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
•
II.
Application of Cognitive-Behavioral Strategies with Couples and Families
•
•
•
•
III.
Philosophy and theory – an overview
Cognition, affect, and behavior
Combined perspectives within a systems framework
Role of core beliefs and schemas and their multimodal dimensions
Video clips
Assessment Techniques and Case Conceptualization
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•
•
•
•
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
•
•
•
•
•
•
•
•
•
•
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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); CognitiveBehavioral 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
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I. HISTORICAL DEVELOPMENT
OF
COTNITIVE-BEHAVIORAL THERAPY
WITH
COUPLES AND FAMILIES
©2007 Frank M. Dattilio, Ph.D., ABPP
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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
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COGNITIVE PERSPECTIVE
ACCEPTS THE BEHAVIORAL PERSPECTIVE
In addition,
FOCUS ON:
1)
2)
3)
4)
5)
6)
7)
Issues of family of origin assessment
Perception and distortions of thinking
Automatic Thoughts, core beliefs, and schemas
Attributions
Expectations
Standards
Modification and restructuring of thoughts and beliefs
©2007 Frank M. Dattilio, Ph.D., ABPP
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II. APPLICATON OF COGNTIVE-BEHAVIORAL
STRATEGIES WITH COUPLES AND FAMILIES
©2007 Frank M. Dattilio, Ph.D., ABPP
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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
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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
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• 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
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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
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Template for Viewing Ourselves
and the World
Beck’s Cognitive Triad
SELF
WORLD
©2007 Frank M. Dattilio, Ph.D., ABPP
OTHERS
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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
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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
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SCHEMA PARAMETERS
PHYSIOLOGY
COGNITION
SCHEMA OF
SELF &
FAMILY
BEHAVIOR
©2007 Frank M. Dattilio, Ph.D., ABPP
EMOTION
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FOUR LEVEL THEORY
• Early maladaptive schema – Beliefs about oneself and others that develop
early in one’s life that tend to have an enduring negative impact (i.e.,
“You can never rely on anyone but yourself”).
• Schema maintenance used to confirm existing schema – i.e., Abandonment
Schema “My spouse will not be available as a stable source of support
when I need him/her.”
[Individual looks for repeated substantiation of this]
• Schema avoidance – Individuals block thoughts and images that are likely to
trigger the schema either by distraction, or other means, in order to avoid
feeling it.
• Schema overcompensation – fighting a schema by thinking, feeling, behaving,
and relating as though the opposite of the schema were true.
[Young, Klosko, & Weishaar, 2003]
©2007 Frank M. Dattilio, Ph.D., ABPP
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Young’s Schema Theory Draws From:
Psychoanalytic
Theory
Constructivism
CBT
Schema
Theory
Gestalt
Psychology
Attachment
Object Relations
Theory
Young’s theory pertains primarily to psychological disturbance with
individuals [personality disorders].
©2007 Frank M. Dattilio, Ph.D., ABPP
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SELF SCHEMAS
Self-worth &
Self-esteem
Trauma
Security
Comfort
Childhood
Experiences
Rejection &
Abandonment
Attachment
Source: Marcus, H. (1977)
©2007 Frank M. Dattilio, Ph.D., ABPP
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CONSCIOUS VS. SUBCONSCIOUS AWARENESS
PHYSIOLOGY
EMOTIONAL
BEHAVIOR
COGNITIONS
-Gastrointestinal
-Anger
-Withdrawn
-Thoughts
-Cardiovascular
-Sadness
-Aggression
-Beliefs
-Respiratory
-Sorrow
-Passivity
-Neuromuscular
-Depression
-Frustration
©2007 Frank M. Dattilio, Ph.D., ABPP
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SCHEMA DEVELOPMENT
Information and experiences continue to affect
the development of schemas until a “template”
forms for viewing ourselves, others, our world,
and relationships. Sometimes these “templates”
can become rigid and almost fixed and are
difficult to modify.
©2007 Frank M. Dattilio, Ph.D., ABPP
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SCHEMA MAINTENANCE
The tendency to seek and locate information that confirms existing
schemata and fortifies it.
Healthy maintenance
Unhealthy Maintenance
New information is used to
balance out old information and
adjust based on substantiating
evidence – assimilation (i.e., first
impression vs. second
impression).
©2007 Frank M. Dattilio, Ph.D., ABPP
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New information violates old
information due to incongruity.
Instead of assimilation and
adjustment, maintains rigid
stance and rationalizes the need
to remain fixed (i.e., first
impression remains only
impression).
SCHEMAS IN COUPLE AND FAMILY RELATIONSHIPS
Family-ofOrigin
Parent
Relationships
Development of
Self Schema
Family
Relationships
External
Influences
Self and
Spouse
Immediate
Family
©2007 Frank M. Dattilio, Ph.D., ABPP
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Identification and
Internalization of
Parental Thoughts,
Emotions, and
Behaviors
ATTACHMENT STYLES
Securely
- These individuals view themselves as worthy and
others as trustworthy. Comfortable with
both intimacy and autonomy. Research
shows that these people are typically more
satisfied in relationships.
Preoccupied - Maintain negative view of self, but positive view
of others. Become over involved with others
and foster unhealthy relationships – depend
on others for sense of self-worth.
©2007 Frank M. Dattilio, Ph.D., ABPP
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Fearful-Avoidant - Maintains a negative view of both themselves
and others. Fearful of intimacy and
avoid relationships with other people.
Dismissing
- Maintain positive view of themselves, but
have a negative view of others. May
avoid relationships with others. Prefer
being independent. Closeness is not
important to them.
Source: Bartholomew, K. & Horowitz, L. M. (1991).
©2007 Frank M. Dattilio, Ph.D., ABPP
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TYPES OF BROAD RELATIONSHIP BELIEFS WITH COUPLES
Assumptions
Standards
- Beliefs about the nature of close relationships in general,
as well as in specific (self and spouse) (i.e., my spouse
should know how I feel in most situations and stand
up or cover for me if I give him/her the eye.)
