Week 5 Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Week 5 Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Assignment: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.

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Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

Review the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings.

By Day 3

Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check. Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

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

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

ROSE

Week 5 Discussion Board

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) evolved in 1960 and was initially developed by Aaron Beck as a psychosocial treatment to help individuals suffering from depression and cognitive distortions (Chand et al., 2023). Widely used nowadays, CBT has been proven effective in the management of psychiatric disorders and was also successfully incorporated in the treatment of some non-psychiatric disorders, such as irritable bowel syndrome, fibromyalgia, and migraines, to name a few (Chand et al., 2023). CBT can be administered individually or in conjunction with psychopharmacology. It helps families, groups, and individuals to reflect on their thoughts, the interpretation of these thoughts, and strategies to modify their patterns of thoughts and behavior to produce changes in the patient’s mood and ways of living. This discussion will focus on how cognitive behavioral group therapy differs from cognitive behavioral family therapy.

CBT in Group (CBGT) Versus Family (CBFT)

CBT started to be administered in group therapy in order to provide cost and time-efficient evidence-based therapies to a group of individuals sharing similar challenges while still meeting the standard of classic CBT. CBGT is provided to a large group of individuals at the same time, often by one therapist, and aims to provide support to each member while creating interpersonal relationships within the group (Pawluk & McCabe, 2021). The dynamic in CBGT promotes increased self-awareness among each individual and boosts individuals’ motivations, often leading to permanent changes in behaviors and thoughts. During CBGT, the therapist ensures that healthy relationships are formed between the group members, between himself/herself and the group as a whole, and sometimes between himself/herself and individual group members. CBGT sometimes results in multiple relationships that can last even after the therapy is over.

CBFT was developed from CBT and is based on the principle that the behavior of one family member is the leading cause of certain behaviors, cognitions, and emotions within the other family members (Lan & Sher, 2018). CBFT sees thoughts and behaviors as the root cause of family dysfunction, whereas attitude changes encourage behavior change. It is provided to families to help them assess and modify behavior patterns or distorted cognition (Lan & Sher, 2018).

While CBGT and CBFT both emphasize behavior change, the CBGT therapist focuses on the group as a whole and does not need to provide special attention to any specific member. In contrast, the CBFT therapist needs to understand the family dynamics in different situations, the strengths and characteristics of each family member, and how their interaction impacts their dynamics. They must constantly reassess the behavioral and cognitive patterns within and between family members. Unlike with CBGT, where the group members often go their separate ways at the end of the therapy, the goal of CBFT is to fix and strengthen the family bond through behavior modification in order to keep the family members together and stronger outside the therapy.

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Challenges of the PMHNPs in Family Therapy

Norman Cotterell (Beck Institute for CBT, 2018), Clinical Coordinator, identified a few challenges while providing CBT during marital therapy. The first challenge he highlighted is that the therapist has two different perspectives to work with in couples therapy. Often, these perspectives are divergent, and as a therapist, his role is to help both parties reflect on their perceptions and behavior and come up with a common ground without him picking a side. Another challenge in couples therapy is that the therapist can only focus on what people have control over, which is usually how they behave and how they interpret their spouse or partner’s behavior. He explained that with couples therapy for example, one person might interpret their partner’s loud tone as aggressive, while it was a possibly wrong expression of their vulnerability. In this case, again, the therapist cannot pick size and has to help both partners reflect on their behavior and change their routine patterns.

CBT’s principle remains the same and focuses on recognizing behavioral patterns and cognitive distortion to bring about permanent behavior modification, whether provided for groups, families, or individuals.

Each of the sources used for this discussion post is a scholarly and evidence-based source published in psychiatric journals, written or reviewed by psychiatrist professionals, and recently published.

References

Beck Institute for Cognitive Behavior Therapy (2018). CBT. YouTube. https://www.youtube.com/watch?v=JZH196rOGsc

Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2023). Cognitive Behavior Therapy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK470241/

Links to an external site.

