A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

Behavior Therapy in a Family Context: Treating Elective Mutism

This paper discusses the necessity of using both behavioral and family approaches in combination, while working with electively mute children. The symptom and its significance within the family system is presented along with a rationale for avoiding the pitfalls of individual approaches with such children. A case history outlining specific behavioral techniques is described in detail with an exploration of the use of reinforcement theory, counter-conditioning, and successive approximations in bringing about change in electively mute children. The need for bringing about changes within the family system so as to maintain the changes that have occurred through use of the behavior techniques is discussed and presented as crucial to the treatment process. The paper takes the position that either approach, by itself, will not be effective in helping electively mute children but that the treatment of choice is a combination of therapeutic techniques.     

Behavioral Family Interventions for Improving Child-rearing: A Review of the Literature for Clinicians and Policy Makers

This paper reviews evidence that behavioral family interventions are effective at improving child-rearing in distressed families and families with children exhibiting disruptive behavior. Essential therapeutic strategies offered within a collaborative therapeutic process are identified. Exemplary materials for parents and clinicians are identified. Differences between behavioral family interventions and two popular press parenting approaches are highlighted, including the lack of empirical support for these widely used programs and the advice they offer which runs counter to behavioral approaches. Recommendations are offered for combining behavioral family interventions with other empirically supported approaches, promoting more widespread use of empirically supported treatments, such as behavioral family interventions, and the need for a public health perspective on family functioning, involving collaboration among clinicians, policy makers, and researchers.     

Techniques for Group Family Enrichment

This article introduces a creative approach to family enrichment. The program emphasizes educational skill-building techniques using nontherapuetic approaches that enable families to resolve difficulties of family members. The meetings, which employ coaching and videotape feedback, enable parents and children to practice communication, cooperation, and problem-solving skills. Evaluation results indicate that participants become successful in the home environment as a result of their involvement in the multiple-family, group-training sessions.     

Cognitive-Behavior Family Therapy: Contemporary Myths and Misconceptions

The field of couple and family therapy has grown in the direction of expanding its horizons by looking toward innovative ideas and whatever works to facilitate change. Despite its demonstrated track record with a broad range of behavioral and emotional disorders, the cognitive-behavior therapies (CBT) may have been underutilized by couples and family therapists unlike some of the more traditional and postmodern approaches. This article explores some of the basic tenets of the cognitive-behavioral approach with families and proposes it as both a useful intervention tool as well as a theoretically compatible model to systemic approaches. In addition, a number of contemporary myths and misconceptions are discussed that may be precluding CBT's utilization by therapists in the field.     

Utilizing Family Strengths and Resilience: Integrative Family and Systems Treatment with Children and Adolescents with Severe Emotional and Behavioral Problems

Community mental health agencies are consistently challenged to provide realistic and effective home-based family-centered treatment that meets local needs and can realistically fit within available budget and resource capabilities. Integrated Family and Systems Treatment (I-FAST) is developed based on existing evidence-based approaches for working with at-risk children, adolescents, and families and a strengths perspective. I-FAST identified 3 evidence-based, core treatment components and integrated them into a coherent treatment protocol; this is done in a way that builds on and is integrated with mental health agencies' existing expertise in home-based treatment. This is an intervention development study in which we conducted an initial feasibility trial of I-FAST for treating families with children at risk of out-of-home placement. The outcomes of the study provide initial empirical evidence that supports the effectiveness of I-FAST. Findings indicate that there were significant improvements in child behavior, significant increases in parental competency, and significant increases in the level of cohesion and adaptability in these families. All observed changes were significant from pre- to posttreatment with the families able to maintain these positive changes at 6-month follow-up. A more rigorous and robust research design, however, will be needed to establish definitive evidence of the effectiveness of I-FAST.     

Play-Based Activities in Family Counseling

Traditional family therapists often work with family members of similar cognitive levels and exclude small children from the therapeutic process. Recent research indicates that children and families benefit when all family members can be involved in counseling (e.g., Thompson, Bender, Cordoso, & Flynn, 2011). Using an integrative intervention model, this article will focus on specific play-based activities which can be used to effectively include children in family therapy. A developmental, step-by step protocol is introduced and specific play-based activities are discussed.     

