course material

1. Discussion: Cognitive Behavioral Therapy: Family Settings Versus
Individual Settings
THE JOB IS TO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. WITH 2
COMPLETED REFERENCE IN APA WITH CITATION ABOVE 2013 PER COMMENT. POST
1 Individual vs. Family CBTCognitive behavioral therapy is short-term psychotherapy that
emphasizes the need for attitude change in order to maintain and promote behavior
modification (Nichols, 2014). Cognitive behavior therapy (CBT) has been found to be
effective in a broad range of disorders. CBT can be done as an individual treatment or in a
family setting. 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. 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
(Nichols, 2014). An example from practicum is a male (T.M) that participates in individual
CBT once a week and family CBT once a week. T.M is struggling with alcoholism.He
originally presented for individual CBT because he had been “told by his wife” that he had a
problem with alcohol. He reported that he drank “a few vodka drinks” three times a week
but none for six weeks. Individual CBT therapy is a collaborative process between the
therapist and client that takes schemas and physiology into consideration when deciding
the plan of care (Wheeler, 2014). We worked with him using open-ended questions to assist
with obtaining cognitive and situational information. He would become angry easily and it
was a felt that he was not being truthful about his alcohol use. Each time he was questioned
about it, the story would change. He attended two individual sessions and it was then
recommended he begin family CBT with his significant other (S.M) because “things were not
going well at home.”With family CBT, cognitions, emotions, and behaviors are seen as
having a mutual influence on one another (Nichols, 2014). The first session was stressful, to
say the least. T.M began talking about his alcohol use. S.M interrupted and said, “what about
that one-time last month at the hotel. You were seeing things.” He became defensive, raised
his voice, and said, “I was drugged. It had nothing to do with drinking.” She then looked
down and was tearful. When he left the room to use the bathroom, S.M questioned if he
could be tested for alcohol. This led the therapist to believe that T.M’s last use was not six
weeks ago.T.M’s automatic thoughts were that his alcoholism was not a problem in the
marriage or in life. One of the core principles in using CBT for SUDs is that the substance of

2. abuse serves as a reinforcement of behavior (McHugh et al., 2010). Over time, the positive
and negative reinforcing agents become associated with daily activities. 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).It was noticed that when T.M was alone,
his stories would change. But when his wife was in the room, he would look at her while he
spoke to ensure what he was saying was accurate. The therapist informed the client that it
would be appropriate to continue individual therapy and family CBT once a week with the
recommendation of joining the ready for change group. The CBT model for substance use
states that, when a person is trying to maintain sobriety or reduce substance use, they are
likely to have a relapse (Morin et al., 2017).Ready for change meetings was recommended
because like this week’s media showed, clients may relate to others that are going through
similar situations. Getting T.M to realize that his alcohol use is a problem, is the primary
goal currently. This example was shared because it shows the difficulties that may be
encountered with psychotherapy and that both individual and family may be needed to
ensure that goals are met. 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). Evaluating and consulting with peers may also assist
with meeting client and family goals.ReferencesMcHugh, R. K., Hearon, B. A., & Otto, M. W.
(2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of
North America, 33(3), 511-25. doi:10.1016/j.psc.2010.04.012Morin, J., Harris, M., & Conrod,
P. (2017, October 05). A Review of CBT Treatments for Substance Use Disorders. Oxford
Handbooks Online. Ed. Retrieved
fromhttp://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935291.001.00
01/oxfordhb-9780199935291-e-57.Nichols, M. (2014). The essentials of family therapy
(6th ed.). Boston, MA: Pearson.Patterson, T. (2014). A Cognitive-Behavioral Systems
Approach to Family Therapy. Journal of Family Psychotherapy, 25(2), 132–144. https://doi-
org.ezp.waldenulibrary.org/10.1080/08975353.2014.910023Ringle, V. A., Read, K. L.,
Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas, R. S. (2015). Barriers to and
Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the
Community. Psychiatric services (Washington, D.C.), 66(9), 938-45.
doi:10.1176/appi.ps.201400134Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced
practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY:
Springer.POST 2 Cognitive Behavioral Therapy is one of the most effective psychotherapy
approaches, whether it be used in group, family, or individual treatment. It is important to
understand the purpose of it what its process consists off. It can be used to treat different
mental health conditions, ranging from addiction to more severe illnesses. Its approach is to
work with the patient into strategizing ways to change unhealthy thoughts and behaviors.
Throughout the process, the patient not only learns solving skills, but also to re-evaluate
and learn how to understand other’s perspectives, skill that helps build their
confidence. Some believe group therapy is more effective than individual therapy, as
established by Kellett, Clarke, and Matthews (2007, p. 211). It has been established that CBT
in general can be effective, but based on the Johnson Family Session video, it leads me to
believe that either group/family or individual would be effective depending on the

3. condition that is being treated. It is clear from the video that the girl who had been sexually
assaulted at the fraternity does not believe talking or sharing her experience, even if it is
with other girls who went through the same experience, will help in any way. She still has
some internal issues that need to be addressed individually in order to make progress and
get her to a place where she can participate in group/family therapy with an awareness that
it will help her and purpose to it. Another important aspect of having a client be committed
to the treatment is that research has showed “Poor compliance can adversely affect the
remaining group members who may become worried or insecure” (Söchting, Lau,
Ogrodniczuk, 2018, p. 185). An example during practicum that supports my belief is the
case of a terminally ill patient who had been recommended comfort care through hospice.
She was ready to do so, understood and accepted her prognosis, but her daughters and
husband were in denial. Every time they participated in a family session the patient held
back on her wishes and verbalized whatever their wishes were as if they were her own.
When treated as an individual client, she would express her concerns of not being able to
“disappoint and abandon my family”. She had suffered all her life from anxiety, insecurities,
severe depression, and low self-esteem. Those were issues that should have been addressed
individually before she could fully engage in a family session in a healthy and productive
way, if she would’ve had the time. CBT would have still been the choice of treatment for
individual therapy for this client, as evidenced by Driessen et al. who stated it “is the
psychotherapy method with the best evidence-base in the treatment of depression” (2017,
p. 654). Not being fully engaged in the program, or believing the treatment will not help, or
having other issues that need to be addressed on an individual basis, are all challenges
presented in a family setting when relying on CBT. ReferencesKellett, S., Clarke, S., &
Matthews, L. (2007). Delivering Group Psychoeducational CBT in Primary Care: Comparing
Outcomes with Individual CBT and Individual Psychodynamic-Interpersonal
Psychotherapy. British Journal of Clinical Psychology, 46(2). Söchting, I., Lau, M., &
Ogrodniczuk, J. (2018). Predicting Compliance in Group CBT Using the Group Therapy
Questionnaire. International Journal of Group Psychotherapy, 68(2).Driessen,E., Van, H. L.,
Peen, J., Don, F. J., Twisk, J. W. R., Cuijpers, P., & Dekker, J. J. M. (2017). Cognitive-
Behavioral Versus Psychodynamic Therapy for Major Depression: Secondary
Outcomes of a Randomized Clinical Trial. Journal of Consulting Clinical Psychology,
85)7).