- Beliefs about the way relationships should be or the way
partners should behave (i.e., he shouldn’t be going
on vacation alone without his wife – that's just not
right!).
(Epstein & Baucom, 2002)
©2007 Frank M. Dattilio, Ph.D., ABPP
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Long-standing and strongly held assumptions and standards
have an impact on emotions and behaviors and serve to
organize one’s perception of the world.
Conflict
Unrealistic,
Too extreme,
Rigid
Not being met in
the relationship
©2007 Frank M. Dattilio, Ph.D., ABPP
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RELATIONAL SCHEMAS
Defined by Baldwin (1992) as: “Cognitive structures representing
regularities in patterns of interpersonal relatedness. 3 components
Interpersonal Script - Key events that occur in the relationship.
Self Schema
- Attributes and traits that describe oneself.
Partner Schema
- Attributes and traits that describe one’s partner.
Baldwin, M. W. (1992).
©2007 Frank M. Dattilio, Ph.D., ABPP
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RELATIONSHIP STANDARDS
- Boundaries within the relationship – the degree of independence vs.
interdependence that each spouse should maintain.
i.e.:
• Amount of time spent together
• Degree of which thoughts and feelings are
shared
- Power and Control – Acceptable standards within the process
of decision making and compromise.
- Degree of Investment in the Relationship – behaviors that show caring
and affection, commitment, willingness to communicate, etc.
©2007 Frank M. Dattilio, Ph.D., ABPP
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III. ASSESSMENT TECHNIQUES
AND
CASE CONCEPTUALIZATION
©2007 Frank M. Dattilio, Ph.D., ABPP
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ASSESSMENT AND CASE CONCEPTUALIZATION
I
Initial Conjoint Interview
•
•
•
•
•
•
•
•
II
Gather background information
Define presenting problem/conflict areas
Compare and contrast spouses’ individual perception of the problem(s)
Listen for any distortion or ingrained beliefs about themselves and their spouses
Explore previous therapeutic interventions and/or self-help strategies – what has worked and what has failed
Learn their dance and the roles that their schemas play
Early formulation of road map about how the function and where conflict occurs
Distribute and explain the use of questionnaires/inventories and how these will be used to identify thoughts and beliefs
Individual Session with Spouse
•
•
•
•
•
Score inventories and review feedback
Focus in on highlighted areas of automatic thoughts, ingrained beliefs, schemas and maladaptive behavior patterns
Probe for the need for personality testing
Assess the amenability to change
Ascertain collaboration
©2007 Frank M. Dattilio, Ph.D., ABPP
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III Second Conjoint Interview
•
•
•
•
•
•
Provide feedback on conceptualization of the problem
Discuss any roadblocks to change
Review realistic vs. unrealistic expectations
Ascertain collaborative set
Orient couple to the cognitive-behavioral model
Establish an initial plan of action (e.g., communication, addressing rigid belief systems, problem solving, etc.)
Family Interviews
•
•
•
•
Members are all interviewed at the same time
Depending on situation, individual interviews may be held, but are rare
The use of questionnaires and inventories may be used, particularly with older children (age 12 and older) who
are not very verbal
Assess individual and family perceptions and schemas
©2007 Frank M. Dattilio, Ph.D., ABPP
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QUESTIONNAIRES AND INVENTORIES FOR COUPLES
•
Marital Attitude Questionnaire – Revised. Pretzer, Epstein and Fleming, 1991.
•
Dyadic Adjustment Scale (DAS). Spainer, 1976.
•
Marital Happiness Scale (MHS). Azrin, Master, & Jones, 1973.
•
Marital Satisfaction Inventory (MSI). Snyder, 1981.
•
Spouse Observation Checklist (SOC). Weiss, 1973.
•
Areas of Change Questionnaire (ACQ). Weiss, 1970.
•
Marital Communication Inventory. Bienvenu, 1970.
•
Abbreviated Barrett-Lennard Relationship Inventory. Schumm, Bollman, & Jurich,
1981.
•
Primary Communication Inventory. Navran, 1967.
•
Communication Patterns Questionnaire (CPQ). Christensen, 1988.
©2007 Frank M. Dattilio, Ph.D., ABPP
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QUESTIONNAIRES AND INVENTORIES FOR FAMILIES
•
•
•
•
•
•
•
•
•
•
•
•
•
The Adolescent-Family Inventory of Life Events and Change. McCubbin and Thompson,
1991.
The Conflict Tactics Scales (CT). Straus and Gelles, 1990.
The Family Adaptability and Cohesion Evaluation Scale (FACES-III). Olson, Portner, and
Lavee, 1985.
The Family Beliefs Inventory (FBI). Roehling and Robin, 1986.
Family of Origin Scale (FOS). Hovestact, Anderson, Piercey, Cochran, and Fine, 1985.
Family Assessment Device (FAD). Epstein, Baldwin & Bishop, 1983.
The Family Awareness Scale (FAS). Green, Kolevzon and Vosler, 1985.
The Family Coping Inventory (FCI). McCubbin and Thompson, 1991.
The Family Functioning Scale (FFS). Tavitian, Lubiner, Green, Grebstein and Velicer, 1987.
Family Sense of Coherence (FSOC) and Family Adaptation Scales (FAS). Antonovsky and
Sourani, 1988.
Kansas Family Life Satisfaction Scale (KFLS). Schumm, Jurich and Bollman, 1986.
Parent-Child Relationship Survey (PCRS). Fine and Schwebel, 1983.
Self-Report Family Instrument (SFI). Beavers, Hampson and Hughs, 1985.
©2007 Frank M. Dattilio, Ph.D., ABPP
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FAMILY CONSTITUTION1
1.
2.
3.
4.
5.
Standards for interrelationships among family members
- the manner in which behavior and emotion is expressed
- the maintenance of power and control in the family
Standards for the division of labor
- how chores are assigned
- who does what in the household
Standards for dealing with conflict
- what is tolerated and what is not
- how resolution is sought
- how balance is restored
Standards for boundaries and privacy
- how and where the lines are drawn
- who can do what, and when
Standards for individuals outside of the family unit
- procedures to be used with extended family members
- procedures with friends
1Adapted
from Schwebel and Fine (1994).