The Family Throughout the Therapeutic Wilderness Process: Our Stories

This article explores the experiences of families that have sent struggling adolescents to therapeutic wilderness programs. We employ a modified case study approach, in which we, the participants, are also observers of the experiences of our entire families. The article begins by explaining what wilderness therapy is and offering an overview of research that has examined the effectiveness of therapeutic wilderness programs. We delineate the process of seeking, selecting and participating in wilderness therapy as well as the role of an educational consultant in facilitating this. We describe our experiences from (1) the time we realized and accepted that our children were struggling and suffering to (2) considering sending our children to wilderness therapy to (3) the stresses of the decision making process to (4) what the experience was like for us including participating in a parent workshop to (5) planning the next steps and discharge, and finally to (6) seeing and living the results over the next few years. Areas of growth and struggle are noted. Our children’s perspectives on our families’ development over time and the interactions among us are also discussed.     

Family Augmented Cognitive Behavioural Therapy: Make Room for Mum!

Familial processes are gaining an increased amount of attention in cognitive behavioural therapy. Their role in initiating, maintaining, and exacerbating distress in children and adolescents has clear clinical implications. Therefore, including parents in their children’s therapy sessions as coaches, collaborators, and co-patients is becoming commonplace in CBT approaches to internalizing disorders such as anxiety. This article describes a case of a 13?year old female who presented with features of Generalized Anxiety Disorder and Separation Anxiety whose course of treatment involved her mother as a coach, collaborator and co-patient. A case formulation is offered and the specific examples of CBT practices used in each session are detailed. Ways of evaluating treatment outcome are also discussed.     

Child Participation in Family Therapy

The full involvement of children, particularly those of younger ages, in family therapy presents a personal and professional challenge to the therapist. Out of his own needs he may favor involvement with one or another generation rather than with the complete three generation family. This issue is discussed and suggestions for therapeutic use of younger children are presented.     

The FOCUS Family Resilience Program: An Innovative Family Intervention for Trauma and Loss

This article describes the core principles and components of the FOCUS Program, a brief intervention for families contending with single or multiple trauma or loss events. It has been administered nationally to thousands of military family members since 2008 and has been implemented in a wide range of civilian community, medical, clinical, and school settings. Developed by a team from the UCLA and Harvard Medical Schools, the FOCUS Program provides a structured approach for joining with traditional and nontraditional families, crafting shared goals, and then working with parents, children, and the entire family to build communication, make meaning out of traumatic experiences, and practice specific skills that support family resilience. Through a narrative sharing process, each family member tells his or her story and constructs a timeline that graphically captures the experience and provides a platform for family discussions on points of convergence and divergence. This narrative sharing process is first done with the parents and then the children and then the family as a whole. The aim is to build perspective‐taking skills and mutual understanding, to reduce distortions and misattributions, and to bridge estrangement between family members. Previous studies have confirmed that families participating in this brief program report reductions in distress and symptomatic behaviors for both parents and children and increases in child pro‐social behaviors and family resilient processes.     

Family Therapy with Families of Holocaust Survivors

This is a clinical review of 7 families of Holocaust survivors who presented for treatment because of problems with an adolescent of the third generation. In 3 cases the problem was anorexia, and the remaining 4 had various clinical presentations, mostly related to separation-individuation issues. A common thread in the narratives that unfolded was that the trauma of the grandparent/survivors had been transmitted across subsequent generations to exercise significant influence on the children and grandchildren. Often, a more recent death or separation crisis had been the catalyst for these difficulties or a trigger that activated the Holocaust trauma. An outline of the therapeutic intervention is presented; it was based on a combination of systemic, structural, strategic, and psychodynamic approaches. It is suggested that open acknowledgment of the transgenerational issues played a critical role in moving families toward a more differentiated outcome.     

The Building of Epistemic Trust: An Adoptive Family’s Experience of Mentalization-Based Therapy

ABSTRACT

Recently, theorists have posited the development of epistemic trust – the trust in others as reliable sources of information – as an essential aspect of the therapeutic relationship and a mechanism of therapeutic change. Epistemic trust is likely to be disrupted in adoptive children and families and Mentalization Based Treatment (MBT) aims to explicitly promote its development. Therefore, this study aims to investigate how epistemic mistrust is addressed and how epistemic trust is established within the MBT framework. This single-case, exploratory study reports data from in-depth interviews with one adoptive family, which were analyzed qualitatively using Interpretative Phenomenological Analysis. Two superordinate themes are reported: pre-therapy factors contributing to epistemic mistrust and factors contributing to the development of epistemic trust. The findings highlight two critical elements in establishing epistemic trust: the use of certain clinical skills that help build a secure base within therapy and the possibility of trust being transferred from and to other professionals/systems beyond therapy. Hence, this study informs a deeper understanding of how epistemic trust may be built in therapeutic work with adopted children and identifies possible clinical approaches that may be used by clinicians working with this client group.     

