Introduction
Cognitive behavioral therapy (CBT) refers to a “predominant form of psychological therapy” wherein negative thought patterns regarding the self and the world are challenged and modified in order to modify unwanted behavioral patterns or in the treatment of mood disorders (Willner & Lindsay, 2016, p. 283). The use of CBT within a familial setting is similar to but differs from CBT at the individual level. In CBT at the individual level the goal is behavior modification of the individual, while the familial approach to CBT explores behavioral modification of the unit, incorporating change processes within all the individuals at the family unit level (Le Grange, Lock, Agras, Bryson, & Jo, 2015). A large amount of overlap is present when exploring the application of CBT within a family setting and the application of CBT within an individual context (Dobson & Dobson, 2018). Within the family setting, the focus of the practitioner is to address behavioral change in the same manner as he or she would at the individual level, but that approach is then magnified across the number of individuals within the family unit and the practitioner must work to keep the change process in alignment across all family members, allowing the change to occur to the unit as a whole in a unified format, as opposed to a staggered behavioral change (Dobson & Dobson, 2018).
Practicum Experience
The CBT approach used in the treatment of the individual or in the treatment of the family will vary depending on the type of behavior that the practitioner desires to change (Dobson & Dobson, 2018; Le Grange et al., 2015). Within my own practicum experience, the most commonly utilized form of CBT at the individual level has been the application of journaling, using the reflection process when the individual reads over what he or she has written to implement conscious behavioral changes. I have also seen individuals take it upon themselves to integrate aversive conditioning to certain behaviors, such as the snapping of a rubber band on the wrist of the individual when he or she catches himself or herself engaged in the behavior that he or she desires to change. A technique that I prefer to use is that of systematic positive reinforcement, where the behavior is changed through the promotion of a positive behavior in place of the behavior that the individual desires to change. An example of this would be a focus on how lovely an individual’s hands look when he or she does not bite his or her nails, focusing on the behavioral change, as opposed to the negative behavior associated with nail biting.
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Challenges of CBT within the Family Setting
Due to the complexities associated with the integration of CBT within a family setting, there are certain issues that a practitioner may face in the application of CBT. Within the Laureate Education (2017) Johnson Family Episode 3, the group leader was attempting to use CBT through positive reinforcement to explain to rape victims how they were not to blame for being victims of that type of physical abuse. Two participants were portrayed within the episode, one who accepted that she was not to blame for the abuse and one who was not ready to accept that she was not to blame for her inability to prevent the rape, a negative perception that was further reinforced by her family members (Laureate Education, 2017). The discrepancy between the two participants response to the use of positive reinforcement showed that the application of positive reinforcement as a means of modifying the behavior and perception of the individual over time was a work in progress. This highlights a certain level of difficulty in application, as each of the two participants responded to the therapy in a different manner, though the first participant noted that it took her a long time to switch her mentality, suggesting that with further prompting and therapy that the other participant could make the change as well.
- Dobson, D., & Dobson, K. (2018). Evidence-based practice of cognitive-behavioral therapy (2nd ed.). New York, NY: The Guilford Press.
- Laureate Education. (2017). Johnson family episode 3 (pp. 1-2). Laureate Education.
- Le Grange, D., Lock, J., Agras, W., Bryson, S., & Jo, B. (2015). Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 54(11), 886-894.e2. doi: 10.1016/j.jaac.2015.08.008
- Willner, P., & Lindsay, W. (2016). Cognitive behavioral therapy. Evidence-Based Practices in Behavioral Health, 283-310. doi: 10.1007/978-3-319-26583-4_11
