What is behavioral family therapy?

Introduction

Behavioral family therapy is a type of psychotherapy used to treat families in which one or more members are exhibiting behavior problems. Behavioral therapy was employed originally in the treatment of individual disorders such as phobias (irrational fears). Behavioral family therapy represents an extension of the use of behavioral techniques from the treatment of individual problems to the treatment of family problems. The most common problems treated by behavioral family therapy are parent-child conflicts; however, the principles of this type of therapy have been used to treat other familial difficulties, including marital and sexual problems.

Role of Learning Theory

The principles of learning theory underlie the theory and practice of behavioral family therapy. Learning theory was developed through laboratory experimentation largely begun by Ivan Petrovich Pavlov
and Edward L. Thorndike
during the early 1900s. Pavlov was a Russian physiologist interested in the digestive processes of dogs. In the process of his experimentation, he discovered several properties regarding the production of behavior that have become embodied in the theory of classical conditioning. Pavlov observed that his dogs began to salivate when he entered their pens because they associated his presence (new behavior) with their being fed (previously reinforced old behavior). From this observation and additional experimentation, Pavlov concluded that a new behavior that is regularly paired with an old behavior acquires the same rewarding or punishing qualities of the old behavior. New actions become conditioned to produce the same responses as the previously reinforced or punished actions.

Another component of learning theory was discovered by Thorndike, an American psychologist. Thorndike observed that actions followed closely by rewards were more likely to recur than those not followed by rewards. Similarly, he observed that actions followed closely by punishment were less likely to recur. Thorndike explained these observations on the basis of the law of effect. The law of effect holds that behavior closely followed by a response will be more or less likely to recur depending on whether the response is reinforcing (rewarding) or punishing.

Building on the observations of Thorndike, American behaviorist B. F. Skinner
developed the theory of operant conditioning
in the 1930s. Operant conditioning is the process by which behavior is made to occur at a faster rate when a specific behavior is followed by positive reinforcement—the rewarding consequences that follow a behavior, which increase the rate at which the behavior will recur. An example that Skinner used in demonstrating operant conditioning involved placing a rat in a box with different levers. When the rat accidentally pushed a predesignated lever, it was given a food pellet. As predicted by operant conditioning, the rat subsequently increased its pushing of the lever that provided it with food.

Gerald Patterson and Richard Stuart, beginning in the late 1960s, were among the first clinicians to apply behavioral techniques, previously used with individuals, to the treatment of family problems. Although Patterson worked primarily with parent-child problems, Stuart extended behavioral family therapy to the treatment of marital problems.

Given the increasing prevalence of family problems, as seen by the rise in the number of divorces and cases of child abuse, the advent of behavioral family therapy has been welcomed by many therapists who treat families. The findings of a 1984 study by William Quinn and Bernard Davidson revealed the increasing use of this therapy, with more than half of all family therapists reporting the use of behavioral techniques in their family therapy.

Conditioning and Desensitization

The principles of classical and operant conditioning serve to form the foundation of learning theory. Although initially derived from animal experiments, learning theory also was applied to humans. Psychologists who advocated learning theory began to demonstrate that all behavior, whether socially appropriate or inappropriate, occurs because it is either classically or operantly conditioned. John B. Watson, an American psychologist of the early twentieth century, illustrated this relationship by producing a fear of rats in an infant known as
Little Albert by repeatedly making a loud noise when a rat was presented to Albert. After a number of pairings of the loud noise with the rat, Albert began to show fear when the rat was presented.

In addition to demonstrating how inappropriate behavior was caused, behavioral psychologists began to show how learning theory could be used to treat people with psychological disorders. Joseph Wolpe, a pioneer in the use of behavioral treatment during the 1950s, showed how phobias could be alleviated by using learning principles in a procedure termed systematic desensitization. Systematic desensitization involves three basic steps: teaching the phobic individual how to relax; having the client create a list of images of the feared object (for example, snakes), from least to most feared; and repeatedly exposing the client to the feared object in graduated degrees, from least to most feared images, while the individual is in a relaxed state. This procedure has been shown to be very effective in the treatment of phobias.