Voices of Dialogue and Directivity in Family Therapy With Refugees: Evolving Ideas About Dialogical Refugee Care

In this article, we reflect on our evolving ideas regarding a dialogical approach to refugee care. Broadening the predominant phased trauma care model and its engaging of directive expertise in symptom reduction, meaning making, and rebuilding connectedness, these developing dialogical notions involve the negotiation of silencing and disclosure, meaning and absurdity, hope and hopelessness in a therapeutic dialogue that accepts its encounter of cultural and social difference. In locating therapeutic practice within these divergent approaches, we argue an orientation on collaborative dialogue may operate together with notions from the phased trauma care model as heuristic background in engaging a polyphonic understanding of coping with individual and family sequelae of forced displacement. This locating of therapeutic practice, as informed by each perspective, invites us to remain present to fragments of therapeutic positioning that resonate power imbalance or appropriation in a therapeutic encounter imbued with a social context that silences refugees’ suffering. In a clinical case analysis, we further explore these relational complexities of negotiating directive expertise and collaborative dialogue in the therapeutic encounter with refugee clients.     

A Structural Approach to the Single-Parent Family

Although the single-parent family is becoming a predominant family structure, there is a surprising scarcity of articles discussing its typical problems or detailing specific therapeutic approaches. This paper attempts, first, to list some core problems encountered by all single parents and, second, to present a sequence of therapeutic approaches geared toward dealing with these problems.
Structural theory, with its emphasis on subsystems, generational boundaries, and organizational patterns, provides a framework for viewing the built-in vulnerabilities of the single-parent family unit. Minuchin's ( 3 ) emphasis on generational boundaries and the problem of enmeshment underlies the theoretical and therapeutic approach presented here. I have drawn heavily on Haley's ( 2 ) idea that the therapist must be an authority, a problem-solver, and a teacher. Finally, the emphasis on creating new organizational patterns is most thoroughly explored in Aponte's ( 1 ) discussions of "underorganized families" (many of whom are single-parent families).     

Neurobehavioral outcomes in diseases of childhood. Individual change models for pediatric human immunodeficiency viruses.

The growing incidence of human immunodeficiency virus-1 (HIV-1) and acquired immunodeficiency syndrome (AIDS) in children is a major public health problem. Current research emphasizes treatments for ameliorating deleterious effects on the child's neurological and behavioral development. This article outlines approaches to the assessment of individual change that may provide alternatives to more traditional approaches to the assessment of neurobehavioral outcomes in children with chronic diseases. These approaches provide more precise conceptualizations of changes that lead directly to statistical designs and measurement strategies for assessing effects of HIV-1 and AIDS on development. Such assessments can be superimposed on current clinical trial methodologies to evaluate the efficacy of pharmacological and behavioral interventions designed to improve quality of life in HIV-1 infected children.     

The Application of Behavioral Family Therapy to Chinese Aggressive Children

Behavioral Family Therapy (BFT) generally targets four typical disruptive behaviors among children ages from 2 to 7 years: noncompliance, aggression, tantrums, and negative talk. This study tests the effect of BFT on 20 Chinese aggressive children (16 boys and 4 girls) who were assigned to a BFT group or a control group. The results showed that the children's level of aggression in the BFT group reduced significantly compared to that of the control group, and the gains were maintained at a 6-month follow-up. These findings support the use of BFT as a treatment modality for Chinese aggressive children.     

Reflections on Ways to Create a Safe Therapeutic Culture for Children in Family Therapy

Although a large number of publications in the family therapy field stress the importance of children in family therapy, some authors report that, in practice, many family therapists do not actively involve children in their therapies. In this article, I reflect on the experiential reasons for this exclusion of children. I will consider the importance of the use of the self of the therapist and of the creation of a safe therapeutic culture for the child. Practical suggestions are made of ways to involve children in family therapy. Finally, these ideas are illustrated in a case example of a family therapy with an adoptive family.     

Family Therapy with a Multiparental/Multispousal Family

This article examines therapy with a Bedouin-Arab family from the Negev, Israel, which consisted of 69 members: a husband, 8 wives, and 60 siblings. The husband, who lived with his youngest wife, paid little attention to his other wives and their children. There was considerable competition, hostility, and jealousy among the wives; no communication between the co-wives or the children of different wives; and a variety of behavioral and psychosocial problems among family members. I describe the varied strategies and systems involved in family therapy. The main strategies were to establish good relationships among the co-wives and to build a coalition among them, including the youngest wife, through group therapy in a medical clinic. A secondary strategy was using the children's problems to get the husband involved in the therapy. With improvement of the children's functioning, and with reduced intra-subfamily hostility, the husband's relationships with his children and wives improved.