Behavioral Family Therapy

Behaviorists are distinguished by their methodological and directive approach to assessment and evaluation, their analysis of behavioral sequences before treatment, their assessment of therapy in progress, and their evaluation of the final results. Many non-behavioralist therapist use behavior techniques (Minuchin), or combine cognitive and behavioral techniques.

Originally, behavioral therapists saw only individuals, such as the wife in a problematic marriage or the child in a problematic family. However, the basic tenets of behavioral therapy are assumed to be applicable to them.

A.The Central Premises of behavior therapy

1.behavior is maintained by its consequences in a more or less complex linear model. Symptoms are learned responses that are caused by dysfunctional reinforcement (often involuntary).
2.behavior change is best brought about by accelerating positive behavior and decreasing aversive control, as well as by improving communication and problem solving skills.
3.treatment is usually time limited and symptom focused.
4.therapist personality is not important, therapist action is
5.focus on dyadic interactions primarily
6.insistence on observation and empirical evaluation
7.treatment is tailored to the specific family
8.Thibaut and Kelley's theory of social exchange (we act to maximize benefits and minimize costs)

II.Normal Family Development

Since they ignore past history, behavioralists have little to say about normal development. Rather, they focus on the functioning of the family in the here and now.

Marital Satisfaction

1.both the presence of positive affect, communication, and child-care, as well as the absence of negative affect and communication are important. Good marriages are more under the control of positive rather than aversive control.
2.a beneficial comparison level between rewards and costs in required
3.effective communication and good problem and conflict-solving skills are also helpful

III.Development of Behavior Disorders

A.Incorrect Reinforcement
Often parents don't know how to reinforce desirable behaviors and reinforce undesirable behaviors. This is a pretty much linear model, which may reach high levels of complexity (interlocking reciprocal behaviors), but is still linear.

B.Aversive Control Techniques
Spouse attempts to control other spouse use of aversive techniques (nagging, threatening, withdrawing), to which the other spouse responds with aversive techniques.

C.Poor Problem-Solving Skills

IV.Goals of Behavioral Therapy

1.are very specific and limited,
2.are unconcerned with system's change or growth,
3.are tailor fit to each family,
4.are designed to increase positive and incompatible behavior,
5.often begin with redefinition of the problem in terms of specific behaviors or conditions, or in terms of positive behaviors to teach
6.often include teaching skills and fostering conscious understanding

V.Conditions for Behavioral Change

1.functional analysis of the behavior beginning with the selection of a specific behavior(s), a specific plan to change behavior, and an empirical evaluation of change.
2.operant conditioning is used most often
3.dyadic change is the unit of change most often
4.attributional shifts in thinking and reasoning
5.resistance is probably due to ineffective case management as opposed to resistance to change, personal factors as opposed to systemic forces, or irrational beliefs as opposed to unconscious forces

VI.Techniques

A.Behavioral Parent Training involves accepting the parent's view that the child is the problem, and teaching skills to handle the problem or change the child's behavior. Assessment methods fall into 3 categories
   a.interviewing
   b.observation
   c.baseline data collection

Assessment steps include

1.problem identification (interviewing parents)
2.measurement and functional analysis (observing and recording problematic behavior, its antecedents, its consequences, the responses to the behavior)
3.matching treatment and client (assessing for the ability to control the environment, parent's ability to be trained, psychological problems in the parent, more effective and economical forms of available treatment)
4.teaching parents skills (contingency management, shaping, token economies, contingency contracting
5.assessment of ongoing therapy
6.evaluation of outcome

B.Behavioral Marriage Therapy began as science with its use of data only, then developed to art with the inclusion of systems's level ideas.

1.Detailed assessment of the strengths and weaknesses of the marriage, the presenting problem, the relationship and problem solving skills of the couple, the competency regarding financial planning and parenting, sex and affection in the couple, the individual functioning of each spouse, and the reinforcement schedules is the first step.
2.Social learning theory formulation is next presented to the couple. The therapist helps each person explain what positive things they want their spouse to do, not what negative things to not do.
3.Stuart teaches couples
   a.how to express themselves in clear behavioral terms
   b.behavioral exchange procedures
   c.improved communication skills
   d.to establish means to share power and decision making
   e.improved problem solving skills for both with and without the therapist
4.Positive reinforcement is increase and aversive control decreased. Contingency contracting is said to be quid pro quo or one spouse performs some behavior the other spouse wants contingent upon the other spouse performing some behavior they want. They may have "caring days" where they deliberately act in such a manner as to please the other spouse one day a week. One problem is that the other spouse can sabotage the contract by not performing their behaviors. Thus, good faith contacting is another way. Each member performs certain behaviors that are pleasing to the other regardless of the other's performance.
5.Communication skills are also taught. Behavioralist communication skills allow the spouses to state their needs clearly in behavioral terms instead of expecting the other to intuit needs and dealing with emotional expression.
6.Barton and Alexander's "functional family therapy" alters the spouses' attributions and cognitions regarding the other's negative traits and their feelings.