©2007 Frank M. Dattilio, Ph.D., ABPP
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IV. TECHNIQUES AND PROCEDURES
FOR
COUPLES AND FAMILIES
©2007 Frank M. Dattilio, Ph.D., ABPP
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BEHAVIOR
EMOTION
Automatic
Thought
Cognitive
Distortions
Life Experiences
+
Schemas
Self
Life
Family
Spouse
Marriage
Cognitive Techniques
•
Socratic Questioning
•
Downward Arrow
•
Miracle Question
•
Before/After Framing
•
Imagery Techniques
©2007 Frank M. Dattilio, Ph.D., ABPP
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AUTOMATIC THOUGHTS
Thoughts or Images that occur to the spouse(s) simultaneously and
are usually associated with negative affect.
e.g.: “It’s too late to save our marriage, its over.”
©2007 Frank M. Dattilio, Ph.D., ABPP
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MALADAPTIVE ASSUMPTIONS
A set of rules that a spouse or family member follows to
guide and evaluate their own and other’s behavior.
e.g.: “I should never let anyone get too close to me – it’s
dangerous!”
©2007 Frank M. Dattilio, Ph.D., ABPP
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SCHEMA ASSESSMENT
Identifying: Automatic Thoughts
Maladaptive Assumptions
Cognitive Distortions
Underlying Beliefs and Schemas
Behavior
Emotion
Familyof-Origin
Traumatic
Events
Life Experiences
©2007 Frank M. Dattilio, Ph.D., AB
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Questionnaires/Inventories
Socratic Questioning
Downward Arrow
Miracle Question
Image Technology
Reframing Techniques
COMMON COGNITIVE DISTORTIONS WITH COUPLES AND FAMILIES
Arbitrary Inference. Conclusions are made in the absence of supporting substantiating evidence. For
example, a man whose wife arrives home a half-hour late from work concludes, “She must be having an
affair;” or parents’ whose child comes home late, “he/she must be up to no good.”
Selective Abstractions. Information is taken out of context and certain details are highlighted while other
important information is ignored. For example, a woman whose husband fails to answer her greeting
the first thing in the morning concludes, “He must be angry at me again;” or a child who is in a bad
mood may be perceived by his/her siblings to be ignoring them.
Overgeneralization. An isolated incident or two is allowed to serve as a representation of similar
situations everywhere, related or unrelated. For example, after being turned down for an initial date, a
young man concludes, “All women are alike, I’ll always be rejected;” or a son whose parents deny him
a night out concludes, "They never let me do anything.”
Magnification and Minimization. A case or circumstance is perceived in greater or lesser light than is
appropriate. For example, an angry husband “blows his top” upon discovering that the checkbook is
unreconciled and states to his wife, “We’re financially doomed;” or if a daughter can’t use her parents’
car to attend a dance concludes, “My social life is ruined.”
Personalization. External events are attributed to oneself when insufficient evidence exists to render a
conclusion. For example, a woman finds her husband re-ironing an already pressed shirt and assumes,
“He is dissatisfied with my preparation of his clothing;” or a father whose daughter would rather go
out with her friends than go shopping with him concludes, She doesn’t like my company anymore.”
©2007 Frank M. Dattilio, Ph.D., ABPP
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Dichotomous Thinking. Experiences are codified as either black or white, a complete success or total failure. This is
otherwise known as “polarized thinking.” For example, upon soliciting his wife’s opinion on a paperhanging job
underway in the recreation room, the wife questions the seams, and the husband thinks to himself, “She’s never happy
with anything;” or children of parents who frequently find them at fault state, “We’re damned if we do and damned if
we don’t.”
Labeling and Mislabeling. One’s identity if portrayed on the basis of imperfections and mistakes made in the past, and
these are allowed to define oneself. For example, subsequent to continual mistakes in meal preparation, a spouse or
child states, “I am worthless,” as opposed to recognizing her error as being human.
Tunnel Vision. Sometimes spouses and family members only see what they want to see or what fits their current state of
mind. A gentleman who believes that his wife “does whatever she wants anyway” may accuse her of making a choice
based purely on selfish reasons; or a parent who tells her daughter that she is not up for driving her somewhere may
conclude, “She’s only concerned about herself.”
Biased Explanations. This is almost a suspicious type of thinking that partners develop during times of distress and
automatically assume that their spouse holds a negative alternative motive behind their intent. For example, a woman
states to herself, “He’s acting real ‘lovey-dovey’ because he’ll later probably want me to do something that he knows I
don’t enjoy;” or children who believe that when their parent is being nice to them it is because they want them to do
an extra chore.
Mind Reader. This is the magical gift of being able to know what the other is thinking without the aid of verbal
communication. Spouses and family members end up ascribing unworthy intentions onto each other. For example, a
gentleman thinks to himself, “I know what is going through her mind, she thinks that I am naïve to her ‘motives’.”
Children also may often believe that their parents know what is bothering them without them having to fully express
themselves.
©2007 Frank M. Dattilio, Ph.D., ABPP
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AUTOMATIC THOUGHT
- My partner is incapable of change
MALADAPTIVE ASSUMPTION
- She’s not going to change even though she acts as though she wants to.
- She only cares about herself.
UNDERLYING SCHEMA
- People are basically selfish and remain the way they are – “A leopard never
changes its spots.
COGNITIVE DISTORTION
- All or nothing thinking
- Arbitrary inference
©2007 Frank M. Dattilio, Ph.D., ABPP
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SOCRATIC QUESTIONING
Therapist: John, I see that on the Beliefs About Change Inventory under “Defeatist Beliefs,” you
placed a checkmark next to the statement, “My partner is incapable of change.”
What immediate thoughts come to your mind when you say that statement?
Spouse:
Well, you see, it was a mutual decision for both of us to come here for counseling;
however, I really do not believe that my wife is capable of changing her ways, even
though she may act motivated to do so when in your presence of the presence of others.
