A Cognitive-Behavioral Approach to Family Counseling
Stacy McConville
Liberty University
Abstract
Goldenberg and Goldenberg (2017) describe many provisionally validated theoretical approaches to family counseling. Cognitive-Behavioral Therapy (CBT) is one of these approaches to counseling, CBT has abounding research supporting its effectiveness for couples, and families dealing with conflict that compromises the family, and each individual as a support system. CBT is a counseling theory which supports the Biblical truth and is effortlessly integrated with a Christian viewpoint to offer acceptance, love, mercy, hope, grace, forgiveness, and comfort. The Holy Spirit, prayer, Scripture memorization, and Biblical doctrine are distinguished tools attainable for the Christian therapist to utilize when assisting the family in continuing to be renewed in the image of Jesus Christ our Savior.
A Cognitive-Behavioral Approach to Family Counseling
Family therapy is often characterized as being an approach that focuses on intimate, familial relationships such as couples and families that have an intimate bond connecting them. The goal of family therapy is for each individual relationship, and the family relationship as a whole to become a healthier functioning unit, in their spiritual, physical, psychological, emotional, and mental components. There are numerous theories that therapist can utilize within the counseling setting. This paper will be focusing on Cognitive-Behavioral Therapy (CBT), CBT’s focus is on aiding the clients to identify their faulty beliefs and understandings. CBT aims at eradicating negative perspectives and beliefs that each individual within the family and the family as a whole has, while also attempting to aid the family in creating healthier, more rational approaches to evaluating issues or problems that may arise in their life, and that they are currently dealing with.
Part I
Leading Figures
CBT initially focused mainly on the individual, now it focuses on intimate relationships, such as marriage, family, couples, etc. CBT is accepted as a treatment method for marriage and family therapy. In the late 1970’s a group of therapists realized that an individual’s personal beliefs, their expectations, their cognition, and their attitudes each affect the individual’s behavior. Initially CBT was created for individual treatment, however within the last few decades there has been an increase in utilizing this approach for couples, marriages, and families struggling with issues. Stuart, Patterson, and Liberman are the CBT’s three pioneers that collaborated to adapt the CBT’s therapeutic approach, so that utilizing it with families, and couples would be successful; their aim was to identify the family assessment process instead of gaining a comprehensive understanding of the family and the families dynamics (Goldenberg, Goldenberg, & Stanton, 2017). During their collaboration, they started to understand and view the approach more diversely, thus moving their interest toward internal cognitions impacting or connected to external behaviors of individuals, couples, marriages, and families. This aided in the development of Cognitive-Behavioral Therapy (CBT). The two leading psychologists utilizing Cognitive-Behavioral Therapy (CBT) are Aaron Beck and Albert Ellis (Goldenberg, Goldenberg, & Stanton, 2017). These two individuals realized the impact that faulty cognition does to an intimate bond through external behaviors. They started combining Behavioral and Cognitive Therapy techniques to help couples overcome obstacles in their marriage.
Albert Ellis was motivated and shaped largely via Adler, that focused on how an individual’s lifestyle and emotional state will affect their cognitive foundation and beliefs. Ellis developed the A-B-C theory of dysfunctional behavior, believing that negative behavior is associated with an activating event (Goldenberg, Goldenberg, & Stanton, 2017). In this theory, the activating events of an individual’s life isn’t responsible for the negative consequences; instead it’s the irrational and unrealistic assumptions and beliefs that are creating the issue.
Aaron Beck’s approach in dealing with family therapy was rare in that he believed that the interactions of the family and/or couple was just as vital as their cognitions. As he worked additionally with clients that suffered from depression he became even more curious about the thought method of clients with dysfunctional behaviors; and the basic cognitive process that depression resulted in inaccurate thought patterns (Kanter, Busch, & Rusch, 2009). Goldenberg, Goldenberg, and Stanton (2017) noted that as folks interiorize negative attributions concerning the tough things that happen in their lives, they develop negative schemas. Once anything that reminds them of this negative schema happens to them, it triggers those previous emotions they experienced, this results in psychological cognitive distortions; altering the depressed person’s ability to think clearly (Flaxman, Blackledge, & Bond, 2011).