Strategic Behavioral Therapy

-Duncan et al, (88)
Strategic Behavioral Therapy (SBT) is an alternative brief model for therapy integrating strategic goals and individual cognitive-behavioral frames at theoretical and pragmatic levels.

I.History
The model was originally designed to deal with "resistance" in clients of behavioral treatment. The strategic approach holds that behavior can not be understood without the context in which it occurs. Thus, difficulty result from attempting solutions that are inappropriate for the situation. Problems result when an inappropriate problem solving technique is repeatedly used, and exacerbates a positive feedback loop which makes the problem more difficult. The behavioral approach assumes that the individual's interpretation of the problem determines its severity and that the consequences of a response determine whether it will be used again. Secondary gain may reinforce a maladapted response.

On the pragmatic level, the two models are very complementary regarding their area of expertise and their emphasis on Type I or Type II change, and similar on a process and conceptual level. On a theoretical level, the two approaches combine a social systems process view with a constructionist's view. This enables the integration of different approaches for depending on the specific client.

On a pragmatic Level, behavioral interventions teach specific skills and are very helpful if compliance can be maintained, which strategic approaches can help do. In some cases, skill acquisition is deemed appropriate to "throw a wrench into the works" of the problem cycle, but strategic approaches are unconcerned with teaching specific skills and thus may limit treatment options. The strategic approach focuses on the repetitive use of an inappropriate response, but ignores the battery of skills from which the response was drawn

While type I intervention, skill acquisition, may really be all that is needed to interrupt the problem cycle, it may also really be just "more of the same" type of repeated use of inappropriate coping attempts. In such cases a type II, change in the system rules or functioning, is needed. A new skill may change the person's perception of the problem (or the rules governing the problem) or may open up new options for coping (thus changing the meaning or context of the problem). Type I and type II approaches are complementary.

On both a pragmatic and a theoretical level:

1.Both are symptom oriented and focus on present patterns of observable behavior which precipitate and maintain problems. They both view ongoing reinforcers as maintaining problematic behavior. They consider as unimportant intrapsychic variables and the role of the past;
2.Both seek behavior change, and thus view insight as unnecessary;
3.Both require concrete and specific observable behavior and utilize homework assignments,
4.Both are brief and use directive and active approaches to accomplish focused interventions,
5.Both share a constructionist's view by stressing the client's conceptualization of the problem and lack a theoretical view of "normality."

On a theoretical level, the client's perception of the problem is important to the behavioral approach and the client's reality to the strategic approach. Both also view the construction of a new frame for a problem or new reality for the problem as paramount in changing the system.

Schmaling et al, (88) introduce

Behavioral Marital Therapy (BMT)

This is the application of cognitive-behavioral and social learning principles to the treatment of marital distress. Behavior Exchange (BE) and problem solving (PS) techniques have been the traditional interventions. The couple feel helpless, and each feels therapy is to change the other.

The idea of BE is to increase the positive experiences between them such that they are reinforced for being with each other. Each makes a list of the things that they could do to please the other, and is then asked to do them.

The idea of PS is to improve communication and problem solving. Tendencies to make overgeneralizations are discouraged. Receptive listening skills, reflection, empathy, I statements, validating, communication at the verbal and non-verbal levels are taught. Problem definition, problem resolution, and solution implementation are taught as well. When a spouse is going to bring up a problem, s/he gives
1. a statement of what pleases the partner about the situation,
2. a statement about what displeases the partner about the situation in clear specific behavioral terms in a non-defensive manner, and
3. a statement of the other's affective response.

The couple is taught to do this initially by the therapist intervening and helping them do it, then by doing it on their own with the therapist evaluating the plan of action and helping the couple learn to do this. The data shows its not bad. However, traditional couples with wives with high affiliative needs and husbands with high independence needs don't respond as well. Wives who are committed, more feminine, and have more + feelings towards their husband showed better response.

BMT is indicated for couples who report
1.onset of problems during crises in relationship
2.failure of individual therapy for one member
3.patient's report of marital discord
4.ability to tolerate interpersonal change

but not for couples where
1.one has a character disorder
2.marital therapy is resisted

Spouses can be involved at 2 levels, as a therapist aid to provide support to the other or as an active participant in marital therapy.

Behavioral Family Therapy
Richard Niolon, Ph.D. 12/99