Therapist: Then your thought is that while she appears motivated, there is little likelihood that she
will change.
Spouse:
Yes, it’s almost a waste of time.
Therapist: Any other thoughts or beliefs about it?
Spouse:
Yes, I also think that I will be placed in a position of expending a lot of energy
toward making the marriage work, and then the joke will be on me when we still end
up in divorce. So, I view it to some degree as a trap.
Therapist: So, you believe that going ahead in marital therapy will only result in making a fool of
you.
Spouse:
Yes, I do and, therefore, I am reluctant to believe my wife when she says that she wants
to try.
©2007 Frank M. Dattilio, Ph.D., ABPP
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Therapist: What is your belief about change in general?
Spouse:
Well, basically, if you want to know the truth, I truly feel that people basically remain
the way they are and are impervious to change, even though they might state that they
wish to change. I believe in the old adage, “A leopard never changes its spots.”
Therapist: Does that include yourself as well John?
Spouse:
Yea, I guess so. We’re all pretty much set in our ways.
Therapist: I see. Then your underlying belief is that change is futile. Therefore, nothing can
improve your relationship.
©2007 Frank M. Dattilio, Ph.D., ABPP
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DOWNWARD ARROW
“I need to scream because Harry doesn’t always listen to me.”
“If I don’t scream, I’ll never be heard.”
“If I am not heard, I am nobody.”
“If I am nobody, I am helpless.”
“If I am helpless, people will run over me.”
“Harry will run over me and this will give him complete control.”
Ref. Dattilio, F. M. (1993). Cognitive Therapy with Couples and Families. The Family Journal,
1(1), 51-65.
©2007 Frank M. Dattilio, Ph.D., ABPP
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MIRACLE QUESTION
If you went to sleep tonight and by some chance, or by a miracle,
the problem vanished overnight so that upon awakening the next morning,
the problem would be gone.
How would you know that the problem was gone? [deShazer, 1988]
©2007 Frank M. Dattilio, Ph.D., ABPP
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BEFORE
AFTER
JEFF’S VIEW OF MARGE
JEFF’S VIEW OF MARGE
WONDERFUL
CHARMING
CAREFREE
SPONTANEOUS
LIVELY
PLAYFUL
FRIVOLOUS
SUPERFICIAL
IRRESPONSIBLE
IMPULSIVE
EMOTIONAL
AIRHEAD
MARGE’S VIEW OF JEFF
STEADY
RELIABLE
SELF-CONFIDENT
DECISIVE
LOGICAL
INTELLECTUAL
MARGE’S VIEW OF JEFF
RIGID
UNYIELDING
COMPULSIVE
CONTROLLING
OPPRESSIVE
STUFFY
Ref: Beck, A. T. (1988). Love is Never Enough. New York: Harper & Row.
©2007 Frank M. Dattilio, Ph.D., ABPP
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LISTING AUTOMATIC THOUGHTS AND LABELING COGNITIVE DISTORTIONS
Automatic Thought
Cognitive Distortion
“My wife should know when I am grouchy,
I am not always angry with her.”
Mind Reading
“It’s too late to do anything about this
marriage.”
“It’s dead on arrival.”
Magnification
“Things are either on or off with us – it’s an
emotional roller coaster.”
©2007 Frank M. Dattilio, Ph.D., ABPP
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Dichotomous Thinking
DYSFUNCTIONAL THOUGHT RECORD
DIRECTIONS: WHEN YOU NOTICE YOUR MOOD GETTING WORSE, ASK YOURSELF, “WHAT’S GOING THROUGH MY MIND RIGHT NOW?”
AND AS SOON AS POSSIBLE JOT DOWN THE THOUGHT OR MENTAL IMAGE IN THE AUTOMATIC THOUGHT COLUMN.
AUTOMATIC
D
SITUATION
THOUGHTS
A
T
E DESCRIBE:
1. Write automatic
1. Actual event leading to
thought(s) that
T
unpleasant emotion, or
preceded emotion(s).
I
2. Stream of thoughts, day
2. Rate belief in
M
dreams, or recollection,
automatic thought(s)
E
leading to an unpleasant
0 - 100%
emotion, or
3. Distressing physical sensations.
EMOTION(S) DISTORTION
DESCRIBE:
1. Specify sad,
anxious/angry,
etc.
2. Rate degree
of emotion
0 - 100%
1. ALL OR NOTHING THINKING
2. OVERGENERALIZATION
3. MENTAL FILTER
4. DISQUALIFYING THE POSITIVE
5. JUMPING TO CONCLUSIONS
6. MAGNIFICATION OR MINIMIZATION
7. EMOTIONAL REASONING
8. SHOULD STATEMENTS
9. LABELING AND MISLABELING
10. PERSONALIZATION
ALTERNATIVE
RESPONSE
1. Write rational
response to
automatic thought(s).
2. Rate belief in
alternative response
0 - 100%
OUTCOME
1. Re-rate belief
in automatic
thought(s)
0 -100%
2. Specify and rate
subsequent
emotions
0 - 100%
Questions to help formulate the ALTERNATIVE RESPONSE: (1) What is the evidence that the automatic thought is true? Not true? (2) Is
there an alternative explanation? (3) What’s the worst that could happen? Could I live through it? What’s the best that could happen? What’s
the most realistic outcome? (4) What should I do about it? (5) What’s the effect of my believing the automatic thought? What could be the
was in this situation and had this thought,
effect of changing my thinking? (6) If
what would I tell him/her?
(person’s name)
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CASE EXAMPLE
FAMILY PROBLEM
Conflict over mother
History/Family-of-Origin
- Parents Holocaust survivors
- Her mother attempted
suicide and blamed her
(daughter)
FATHER
- History of over controlling
mother, passive, detached
father.
- Resented his own mother
- Formed coalitions with his
own siblings against his
mother to deal with her
overbearingness
MOTHER
Schema - To keep
my family strong
and healthy, I must
remain firm – no
room for softness.
SCHEMA
- We have to stick together
in dealing with Mom.
