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Comprehensive Cognitive-Behavior Therapy with Couples and Families: a Schema Focused Approach

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Comprehensive Cognitive-Behavior Therapy with Couples and Families: a Schema Focused Approach COMPREHENSIVE COGNITIVE-BEHAVIOR THERAPY WITH COUPLES AND FAMILIES: A SCHEMA FOCUSED APPROACH FRANK M. DATTILIO, PH.D., ABPP HARVARD MEDICAL SCHOOL ©2007 Frank M. Dattilio, Ph.D., ABPP COGNITIVE-BEHAVIORAL STRATEGIES WITH COUPLES AND FAMILIES Frank M. Dattilio, Ph.D., ABPP HArvArd MedicAl ScHool Introduction I. Historical Development of Cognitive-Behavior Therapy • Philosophy and theory – an overview II. Application of Cognitive-Behavioral Strategies with Couples and Families • Cognition, affect, and behavior • Combined perspectives within a systems framework • Role of core beliefs and schemas and their multimodal dimensions • Video clips III. Assessment Techniques and Case Conceptualization • Conjoint, individual, and family interviews • Use of surveys, questionnaires, and assessment measures • Development of case conceptualization including negative automatic thoughts • Assessing personality and other disorders • Orient couple or family to the cognitive-behavioral model ©2007 Frank M. Dattilio, Ph.D., ABPP IV. Techniques and Procedures for Couples and Families • Identify automatic thoughts, underlying schemas, maladaptive assumptions, and cognitive distortions • Draw link between emotions and negative automatic thoughts and misperceptions. Use of the Daily Dysfunctional Though Record • Identify negative frame and ingrained beliefs associated with cognitive distortions • Weighing evidence and challenging automatic thoughts and schemas • The use of new evidence in correcting distorted thinking and ingrained schema • Practice alternative (balanced) explanations and behavioral follow through • Reframing through restructuring of thoughts, belief systems, and schemas • Additional techniques: Quid Pro Quo behaviors, communication training, problem-solving strategies, caring days and pleasing behaviors, positive behavior change, agreements, role play, the Pad and Pencil Technique, coaching, time out, homework assignments, and bibliotherapy • Family therapy intervention • Integration with other modalities of treatment • Integration of cognitive-behavioral strategies with other modalities of couple and family therapy V. Videotape or Live Demonstration VI. Questions and Answers/Summary Discussion ©2007 Frank M. Dattilio, Ph.D., ABPP ABOUT THE PRESENTER FrAnk M. DAttilio, PH.D., ABPP, holds a joint faculty position with the Department of Psychiatry at Harvard Medical School and the University of Pennsylvania School of Medicine. He is a clinical psychologist in private practice in Allentown, Pennsylvania. He is a licensed psychologist, listed in the National Register of Health Service Providers in Psychology. Dr. Dattilio is board certified in both clinical psychology and behavioral psychology with the American Board of Professional Psychology and is a clinical member of the American Association of Marriage and Family therapy. He has also been a visiting faculty member at several major universities and medical schools throughout the world. Dr. Dattilio trained in behavior therapy through the Department of Psychiatry at Temple University School of Medicine under the direction of the late Joseph Wolpe, M.D., and received his postdoctoral fellowship through the Center for Cognitive Therapy, University of Pennsylvania School of Medicine under the direction of Aaron T. Beck, M.D. Dr. Dattilio is one of the originators of cognitive-behavior family therapy. He has 220 professional publications, including 15 books. He has also presented extensively throughout the United States, Canada, Africa, Europe, South America, Asia, Australia, New Zealand, Mexico, Cuba, and the West Indies on cognitive-behavior therapy. To date, his works have been translated into 25 languages and are used in 80 countries. Among his many publications, Dr. Dattilio is co-author of the books, Cognitive Therapy with Couples (1990); Panic Disorder: Assessment & Treatment through a Wide Angle Lens (2000); The Family Psychotherapy Treatment Planner (2000); and The Family Therapy Homework Planner (2001); co-editor of Comprehensive Casebook of Cognitive Therapy (1992); Cognitive- Behavioral Strategies in Crisis Intervention (1994) (2nd edition (2000) (3rd edition (2007); Cognitive Therapy with Children and Adolescents: A Casebook for Clinical Practice (1995) (2nd edition, 2003); Comparative Treatments for Couple Dysfunction (2000); and editor of Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives (1998). He has filmed several professional videotapes and audiotapes including the popular series “Five Approaches to Linda” (Lehigh University Media, 1996) and remains on the editorial board of a number of professional journals, nationally