Cognitive behavioral therapy (CBT) and family systems theory

Introduction
Cognitive behavioral therapy (CBT) and family systems theory are two schools of counseling and psychotherapy that can be used to treat individuals and groups. Both have been well-researched and are strongly supported with evidence that shows their effectiveness. However, each one has more applicability in certain situations and with certain populations. Understanding the merits of each school within its proper context can help one to apply it in the most relevant circumstances. This paper will compare and contrast the two schools of counseling and psychotherapy, provide an overview of the evidence used to support their applicability, discuss the pros and cons of each for specific populations, address what current research indicates on the applicability of these theories to various cultures, identify the cultures that would best be served by these theories, and provide an original case study that exemplifies the findings of this research.
Comparing and Contrasting Cognitive Behavioral Therapy with Family Systems Theory
CBT came about as a merger of cognitive therapy and behavioral therapy. Cognitive therapy was used to treat depression, widely acknowledged to be established and promoted by Aaron Beck (Rosner, 2018). Behavioral therapy stemmed from behavior research initiated by Pavlov, John B. Watson and B. F. Skinner, who emphasized operant conditioning. Others, like Mary Cover Jones used behavior modification therapy to assist children in unlearning their fears. Wolpe promoted behavioral therapy as a way of desensitizing patients. Albert Bandura merged cognitive and behavioral theories to create a more holistic approach to counseling, which led the way to CBT (Abramowitz et al., 2018). CBT is used to foster self-awareness in the patient so that the patient can identify negative impulses and triggers that contribute to a negative state of mind. The counselor helps the patient to see how specific triggering events lead to thoughts, feelings and behaviors that cause problems for the individual. Together, the patient and counselor then focus on identifying positive goals that the patient would like to pursue and implementing a strategy that is behavior-focused that will enable the person to reach those goals. For instance, a person who is addicted to drugs wants to break his addiction but struggles because of the influence of negative thoughts and friends who keep pressuring him to abuse drugs. He wants to finish school, get a job and get married. The counselor suggests that whenever he senses a negative trigger coming—like self-pity or certain friends who are a bad temptation—he should get out his school books and put on some music that he enjoys listening to to help him study. The focus is on moving the mind and body away from negative impulses towards positive ones so that the person can reach the goals and change his life for the better.
Family systems therapy is different in that it focuses not on the individual but rather the relationship of the individual to the whole, particularly to his role in the family. It looks at how family members impact one another. It applies systems theory to the family structure so that individual members of the family can better understand the complex manner in which they relate to one another and impact one another. The major assumption of family systems therapy is that by uncovering the meaning of these relationships, individuals will be better positioned to support one another and address the problems they are experiencing in their own and in each other’s lives. Family systems theory is helpful because it focuses on the complexities of family relationships and the way those complexities have an effect on individual issues, like substance abuse, depression, eating disorder and so on (Slesnick & Zhang, 2016; ). The fundamental approach of family systems theory is first to allow for the differentiation of self, i.e., acceptance of the fact that people cope with life in different ways. Second, the theory posits that relationships are triangular and that families must process emotions in a triangular way, i.e., by encompassing both parents and the child. Fourth, the theory posits that parents tend to project their own failings and problems onto their children, which is not fair to the children and which can often cause the children to develop the problems that the parents are projecting onto them where they did not exist before. Then family members begin to distance themselves from one another in response. Generational gaps widen, and sibling rivalry can commence. The environment in which the family exists is also a factor to consider. Family systems therapy focuses on all these issues and, by examining them closely, helps family members to better understand why they are the way they are and thus experience catharsis, closure, and overcome their problems. To some degree, the humanistic influence of Adlerian theory is evident in this approach (Bitter & Carlson, 2017).
The two theories are different in that CBT focuses on behavior and thought modification rather than on understanding hidden meanings and motivations of the unconscious. Family systems therapy focuses instead on uncovering the hidden meanings and motivations within the family system that lead to individual problems among children or that blind parents to their own issues. Family systems approach focuses first on understanding the motivations then provides a window towards addressing them with full awareness. CBT focuses first on identifying problematic behavioral and thought impulses that prevent one from achieving one’s goals, and then sets about implementing positive behavioral and thought practices that can be utilized in place of the negative ones. Understanding unconscious desires is not needed in CBT.
Evidence-Based Research on Applicability of Each
There is solid evidence on the applicability of CBT for treating a range of issues, such as depression, drug abuse, eating disorders, etc. (Moore, Carr & Hartnett, 2017). However, researchers also note that CBT is most effective when coupled with other forms of therapy, such as art therapy, family systems or some other psychoanalytic therapy (Lock, Fitzpatrick, Agras, Weinbach & Jo, 2018). Campbell, Decker, Kruk and Deaver (2016) showed that CBT is most effective when used in conjunction with other approaches for treating issues like PTSD or substance abuse, and thus it is commonly used today in conjunction with pharmacological therapy.
Slesnick and Zhang (2016) show that family systems therapy works in helping family members address their individual and group issues. The theory has been validated in research and its applicability has been recognized by Haddock, Weiler, Trump and Henry (2017) in the treatment of depression among college students as well. By itself, it is similar to CBT in that it can help individuals but for most effective results it should be combined with cognitive therapy. Like any intervention strategy, a single approach limits the patient or patients, whereas a multi-pronged approach can provide them with multiple supports and angles of assistance.