Downward Arrow
©2007 Frank M. Dattilio, Ph.D., ABPP
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Now daughter, a mother herself,
overreacts
Intolerant and resentful of
weakness in her family
members (dichotomous
thinking)
FAMILY MEMBERS
Automatic Thoughts
- Our mother/my wife is unstable/ill and needs to be
treated gently.
- She is unreasonable and unfair due to her own
upbringing.
- Don’t rock the boat.
SCHEMA
- We must walk on egg shells and placate mother so that
she doesn’t experience an emotional breakdown - we
must be cautious.
- People are like a welded piece of metal, if there is too
much pressure on them, they will crack. This is how
the maternal grandmother cracked.
Behavior
- Avoidance, acquiescing, hide emotions.
Emotion
- Resentment, anger, flatness
JOINT FAMILY
SCHEMA
©2007 Frank M. Dattilio, Ph.D., ABPP
- Don’t discuss emotions – it is a dangerous topic
- Protect each other – don’t rock the boat.
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Beliefs and Schemas Developed From
Family-Of-Origin
Mother
(Behavior)
Is vigilant and intolerant of any
expressions of weakness in self or other
family members.
(Automatic Thought)
“There is no room for weakness in life. I
must be firm. My husband is soft.
Beliefs and Schemas Developed From
Family-Of-Origin
Children’s Reaction
(Behavior)
Children act-out the dissension between
parents, demonize mother. Idolize father.
Polarization occurs.
(Automatic Thought)
“I have to choose sides, either my father or
my mother.”
Father
(Behavior)
Placates mother because he understands
her upbringing, but subtly undermines
her.
(Automatic Thought)
“My wife is unreasonable. I don’t blame
the kids – she’s being too rigid.
(Schema)
(Schema)
(Schema)
As a loving wife and mother, I must
ensure that the family avoids falling prey
to weakness.
You have to be careful what you say and do
with some people – you’ll always be in the
middle.
It’s okay to show some vulnerability in life.
I’ll just play it safe, but pull the children
aside and tell them to ignore mother’s
tirades.
(Action)
(Action)
(Action)
Mother is intolerant of any signs of
weakness and/or passivity and scolds
father for siding with others against her.
Avoid conflict at all costs. Try to keep
everyone happy.
Additional Conflict
©2007 Frank M. Dattilio, Ph.D., ABPP
[Action]
Mother is alienated
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Father plays both sides in order to avoid
conflict.
Family Schema
Analysis and Intervention
Step 1: Uncover and identify shared family schemas and highlight those areas
of conflict and dysfunction that are fueled by the schemas. Schemas can be
uncovered by probing automatic thoughts and using techniques, such as
Downward Arrow, as was done with the mother in this case (Dattilio, 1998a;
Dattilio & Padesky, 1990). Once schemas are identified, verification should be
made by obtaining some measure of agreement from family members.
Step 2: Trace the origin of family schemas and how they have evolved to become
an ingrained mechanism in the family process. This is done by probing into the
parents’ backgrounds and the parenting styles that their parents used during
their upbringing. Similarities and differences should be delineated between
parents’ backgrounds and their individual schemas in order to clarify how
they have contributed to their immediate family schemas.
©2007 Frank M. Dattilio, Ph.D., ABPP
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Step 3: Point out the need for change, indicating how the restructuring of a
schema may facilitate more adaptive functioning and harmonious family
interaction. At this stage, it is essential to point out to the family that
modification of schemas may ease the tension and lower the level of conflict in
the family. For example, one of the areas to address with the mother who
feared weakness was the burden involved in her belief that she has to be
emotionally responsible for anyone else’s ability to withstand stress.
Step 4: Elicit acknowledgment and encourage cooperation from the family as a
whole for the need to change or modify existing dysfunctional schemas. This is
imperative for change to actually occur, and it paves the way for a
collaborative effort between the therapist and the family members. For
family members who have different or incompatible goals for treatment,
finding a common ground between family members becomes a major
objective for the therapist. Using newly gathered information may aid in the
modification of goals.
©2007 Frank M. Dattilio, Ph.D., ABPP
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Step 5: Assess the family’s ability to make changes and plan strategies for
facilitating them. It is important to determine how capable a family is of making
significant changes in their basic beliefs. Potential limiting factors include
limited ability levels and resistance to acquiring effective coping skills. For
example, if a family is functioning on a lower intellectual level, their coping
skills may be less sophisticated and the intervention may need to be more
concrete, and the process may be slower. Also, it is essential to assess the
amount of resistance that exists within the family that can maintain a level of
homeostasis.
Step 6: Implement change. The family’s therapist functions as an instrument to
facilitate change, encouraging family members to consider modified versions of
their basic beliefs. This is done through the use of collaborative experiences
(such as is referred to in Step 5), brainstorming ideas for modifying beliefs, and
weighing the effects that modifications to existing beliefs are likely to have on
family interactions. The key in the change process is identifying how family
members actually will behave differently toward each other if they are living
according to the modified schema.
©2007 Frank M. Dattilio, Ph.D., ABPP
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Step 7: Enacting new behaviors. This involves trying out the changes and
feeling the fit. The use of family exercises and homework assignments is
imperative in enacting permanent change (Dattilio, 2002).
Step 8: Solidifying the changes. This stage involves establishing the changed
schema and associated family behaviors as a permanent pattern in the family
through repeated practice, while family members also remain flexible to
future modifications.
©2007 Frank M. Dattilio, Ph.D., ABPP
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CHALLENGING AND RESTRUCTURING SCHEMAS
MOTHER
FATHER
Challenged Belief
What evidence supports the idea that all
signs of weakness lead to a threat to
one’s welfare? Might this be a
distortion due to my childhood
exposure?
Challenged Belief
It I encourage my wife to express some
negative emotion, would that be so terrible?
What’s the evidence that supports the
notion that she would “fall apart?”
Challenged Belief
Why can’t I just express to my parents
that I don’t want to be placed in the
middle of their arguments? Will they
hate me if I do?
