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Cognitive-Behavioral Therapy. Family Versus Individual Settings
Cognitive-behavioral therapy (CBT) posits maladaptive behavior and dysfunctional thoughts that relate to self, others, and the
world that are rooted in illogical or irrational assumptions. This individual view of the world, self, and others are central to the
determination of emotions, thoughts, and behaviors and by changing these, behavior can also be changed.  (Wheeler, 2014).
According to Patterson (2014), family therapy is usually focused on behavioral outcomes which when it comes to cognitive-
behavioral therapy (CBT), the term behavior tends to be the primary focus. Wheeler (2014) states that CBT can also be further broken
down into primary and secondary thinking which is a structured hierarchy. Cognitive processes are understood as
primary secondary with primary thinking recognizing negative, intermittent, and irrational thinking as an ongoing human action.
Secondary thinking views the cultural and social world in a more positive, rational, and determinant term.
Therapeutic alliance has been identified as one of the most important factors in individual therapy of any kind (Nichols and Davis,
2020) It is, however, more difficult to establish a therapeutic alliance in family or group therapy due to a number of different reasons
such as an increased number of participants with individual thoughts and feelings.  Assessment is a pivotal part of CBT and
the advantages of a behavioral emphasis are that it can provide definitive goals, baseline data, and a reliable way to measure
therapeutic success. Certain disadvantages are that by using a structured environment in family therapy, the active family interactions
can not be viewed. All that is seen is individual patient reports (Nichols and Davis, 2020).
A study by Thimm and Antonsen (2014) examined the effectiveness of group CBT for depression in a routine outpatient setting,
looking also at predictors of dropout and response. Results suggested a large reduction in anxiety and depression among
participants who received CBT with these observed results maintained at a three-month follow-up. CBT is a very effective therapy with
individual clients but can prove to be challenging in group and family settings.  The video of the Johnson Family Session (2013c)
is an example of a group of women who had experienced similar trauma but had very different thoughts and feelings about
the experience.  The therapist may find the establishment of a trusting therapeutic alliance somewhat difficult in this situation.
References
Laureate Education (Producer). (2013c). Johnson family session 3. (Video file). Baltimore, MD: Author
Nichols, M. & Davis, S. d. (2020). The essentials of family therapy. (7th ed.). Boston, MA: Pearson
Patterson, T. (2014). A cognitive-behavioral systems approach to family therapy. Journal of Family Psychotherapy, 25(2)
132-144. doi.10.1080/08975353.2014.910023
Thimm. J. C. 7 Antonsen, L. (2014). Effectiveness of cognitive-behavioral therapy for depression in routine practice.
 BMC Psychiatry, 14, 292. https?doi.org/10.1188/312888-014-0292-x
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based 
 practice. New York, NY: Springer

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