Cognitive Behavioral Family Therapy Techniques

Instructor: Karin Gonzalez

Karin has taught middle and high school Health and has a master's degree in social work.

Thoughts are powerful, and negative ones can create a host of communication and relationship problems within a family. Cognitive behavioral therapy (CBT) works on replacing negative thoughts and beliefs with positive ones to improve family behavior. Learn about CBT techniques with families in this lesson.

What Is Cognitive Behavioral Therapy?

The Jones family visits Dr. Ross for family therapy.The family is comprised of Mr. and Mrs. Jones and their 10-year-old daughter Morgan. Mrs. Jones is permissive with Morgan and is afraid to discipline her. Mr. Jones usually steps in as the authoritarian and is verbally aggressive and forceful with Morgan. Morgan is angry about her parents' lack of cohesiveness and decisiveness with rules and limits. Furthermore, when Morgan expresses anger, her parents punish her more, which often make the situation worse.

Cognitive behavioral therapy (CBT) is a psychotherapy that targets negative thoughts and works to replace them with positive thoughts so as to create favorable behaviors and emotions. After the initial assessment, Dr. Ross can see that the Joneses hold several cognitive distortions, or flawed ways of thinking that are damaging to family functioning and cohesiveness:

  • Mrs. Jones thinks that if she disciplines Morgan then Morgan will hate her.
  • Mr. Jones thinks that the only way Morgan will respect him is if he barks orders at her.
  • Mr. Jones is uncomfortable when Morgan expresses sadness, and therefore fails to empathize with his daughter.
  • Both Mr. and Mrs. Jones think that any expression of anger from a child is disrespectful.

If parents can challenge their cognitive distortion that a child expressing anger is bad, they can move towards helping their child express anger in a healthy and nondestructive manner.
Image of angry boy

CBT Family Therapy Techniques

The Joneses work with Dr. Ross under a cognitive behavioral treatment approach using the following techniques:

Mood Check In

To begin a session, each member of the Jones family will report on their moods. The goal is that family members' moods improve throughout therapy and serve as an objective measurement tool to indicate progress. In the first session, the Joneses are feeling disheartened and angry.

Agenda Setting

Also to begin sessions, the Joneses take turns briefly verbalizing which issues they would like to talk about in that session. The family and the therapist collaboratively decide which issues they will tackle as well as how much time will be dedicated for each issue. This ensures that each session is productive and efficient.

Acceptable Feelings Activity

Dr. Ross gives each member of the Jones family a piece of paper with a list of feelings. The Joneses are instructed to indicate which feelings are acceptable and not acceptable to express within the family system. This is where Mr. Jones's discomfort with expressions of sadness and Mr. and Mrs. Jones's intolerance of expressions of anger become evident.

Role Playing

Role playing is a way for the Jones family to play out real-life problem scenarios in the therapist's office with the guidance of Dr. Ross. Dr. Ross could also participate in the role play if he wants to model positive interaction and communication methods. For example, Dr. Ross could act like the parent in a scenario with Morgan so he can model positive discipline strategies for Mr. and Mrs. Jones.

The Chair Technique

Dr. Ross asks the Joneses to place a problem on an empty chair in the room and talk to the chair in trying to resolve the problem. They put 'Morgan's anger' on the chair. This is a helpful strategy in that it separates Morgan from the problem, lessening the likelihood that Morgan will feel blamed when her parents tackle the problem.

Homework

At the end of the session, Dr. Ross asks Mr. and Mrs. Jones to do a behavior experiment as homework. For every issue that comes up, Mr. and Mrs. Jones must listen to Morgan's opinion/feelings/thoughts without interrupting for five minutes (using an egg timer to track time). Then they have to come together and make a decision on how to deal with the issue. If Morgan does not like their decision, they can leave the room, but they must allow her expression of anger, as long as it does not harm property, herself, or others. Further, they must stick to their decision, even if Morgan is angry.

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