In a 2- to 3-page paper, address the following:
- Summarize the key points of both structural family therapy and strategic family therapy.
- Compare structural family therapy to strategic family therapy, noting the strengths and weaknesses of each.
- Provide an example of a family in your practicum using a structural family map. Note: Be sure to maintain HIPAA regulations.
- Recommend a specific therapy for the family, and justify your choice using the Learning Resources.
The American Journal of Family Therapy, 42:167–174, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0192-6187 print / 1521-0383 online DOI: 10.1080/01926187.2013.794046
The Intersection of Facebook and Structural Family Therapy Volume 1
NINA ANNE MÉNDEZ, MISBHA ENAM QURESHI, RENATA CARNERIO, and FLORINA HORT
Drexel University, Philadelphia, Pennsylvania, USA
Facebook has quickly been made into a household name with more than 700 million users worldwide (Carpenter, 2011). With the pop- ularity of Facebook continuously growing, it is important to analyze the influence of Facebook on relationships. This article examines the intersection of Facebook and family therapy. More specifically, Facebook is viewed through the lens of structural family therapy. Key concepts in structural family therapy are provided along with a case vignette to demonstrate how Facebook can be used as a tool to help heal struggling relationships. Suggestions for future recom- mendations related to treatment and research are discussed.
A TECHNOLOGICAL WORLD
The word “connection” has transformed to a different meaning due to the many technological advances that have occurred over the past few decades. In a world that once communicated through telegrams and standard letter mail, human communication is being completed simply by the click of a button. The culture of communication is focusing less on human-to-human connection and more on human-device-human connections. More and more people are communicating with one another through the use of social net- working sites, cell phones, face-to-face video streaming (i.e., Skype, Ovoo), and e-mail.
In 2010, the Nielsen Company reported that there are over 300 million cell phone users in the United States. In addition, within those 300+ million users, by 2009, 21% of United States households converted to cellphone- only homes, ditching the once popular land line telephone (Nielsen, 2010). Further statistics support the enormous amounts of communication being
Address correspondence to Nina Anne Méndez, 2056 East Arizona Street, Philadelphia, PA 19125. E-mail: email@example.com
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completed through the use of various technologies. The Wireless Association reported in 2009, American’s used 2.3 trillion cell phone use minutes and sent 152.7 trillion text messages (The Wireless Association, 2009). Beyond cell phone use, Skype is keeping over 37.5 million people connected through face to face streaming on the computer (Wolff, 2012).
The unprecedented popularity of social networking sites is prevalent in the world’s most popular internet site, Facebook.com. Facebook has become a household name that is reaching dominance in cultures beyond the United States. Facebook not only transformed the meaning of the word “friend” but due to the alarming growth and consistency of users, Facebook is the sole contributor to the word “unfriend” being added to the Oxford American Dictionary in 2009 (Gross, 2009).
Since the site’s launch in 2004, Facebook.com has expanded to over 700 million users today. In this article, authors will review key concepts in struc- tural family therapy. Using the key concepts of structural family therapy, the authors will compare ways Facebook use and the concepts intersect. The key components and concepts of structural family therapy will be described, fo- cusing on potential impacts Facebook use can bring to therapy. The authors will then provide a clinical case example to help demonstrate ways thera- pists can have an awareness of how Facebook is integrated into relationships today. Lastly, clinical implications, treatment, and future recommendations will be provided.
STRUCTURAL FAMILY THERAPY
In order to evaluate the intersection of Facebook and structural family ther- apy (SFT), one must first review the key concepts associated with the SFT model. Structural family therapy, developed by Salvador Minuchin, became one of the most influential and widely practiced approach to family ther- apy by the 1970s. Structural family therapy offers a framework from which to analyze the process of family interactions, such that it provides a basis for consistent strategies (Nichols & Schwartz, 2006). Based on the model, a functional family is able to cope and adapt to various stressors that main- tains family continuity while being able to restructure itself (Umbarger, 1983). Therefore, dysfunction occurs when the family is unable to cope or adapt to stressors resulting in a lack of growth in its family members or dysfunctional patterns of interaction.
The goal of the therapist using SFT as a model, is to assist the family in changing its structure or its organization; specifically, establishing a structure in which members and its subsystems are clearly differentiated from one another and hierarchically integrated (Navaree, 1998, p. 559; Silver, 1983). In doing so, it is important to grasp a clear understanding of some of the main concepts that are essential to SFT, which include: structure, subsystems,
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boundaries, alignments, and coalitions. There are several more concepts within SFT, however, for the purposes of this paper only these concepts will be discussed. For an in-depth understanding of SFT, we recommend Families and Family therapy by Salvador Minuchin.