as well as internationally. Dr. Dattilio’s areas of expertise are in couple and family problems, forensic psychological evaluations, as well as the treatment of anxiety and depressive disorders. He is the recipient of numerous professional awards for his contribution to the field of psychology and psychotherapy. Dr. Dattilio can be reached at the e-mail address: [email protected] - Website: www.dattilio.com. ©2007 Frank M. Dattilio, Ph.D., ABPP - 1 - I. HISTORICAL DEVELOPMENT OF COTNITIVE-BEHAVIORAL THERAPY WITH COUPLES AND FAMILIES ©2007 FrAnk M. DAttilio, PH.D., ABPP - 2 - POPULARITY OF COGNITIVE-BEHAVIOR THERAPY AAMFT In a recent national survey conducted by the American Association for Marriage and Family Therapy (AAMFT), MFT’s were asked to report “their primary treatment modality in a word or two” (p. 448). Of the 27 different modAlities tHAt were identified, tHe most frequently identified modality was cognitive-behavioral family therapy (Northey, 2002). PsycHotHerApy Networker A survey that was partnered with Columbia University reported that of the 2,281 responders, 1,566 (68.7%) stated that they use CBT (mostly in combination with other methods) (PsychotHerapy Networker, 2007). ©2007 Frank M. Dattilio, Ph.D., ABPP - 3 - - 4 - - 5 - - 6 - COGNITIVE PERSPECTIVE ACCEPTS THE BEHAVIORAL PERSPECTIVE In addition, FOCUS ON: 1) Issues of family of origin assessment 2) Perception and distortions of thinking 3) Automatic Thoughts, core beliefs, and schemas 4) Attributions 5) Expectations 6) Standards 7) Modification and restructuring of thoughts and beliefs ©2007 Frank M. Dattilio, Ph.D., ABPP -7 - - 8 - II. APPLICATON OF COGNTIVE-BEHAVIORAL STRATEGIES WITH COUPLES AND FAMILIES ©2007 Frank M. Dattilio, Ph.D., ABPP - 9 - - 10 - - 11 - - 12 - SCHEMA Definition: Greek Root Word “!XHMA” (Scheen) - “To have” - “To Shape,” To plot or make a detailed plan or outline EARLY SCHEMA THEORY “What disturbs human beings most is not the things themselves, but their conceptions of things.” [Epictetus, M5 (undated)] Stoic Greek Philosopher ©2007 Frank M. Dattilio, Ph.D., ABPP - 13 - DEVELOPMENTAL PSYCHOLOGY • Piaget’s Theory on Accommodation and Assimilation (1950) – schema formation. “Intelligence progresses from a state in which accommodation to the environment is undifferentiated from the assimilation of things to the subject’s ‘schemata’ to a state in which the accommodation of multiple schemata is distinguished from their respective and reciprocal assimilation” (Piaget, 1954) (p. 395). ©2007 Frank M. Dattilio, Ph.D., ABPP - 14 - • Kelly’s Cognitive Constructs (1955) – Cognitive structural constructs. How information is stored and organized and how it structures the processing of information. Viewed man as a scientist. “Man looks at the world through transparent patterns or templates, which he creates and then attempts to fit over the realities of which the world is composed … Let us give the name constructs to these patterns that are tried on for size. There are ways of construing the world” (Kelly, 1955 – pp. 8-9). • Bowlby’s Attachment Theory (1969) – Based on experience with caregivers, children develop internal working models of close relationships. These models may later be used to form an internal working model of adult romantic relationships. ©2007 Frank M. Dattilio, Ph.D., ABPP - 15 - FURTHER ELABORATED DEFINITIONS “A structure for screening, coding and evaluating the stimuli that impinge on the organism. On the basis of the matrix of schemas, the individual is able to orient himself in relation to time and space, and to categorize and interpret experiences in a meaningful way” [Beck, 1967, p. 283]. Schemas play a central role in accounting for repetition in free associations, images, and dreams. ©2007 Frank M. Dattilio, Ph.D., ABPP - 16 - TemplAte for Viewing Ourselves and the World Beck’s Cognitive TriAd SELF WORLD OTHERS ©2007 Frank M. Dattilio, Ph.D., ABPP - 17 - EXPANDED CONCEPTS ON SCHEMA “Organized elements of past reactions and experiences that form a relatively cohesive and persistent body of knowledge capable of guiding subsequent perception and appraisals.” [Segal, 1988, p. 147] “Set of rules held by an individual that guides his or her attention to particular stimuli in the environment and shapes the types of inferences the person makes from unobserved characteristics.” [Arias & Beach, 1987, p. 110] ©2007 Frank M. Dattilio, Ph.D., ABPP - 18 - CENTRAL THEME Most definitions maintain that cognitive schemas represent highly generalized superordinate-level cognition that are resistant to change, and exert a powerful influence over thought, affect, and behavior. ©2007 Frank M. Dattilio, Ph.D., ABPP - 19 - SCHEMA PARAMETERS PHYSIOLOGY COGNITION SCHEMA OF SELF & FAMILY BEHAVIOR EMOTION ©2007 Frank M. Dattilio, Ph.D., ABPP - 20 - FOUR LEVEL THEORY • Early maladaptive schema – Beliefs about oneself and others that develop
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