Behavioral family therapy makes the same assumptions regarding the causes of both individual and family problems. For example, in a fictional case, the Williams family came to treatment because their seven-year-old son, John, refused to sleep in his own bed at night. In attempting to explain John’s behavior, a behaviorally oriented psychologist would seek to find out what positive reinforcement John was receiving in response to his refusal to stay in his own bed. It may be that when John was younger his parents allowed him to sleep with them, thus reinforcing his behavior by giving him the attention he desired. Now that John is seven, however, his parents believe that he needs to sleep in his own bed, but John continues to want to sleep with his parents because he has been reinforced by being allowed to sleep with them for many years. This case provides a clinical example of operant conditioning in that John’s behavior, because it was repeatedly followed by positive reinforcement, was resistant to change.

Treatment Process

Behavioral family therapy is a treatment approach that includes the following four steps: problem assessment, family (parent) education, specific treatment design, and treatment goal evaluation. It begins with a thorough assessment of the presenting family problem. This assessment process involves gathering the following information from the family: what circumstances immediately precede the problem behavior; how family members react to the exhibition of the client’s problem behavior; how frequently the misbehavior occurs; and how intense the misbehavior is. Behavioral family therapy differs from individual behavior therapy in that all family members are typically involved in the assessment process. As a part of the assessment process, the behavioral family therapist often observes the way in which the family handles the presenting problem. This observation is conducted to obtain firsthand information regarding ways the family may be unknowingly reinforcing the problem or otherwise poorly handling the client’s misbehavior.

Following the assessment, the behavioral family therapist, with input from family members, establishes treatment goals. These treatment goals should be operationalized; that is, they should be specifically stated so that they may be easily observed and measured. In the example of John, the boy who refused to sleep in his own bed, an operationalized treatment goal would be as follows: “John will be able to sleep from 9:00 p.m. to 6:00 a.m. in his own bed without interrupting his parents during the night.”

Applying Learning Theory Principles

Once treatment goals have been operationalized, the next stage involves designing an intervention to correct the behavioral problem. The treatment procedure follows from the basic learning principles previously discussed. In cases involving parent-child problems, the behavioral family therapist educates the parents in learning theory principles as they apply to the treatment of behavioral problems. Three basic learning principles are explained to the child’s parents. First, positive reinforcement should be withdrawn from the unwanted behavior. For example, a parent who meets the demands of a screaming preschooler who throws a temper tantrum in the checkout line of the grocery store because he or she wants a piece of candy is unwittingly reinforcing the child’s screaming behavior. Time-out is one procedure used to remove the undesired reinforcement from a child’s misbehavior. Using time-out involves making a child sit in a corner or other nonreinforcing place for a specified period of time (typically, one minute for each year of the child’s age).

Second, appropriate behavior that is incompatible with the undesired behavior should be positively reinforced. In the case of the screaming preschooler, this would involve rewarding him or her for acting correctly. An appropriate reinforcer in this case would be giving the child the choice of a candy bar if the child were quiet and cooperative during grocery shopping, behavior inconsistent with a temper tantrum. For positive reinforcement to have its maximum benefit, before the specific activity (for example, grocery shopping) the child should be informed about what is expected and what reward will be received for fulfilling these responsibilities. This process is called contingency management because the promised reward is made contingent on the child’s acting in a prescribed manner. In addition, the positive reinforcement should be given as close to the completion of the appropriate behavior as possible.

Third, aversive consequences should be applied when the problem behavior recurs. When the child engages in the misbehavior, he or she should consistently experience negative costs. In this regard, response cost is a useful technique because it involves taking something away or making the child do something unrewarding as a way of making misbehavior have a cost. For example, the preschooler who has a temper tantrum in the checkout line may have a favorite dessert, which he or she had previously selected while in the store, taken away as the cost for throwing a temper tantrum. As with positive reinforcement, response cost should be applied as quickly as possible following the misbehavior in order for it to produce its maximum effect.