Lan, J. & Sher, T. G. (2018). Cognitive-Behavioral Family Therapy (pp. 1-9). In: Lebow, J., Chambers, A., Breunlin, D. (eds) Encyclopedia of Couple and Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-15877-8_40-1

Pawluk, E. J., & McCabe, R. E. (2021). Cognitive behavioral group therapy. In A. Wenzel (Ed.), Handbook of cognitive behavioral therapy: Applications (pp. 479–511). American Psychological Association. https://doi.org/10.1037/0000219-015

MATTHEW

Cognitive Behavioral Therapy (CBT) is a widely used psychotherapeutic approach that focuses on identifying and modifying dysfunctional thoughts, emotions, and behaviors (Gautam et al., 2020). CBT can be effective in various settings, including individual, group, and family therapy, but each setting has its own unique challenges and considerations for Psychiatric Mental Health Nurse Practitioners (PMHNPs). CBT in individual settings involves one therapist dealing with one client at a time. It allows the therapists to tailor the CBT techniques to the unique needs and goals of the clients, allowing for a personalized approach and deep exploration of the client’s dysfunctional thought patterns, emotions, and behaviors (Gautam et al., 2020). It also allows the therapists to solely focus on the client, which is essential in developing a strong therapeutic relationship with the client. On the other hand, CBT in family settings involves one or more therapists offering psychotherapy interventions to two or more clients who are family members at a go to improve communication, understand, handle, and solve family issues (e.g. marital issues, parent-child conflict, sibling rivals, etc.), and establish a more functional family (Varghese et al., 2020). This allows the members to offer each other support and feedback, encourages learning, and validation, reduces feelings of isolation and stigma, and creates a sense of belonging, and support (Rosendahl et al., 2021). It also helps the family members to understand each other’s perspectives and how their behaviors influence one another.

The key challenges in family CBT are complex dynamics, confidentiality concerns, and focusing on one or some clients. In family CBT, the PMHNP must navigate complex family dynamics, including each other’s perspectives, communication patterns, power struggles, and intergenerational conflicts, which can complicate the CBT implementation and progress (Varghese et al., 2020). In one of the week’s media, the Beck Institute for Cognitive Behavior Therapy (2018, June 7), dealing with the different perspectives of each member is mentioned as a key challenge couple CBT. Maintaining confidentiality when dealing with more than one client, even when they are families is challenging, particularly when discussing sensitive topics (Rosendahl et al., 2021). The PMHNP must develop clear guidelines for confidentiality and ensure that each family member understands the importance of maintaining confidentiality through education and training (Brown & Lefforge, 2023). According to Varghese et al. (2020), focusing on one client, especially the index one is a common challenge that PMHNPs face in family CBT. Most families present with the belief that the index client is the key cause of their problem which may push the therapist to focus on him or her and not include or involve all the members in the sessions. This can leave many issues unresolved especially if the family’s beliefs are untrue and the problem is complex. The strategy to address this is to inform the patient from the beginning of the session that the problem may lie with the family and not necessarily with any one member. The PMHNP should also advise and encourage all the members to attend and actively engage in the therapy sessions (Varghese et al., 2020).

References

Beck Institute for Cognitive Behavior Therapy. (2018, June 7). CBT for couples. YouTube. https://www.youtube.com/watch?v=JZH196rOGsc

Links to an external site.

Brown, N. W., & Lefforge, N. L. (2023). Education and training guidelines for group psychology and group psychotherapy. Training and Education in Professional Psychology, 17(2), 126–132. https://doi.org/10.1037/tep0000417

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive behavioral therapy for depression. Indian Journal of Psychiatry, 62(Suppl 2), S223. doi: 10.4103/psychiatry.IndianJPsychiatry_772_19

Rosendahl, J., Alldredge, C. T., Burlingame, G. M., & Strauss, B. (2021). Recent developments in group psychotherapy research. American Journal of Psychotherapy, 74(2), 52-59. https://doi.org/10.1176/appi.psychotherapy.20200031

Links to an external site.

Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian journal of psychiatry, 62(Suppl 2), S192-S200. doi: 10.4103/psychiatry.IndianJPsychiatry_770_19