chapter  9
60 Pages

Cognitive-Behavioral Therapies for Couples and Families

WithNorman B. Epstein, Mariana K. Falconier

Behavioral treatments for couple and family problems are based on the assumption that dysfunctional behaviors are learned and can be reduced or replaced with more constructive behaviors through new learning processes. Behavioral approaches for a wide range of human problems had their roots in laboratory research on learning processes in animals and humans. Ivan Pavlov (1932) demonstrated how emotional and behavioral responses could be conditioned so that they would be elicited by a neutral stimulus, by pairing the neutral stimulus with an existing refl exive response. For example, a dog could be conditioned to salivate at the sound of a bell if the bell was rung a number of times as the dog was salivating to the smell and taste of food. John Watson’s publicized case

of “Little Albert,” in which a phobia was established in a child through such classical conditioning (Watson & Raynor, 1920), increased interest in applying learning principles to understand a variety of human clinical disorders. However, it was not until Joseph Wolpe (1958) developed systematic desensitization as a treatment for phobias that therapeutic interventions based on learning principles gained signifi cant credibility as effective treatments. Based on the concept that a phobia is a classically conditioned response to a stimulus that is not dangerous, systematic desensitization involves pairing the anxiety-producing stimulus (e.g., a mouse) with relaxation, assertiveness, or some other response that is incompatible with anxiety. The exposure of the individual to the anxietyprovoking stimulus is done in steps, or a hierarchy, beginning with a mildly distressing aspect of the feared stimulus, such as looking at a caged mouse from across a room, and eventually progressing to holding a mouse. At each step, the individual practices the relaxation or other response that counteracts the anxiety response, and moves to the next higher step in the hierarchy only when he or she has deconditioned the anxiety at the current step. Wolpe’s work advanced the fi eld of behavior therapy and contributed to the development of effective treatments for a variety of clinical problems, such as anxiety disorders and sexual dysfunctions. Nevertheless, the focus of the behavioral assessment and interventions tended to be on the individual, and potential application to interpersonal problems was unclear.