Beck main objective was to form things for clients that created circumstances where they may learn a way to manage and disapprove negative schemas moreover as psychological feature distortions (Wills, 2009). once this is often applied to marriage and family therapy, every individual may examine their own personal schemas, allowing them to focus their expectations on close family and matrimonial relationships, and the way they personally affect each individual’s behavior as a person. Focusing on the entire family’s schemas, and how they interact with one another, is crucial. Once this occurs within the family, it can work as a unit to change the individual and shared schemas, so that the dysfunctional beliefs can be eradicated, bringing about a positive modification in the family’s behavior (Kanter, Busch, & Rusch, 2009).
Concepts and Techniques
CBT draws its techniques from cognitive therapy and behavioral therapy. Restructuring negative schemas, faulty thought processes, cognitive distortions are an important part of CBT techniques. A CBT therapy session follows “signature session structure including mood check-ins, homework review, agenda setting, homework assignment, and eliciting feedback” (Friedberg, p. 160). The goal of CBT is not to eradicate or standardize the client’s emotions but to activate the client’s abilities to create a more realistic assessment of the situation. The CBT is an empirically based modality based on scientific methods that can be evaluated and tested for its effectiveness (Goldberg, & Goldberg, 2013) and is a way for the client and therapist to work together to develop a solution to the client’s problem. According to Asmundson, Beck and Hoffman (2013), “A number of studies from the field of neuroscience support the notion that changes in cognitions and conscious self-regulation of emotions directly influence the electrochemical dynamics in the brain” (p. 203) making CBT a great way to implement second-order changes.
Therapists who practice from a CBT modality believe that emotions influence how individuals perceive certain events and situations (Asmundson, Beck, & Hofmann, 2013). Therapists attempt to help clients by changing how they perceive events and their emotional responses to those events. CBT replaces cognitive distortions and maladaptive thoughts to increase a client’s coping ability and reduce emotional distress through a series of techniques designed to implement second-order changes. CBT has been found to be effective people of all ages in a great many different disorders, including, substance abuse, marriage counseling, depression, anxiety disorders, bipolar disorder, many medical disorders, eating disorders and schizophrenia.
Relationships
Cognitive behavioral therapy is a collaborative relationship and the perception of the client’s therapist relationship is a contributing factor in the success of therapy (Leahy, 2008). Developing a collaborative relationship with a client is more than saying hello and having a good handshake. To create a relationship with the client the therapist must be an active listener, caring and empathetic without being condescending or judgmental, validating the client creating an environment where the client feels safe and secure. When the client feels safe, cared for and respected, he may open up easier and be more forthright and honest.
Comparison of Theories
Cognitive-Behavioral Therapy is different than other methodologies in many ways. First, CBT encourages families and couples to attend sessions together. Working with families creates unique situations that the therapist must consider before working with couples or families. For example, the therapist must carefully design the informed consent process to include ways to inform children and teens of their rights (Corey, Corey, & Callanan, 2011). In individual therapy, each person comes with his or her own plan. A parent may want their child fixed and the teen may think her parents are the problem. In CBT the therapist is able to see how the family functions and can correct faulty family transactional patterns that may be causing the child to act out. The CBT therapist focuses on the entire units’ thoughts, feelings, behaviors and emotions while an individual therapist concentrates on one person and doesn’t consider the whole unit (Friedberg, 2006).
Studies have proved that CBT in conjunction with antidepressants to be as effective as psychodynamic and interpersonal therapy in managing severe and chronic depression (Rupke, Blecke, & Renfrow, 2006, p. 84). For chronically depressed patients that do not respond to pharmaceutical treatment, studies have shown CBT to be an successful form of treatment (Mitte, 2005). CBT techniques are more effective than traditional cognitive therapies especially positive reinforcement, scheduling enjoyable outings with others, and homework. These tasks have proven to improve relapse rates (Rupke, Blecke, & Renfrow, 2006, p. 84).
