The Assignment:

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. Support your responses with evidence-based literature with at least two references in each colleagues response.

 Response post #: 1

The use, focus, and structure of group versus family cognitive-behavioral therapy (CBT) vary considerably.  Group CBT can be tailored to treat a specific type of diagnosis.  CBT is recommended as the first-line treatment for depression (Thimm, & Antonsen, 2014).  CBT has also been shown to be effective in treating anxiety disorders like panic disorder, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, specific phobia, and post-traumatic stress disorder (Wolgensinger, 2015).  Group CBT is equally as beneficial for clients as individual CBT (Safak, Karadere, Ozdel, Ozcan, Turkcapar, Kurur & Yucens, 2014).  The focus of group CBT is much like individual CBT, learning to identify and modify cognitive errors and behaviors.  The structure of group therapy allows less time for each patient and is not specifically tailored to treat the individual client (Thimm & Antonsen, 2014).  Although not tailored to their individual needs, group therapy can provide peer support, encouragement, an opportunity to build a social network and adopt strategies that can produce therapeutic outcomes (Cruz, Osilla, & Paddock, 2019).    

CBT in family therapy varies considerably from group therapy.  Family therapy generally consists of a smaller group of individuals 3 to 4 typically, whereas group therapy typically consists of 6 to 8 members.  Families seek out therapy to improve it’s functioning, whereas, in group CBT, individuals seek out help.  In family therapy, members of the group have a vested interest in each other, and this interest may also develop in a group CBT setting.  There are protective factors that can make family CBT a more supportive or dysfunctional environment.  CBT recognizes that family members influence and are influenced by each other, especially with family CBT (Nichols & Davis, 2020).  Family interactions are shaped by schemas influenced by the parent’s experiences and by families in general (Nichols & Davis, 2020).  

Interventions focus on identifying cognitive distortions, testing assumptions, identifying family schemas, eliciting acknowledgment of the need to change, implementing changing, and enacting new behaviors (Nichols & Davis, 2020).  The structure of family CBT looks at the family unit but also takes into account all members’ perspectives.  Families can help each other use the skills learned at therapy at home and can sustain their therapeutic gains outside of therapy (Landa, Mueser, Wyka, Shreck, Jespersen, Jacobs, Griffin, van der Gaag, Reyna, Beck, Silbersweig, & Walkup, 2016).  This writer’s clinical site provides ample opportunity for experience in group CBT, but little in the way of family CBT.  Group therapy examples seen in practice include psychoeducation on cognitive distortion, reframing thinking to include more rational thoughts.  Group activities include recording automatic thoughts, rationalizing them, and reframing them.

There is a multitude of challenges that therapists may encounter in the group setting while providing CBT.  A therapist may encounter various levels of concentration and the ability to understand psychoeducation.  Difficulty concentrating is common with both anxiety and depressive disorders.  It is essential to make sure that the material presented is simplified and well organized.  Another example a therapist might encounter is the patient has significant interpersonal problems, which can reduce their ability to be fully present in the moment and may increase the risk that the client will drop out or have poor group attendance.  Helping client meet their basic needs and minimize distractions while in the group will help produce better outcomes,    

Response post #: 2

Cognitive Behavioral Therapy for Family Settings versus Group Settings

According to Wheeler (2014), cognitive behavioral therapy (CBT) is a therapeutic treatment approach which can be applied on an individual, group or family, so it can be applied as a regimen for different mental health disorders. Edwards (2015) propound that some writings still in existence about CBT are not consistent regarding the effectiveness of the treatment approach for individuals or groups. The aim of this writing is to compare CBT for groups and CBT for families, as well as examining the challenges that confronts the counselors applying both approaches with reference to the video.

CBT deals with training a patient who is negative minded to realize the negative thoughts and adopts the power to reframe the mind into adopted positive thoughts and attitude towards the same issue (Lau, 2017). There are multiple ways and principles that can be used for the for the effective application of cognitive behavioral therapy in family or group setting. In a family session, CBT deals with the interconnections of the members; their feelings; apprehension; associations and behaviors. Accordingly, CBT is not directly aimed on the client if  it is in use in a family set-up, but generally focuses on all the members of the family involved since they are also the important aspect towards mediation which will bring about a turnaround in the clients issues.

During a group session, the therapist applying CBT tailors the needs, demand and different thoughts and ideas of the clients individually into the group discussion. The effectiveness of CBT in groups is seen when participants shares their individual way of behaving openly with others in order to achieve a common goal (Nichols, 2014).

Practicum Experience

This group session involves 16 years old and 18 years old male clients who presented at the clinic with diagnosis of ADHD which was diagnosed since childhood, and GAD. Both teenagers display behavioral issues at home and in school. The two teenagers are non-compliant with school regulations with poor academic grades. They also have problems focusing in any work due to easy distractibility, they have poor sleeping patterns and never like attending schools. The application of CBT helped to realize their dysfunctional thoughts of not doing anything right at home and also lack and enthusiasm about their education. The use of CBT approach helped to realize the negative thoughts of these young men that getting a job to make some money is a faster way to succeed so they preferred dropping out of school to pursue life to its fullest. The therapist educated the clients on the importance of completing their education in order to become successful. They were taught to replace their dysfunctional thoughts with positive ideas of becoming successful in life, they were also educated to follow rules and regulations in whatever they do with positive minds as they pursue their dreams. This will enable the young men to drop off their negative thoughts and view self-actualization and build their high self-esteem. The young men were educated on the adaptation of positive thinking skills as they replaced it with their negative thoughts (Wheeler, 2014).

The CBT approach noted in family session involved a young lady who presented with history of anxiety and social phobia which started after he witnessed the fatal shooting that happened in his neighborhood when he was eight years old. The situation did not affect the client but also affects every member of the family directly or indirectly so they brought the client to meet with a therapist. The use of Cognitive behavior therapy in this family treatment implies making sure that all family members replaces their negative thoughts and fears with beliefs that will build their self-esteem. Education on realities of life which will help empower fears and adopt positive thinking in every aspect of life is paramount in this family as they socialize with the world. Additionally, the application of CBT as a therapeutic approach for this family psychotherapy sessions assisted to enhance the client’s issues very well (Nichols, 2014).

Challenges Counselors Might Encounter Using CBT in Group Setting

Counselors encounters multiple challenges as they use CBT in group setting. Lau (2017) noted in his work that a group member who is positive minded amounts to the success of the session since it brings about better collaboration of all participants in the group. Building a session that all the participants are cooperative during the meeting is always a challenge for the counselors. The inability of any or some of the participants to be in attendance can affect the success of the sessions (CTA, 2018). Another notable challenge for the counselor is when members are biased about groups and are unable to share their views with other members because they are secretive about their issues (Yalom & Leszcz, 2005).

Finally, misunderstanding amongst group members could cause a member of the group to stop attending which can lead to a huge difficulty for the client which could make it hard for the clients to achieve their target goals and objective of the group. Moreover, it is hard for an individual to change their behavior if any of the participants refuses to accept that there is an issue with their behavior. Phillip in the video refused to admit his sexual addict in order to bring about a change although he apologized for his wrong doing to the other client involved. Conclusively, the application of CBT in the group when staying away from negativities and embracing positive changes in an individual’s life is quite challenging (Psychotherapy.net (Producer). (2011a)