As defined by Minuchin (1974, p. 51), “family structure is the invisible set of functional demands that organizes the ways in which family members interact. A family is a system that operates through transactional patterns and these repeated transactions establish patterns of how, when, and with whom to relate, and these patterns underpin the system.” Therefore, family structure refers to the organized patterns in which family members interact and it is reinforced by the expectations that establish rules in the family (Nichols & Schwartz, 2006).
According to Minuchin (1974), subsystems can contain an individual family member, dyad, or more and be formed according to generation, gender, common interests, and role within the family. Within the model of SFT, there are three main identified subsystems in each family system: spousal, parental and sibling. Each family member has his or her own role, skills, and power within each subsystem. It is these relationships between subsystems that help define the structure of the family and helps maintain functionality (Becvar & Becvar, 1995). Additionally, different members of the family hold different positions in each of these subsystems; one member can hold a position in more than one subsystem (i.e., a mother would be part of a spousal and parental subsystem).
Minuchin states that functional families possess well-organized boundaries. Boundaries are defined as rules regulating who participates, how someone participates, and serves to protect the differentiation of a system (Minuchin, 1974). Boundaries are based upon the ideal structure of the family, which should include essential functions, such as support, nurturance, and social- ization of each family member (Navaree, 1998). These functions are usually carried out by different family members within each subsystem (spousal, parental, sibling), therefore, what happens within each subsystem impacts the whole family. There are three different types of boundaries Minuchin
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describes that are rigid, diffuse, and clear. Dysfunction occurs as a result of these boundaries being too weak or overly rigid.
A rigid boundary is exemplified by impermeable barriers between the subsystems. Family members will not or do not share and participate within the subsystems. This results in a disengaged family, where there is great interpersonal distance and little potential for connectedness. On the other hand, a diffuse boundary is easily permeable, blurred, and there is no clear distinction between subsystems. A diffuse boundary results in enmeshment, where there is little interpersonal distance between family members who are over involved and over concerned. Lastly, clear boundaries are firm yet flexible in that there is an allowance of new information between subsystems and the structure does not falter due to stress or struggles (Becvar & Becvar, 1995). Family members are able to grow, be nurtured, and be supported.
Alignments and Coalitions
The other concepts of structural family therapy are alignments and coalitions. As was previously described, boundaries regulate the amount of interactions between the subsystems. On the other hand, alignments are a way in which members can interact; in this case, an alignment is when at least two members of the system create an alliance. Even though an alliance can be neutral, the members can join and oppose another member of the family, which is called a coalition (Umbarger, 1983). There are certain types of alignment that Minuchin (1974) considers triangulation of which are detouring and cross- generational coalition. A cross-generational coalition is when a parent and a child are in a continual union against the other parent. A detouring coalition occurs when members hold a third member responsible for the conflicts or struggles in their coalition (Umbarger, 1983).
Now that the key concepts in SFT have been described, the following case vignette will provide a detailed account of a common way an issue related to Facebook use is presented in a therapy session. An analysis of the case will be provided particularly looking at structure, subsystems, boundaries, and coalitions. For confidentiality purposes, clients’ name and identifiable information were changed to protect privacy.
Beatrice Kiamma was a 15-year-old Japanese-American young girl, who was referred to treatment by the principal of her high school. According to the principal, Beatrice once a good student, was skipping classes frequently and engaging in physical altercation with other students.