There is a vast amount of research on CBT therapy and not all agree on which type of therapy is the best approach. Tolin (2010) conducted “a meta-analysis evaluating the effectiveness of CBT and found that briefer CBT appears to be superior to briefer alternative psychotherapies, and longer CBT appears to be superior to longer alternative psychotherapies” (p. 719). Another study analyzed 13 different studies and found that CBT “fails to provide corroborative evidence for the conjecture that CBT is superior to bona fide non-CBT treatments” (Baardseth, Goldberg, Pace, Wislocki, Frost, Siddiqui, & Wampold, 2013, p. 395)
There are other theories that focus on the use of the internal thought process; however CBFT is noted to be the only theory that uses systemic methods reliable (Flaxman, Blackledge, & Bond, 2011). The unconscious effects that are driven by external behavior are the focus of Psychodynamics. Even though CBT main focus is on the conscious thought of the person, Beck often suggested that the negative schemas exist in our subconscious thoughts; however they could exist totally in our unconscious thoughts. Goldenberg and Goldenberg placed high importance on applying the therapeutic techniques to alter behavior. The alteration of cognitive attributions to help resolve symptomatic behavior is known as the Milan Systemic Model and is also used in family therapy. Then there is Narrative Therapy that is a Social Construction Model that replaced negative thought and beliefs with positive ones (Goldenberg & Goldenberg).
Part II
A study in 1990 showed that 79% of clients being seen in a mental health capacity stated that religion is a crucial part of their life, compared to the 29% of mental health employees that view religion as a vital part of their life. Unfortunately, the American Psychologists Association still failed to incorporate religion into being a part of their standards until 1992 (Hawkins, Siang-Yang, &Turk,1999). Therapist that utilize the CBT approach from a Christian perspective is able to easily modify their techniques to be able to incorporate the Christian perspective.
As a Christian, I view counseling and assisting others in a different manner than a non-Christian would, however, I won’t impose my Christian beliefs on clients or their family members which may come for family counseling. Regrettably, a large majority of the counseling field does not endorse Christian counseling. Counseling theories and techniques may be substantially distinctive for individuals who are Christians. A greater number of mental health workers need to be more educated and open to nonsecular issues and the impact that it may have on their clients and the families they counsel. Christianity has a restorative impact that families could benefit from (Goldenberg & Goldenberg, 2017).
Integrating spirituality and counseling is extremely crucial to counseling and family therapy. Plenty of faulty thinking is created from having defective religious views and beliefs. Christians feel that enable to be loved by God we have to be sinless and perfect. This isn't the case and it has prompted many Christians to develop cognitive issues through the years, due to the fact they're incapable of achieving this sinless perfect individual. Being overbearing on clients regarding Christianity could make them believe they are unworthy, or inferior. An inferiority complex can push clients farther away from the counselor within the counseling process.
The Bible tells us that, “For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life” (John 3:16 NIV). This Bible verse clears the air regarding the ideal Christian idea that numerous individuals fall victim to. God sent His perfect and only Son into the world because He loves each of us. God observed the torment that numerous individuals were facing enduring sin and he sent his Son into the world to save everyone that would come to him.
As a counselor, I plan to take a Christian approach when counseling clients by addressing them in a compassionate, loving, accepting, and nonjudgmental manner. As a Christian counselor, it'd be crucial for me to be compassionate, forgiving, understanding, thoughtful, and to integrate prayer into the counseling session to truly assist the client in all aspects of their life. Counselors have a dire duty to do no harm to their client and must take this extremely serious due to the fact they're accountable for their intellectual well-being. The Bible is obvious on being attentive to others, “wherefore, my beloved brethren, let every man be swift to hear, slow to speak, slow to wrath” (James 1:19 NIV). When counseling client’s counselors should listen to them with the intention to understand the client's issues. The counselor’s opinion could be very essential to the client and may in a few instances turn out to be life-changing (Goldenberg & Goldenberg, 2017).
Counseling may be complicated via itself without including the Holy Spirit to intercede and direct us as the counselor. Christians are born sinners, God decided to provide us the gift to pick whether or not to accept a life of truth with Him. All of us have the intuition to be righteous, however we're natural sinners and cannot help but desire to sin. God recognized this and sent His Son to die in order for our sins to be forgiven (Goldenberg & Goldenberg, 2017).
