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...…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.