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Beatrice lived with her father and younger sister. Her mother had passed five years ago due to a tragic car accident. The family had immigrated to the United States when Beatrice was a baby. The principal, Mrs. Mor- rison, has always felt sorry for Beatrice and treated her as if she was her own daughter. They knew each other since elementary school. Mrs. Morrison could not understand how a sweet girl like Beatrice was acting so strange lately. According to Mr. Kiamma, Beatrice has always been the “good daughter” but, since three months ago everything has changed. Beatrice who was raised to obey her parents was very disrespectful towards her father. She was argumentative, refused to go to church and did not follow the house rules especially when came to terms of giving up her cell phone before bed time. Beatrice was “stealing” her younger sister cell phone to chat with her friends. Her father had monitored her Facebook account, and just found that Beatrice had created a new Facebook account for her “real” friends. According to father, Beatrice started communicating with this “boy” who claimed to be in prison. Her father had forbidden Beatrice to continue the relationship, so Beatrice created a new Facebook account just to be with her “boyfriend.” Beatrice’s father found out about the boyfriend through his youngest daughter, Bianca. According to Bianca, Beatrice was planning to run away with her allegedly boyfriend when he got out of prison. Fearing that her sister was at risk Bianca decided to tell her father what she knew. Mr. Kiamma confronted Beatrice. She was furious with her father and sister and tried to run away. However, Mr. Kiamma caught her trying to escape the house with a backpack. Feeling in a bind Mr. Kiamma, decided to ask the school principal Mrs. Morrison for help. Mrs. Morrison immediately alerted the school’s therapist to see Beatrice right away, as she was at a high risk to flee school. The therapist’s initial reaction was to refrain from discussing the context of what occurred on Facebook. The therapist worked toward removing the discussion of Facebook from therapy because there is much more beneath the relationship of this family that existed before the use of Facebook.
Although the therapist was correct in identifying and sensing that there was an underlying issue within Kiamma family, the approach was problematic. It is correct that there are issues related to the systems, boundaries, and coalitions within this family but rather than attempting to remove Facebook from the discussion, the therapist could utilize it as a tool to gather more information. How the family has organized themselves around Facebook could be used as a way to better understand the way the family system is organized as well.
172 N. A. Méndez et al.
Facebook and Structural Family Therapy
The way in which the Kiamma family is organized can be seen through the apparent rules that were established around Beatrice’s Facebook use and her attempts to defy them. Her father allowed her to use Facebook with the understanding that he is able to monitor her use. The patterns that exist within the family demonstrate an unbalanced hierarchy between father and daughter. The father establishes rules and Beatrice has been defying the rules since the new relationship was introduced to the system. The therapist, rather than attempting to take Facebook out of discussion, should allow the family to engage in an enactment and join them in order to fully understand the dynamic of their relationships.
The father-daughter system is one that would be the main focus of the session. However, it would be important for the therapist to fully understand the relationship between Facebook and the family. The father has been using Facebook as a way to monitor his daughter’s behavior. Additionally, Beatrice has been building intimate relationships through Facebook. Therefore it is safe to say that Facebook is an integral part of understanding the dynamics between the systems and subsystems in the family.
As mentioned previously, boundaries as described through a structural family therapy model can be rigid, diffuse, or clear. In the case vignette the father was attempting to establish clear boundaries through Facebook. However, in looking at the pattern that existed in their relationship, the father-daughter relationship is currently at a rigid stance where little to no information is being exchanged. The daughter is creating her own rules and has been utilizing Facebook as a platform to do so.
Although Facebook is simply a social media website, some may ar- gue that children who engage in behaviors like Beatrice, have aligned with the site and use it as a way to engage in negative behaviors. It could be considered the equivalent to a husband disengaging from his wife and his wife therefore attempting to engage more. With the case vignette, Beatrice is struggling to align with the rules established by her father and changes are being seen through her school work and other rule breaking behaviors. As her father attempts to establish rules in the home, Beatrice rebels more on the site and finds ways to break the rules.
CLINICAL IMPLICATIONS AND TREATMENT
There is much more to learn about Beatrice and her family. The outcome of this case entailed the therapist learning to utilize Facebook as a way to reconnect father and daughter. The therapist worked to help reinforce the father’s rules and establish his role in the hierarchy. However, the therapist ensured to work with Beatrice on understanding what void the gentleman in jail was fulfilling for her.
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Therapeutic change is when the process of helping the family to out- grow its stere-otyped patterns of which the presenting problem is a part (Colapinto, 1982). In looking at this definition, the therapist implemented new patterns the family abided by to help re-establish the father daugh- ter relationship. The father was able to establish his role by implementing stricter rules on the use of Facebook in the house. However, the therapists cleverly encouraged the family to set up father-daughter events, a feature on Facebook, to add structure and consistency of time spent with one an- other. Beatrice and her father responded well to this as they share a common interest for their love of technology.
Creating an intervention in using Facebook was a way that the therapist stopped fighting against the intersection of relationships and technology and used it to help bridge connections within the system. This is one of many examples of how therapists can utilize Facebook to be an asset rather than a deterrent.