Experiment
Take the risk with myself to see if a
display of negative emotion is
necessarily “deadly.” Allow my-self to
cry on one occasion in front of my
family.
Experiment
Try saying nothing if she experiences
negative emotions, especially to the
children, and keep in mind that it doesn’t
mean that I’m a “bad husband.”
Experiment
Try to express my desire to remain
neutral and that I love them both and
don’t want to have to choose.
Action
Cries briefly during an argument with
husband.
Action
Avoids interfering to protect mother.
Remains neutral.
Result
Wife cries, children support mother in
expressing her emotion.
Result
No serious rejection. Parents don’t hate
me.
Restructured Belief
Nothing terrible happened.
Restructured Belief
I can be myself without always worrying
about negative repercussions.
Result
Family members appear relieved. I
didn’t fall apart.
Restructured Belief
Maybe it’s not so terrible to show some
negative emotion at times. In fact, it felt
kind of good.
©2007 Frank M. Dattilio, Ph.D., ABPP
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CHILD
Action
BEHAVIOR INTERVENTIONS
•
TECHNIQUES
-
Communication training
-
Problem solving strategies
-
Behavioral change agreements
-
Assertiveness training
-
Paradoxical intention
-
Behavioral rehearsal
-
Bibliotherapy
-
Homework
©2007 Frank M. Dattilio, Ph.D., ABPP
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BEHAVIORAL TECHNIQUES
PARADOXICAL TECHNIQUES AND INTENTIONS
PRESCRIBING THE PROBLEM
These techniques are best used when couples of families are legitimately stuck in a
gridlock or are resistant to other therapeutic interventions.
i.e.: Problem: Daughter is acting-out and is attempting to take charge in a single
parent family.
Prescription: Daughter is instructed to exaggerate her taking charge of
mother. Mother is instructed to assume the paradoxical role of the child and
to give up her position of authority and to be a “helpless child.”
©2007 Frank M. Dattilio, Ph.D., ABPP
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QUID PRO QUO CONTRACT
BASED ON SOCIAL EXCHANGE THEORY
ContingencyContracting - Contract in which the behavior of one spouse
is contingent on that of another.
e.g., husband agrees to do the dishes on two evenings in exchange for
the wife taking out the garbage or doing some other task
©2007 Frank M. Dattilio, Ph.D., ABPP
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CARING DAYS AND
PLEASING BEHAVIORS
(LOVE DAYS)
-Developed by Richard Stuart. Each spouse identifies various behaviors that
their partner finds enjoyable and commits him or herself to increasing these
behaviors. Both keep a daily record of their observations.
- Ratio to Reward -
BEHAVIOR CHANGE AGREEMENTS
AND CONTRACTING
ROLE PLAY OR
MODELING
COACHING
- Agreement to engage in shared activities or specific
behavioral change or modifications.
- The use of modeling or role playing may help to show couples or family
members what the behavior change might look like.
-The therapist actually structures the interaction between couples or family members as a
guide to facilitate change. This is often combined with role play (e.g., use of
assertiveness training, etc.).
©2007 Frank M. Dattilio, Ph.D., ABPP
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HOMEWORK
ASSIGNMENTS
BIBLIOTHERAPY
OR VIDEOTHERAPY
TIME OUT
- Usually germaine to the topic discussed during weekly sessions, but may
involve communication, problem solving, behavior change, etc.
- Designed to supplement techniques and theories promoted in treatment;
e.g., “Love is Never Enough” and “Fighting for Your Marriage.”
- Typically implemented with couples or family members who have anger problems or
who are prone to acting-out physically.
Individuals are instructed to “T” for time out and extricate themselves from situation.
Also combined with other cognitive techniques (e.g., thought stopping, deep breathing,
imagery, etc.).
THE PAD AND
PENCIL TECHNIQUE
- Used for helping spouses and family members refrain from
interrupting each other.
©2007 Frank M. Dattilio, Ph.D., ABPP
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COMMUNICATION TRAINING
Techniques used to increase spouses or family members’ skills in:
•
Expressing thoughts and emotions clearly
•
Listening to other’s messages
•
Filtering out the extraneous
•
Sending constructive rather than destructive messages
©2007 Frank M. Dattilio, Ph.D., ABPP
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RULES FOR THE SPEAKER
When speaking to your spouse, try to emphatically identify the needs of the listener so that he or she can understand
your message. The following guidelines are helpful when expressing yourself.
1.
Speak attentively: Just as one listens attentively, one should also speak in the same manner, maintaining
appropriate and direct eye contact and looking for body signals (facial or posture) which indicate that your
partner is listening.
2.
Phrase meaningful questions: One way to keep a conversation short (and unproductive) is to ask a question
that can be answered by either a “yes” or a “no.” Instead, try to ask questions that lead to more of a response
from you partner that will help you understand him or her better.
3.
Don’t over talk: Speak to the point and avoid drawn-out statements that “over tell” a story or reaction. This
will give your spouse a chance to clarify and reflect on what he or she hears from you.
4.
Accept silence: Sometimes one of the best ways to make a point is to pause or use a period of silence after
speaking. This allows you and your listener to digest what is being said.
5.
Don’t cross-examine: Avoid firing questions at your spouse when attempting to learn something during a
conversation. The use of tact and diplomacy express respect and may serve as a far better means of learning
what you need to know.
Adapted from Dattilio, F. M. (1989). A guide to cognitive marital therapy. Innovations in clinical practice: A source book. Professional
Resource Exchange, Sarasota, FL, and Beck, A. T. (1988). Love is never enough. Harper & Row, New York.
©2007 Frank M. Dattilio, Ph.D., ABPP
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RULES FOR THE LISTENER
Many couples listen to each other, but only in the strict behavioral sense. They do not actually
hear what each other is saying. Good listening skills involve a clear understanding of what is being
said. Here the therapist may want to instruct the partners how to listen and hear what is being said by
following several guidelines.
1. Listen attentively: Keep good eye contact with your spouse and acknowledge that you are
hearing him or her.
2.