Pros and Cons for Specific Populations
CBT is often used for populations experiencing depression, substance abuse, or personality disorder. These experiences are essentially universal and not specific to any culture or population. Thus, it is thought of more in terms of what it can be used to treat effectively rather than what type of ethnic group or people of a particular cultural background for whom it can best be used. The pros of CBT for these specific mental health issues are that it helps the person to get out of the mental and behavioral rut that he is stuck in by actively promoting a new thought and behavior regimen that can be monitored by the person and the counselor so that accountability can be maintained and the person can gradually improve. The con of the approach for people experiencing these mental health issues is that the approach is often insufficient by itself to facilitate a complete recovery; in most cases, it has to be paired with another form of therapy, whether drug therapy or psychotherapy, or humanistic therapy like drama therapy or animal-assisted therapy (Lock et al., 2018; Moore et al., 2017).
The population best served by family systems therapy would be those populations where family structure is still somewhat intact. This is getting harder and harder to find in most populations in the US, as the divorce rate is high and half of marriages end in divorce. Moreover, the rise of unwed mothers and single parent homes has increased the difficult for which this therapy can be implemented. That is the major con of family systems therapy: big families are not as prevalent as they used to be. The major pro of this approach is that it helps families, wherein they are still together, to come to terms with their various issues and the ways in which they interact or have grown apart. It presupposes that there is good will on the part of the family members, or enough so that they can all get together in one place for therapy. However, in families where substance abuse is a problem, the family members may feel shame about their issues and thus be reluctant to seek help for them. Even though it has been found to be an effective therapeutic approach, it is difficult to get everyone in the family to commit to it. Getting everyone to commit to it is a great first step and sign that the family’s problems can be overcome.
Current Research on the Level of Applicability of Theories to Various Cultures
Escobar and Gorey (2018) have found that CBT is most applicable with non-Hispanic white populations. Duncan (2017) has shown that family systems therapy can be applied in any culture or with any population so long as culturally-informed approaches are used that demonstrate cultural competence on the part of the therapist. Cultural competence is really needed for any therapy to be most effective, and Bedoya, Dale and Ehlinger (2017) have found this to be true for CBT as well.
Which Cultures are Best Served?
Still, cultures that are best served by CBT do appear to be white cultures (Escobar & Gorey, 2018). Cultures best served by family systems therapy are those wherein a strong family structure and dynamic persists. This can be in any culture—white, Hispanic, Asian, or African America; the key is for the therapist to use cultural competence and culturally-informed approaches when implementing the family systems therapy (Duncan, 2017).
Original Case Study
The case of serial killer Ted Bundy is a good example of how cognitive behavioral therapy might have been used to effectively treat Ted before his homicidal impulses overtook him. It is a case of why family systems therapy would not have worked. Ted was born out of wedlock in 1946. His mother pretended that he was her little brother to avoid scandal in the community. Ted was effectively raised by his grandparents as a result. His grandfather introduced him to violent pornography as a young man. When his mother finally married it was to a strict disciplinarian who demanded respect from everyone and did not tolerate disrespect particularly from women. Ted thus harbored narcissistic tendencies and feelings of grandeur as well as anti-social personality disorder (Williams, 2020). Had Ted come in for therapy after first realizing that he was losing control of his emotions, CBT could have been used to help Ted address his anger issues, especially towards women and redirect his energy towards improving himself by pursuing a law degree. During his trial for murder, after all, Ted defended himself and showed that he was capable of mounting an intelligent and forceful defense, even winning the praise of the judge at the end of the trial (even though he was found guilty). A CBT approach might have helped Ted resist the homicidal impulses that eventually gained mastery of him; it might have helped him develop better habits that could have been put in place to correct for the negative impulses nursed in his childhood through exposure to violent pornography and a demanding step-father.
Family systems theory probably would not have helped in this case because Ted’s family was not interested in him or in really acting as a family. His mother was basically disconnected from him for his whole life, and he never knew his biological father. His step-father was stern and distant. His grandfather was as well and only related to Ted in a perverse sexually deviant way. Had it been possible for the family members to come together for family counseling, the impact might have helped to address Ted’s needs, but the problem here is that the situation was not one in which the family was likely to respond to the suggest of family systems therapy. Family systems therapy is best applied in situations where there is a willingness on the part of the family to address its own internal, complex inter-workings. Culturally speaking Ted was educated and enjoyed the typical privileges that most middle-class white Americans enjoy. Pathologically, he had borderline personality disorder and was in need of mental health care that never came because he never sought help and no one in his life suggested he get help. This is where the lack of family support comes into play and is why family systems theory would not have worked here. However, CBT really works best when implemented with other approaches like family therapy. Thus, it would have been in Ted’s (and everyone else’s) best interest had he received both CBT and family systems therapy—for the two really should go together.
Conclusion
This paper has shown that CBT and family systems theory are two evidence-based practices that can be employed in counseling or therapy to assist in the mental health care of patients. CBT is most effectively and most often used for individuals who are going through a crisis, such as drug addiction, some trauma, relationship issues, or dealing with a personality disorder. Rather than try to uncover the hidden meaning of one’s unconscious, CBT simply focuses the attention of the individual patient on identifying triggers and implementing a plan that will help the person respond in a more positive way when the risk of being triggered arises. CBT focuses on changing behavior to help the person become more productive. Family systems theory focuses more on the family dynamic and how the arrangement, relationships, and needs of family members affect one another in that family. Unlike CBT, it focuses on uncovering hidden meanings and bringing them to the surface so that family members can understand their place and how they impact others as well. Both are effective tools in psychology, but each has utility in certain situations.
References
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