Future recommendations start with the acceptance that technology is here to stay and rather than fighting against it, family therapists should accept it and learn to use it to meet therapeutic goals. It important that we accept people for where they are and with Facebook being involved in the lives of over 700 million people world wide, it is quite possible that Facebook is a huge part of day-to-day living and relationships. When clients reach out to therapists with a situation related to Facebook, we must accept this and learn to utilize responses to questions about Facebook use as another tool to get to know our clients more.
The couple and family therapy field should conduct more empirical research to help understand the impact that Facebook and other advances in social media have on human-to-human connections. We must understand its impact through research, in order to potentially use aspects of it for the greater good of therapeutic success and relationships. A child who spends all of their time on Facebook or a cell phone can give the therapists some insight to the type of connections and patterns that exist within a family. Similarly, a mother or father who spends hours on their cell phones or computers can give the therapist some insight as to what occurs in the home related to loving and nurturing relationships within the system.
Regardless of how technology and social media have caused the system to reorganize itself, until research is conducted on the topic, theories on how to use technology and social media in session remain just that, theories. Family therapists should overall accept that technology and social media is here to stay. We must learn it, research it, and rather than fight against its advances, use it for the benefit of our clients.
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Becvar, D. S., & Becvar, R. J. (1995). The structural approach. Family therapy: A systemic integration (3rd ed.). Boston, MA: Allyn & Bacon.
Carpenter, C. J. (2011). Narcissism on Facebook: Self-promotional and anti-social behavior. Personality and Individual Differences, 52, 482–486.
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Gross, D. (2009). Dictionary word of the year: “Unfriend.” Retrieved on April 5, 2012, from http://articles.cnn.com/2009-11-17/tech/unfriend.word_1_unfriend- defriend-facebook?_s=PM:TECH
Navarre, S. E. (1998). Salvador Minuchin’s structural family therapy and its application to multicultural family systems. Issues in Mental Health Nursing, 19, 557–570.
Nichols, M. P., & Schwartz, R. C. (2006). Family therapy: Concepts and methods (7th ed.). Boston, MA: Pearson Education.
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Running head: COGNITIVE BEHAVIORAL THEORY 1
Cognitive Behavioral Theory Versus Rational Emotive Behavioral Theory
Kayla C. Sharpe
COGNITIVE BEHAVIORAL THEORY 2
Cognitive Behavioral Theory Versus Rational Emotive Behavioral Theory
Cognitive Behavioral Theory (CBT) and Rational Emotive Behavioral Theory (REBT)
are two psychotherapeutic techniques that are used in the treatment of mental health disorders.
CBT has been demonstrated to be effective in the treatment of many emotional and behavioral
issues (Wheeler, 2014). CBT is often the treatment of choice for most patients who need internal
resources and enhanced coping skills (Wheeler, 2014). REBT is the original form and one of the
main pillars of CBT, and has served as the basis for the development of CBT (David et al.,
2018). In REBT, irrational beliefs are considered central factors of emotional distress (David et
al., 2018). The focus of REBT is changing irrational beliefs into rational beliefs, with the aim of
changing dysfunctional emotions and maladaptive behaviors into functional and adaptive ones
(David et al., 2018). As a Psychiatric-Mental Health Nurse Practitioner, it is important to
understand the implications of both CBT and REBT in the treatment of psychiatric disorders.
This week’s assignment will focus on the similarities and differences between CBT and REBT,
and explain which therapy I will utilize as a future PMHNP.
Similarities Between Theories
As REBT is one of the main pillars of CBT, there are many similarities between the two
therapies. CBT is a form of psychotherapy that challenges negative patterns of thought about the
self and the outside world, in order to change unwanted behaviors. The basic premise of CBT is
that depression and anxiety are the result of cognitive distortions and these distortions are learned
errors in thinking (Wheeler 2014). The individual’s view of the self and the world is central to
the determination of emotions and behaviors and thus by changing one’s thoughts, emotions and
behaviors can also be changed (Wheeler, 2014). The premise of REBT is that mental illness
COGNITIVE BEHAVIORAL THEORY 3
comes from inappropriate thoughts, and the elements that make up these thoughts are irrational
beliefs (Xu & Liu, 2017). These beliefs are irrational, nonexperimental and non-functional and
do not confirm the realities of people’s lives and cause emotional and behavioral harm (Xu &
Liu, 2017). These therapies focus on changing destructive thought processes that impact daily
lives, and there are many similarities between the two.
