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Unit 12 Cognitive Behavioural Family Therapy

1. Describe the A-B-C theory proposed by Albert Ellis as part of Rational Emotive Behaviour Therapy.

The core of Rational Emotive Behaviour Therapy is the A-B-C theory. 'A' stands for Activating Event which is an environmental situation or event; 'B' represents the irrational and/or rational belief arising from the person's evaluations of the event and 'C' is the emotional and behavioural consequences following the belief.

• (A) Activating Event - actual event, person’s immediate interpretation of event
• (B) Beliefs - evaluations, rational or irrational
• (C) Consequences - emotions, behaviours

2. What are cognitive distortions? Illustrate the important cognitive distortions that are assessed in cognitive behavioural family therapy.

Cognitive distortions are inaccurate or irrational thought patterns that cause emotional distress. The following are important cognitive distortions assessed in cognitive behavioural family therapy:

• Arbitrary inferences: Drawing conclusions without evidence.
  • For example, if a person assumes that their friend is angry at them even when there are no clear indications of it.
• Selective abstraction: Focusing only on the negative details, while ignoring the positive aspects.
  • For example, if a person receives positive feedback on a report, but focuses only on a minor criticism, and concludes that the report is a failure.
• Overgeneralization: Forming general conclusions based on a single event.
  • For example, if one person experiences a bad day at work, they may start believing that they will fail in all future work endeavours.
• Magnification and minimization: Exaggerating the negative and minimizing the positive.
  • For example, a person may magnify the importance of making a small mistake, while minimizing an accomplishment.
• Personalisation: Relating external events to oneself.
  • For example, if a person believes that they are the reason why their friend is sad, despite any evidence to support that belief.
• Labeling and mislabeling: Using extreme or inaccurate labels for themselves or others.
  • For example, a person may label themselves as a failure, instead of recognizing that they have merely made a mistake.
• Polarized thinking: Also known as all or none thinking, which involves viewing things in extremes, without considering the middle ground.
  • For example, a person may think they are either a success or a failure.

3. Elaborate on the concept of family schemas. Outline the steps involved in modifying schemas during cognitive behavioural family therapy.

Family schemas are core beliefs about what people and relationships should be like. These schemas are shared by family members and influence their interactions and interpretations of family events. General cognitive interventions that could be applied to family schemas:

• Identification: The first step would be to identify the family's negative or dysfunctional schemas, which can be achieved through assessment. Therapists can use techniques such as the downward arrow technique to uncover core beliefs or schemas.
• Challenge and Re-evaluation: Once identified, the therapist can help the family to challenge these schemas using Socratic questioning. This involves guiding the family members to re-evaluate their core beliefs.
• Cognitive Restructuring: Through cognitive restructuring, the family members are encouraged to modify their thinking patterns, and view situations more clearly. This might include learning to identify and challenge negative automatic thoughts, and develop more realistic and helpful interpretations.

4. Describe the use of the dysfunctional thought record as a cognitive restructuring technique.

Dysfunctional Thought Record

The dysfunctional thought record is a tool used in cognitive behavioural family therapy to help individuals identify and modify negative thought patterns. It is a structured method for clients to record their thoughts, feelings, and behaviours in response to specific situations. Here’s how it’s used:

• Monitoring Automatic Thoughts: Clients are encouraged to keep a systematic record of their automatic thoughts, especially those linked with relationship distress or conflict. This involves noting down the immediate thoughts that arise in response to a situation.
• Identifying Connections: This process helps them identify the links between these automatic thoughts and their negative emotions and behaviours during interactions.
• Recording Structure: The dysfunctional thought record typically includes columns to describe:
  • The actual event leading to an unpleasant emotion, or a stream of thoughts, daydreams, or recollections that lead to such an emotion.
  • The specific thoughts that occurred.
  • Any cognitive distortions present in the thoughts.
  • The emotional response to the event.
  • The behavioural outcome of the event.
• Facilitating Change: By systematically recording and analysing these thoughts, individuals can begin to recognise patterns of negative thinking and see how these contribute to their distress. This awareness is the first step towards changing those thought patterns.
• Identifying Distortions: The therapist guides the family members to recognise distorted cognitions in their automatic thoughts and label them in their records.
• Example: A person might record an event such as "my partner didn't do the dishes," followed by the thought "they don't care about me," labelling this as an example of “personalisation” and noting their resulting anger and withdrawal.

5. Illustrate the use of socratic questioning and the downward arrow technique.

Socratic Questioning and the Downward Arrow Technique

These are two key cognitive restructuring techniques:

• Socratic Questioning: This is a method of questioning in a non-judgemental manner that does not require a 'correct' answer. This dialogue is used to:
  • Clarify and define problems.
  • Assess the consequences of specific thoughts and behaviours.
  • Re-evaluate previous conclusions and develop new ideas.
  • Encourage family members to learn to use this questioning approach themselves.
  • Example: Instead of telling someone they are wrong, a therapist might ask "What evidence do you have to support that idea?" or "Can you see any other way of interpreting that situation?". The goal is to guide family members towards more realistic and helpful conclusions.
• Downward Arrow Technique:
• This technique involves a series of questions to tap into the underlying meanings of family members' reactions. It's used to uncover core beliefs or schemas.
• The therapist asks a series of questions that explore what a thought means to an individual or family member. Each answer is then explored further by asking "And if that happens, what will it mean to you?" or "What will that lead to next?"
• This process continues until the underlying core beliefs or schema is uncovered, including any catastrophic expectations.
• Example: Starting with the initial thought, "If my partner is late, it means they don't care about me." Then, "If they don't care about me, what does that mean?" followed by "If they don’t care about me, what will that lead to?" This series of questions might reveal a core schema of feeling unloved or worthless.

6. Briefly discuss the use of communication skills training and problem solving skills training in sessions with distressed couples and families.

Communication Skills and Problem-Solving Skills Training

These are essential components of behavioural interventions in cognitive behavioural family therapy.

• Communication Skills Training:
  • This focuses on improving how family members express themselves and listen to each other.
  • It includes guiding family members in both listening and expressive skills.
  • Techniques include active listening, expressing feelings in a clear and respectful way, and non-blaming communication.
• Problem-Solving Skills Training:
  • This training helps families address their issues in a structured way by encouraging them to break down problems into manageable steps.
  • The steps in problem-solving typically include identifying the problem, generating a range of solutions, weighing the advantages and disadvantages of each solution and implementing the chosen solution.

Important Points 

• Cognitive-behavioural family therapy focuses on thoughts, feelings and behaviours that are conscious.
• Family members are seen together throughout the assessment phase of cognitive behavioural family therapy.
• Identification of negative cognitions is the hallmark of the assessment phase in cognitive behavioural family therapy.
• Homework assignments that focus on thoughts and behaviours are an essential part of the treatment in Cognitive behavioural family therapy
• In cognitive behavioural family therapy, the dysfunctional thought record is the method by which the therapist teaches the client to identify and document thoughts and cognitions.
• All of the following are components of cognitive behavioural family therapy:
• downward arrow technique
• socratic questioning
• cognitive restructuring
• Downward arrow technique: A chain of questions using the can be used by therapists to uncover core beliefs or schema.
• In cognitive behavioural family therapy, schema analysis uncovers shared patterns of beliefs held by families. 
• Weighing the advantages and disadvantages of each solution is the third step in problem solving skills training.
• Communication skills training includes guidance in listening and expressive skills.