Selected Essays And Book Reviews
COUN 612 - Theories and Techniques of Counseling I
Lessons 22. Marital Therapies: Behavioral and Cognitive {1,038 words}
1. Discuss an overview of behavioral and cognitive marriage therapy. Jacob, Margolin, and Stuart started out behavioral but have become more cognitive. Behavioral marital therapies have become more social learning-cognitive marital therapies. Cognitive marital therapies have included behavioral techniques. The two together have led to a cognitive-behavioral marital therapy.
2. Discuss the theoretical foundations of cognitive-behavioral marriage therapy. D. H. Baucom and N. Epstein wrote a article entitled Cognitive-behavioral marital therapy. They emphasized the following premise: When a couple experience troubles, the troubles are due to behavioral, cognitive, and affective components, and these three types of factors mutually influence each other.
A. Behavioral: (1) Troubled couples exchange higher rates of negative behavior and lower rates of positive behavior (which are independent of each other). (2) Troubled couples use less effective (such as unclear and indirect) and more aversive (such as critical) communication to express their thoughts and feelings. Troubled couples use put-down humor, whereas untroubled couples usually do not. (3) Troubled couples attempt to solve relationship problems with less effective problem solving skills. They cross complain a lot, and they metacommunicate (talk about how they talk) negatively. (4) Troubled couples use more coercive methods for attempting to change the marital partner's behavior. The biggest threat is divorce because once one has made it, there is nothing left to threaten.
B. Cognitive: The couple should look at their: (1) assumptions about the marriage and nature of the spouses, (2) standards about how the marriage and the spouse should be, (3) attributions about the causes of positive and negative marital events (ask questions about what makes them argue; stable negative situations cannot be changed; strive for unstable negative or stable positive), (4) expectations about the likelihood that particular marital events will occur in the future, and (5) perceptions (notably selective attention) of the information available when observing one's interactions with one's partner.
C. Affective (emotions): The couple should look at: (1) each spouse's degree of positive and negative emotion toward the partner, (2) spouses' awareness of their emotion and cause of their emotional states, (3) degree to which spouses express their emotion and respond to their partner's emotions, and (4) forms and intensities of affect that can interfere with good marital functioning.
3. Discuss the assessment phase of cognitive-behavioral marital therapy. This phase tries to find where the problems are within the ABC (Affect, Behavioral, Cognitive) system.
A. Behavioral: Look at problem content areas, excesses and deficits in exchange of pleasing and displeasing behaviors, communication skills, problem-solving skills, and behavior change skills.
B. Cognitive: Perceptions, attributions, expectations, assumptions, and standards. Use an interview.
C. Affective: Look at:
(1) Amount and intensity of spouse's positive and negative affect regarding the marriage.
(2) Degree to which spouses recognize and differentiate their emotions and the aspects of their marriage that elicit emotional states.
(3) Excesses and deficits in the expression of emotion.
(4) Types of affect that impede effective marital functioning.
D. Basic Premise: Assessment is necessary to plan effective intervention, and assessment goes on continually throughout the marriage counseling.
4. Discuss changing behavior, cognition, and affect.
A. Behavioral: Increase positive behavior (the number of pleases) between the spouses. Have love days or caring days. On communication, have expression of emotion and problem solving taught separately. All communication has three components (semantic (what is being said), syntax (how verbal punctuation is being placed), and pragmatics (what are the effects of what is being said in terms of power). The power rule is the problem in all relationships with communication problems. On conflict resolution, state problem clearly and succinctly, discuss possible solutions, decide on solution, and set a trial period. Contract for change. Quid pro quo means that I will change if you do. Good faith means that I will change on faith. Holistic means that I will choose what to change from a list.
B. Cognition: The goal is to identify and modify aspects of each spouse's cognitions (perceptions, attributions, expectations, assumptions, and standards) that produce dysfunctional emotions or behavior during marital interactions. If the cognitions are accurate, then the change will be aimed at behavioral modifications.
(1) Step one: Teach the cognitive model. Use evidence from the couple's own interactions as much as possible. Include a general rationale and specific types of cognitions that will be the focus of treatment.
(2) Step two: Teach the couple to recognize and attend to their thoughts. Perceptions, attributions, and expectations are usually easier to identify than are assumptions and standards. Spend two or three sessions at catching the thoughts typically expressed in emotional circumstances.
(3) Step three: Introduce the difference between the content of the automatic thought and the logic of the thought.
(4) Step four: Introduce the ideas of perceptions, attributions, expectations, assumptions, and standards.
(5) Step five: Test and modify cognitions.
(6) Step six: At times work with one partner while the spouse looks on, if necessary.
(7) Step seven: Resolve incompatible standards.
C. Affect (the emotional part): The steps are labeling and understanding emotions, learning how to hear and express emotions, and dealing with anger (retribution, restitution, and refuge).
5. Discuss process of therapy for cognitive-behavioral marital therapy. The therapist should develop an overall treatment plan, not try things that are not broken (if something works for the couple, do not try to get them to use your program), use sequencing interventions (to deal with client concerns, issues requiring immediate attention such as crisis and abuse, skill level, and moderating affective tone), begin with behavioral and shift to cognitive focus (if couples continue to get off track or blocked or if behavioral interventions have worked), use behavioral interventions to check for lasting and cross-situational nature of cognitive shifts, and if the couple cannot communicate, shift to communication training.
Tom of Bethany
"He that hath the Son hath life; and he that hath not the Son of God hath not life." (I John 5:12)
"And ye shall seek me, and find me, when ye shall search for me with all your heart." (Jeremiah 29:13)
Index to Selected Essays And Book Reviews
Lesson 23. Marital Therapies: Worthington's Approach
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