This paper examines the approach towards the counselling of families and the technique behind cognitive behavioural therapy, within the context of psychology. The paper provides a brief introduction to family counselling methods and approaches and particular focus on cognitive behavioural therapy. The paper is structured into two main parts: Part 1 deals with the method, technique and application of cognitive behavioural therapy whereas Part 2 deals with the more holistic approach of integrating this with personal belief and family values. The conclusion provides a summary of the key points.
There are varied approaches to Family Counselling and these include such items as structural, psychoanalytic, bowenian, experiential etc. This paper focuses upon the aspect of cognitive behavioural family therapy. Early in the family therapy movement, this approach was treated with a degree of scepticism by the more traditionalist family counsellors. They saw the technique as having insufficient depth to deal with the complexities and dynamics of family dysfunction. In the early days, this approach was only considered useful in the counselling of children with family disorders but it has since evolved into much wider applications. It is only in the last 10 years that Cognitive Behavioural therapy as emerged in its own right as a major approach to family counselling. (Leahy, R. 2004)
The different approaches to family counselling are extensively discussed in the work of Goldenberg. (Goldenberg, H, 2008). Cognitive behavioural approaches have been particularly successful in treating adolescents and youths with behavioural problems. The theoretical approach has the capability of adapting to different behavioural circumstances and environments. It deals with both emotional and social domains and as such is extremely persuasive in its applied application. The theory deals directly with those cognitive forces that stimulate emotional reactions and behavioural responses. As such it provides a problem solving orientation in order to determine the best or most suitable forms of psychological treatment. In order to deal successfully with cognitive problems it is important to gain a precise understanding of the emotions being displayed and understand the causation factors behind these. Mental health professionals have outlined the importance of family and social relationships as an important contributory part of the therapeutic process in treating problems. As such favourable outcomes in treatment are highly influenced by a positive approach and supportive stance being adopted from the parents. (Kendall, P.C. 2006)
COGNITIVE BEHAVIOURAL FAMILY THERAPY
In the early days, the behavioural therapist saw only those individuals who were involved in problematic marriages. The others are children within problem families. The concept of strategic behavioural therapy developed the need to build on individual cognitive frameworks. Two of the major contributors were Aaron Beck and Albert Ellis. Both of these were influenced by Freud (instinct), Jung (mysticism) and Adler (common sense). Hence, from the perspective of the behavioural counsellor – thoughts resulted in feelings and these in turn led to behavioural responses. (Friedberg, R.D. 2010)
The problem areas that most readily identified with cognitive behavioural approach were that of posttraumatic stress disorder (PTSD), substance abuse, Obsessive-compulsive disorder (OCD), Anxiety, mood disorder, marriage and family therapy and eating disorders. The goal of CBT is considered threefold: (i) To enable the patient to become more aware that help is available and remedial action can be applied (ii) To assist the client in greater awareness of the problem and thereby invoke both confidence and belief (iii) to inspire the counsellor towards a more positive therapeutic approach. It is important that the counsellor develops a rapport with the patient and helps in the development of new cognition.
The important aspect of CBT is that it is a relative short form of treatment and only requires about 4-7 months of therapy in order to treat most form of problems. It is essentially a combination of psychotherapy and behavioural therapy and combines a joint approach between patient and counsellor in order to determine a set of principles that can be applied to their daily lives. CBT uses the assumption that it is not the events that disturb us but the interpretation and meaning we give them. Hence if we provide too much of a negative emphasis we are blocked from doing action that we do not believe in. In this concept we only hang on to old thoughts and are prevented from learning new things. (Martin, B. 2012)
Dialectical Behaviour Therapy (DBT) may be described a treatment modality that combines a number of techniques i.e. relaxation and soothing skills, cognitive behavioural techniques and improvement of self-awareness skills. In this context, modality may be defined as an application approach using a therapeutic agent. The approach to treatment is by that of problem solving, cognitive modification, exposure skills and contingency management. Patients with borderline personality disorders or those showing suicidal tendencies are difficult to treat. DBT is an innovative therapeutic approach aimed at addressing these needs. (Swales, B.K. 2011)
The main aspect of DBT is that of accepting the condition of the patient whilst trying to teach them to change. This is achieved by building and maintaining a positive relationship with the client. The therapy looks towards getting the client to understand the reasons for the suicidal or dysfunctional behaviour. There are essentially four modes of treatment: (i) Individual Therapy – the main body of work (ii) Group Skills – teaching a number of techniques that include emotion moderation skills, inter-personal effectiveness, distress, tolerance etc. (iii) Telephone contact – provision of help line sessions by telephone, outside of the main therapy sessions (iv) Therapist consultation – group sessions in the DBT mode; the therapists work collectively to remain dialectical in the interaction with one another. (Capuzzi, D. 2008)
There is a large literature base covering this area. Much of the work on dialectical behavioural therapy comes from Marsha Lineham who is a clinical psychologist based in Seattle. (Palmer, 2002). The concept of dialectical thinking has been defined as the manner in which the broader thought concept expresses the considered limitations of linear ideas on causation. (Palmer, R.L. 2002).
