CBT vs. Family Systems Theory: A Comparative Analysis

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 demonstrating their effectiveness. However, each has greater applicability in certain situations and with certain populations. Understanding the merits of each school within its proper context helps practitioners apply it in the most relevant circumstances. This paper compares and contrasts the two schools of counseling and psychotherapy, provides an overview of the evidence supporting their applicability, discusses the pros and cons of each for specific populations, addresses what current research indicates about their applicability to various cultures, identifies which cultures are best served by each theory, and presents an original case study that exemplifies these findings.

Comparing and Contrasting CBT with Family Systems Theory

CBT emerged as a merger of cognitive therapy and behavioral therapy. Cognitive therapy was used to treat depression and is widely acknowledged to have been established and promoted by Aaron Beck (Rosner, 2018). Behavioral therapy stemmed from research initiated by Pavlov, John B. Watson, and B. F. Skinner, who emphasized operant conditioning. Others, such as Mary Cover Jones, used behavior modification therapy to help children unlearn their fears, and Wolpe promoted behavioral therapy as a method of desensitizing patients. Albert Bandura then merged cognitive and behavioral theories to create a more holistic approach to counseling, paving the way for 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 see how specific triggering events lead to thoughts, feelings, and behaviors that cause problems. Together, the patient and counselor focus on identifying positive goals and implementing a behavior-focused strategy that will enable the person to reach those goals. For instance, a person addicted to drugs who wants to break his addiction but struggles due to negative thoughts and peer pressure might be guided so that whenever he senses a negative trigger — such as self-pity or certain friends who tempt him — he gets out his schoolbooks and puts on music he enjoys to help him study. The focus is on moving the mind and body away from negative impulses toward positive ones so that the person can reach his goals and change his life for the better.

Family systems therapy is different in that it focuses not on the individual but on the individual's relationship to the whole — particularly his or her role within the family. It examines how family members impact one another by applying systems theory to family structure, enabling individual members to better understand the complex ways in which they relate to and influence each other. 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 lives 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 affect individual issues such as substance abuse, depression, and eating disorders (Slesnick & Zhang, 2016).

The fundamental approach of family systems theory begins with the differentiation of self — that is, 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, encompassing both parents and the child. Third, the theory holds that parents tend to project their own failings and problems onto their children, which is unfair and can cause children to develop the very problems being projected onto them. Family members may then begin to distance themselves from one another in response, generational gaps widen, and sibling rivalry can emerge. The environment in which the family exists is also a relevant factor. Family systems therapy addresses all of these issues and, by examining them closely, helps family members understand why they are the way they are, thereby facilitating catharsis, closure, and the resolution of problems. To some degree, the humanistic influence of Adlerian theory is evident in this approach (Bitter & Carlson, 2017).

The two theories differ in that CBT focuses on behavior and thought modification rather than on uncovering the hidden meanings and motivations of the unconscious. Family systems therapy, by contrast, focuses 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. The family systems approach prioritizes understanding those motivations first, then provides a pathway to addressing them with full awareness. CBT, on the other hand, focuses first on identifying problematic behavioral and cognitive impulses that prevent a person from achieving his or her goals, then sets about implementing positive behavioral and thought practices that can replace the negative ones. Understanding unconscious desires is not required in CBT.

Evidence-Based Research on Applicability

There is solid evidence supporting the applicability of CBT for treating a range of issues such as depression, drug abuse, and eating disorders (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 therapy, or another psychoanalytic approach (Lock, Fitzpatrick, Agras, Weinbach, & Jo, 2018). Campbell, Decker, Kruk, and Deaver (2016) demonstrated that CBT is most effective when used in conjunction with other approaches for treating issues such as PTSD or substance abuse, and it is therefore commonly used today alongside pharmacological therapy.

Slesnick and Zhang (2016) show that family systems therapy is effective in helping family members address their individual and collective issues. Its applicability has been further validated by Haddock, Weiler, Trump, and Henry (2017) in the treatment of depression among college students. Like CBT, family systems therapy can help individuals on its own, but most effective results are achieved when it is combined with cognitive therapy. As with any single intervention strategy, a solitary approach limits what can be offered to the patient or patients, whereas a multi-pronged approach provides multiple supports and angles of assistance.

Conclusion

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Moore, L. M., Carr, A., & Hartnett, D. (2017). Does group CBT for depression do what it says on the tin? A systematic review and meta-analysis of group CBT for depressed adults (2000–2016). Journal of Contemporary Psychotherapy, 47(3), 141–152.

Rosner, R. I. (2018). Manualizing psychotherapy: Aaron T. Beck and the origins of cognitive therapy of depression. European Journal of Psychotherapy & Counselling, 20(1), 25–47.

Slesnick, N., & Zhang, J. (2016). Family systems therapy for substance-using mothers and their 8- to 16-year-old children. Psychology of Addictive Behaviors, 30(6), 619.

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