to new life circumstances.
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