CBT and REBT are similar in that they include steps that allow an individual to complete
the cognitive, emotive, and behavioral homework that is assigned after each treatment (Iftene,
Predescu, Stefan, & David, 2015). The best outcomes for both of these therapies is typically seen
when completed with a therapist that specializes in CBT and REBT (Iftene et al., 2015). Both
CBT and REBT teach individuals how they can use their negative patterns of thinking to shape
their future thoughts into more functional and constructive ones (Iftene et al., 2015). These
therapies focus on changing dysfunctional and irrational thoughts so that individuals are able to
break the cycle of emotional disturbance and self-sabotaging behaviors (Iftene et al., 2015).
Differences Between Theories
Along with similarities, there are also differences between CBT and REBT, and how they
should be approached in the treatment of psychological disorders. CBT focuses on altering the
person’s view of themselves, whereas REBT focuses on the beliefs that cause the certain
behavior. For example, REBT distinguishes between rational and irrational beliefs, and suggests
that in response to failure, maltreatment, and misfortune, people can react with either healthy or
unhealthy emotional and behavioral responses (Turner, 2016). This could be helpful in the
treatment of anxiety and depression, as the client could identify how their beliefs influence their
behaviors and therefore their mental health. Another difference between CBT and REBT, is that
COGNITIVE BEHAVIORAL THEORY 4
REBT addresses the philosophical foundation of cognitive distortions, which are the focus of
CBT. REBT places this central idea or philosophy into an ABC framework where the event is
represented by the letter A (activating event or adversity), the beliefs are allocated the letter B,
and finally emotions and behaviors are represented by C (consequences) (Turner, 2016).
Inspired primarily by the Stoic philosophers, REBT holds that it is not the events that
directly cause emotions and behaviors, but one’s beliefs about the events that lead to emotional
and behavioral reactivity (Turner, 2016). REBT looks at the underlying reason for dysfunctional
thoughts, making the individual look deeper into the cause of their behaviors. Unlike with CBT,
REBT proposes a binary model of distress whereby healthy negative emotions (HNEs)
associated with adaptive behaviors stem from rational beliefs, whilst unhealthy negative
emotions (UNEs) associated with maladaptive behaviors stem from irrational beliefs (Turner,
2016). This allows providers to help clients identify rationality from irrational thinking, thereby
addressing cognitive distortions and behaviors.
As a future PMHNP, it is important to understand both CBT and REBT, and what
resources these therapies provide to individuals under your care. As a provider, I hope to utilize
both of these therapies in the clinical setting, as they both serve a purpose in the treatment of
psychological disorders. Dr. Aaron Beck states that therapy should be easily interlocked with
theory so that you can derive from the theory a particular set of therapeutic devices (Beck, 1994).
This means that when using either CBT, REBT, or a combination of both, utilizing the
therapeutic devices taught within the theory will be beneficial to your practice and the therapy
provided to patients. These theories are based on treatment plans that have been conceptualized
COGNITIVE BEHAVIORAL THEORY 5
and tested, and guide the provider through each action, session, and overall plan of care
(Wheeler, 2014). I believe that both CBT and REBT provide a framework that allow individuals
to truly change their negative thought processes, therefore changing their overall wellbeing.
COGNITIVE BEHAVIORAL THEORY 6
Beck, A. (1994). Aaron Beck on cognitive therapy [Video file]. Mill Valley, CA:
David, D., Cotet, C., Matu, S., Mogoase, C., & Stefan, S. (2018). 50 years of rational-emotive
and cognitive-behavioral therapy: A systematic review and meta-analysis. Journal of
Clinical Psychology, 74(3), 304–318.
Iftene, F., Predescu, E., Stefan, S., & David, D. (2015). Rational-emotive and cognitive-behavior
therapy (REBT/CBT) versus pharmacotherapy versus REBT/CBT plus pharmacotherapy
in the treatment of major depressive disorder in youth; A randomized clinical trial.
Psychiatry Research, 225(3), 687–694.
Turner, M. J. (2016). Rational Emotive Behavior Therapy (REBT), Irrational and Rational
Beliefs, and the Mental Health of Athletes. FRONTIERS IN PSYCHOLOGY, 7.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to
guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing
Xu, L., & Liu, H. (2017). Effects of Rational Emotive Behavior Therapy (REBT) Intervention
Program on Mental Health in Female College Students. NEUROQUANTOLOGY, 15(4),