CBT in Family vs. Individual Settings: Key Differences

CBT in Family vs. Individual Settings: An Overview

As Lee and Edget (2012) observe, at first glance, cognitive behavioral therapy (CBT) in family settings and CBT in individual settings could appear contradictory. However, although the two approaches differ in some ways, they also have a great deal in common. Both approaches are short-term in nature, typically lasting a couple of months. Furthermore, both approaches are behavioral-based. In essence, in both settings, "individuals learn to recognize the mistakes in their thinking that impacts behavior, then make modifications to change that behavior" (Lee and Edget, 2012, p. 137).

The central focus of each approach, however, can differ significantly. CBT in individual settings is largely focused on the individual person following diagnosis. For instance, in clinical practice involving the treatment of persons with alcohol use disorder, the overall goals of treatment tend to be the achievement and maintenance of sobriety, as well as recovery from the damage caused by addiction. On the other hand, the main focus of CBT in family settings is the establishment of productive changes aimed at promoting not only engagement but also communication within the family unit. There is, therefore, an expanded focus in family-based work. As Gobbard (2009) notes, "when applied to families, the cognitive–behavioral therapeutic approach examines the interactional dynamics of family members and how they contribute to family functioning and dysfunction" (p. 87).

Core Differences in Focus and Goals

Compared to CBT in individual settings, family-focused cognitive behavioral interventions have been shown to be more effective in certain scenarios — most notably in the treatment of children with anxiety disorders. In the words of Groot, Cobham, Leong, and McDermott (2007), studies conducted previously have suggested that "children with anxiety disorders appear to improve following a family-focused cognitive behavioral intervention" (p. 994). This finding is consistent with clinical observation: an 11-year-old girl diagnosed with generalized anxiety disorder (GAD) who had undergone individual therapy only began to show meaningful signs of improvement once her family was incorporated into the therapeutic process.

There are a number of challenges that counselors may face when utilizing CBT in family settings. First, garnering the cooperation and commitment of all those involved can be a significant obstacle. According to Gobbard (2009), CBT for families involves a wide range of activities, including thought recording and journaling — demands that some families may find excessive. Furthermore, "each individual must commit to being open and examining their own behavior" (Gobbard, 2009, p. 212). Obtaining this level of commitment from every participant is often difficult. Because family involvement is a central component of the approach, a lack of perseverance on the part of any member can undermine the recovery process.

Effectiveness of Family-Focused CBT

A second challenge concerns the emergence of interpersonal conflicts that make it difficult to maintain focus on relevant coping mechanisms (Gobbard, 2009). In individual settings, conflict is more manageable given that the therapeutic engagement is primarily between the therapist and the client. In family CBT, however, the inclusion of additional family members can give rise to additional concerns and conflicts that interfere with the attainment of therapeutic objectives.

Gobbard, G. O. (2009). Textbook of Psychotherapeutic Treatments. American Psychiatric Pub.