Counselling and Marriage Problems
Modern society poses numerous challenges upon a successful marriage. One of the most demanding is that of financial hardship. That might be brought on by a job loss or physical illness, leaving one’s spouse to cope with the problem. This is often the situation where marital communications breakdown, when in fact it is the most important time for working as a team and communicating with one another. Another important issue is the loss of self-image, where either weight gain or loss occurs. [The concept of obesity or anorexic] this can lead to bouts of depression and subsequent illness. Another factor is dealing with family relationships, and this is particularly trying in new marriages. The concept of dealing with intervention and demands by in-laws, and having to deal with expectations that posed a strain on the marriage. The concept of long-term illness, disability or major illness can impose a tremendous strain on the spouse who is working and equally having to look after their partner. (Long, H. 2010)
In the last 20 years we have seen a dramatic rise in divorce rates, particularly in the US and Western Europe. Studies have indicated that this decline in marriage is largely due to the general breakdown and weakening of the traditional family structure. It is the maintenance of the family structure that really necessitates the importance of marriage. The children produced from the marriage are the future in terms of perpetuating human society. Strong family values teach the children the ethics and the social responsibilities of adulthood. The love of the parents to the children translates to the personality of the adult. The displacement of this leads to a more random outcome and potentially more uncaring society. Research carried out in the UK indicated that a large majority of those surveyed feel marriage is no longer necessary today. (Papadopoulos, L. 2010)
FAMILY COUNSELLING AND CHRISTIANITY
Family counselling can be provided from a Christian perspective and there are many voluntary services that offer this service. I believe that you don’t necessarily have to be a Christian in order to help others in distress or need but the overarching philosophy of Christianity supports this. The objective of the Christian approach is to bring the sincerity of love and care into the power of healing and a theoretical orientation into listening, understanding and relating to people’s problems. As such faith based counselling is not applied based on winning converts to Christianity but is part of an overall philosophy of the religion that is devoted to the care, well-being and help of mankind. There are for example biblical teachings that help in provision of guidance for dealing with people that have mental issues and family troubles. This is not achieved by the imposition of views on others but understanding client needs and providing a service of focused intervention in order to help them navigate towards a successful outcome.
One of the fundamental approaches to that of Christian counselling is the provision of holistic strategies that equip the families with a basis to understand their relationships, the ability to re-connect and rediscover the love for one another and getting to grips with the root cause analysis of problems in order that they are better equipped to deal with them. Using the strengths-based approach it is helped that such counselling services helps to make a difference and by a joint participatory approach it is possible to heal people from past hurts and retributions in order to expose the family to a renewed and better relationship through the preservation of family relationships.
A break down in family communications are often attributed to many of the marital problems that require intervention and counselling. There are numerous challenges in the integration of Christian principles into family therapy and counselling services. It was Berger and Luckman (1967) that managed to distinguish between two core competencies in family counselling i.e. primary socialisation where the process involves the identification as a member of a social group i.e. where a child still has abstract views of the social world and that of secondary socialisation where a child has already internalized a specific view of the world. In a marital break-down, the children are often the most vulnerable in terms of conceptualising what is taking place in terms of a communications breakdown.
The more modern approach is that of permissive parenting. These types of parents often adopt an indulgent style as such they have very few demands to make of their children because they have low expectations from them in terms of discipline and maturity. The parents become more responsive than demanding. Such approaches are very lenient, flexible and do not require mature behaviour. The style is very much geared towards nurturing the children and becoming more of a trusted friend than that of a parent. In the US this has been termed the ‘buddy approach’. It is seen as being far more effective from a communications viewpoint as the child is more likely to confide in you and seek advice as a friend as opposed to a figure of authority that scares or intimidates. It provides for a healthier more deeply affectionate relationship as the parent is viewed more of a coach / mentor figure that someone who is rule bound and inflexible. This style can make for much happier parenting relationships and provides much better management of the puberty and teenage years.
The downside is that you may not always be taken seriously and in the teenage years the children may become manipulative. This is the question of balance and ensuring that whilst you are a friend you are also the parent and as such have the final decision in terms of the more important decisions that need to be made. This particularly where teenage relationships and wise counselling are concerned e.g. substance abuse, external influences, behavioural considerations etc.