Don’t interrupt: It’s difficult to hear when you are talking yourself.
3. Clarify what you hear: Sum up or make clear with your spouse your understanding of what is
being said at the end of a statement or phrase. This will aid you in getting the correct message. It is
also important to admit you don’t understand something.
4. Reflect on what you hear: This is different than clarification. Reflection involves showing your
spouse that you are aware or understand what her or she feels. In essence, you hold up a mirror so your
spouse can see what he or she is saying.
5. Summarizing: Both spouses should always attempt to summarize their conversation so that no
loose ends are remaining and both have a clear understanding of what has been discussed. A summary
also allows a couple to set a direction for constructive follow-up.
Adapted from Dattilio, F. M. (1989). A guide to cognitive marital therapy. Innovations in clinical practice: A
source book. Professional Resource Exchange, Sarasota, FL, and Beck, A. T. (1988). Love is never enough. Harper
& Row, New York.
©2007 Frank M. Dattilio, Ph.D., ABPP
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STEPS FOR COUPLES AND FAMILY
PROBLEM SOLVING EXPERIENCES
•
Define the problems in specific behavioral terms – Compare perceptions and arrive at some
agreeable description of the problem.
•
Generate a possible set of solutions.
•
Evaluate the advantages and disadvantages of each solution – then select a feasible solution.
•
Implement the chosen solution and evaluate its effectiveness.
Adapted from Epstein, N. & Schlesinger, S. E. (1994). In A. Freeman & F. M. Dattilio (Eds.)
Cognitive-behavioral therapy in crisis intervention. New York: Guilford.
©2007 Frank M. Dattilio, Ph.D., ABPP
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V. INTEGRATION OF COGNITIVE-BEHAVIORAL
STRATEGIES WITH OTHER
MODALITIES OF COUPLE AND FAMILY THERAPY
©2007 Frank M. Dattilio, Ph.D., ABPP
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STRATEGIC FAMILY THERAPY
•
Similarities
- Utilizes problem solving strategies and collaborative reframing
- Regard family as a system
- Therapist has a direct role in facilitating change
•
Dissimilarities
- Defines terminology with different language
- Explains actions in more indirect terms
•
Level of Integratability – High
©2007 Frank M. Dattilio, Ph.D., ABPP
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CONTEXTUAL APPROACH
•
•
•
Similarities
– Oriented toward behavioral change
– Focus on client’s considering rejunctive alternatives
– Focus of some degree on schemas
– Role of therapist is direct
– Emphasis on legacy or family of origin
Dissimilarities
– More focus on reciprocal efforts at enhancing and understanding emotional acceptance
– More emphasis on the restoration of reciprocal trust rather than a shift in behavioral
interaction pattern
– More focus on “loyalty framing,” “balanced siding” and “holding accountable”
Level of integratability – High
©2007 Frank M. Dattilio, Ph.D., ABPP
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SOLUTION-FOCUSED APPROACH
•
Similarities
– Therapist active role
– Focus on how clients construe their psychological realities
– Assists clients in developing new perspectives
– Here and now orientation
•
Dissimilarities
– Therapist uses a more indirect role of influencing the client to find solutions
– More mutually collaborative
– More future focused
– Less focus on negative affect and assessing deficits in thinking
– More aligned with the Constructivist view
•
Level of Integratability – High
©2007 Frank M. Dattilio, Ph.D., ABPP
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INTEGRATIVE COUPLES THERAPY
IMAGO RELATIONSHIP THERAPY
TRANSGENERATIONAL APPROACH
•
Similarities
– Adhere to a social learning model
– Respect the role of schema in family and relationship dysfunction
•
Dissimilarities
– Role of therapist is more of a coach
– Less technique oriented and more emphasis on the process of therapy
•
Level of Integratability – High
©2007 Frank M. Dattilio, Ph.D., ABPP
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MODERATELY COMPATIBLE
INTERNAL FAMILY SYSTEMS
NARRATIVE SOLUTIONS APPROACH
FEMINIST COUPLE THERAPY
•
•
•
Similarities
– Espouse to a problem centered approach
– Contends that feelings emerge from thoughts and beliefs
– Focus on altering family members internal systems
– Concerned about how pattern of thinking and behavior affect and maintain
relationships
Dissimilarities
– Integration of more psychodynamic principles
– Focus more on elaborate aspects of schemas (e.g.: internal “parts”)
– Utilizes internal resources of the client in a way that facilitates more independence
– More concern over the client’s perception of the therapist’s role as intrusive
Level of Integratability – Moderate
©2007 Frank M. Dattilio, Ph.D., ABPP
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EMOTIONALLY FOCUSED APPROACH
•
Similarities
– Explores all beliefs in the process of exploring specific emotions
– Attempts are made to modify certain beliefs, but in a more indirect manner
•
Dissimilarities
– Much like the structural family therapists, increases the affective component to evoke change
– Do not recognize certain beliefs as distortions, but views them from a perspective of
emotional disengagement
– Do not use homework assignment
– Do not see changing thoughts as sufficient to create lasting change
•
Level of Integratability – Minimal
©2007 Frank M. Dattilio, Ph.D., ABPP
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PSYCHOANALYTIC
•
Similarities
– Both view behavior and cognition as having histories learned largely in past relationships
– Use same prescription of behavior change
•
Dissimilarities
– View unconscious factors as playing an important role in human behavior
– Listen and interpret unconscious wishes in a more open-ended setting
– Look more at deeper layers of the distant past
•
Level of Integratability – Minimal
©2007 Frank M. Dattilio, Ph.D., ABPP
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SOCIAL CONSTRUCTIVE APPROACHS
Similarities
– Uses language as a major means of co-constructing change
– Recognizes the importance of clients to distinguish the importance of their own contribution
in change
•
Dissimilarities
– Places more emphasis on the interpersonal process
– Therapist uses a less directive role in treatment
– Places less emphasis on surface phenomena and more on deeper experiences
•
Level of Integratability – Minimal
©2007 Frank M. Dattilio, Ph.D., ABPP
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SYMBOLIC EXPERIENTIAL APPROACHES
•
Similarities
– Believes that experiences produce change
– Some interest in cognition, with less direct involvement in the restructuring process
•
Dissimilarities
– Takes the therapeutic process beneath the surface of the family’s limited experience into the
realm of myth
– Uses a more non-rational, intuitive style
– Greatest emphasis is placed on observation
•
Level of Integratability – Minimal
©2007 Frank M. Dattilio, Ph.D., ABPP
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BEHAVIORAL
•
Similarities
– Focus on behavioral techniques to shape the course of change
– Follow a structured regime of guiding the client toward behavioral change
– Believes that behavioral changes will lead to a change in emotion
•
Dissimilarities
– Place more emphasis on the power of behavioral change alone to be sufficient
– Believes that delving into thought content and memories will actually slow down therapy
•
Level of Integratability – Minimal
©2007 Frank M. Dattilio, Ph.D., ABPP
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STRUCTURAL FAMILY THERAPY
•
Similarities
– Uses some direct cognitive strategies at times
(e.g.: when enactment’s break down)
– Facilitates awareness to enable people to change
•
Dissimilarities
– Focus of responsibilities for change rests almost entirely on the individuals and families
– Techniques are more tacitly implied
– Therapists serve as a self-reflective instrument toward change
•
Level of Integratability – Low
©2007 Frank M. Dattilio, Ph.D., ABPP
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REFERENCES AND SUGGESTED READINGS
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Psychotherapy, 2(4), 219-236.
