INTRODUCTION TO THE SPECIAL SECTION: THE ROLE OF COGNITIVE-BEHAVIORAL INTERVENTIONS IN COUPLE AND FAMILY THERAPY

Journal of Marital and Family Therapy, Jan 2005 by Dattilio, Frank M, Epstein, Norman B

Marriage and family therapists' perspectives on cognitive-behavior family therapy (CBFT) have seen major changes over the years. The focus on cognitions and behaviors in treatment is now widely embraced by marriage and family therapists because of the effectiveness of the approach and its flexibility and integrative potential. This article provides an introduction to the special section and a brief history and overview of the application of CBFT to the field and some of the benefits it can provide to the growing and ever-challenging area of couples and family therapy.

In 1946, the film It's a Wonderful Life was released. To the surprise of its producers, and many of the cast, the picture was a flop. Decades later, however, the film's popularity grew, and it is now considered a classic. The film itself did not change at all, but people's perspectives on it did. Over the years, viewers began to see it as addressing important truths about human relationships, foibles, and second chances.

The same might be said about cognitive-behavior therapy with couples and families. Initially, cognitive-behavior family therapy (CBFT) was not viewed favorably among a substantial portion of marriage and family therapists (MFTs), and it commonly was given minimal attention in books and journals in the field. Although the approach has developed over the decades, its most basic tenets regarding the importance of cognition and behavior interactions among family members have remained the same. Nevertheless, MFTs' perspectives on CBFT have indeed changed, and its focus on cognitions and behaviors in treatment of couples and families now is widely embraced.

Applications of CBFT to problems with intimate relationships were first introduced more than 40 years ago with Albert Ellis's early writings on the important role that cognition plays in marital problems (Ellis & Harper, 1961). Ellis and his colleagues proposed that relationship dysfunction occurs when an individual (a) holds irrational or unrealistic beliefs about his or her partner and relationship, and (b) makes extreme negative evaluations when the partner and relationship do not live up to such extreme expectations. When these negative cognitive processes occur, the individual is likely to experience strong negative emotions (anger and other aspects of marital distress) and to behave in negative ways toward the partner. The principles and procedures of Ellis's rational emotive therapy (RET) were applied to work with distressed couples, challenging the irrationality of their thinking (Ellis, 1977; Ellis, Sichel, Yeager, DiMattia, & DiGiuseppe, 1989). However, despite the overall popularity of RET as a form of individual or group treatment of many human problems, RET with intimate relationships received only a lukewarm reception from MFTs during the 1960s and 1970s. These decades marked the early development of the field of MFT, which was spearheaded by theorists and clinicians who eschewed mental health models that focused on internal psychological processes and linear causality in favor of observable family interaction patterns and the circular causal concepts of systems theory (Nichols & Schwartz, 2001). Ellis's work on cognition and the generally linear nature of his "ABC" model, in which irrational beliefs mediated individuals' emotional and behavior responses to life events, was seen as incompatible with a family systems approach.

Another major development in the field of psychotherapy during the 1960s and early 1970s involved behavior therapists' utilization of learning-theory principles to address various problematic behaviors of individual children and adults. As time went on, behavior principles and techniques that were successfully used in the treatment of individuals were applied to distressed couples and families. For example, Stuart (1969), Liberman (1970), and Weiss, Hops, and Patterson (1973) described the use of social exchange theory and operant learning strategies to facilitate more satisfying interaction in distressed couples. Similarly, Patterson, McNeal, Hawkins, and Phelps (1967) and others (e.g., LeBow, 1976; Wahler, Winkel, Peterson, & Morrison, 1971) applied operant conditioning and contingency-contracting procedures to develop parents' abilities to control the behavior of aggressive children. This approach had solid empirical support and became popular among behaviorly oriented therapists, but it still received little recognition from MFTs. The behavior approaches shared with family systems approaches a focus on observable acts and the factors in interpersonal relationships that influence their occurrence, but there were fundamental differences between the models that made the behavior therapies unacceptable to many family therapists. First, the behavior model, with its emphasis on stimulus-response links and behaviors controlled by their consequences (reinforcement), tended to be too linear for systemically oriented therapists. Second, even though the systems concept that an individual's negative behavior serves a function in the family seems compatible with the behavior approach to "functional analysis" of antecedents and consequences of a problematic act, MFTs commonly focused more on an individual's symptoms having symbolic meaning for a larger family problem. Thus, even though early forms of behavior family therapy did attend to reciprocal influences that parents' and children's behavior have on each other, MFTs tended to consider them relatively linear and simplistic when it came to accounting for complex family interactions.