Respond to at least two of your colleagues by recommending CBT strategies to overcome the challenges your colleagues have identified. Support your recommendations with at least two evidence-based literature and/or your own experiences with clients.

**Include 2 citations and two references for NB

NB

Discussion – Week 5 Main Post

Top of Form

Whether used with individuals or families, the goal of cognitive behavioral therapy (CBT) is to modify client behavior. Although CBT for families is similar to CBT for individuals, there are significant differences in their applications. As I develop treatment plans, it is important to recognize these differences and how they may impact the therapeutic approach with families. For this discussion, I will compare the use of CBT for families and individuals and consider the challenges of applying this therapeutic approach to my own client families.

CBT with Families Versus Individuals

Individual CBT has a broadly defined framework with an emphasis on harm-reduction, especially with clients that have anxiety and substance abuse (Wheeler, 2014). Cognitive-behavioral therapy for families is also brief and is solution-focused. Both are behavioral-based; CBT helps individuals learn to recognize their mistakes in thinking that impacts their behavior, then helps them to make modifications to change that behavior. Family CBT is focused on supporting members to act and think in a more adaptive manner, along with learning, to make better decisions to create a friendlier, calmer family environment (Patterson, 2014). In family therapy, the goals are a little different; family therapy is focused on meeting the needs of the family, whatever those may be. It’s about learning to make productive changes that work to improve the communication and relationships within the family dynamic (De Groot, 2007). Landa et al. (2016) found that family members showed significant improvements in use of CBT skills, enhanced communication with their offspring, and greater confidence in their ability to help. This study also demonstrated the feasibility of teaching family members CBT skills and all participants reported improved family communication (Landa et al., 2016).

An example from practicum is a 37-year-old female that is married and struggling with abuse of prescription narcotic medication. She participates in individual CBT once a week and family CBT once a week. She came to therapy because her husband had told her that she “either needs to get help or they need to get a divorce”. She stated that she only took “a few more pills” when her back pain was “too much for her to handle”. My preceptor and I worked with her using open-ended questions to assist with obtaining cognitive and situational information. She would become angry easily when her husband was with us and it was felt that she was not being truthful about her narcotic usage. When she was in individual therapy it seemed like she was being more honest, while when she was in family therapy her stories would change. When the client was in family therapy and was talking about her drug usage, her husband would often time interject and say things like “you finished your prescription bottle two weeks early”, this would make the client very defensive. The client felt like her drug usage was not the problem in their marriage. One of the core principles in using CBT for substance use disorders (SUDs) is that the substance of abuse serves as a reinforcement of behavior and that over time, the positive and negative reinforcing agents become associated with daily activities (McHugh et al., 2010). CBT tries to decrease these effects by improving the events associated with abstinence or by developing skills to assist with reduction (McHugh et al., 2010). Getting the client to realize that her drug abuse use is a problem, is the primary goal currently. New coping mechanisms and stress-relieving skills are learned and utilized until the addict is functioning on his or her own (McHugh et al., 2010).

Challenges with CBT in a Family Setting

The example that was given from my own practicum experience shows the difficulties that may be encountered with CBT in a family setting. The challenges that I encountered was that the patient was not being honest with us in the therapy sessions, due to her fear of the repercussions she would face at home. Some challenges that counselors face when using CBT in the family setting are wondering if the structure of the session and if the proper techniques were effective (Ringle et al., 2015). Some additional challenges we encountered while using CBT in the family setting included difficulties in restructuring the thinking pattern of the clients at the same time. There are also always issues of privacy and confidentiality that may present a challenge in a group or family setting (Ringle et al, 2015). Overall, using CBT in a family setting, family members reported increased empathy and understanding of their family’s experiences, and greater confidence in their ability to help (Landa et al., 2016).