Arias, I. & Beach, S.R.H. (1987). The assessment in social cognition in the context of marriage. In K.D.
O’Leary (Ed.), Assessment of marital discord (pp. 109-137). Hillsdale, NJ: Erlbaum.
Baldwin, M. W. (1992). Relational schemas and the processing of social information. Psychological Bulletin,
112, 461-282.
Bartholomew, K. & Horowitz, L. M. (1991). Attachment styles among young adults: A test of the four
category model. Journal of Personality and Social Psychology, 61, 226-244.
Beach, S. R. A., Sandeen, E.E., & O’Leary, K. D. (1990) Depression in marriage. New York: Guilford.
Beck, A. T. (1967). Depression: Clinical, Experimental and Theoretical Aspects. New York: Hoeber.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities
Press.
Beck, A. T. (1988). Love is never enough. New York: Harper & Row.
Beck, A. T., Rush, J. A., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York:
Guilford.
Bevilacqua, L. J. & Dattilio, F. M. (2001). Brief family therapy homework planner. New York: John Wiley &
Sons, Inc.
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Burns, D. (1980). Feeling good: The new mood therapy. New York: William Morrow and Company, Inc.
Bowlby, J. (1969). Attachment and loss: Vol. I attachment. New York: Basic Books.
Dattilio, F. M. (1993a). Cognitive techniques with couples and families. The Family Journal, 1(1), 51-65.
Dattilio, F.M. (1994). Videotape. Cognitive therapy with couples: The initial phase of treatment, (56 minutes).
Sarasota, FL: Professional Resource Press
Dattilio, F. M. (1998) (Ed.). Case studies in couple and family therapy: Systemic and cognitive perspectives.
New York: Guilford.
Dattilio, F. M. (2007). Families in crisis. In F. M. Dattilio and A. Freeman (Eds.) Cognitive-behavioral
strategies in crisis intervention (3rd ed.) p. 327-351. New York: Guilford.
Dattilio, F. M. (2001). Cognitive-behavioral family therapy: Contemporary myths and misconceptions.
Contemporary Family Therapy, 23(1), 3-18.
Dattilio, F. M. (2002). Homework assignments in couple and family therapy. Journal of Clinical Psychology,
58(5), 83-88.
Dattilio, F. M. (2003). Family therapy. In R. E. Leahy (Ed.) (236-252), Overcoming roadblocks in cognitive
therapy. New York: Guilford.
Dattilio, F. M. (2004). Cognitive-behavioral family therapy: A coming-of-age story. In R. E. Leahy (Ed.),
Contemporary cognitive therapy (389-404). New York: Guilford.
Dattilio, F. M. (2005). Restructuring family schemas: A cognitive-behavioral perspective. Journal of Marital
and Family Therapy, 31(1), 15-30.
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Dattilio, F. M. (2005). Cognitive-behavioral couple therapy (pp. 21-33). In G. Gabbard, J. Beck, & J. Holmes
(Eds.), Concise Oxford textbook of psychotherapy. Oxford, UK: Oxford University Press.
Dattilio, F. M. (2005). Clinical perspectives on involving the family in treatment. In J. L. Hudson & R. M.
Rapee (Eds.) Psychopathology and the family (301-321). London: Elsevier.
Dattilio, F. M. (2006). Restructuring schemata from family-of-origin in couple therapy. Journal of Cognitive
Psychotherapy, 20(4), 359-373.
Dattilio, F. M. & Bahadur, M. (2005). Cognitive-behavioral family therapy with East Indian populations.
Contemporary Family Therapy, 27(3), 367-382.
Dattilio, F. M & Bevilacqua, L. J. (2000). Comparative treatments for relationship dysfunction. New York:
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SUGGESTED PATIENT READINGS
Abrams-Spring, J. (1997). After the affair: healing the pain and rebuilding trust when a partner has been
unfaithful. New York: Harper/Collins.
Alberti, R. E. & Emmons, M. (1986). Your perfect right (5th ed.). San Luis Obispo, CA: Impact Publishers.
Beck, A. T. (1988). Love is never enough, New York: Harper & Row.
Gottman, J. (1995). Why marriages succeed or fail. New York: Fireside Books.
Guerney, B.G. Jr. (1977). Relationship enhancement. San Francisco: Jossey-Bass.
Markman, H., Stanley, S., & Blumberg, S. L. (19940. Fighting for your marriage. San Francisco, CA: JosseyBass.
McKay, M., Fanning, P., & Paleg, K. (1994). Couple skills: Making your relationship work. Oakland, CA:
New Harbinger Publications, Inc.
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