Cognitive Behavioral Therapy (CBT)
The goal of CBT is to identify unhealthy thought patterns which lead to negative emotions and behaviors, when the therapist and client can identify the unhealthy thoughts and impulses we can then begin to reframe and restructure them so that we can have a more positive response to our life stressors. Part of this process involves disproving untrue beliefs about ourselves, Socratic questioning, reattributing blame for the negative assumptions about the stressor, thought stopping, self exploration and cognitive restructuring (Wheeler, 2014). CBT is aimed at changing a pattern of thinking which is irrational in nature and assisting the client to identify the rational and real event or emotion and reduce the emotional response to be more proportionate to what actually happened or is still happening (David, Cotet, Matu, Mogoase & Stefan, 2018). While the approach may differ minimally between family and individual CBT processes, because there will be more persons involved in the family approach, the overall idea is the same: cognitive thought restructuring.
While traditional CBT practitioners focus on individual interpersonal relationships and subsystems which the client identifies as the main stressor, CBT in families takes a much more thorough approach by identifying negative belief and thought patterns that are reinforced by family members (Nichols & Davis, 2020). Nichols and Davis (2020) also explain that doing CBT with an individual who return home to a family in which reinforces the negative thought and belief patterns about themselves sets the stage for failure for the client. CBT in families and romantic couples shows strong evidence of success and can greatly improve relationship dynamics, interactions, mindfulness of each other’s emotions and have long-term positive outcomes for the family or romantic couple (Nichols & Davis, 2020).
CBT in my practicum experience has been… very interesting. I am doing my clinical hours at a long-term care psychiatric facility, it is much like an AFC home, but it is a 20 bed facility with much more staff and resources than a typical AFC, many of the clients are stepped down there from the state hospital or a long-term hospitalization. A lot of the counseling that my preceptor and I do is helping the residents navigate relationships with their roommates, peers, staff and families in order to prepare them for those interactions in the real world when they are hopefully released to begin their more independent journeys. Counseling two roommates who are struggling to co-exist has a lot of the same hallmarks as couples or family counseling when the clients are living together long-term (at least one year), but with so much acuity and other dynamics in the facility, achieving those cognitive changes can be very challenging when they are immediately disproven by the behavior of other clients on the unit. With one set of roommates in particular, we have been working with them on setting firm boundaries, communicating assertively, helping them to reframe their thoughts and feelings toward each other and identify the positive aspects of their relationship. Achieving these outcomes, especially in clients with serious and persistent mental illness, is very challenging, but because of that heightened challenge comes a lot of reward, as after five weeks now I have slowly begun to see the results of drilling some of these healthy changes into each and every individual and group counseling sessions. I consider it a very good day when we witness a behavior and another client in the facility yells “you need to set better boundaries”! (haha)
Challenges In the Family Setting
CBT in the family setting can be very challenging for the family and for the therapist – the therapist is working to rewire years of taught and learned behavior, evaluate subsystems within the family and address those toxic relationships, evaluating the structure of the family and determining how that affects cognitive thought patterns in the home. Patterson (2014) writes that sometimes in family therapy there is a risk of evaluating cause and effect patterns which may ignore the signs or protection of an actual victim-perpetrator relationship, such as in domestic violence cases, and through the use of a CBT approach increases the likelihood of safety and independence of for the victim of abuse. There are many moving parts and pieces to family CBT and there is a lot of conflict that must be worked through before one can start to change those thought patterns and in-turn their behavior and reactions toward one-another.