As a Christian counselor, I might need to expose my clients to how loving, caring and accepting God is. I would aspire to reveal to them His love, empathy, understanding, acceptance, and trustworthy manner. McMinn (2006) stated that people were created with a choice, we are able to choose to be kind and loving toward each other while creating relationships that are meaningful and close, along with forming a relationship with Jesus Christ, or we can continue being miserable, selfish, self-focused, sinful, miserable individuals living the life Satan wants us to (McMinn, 2006).
God desires us to have creativity and the strength to finish our jobs and be able to establish a personal relationship with Jesus which can provide us with our meaning of existence. The counselor must redirect the client’s faulty thinking about their relationship with God. Many individuals see God as being strict and overbearing; however, He's compassionate and loving. The Bible says that “No, in all these things we are more than conquerors through him who loved us. For i am positive that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord” (Romans 8:37-39 NIV). Counselors need to combine their spiritual perspectives into the counseling session. We want to take into account that these families are genuinely suffering, and a lot of their issues may be from spiritual misconceptions (McMinn, 2006). To approach families with the CBT method of counseling, we should keep in mind that the family as visible through the eyes of God is about togetherness, impacted by what one individual within the family thinks about themselves or the family, it has an instantaneous effect on the entire family (Richards & Bergin, 2005). We must understand that if one member is ill within the family than the entire family is suffering. Treating the family as a whole is an exceptional aspect of CBT family counseling. CBT understands the idea that when one individual inside the family is acting out, the entire family is out of sync (McMinn, 2006).
A client must learn how to recover from the defective thinking of disgrace and guilt that comes with sin. Clients need to learn forgiveness rather than disgrace and guilt. After they forgive themselves and others, clients will be capable of moving beyond their defective thoughts that they've believed about themselves. Many anxiety issues that manifest are because of faulty thinking and not trusting in God to assist with our issues. The Bible says “do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus” (Philippians 4:6-7 NIV). Once clients turn their issues over to God a number of their defective thoughts and wondering will go away, and they will turn into rational thoughts. Defective thinking within the families can alter the thinking process for the entire family because of the domino effect. It is essential for us as counselors to recognize this truth. One family member’s defective thinking can cause the entire family to come to be dysfunctional. This is why a Spiritual approach to family counseling is so powerful. Families that pray together and turn all of their faulty thinking into Spiritual thinking will be less probably to be dysfunctional (McMinn, 2006). The fundamental moral ideas of Christian faith must be included into Christian family counseling. As Christians, we're taught that we're beautiful and God will accept us regardless of what sin we have committed or what area in life we come from. CBT therapy works nicely with integrating religion because it does not see the individual as being awful, but instead their ideas are defective. Converting an individual's negative thoughts into greater positive Christian thoughts is where Christian counseling does the changing of the individual in CBT. The Bible offers an excellent dialogue about thinking “do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect” (Romans, 12:2 NIV).
Conclusion
Providing counseling to individuals that are lost, broken, and hurting is a crucial and serious responsibility. As long as the therapists’ practices within their scope of competency and apply approved techniques, seeks God’s guidance and understanding, prays, fasts and studies then the possibility of lives being healed are far greater than relying on oneself. Cognitive-Behavioral Therapy is an empirically researched therapeutic approach that provides realistic cognitive and behavioral approaches to address the individual’s psychological, social, spiritual, and emotional wellbeing. Once a CBT therapist incorporates Jesus Christ into their therapy techniques, they provide the missing link to the puzzle, thus giving the client the ultimate access to achieve a complete healing from our Creator and Father.
CBT provides clients with many tools that align with the Biblical perspective. Assessing transactional patterns, correcting negative or faulty automatic thoughts, utilizing homework assignments, behavioral enactments, RSA and other CBT techniques provides the therapist a manner in which being in a position to enable the client to bring about change through giving visible and understandable behaviors that can be identified and changed. Each of these techniques are Biblically appropriate, and if used positively can assist the client towards obtaining a healthier life, with better relationships, and the ultimate reward a closer walk with the Lord.
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