Designing Treatment Intervention

Once parents receive instruction regarding the principles of behavior therapy, they are actively involved in the process of designing a specific intervention to address their child’s behavior problems. The behavioral family therapist relates to the parents as cotherapists with the hope that this approach will increase the parents’ involvement in the treatment process. In relating to Mr. and Mrs. Williams as cotherapists, for example, the behavioral family therapist would have the couple design a treatment intervention to correct John’s misbehavior. Following the previously described principles, the couple might arrive at the following approach: They would refuse to give in to John’s demands to sleep with them; John would receive a token for each night he slept in his own bed (after earning a certain number of tokens, he could exchange them for toys); and John would be required to go to bed fifteen minutes earlier the following night for each time he asked to sleep with his parents.

Once the intervention has been implemented, the therapist, together with the parents, monitors the results of the treatment. This monitoring process involves assessing the degree to which the established treatment goals are being met. For example, in the case of the Williams family, the treatment goal was to reduce the number of times that John attempted to get into bed with his parents. Therapy progress, therefore, would be measured by counting the number of times that John attempted to get into bed with his parents. Careful assessment of an intervention’s results is essential to determine whether the intervention is accomplishing its goal.

Detractions

In spite of its popularity, this type of therapy has not been without its critics. For example, behavioral family therapists’ explanations regarding the causes of family problems differ from those given by the advocates of other family therapies. One major difference is that behavioral family therapists are accused of taking a linear (as compared to a circular) view of causality. From a linear perspective, misbehavior occurs because A causes B and B causes C. Those who endorse a circular view of causality, however, assert that this simplistic perspective is inadequate in explaining why misbehavior occurs. Taking a circular perspective involves identifying multiple factors that may be operating at the same time to determine the reason for a particular misbehavior. For example, from a linear view of causality, John’s misbehavior is seen as the result of being reinforced for sleeping with his parents. According to a circular perspective, however, John’s behavior may be the result of many factors, all possibly occurring together, such as his parents’ marital problems or his genetic predisposition toward insecurity.

Integration with Other Therapies

Partially in response to this criticism, attempts have been made to integrate behavioral family therapy with other types of family therapy. Another major purpose of integrative efforts is to address the resistance often encountered from families during treatment. Therapeutic resistance is a family’s continued attempt to handle the presenting problem in a maladaptive manner in spite of having learned better ways. In the past, behavioral family therapists gave limited attention to dealing with family resistance; however, behavioral family therapy has attempted to improve its ability to handle resistance by incorporating some of the techniques used by other types of family therapy.

In conclusion, numerous research studies have demonstrated that behavioral family therapy is an effective treatment of family problems. One of the major strengths of this type of therapy is its willingness to assess objectively its effectiveness in treating family problems. Because of its emphasis on experimentation, behavioral family therapy continues to adapt by modifying its techniques to address the problems of the modern family.

Bibliography

Atwood, Joan, ed. Family Therapy: A Systemic Behavioral Approach. Chicago: Nelson, 1999. Print.

Clark, Lynn. The Time-Out Solution. Chicago: Contemporary, 1989. Print.

Falloon, Ian R. H., ed. Handbook of Behavioral Family Therapy. New York: Guilford, 1988. Print.

Gladding, Samuel T. Family Therapy: History, Theory, and Practice. Boston: Prentice, 2011. Print.

Goldenberg, Herbert, and Irene Goldenberg. Family Therapy: An Overview. 7th ed. Belmont: Brooks, 2008. Print.

Gordon, Thomas. Parent Effectiveness Training: The Proven Program for Raising Responsible Children. Rev. ed. New York: Three Rivers, 2000. Print.

Nichols, Michael P. “Cognitive-Behavioral Family Therapy.” Family Therapy: Concepts and Methods. Ed. Michael P. Nichols and Richard C. Schwartz. 8th ed. Boston: Allyn, 2008. Print.

Podell, Jennifer, and Philip Kendall. "Mothers and Fathers in Family Cognitive-Behavioral Therapy for Anxious Youth." Jour. of Child & Family Studies 20.2 (2011): 182–95. Print.

Rasheed, Janice M., Mikal N. Rasheed, and James A. Marley. Family Therapy: Models and Techniques. Los Angeles: SAGE, 2011. Print.

Robin, Arthur L., and Sharon L. Foster. Negotiating Parent-Adolescent Conflict: A Behavioral Family Systems Approach. New York: Guilford, 2003. Print.