1 Running head: COGNITVE VS.

FAMILY SYSTEMS

Theoretical Comparison: Cognitive Theory versus Family Systems Theory Jo Friesen University of Calgary

COGNITIVE VS. FAMILY SYSTEMS

Table of Contents

Introduction .....3 Philosophical Elements .3 Therapeutic Focus ....3 The Nature of Change .4 Cause of Dysfunction ...5 Descriptive Elements .6 View of Psychopathology ....6 Conceptual Frameworks ..7 Client Considerations ...9 Prescriptive Elements .11 Therapeutic Goals ..11 The Therapeutic Relationship ..12 The Therapeutic Process ..13 Evaluative Elements ...16 Subjective Evaluation .16 Objective Evaluation ..16 Concluding Remarks ...16 References ...17

COGNITIVE VS. FAMILY SYSTEMS

The goal of counseling is generally related to helping a client to facilitate change in their life. A number of different theoretical perspectives exist which seek to explain what type of change might be necessary, why change may help the client to heal, and how change occurs. However, theories differ in regards to where the locus of control, and the responsibility to

change, is found. In cognitive theory, cognitions play a significant role in dysfunctional reactions, and focus of therapy is on the individual patient (Corsini & Wedding, 2011). Family systems theory, on the other hand, puts relationships at the heart of dysfunction and focuses on facilitating change in the family unit as a whole (Corsini & Wedding, 2011). From these different starting points, there are intriguing similarities in ideas and interventions, as well as significant differences. Both of these perspectives will be explored in this paper through a discussion of the philosophical, descriptive, prescriptive and evaluative elements of each theory. Philosophical Elements Therapeutic Focus While facilitating change in a clients life may be a common goal in cognitive theory and family systems theory, these two approaches differ on where the focus of therapy lies. Cognitive therapy focuses on the individual, with a belief that an individuals cognitive system is responsible for regulating how events are perceived, interpreted and given meaning (Corsini & Wedding, 2011). Dysfunction occurs when these events are misperceived or misinterpreted (Corsini & Wedding, 2011). Cognitive theory gives careful consideration to emotional and behavioral influences and responses, as well as to the individuals interaction with their environment, but focus remains on the individual (Corsini & Wedding, 2011). Attention is given to the individuals personal experiences and perspectives, and therapy centers around helping the individual to make changes (Corey, 2009). Family systems theory focuses on a family framework. In this theory, there is a recognition that each individual has their own set of behavioral responses, but those responses are interconnected to their relationships with other family members in such a way that change only occurs within the family system as a whole

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(Corsini & Wedding, 2011). The interactions between family members are considered reciprocal, and an individual clients dysfunction is believed to be a reflection of the family units dysfunction (Corsini & Wedding, 2011). Family therapy considers the various rule, cultural,

transgenerational and gender perspectives that are a part of the family system, as well as how a society as a whole affects the family (Corsini & Wedding, 2011). Therapy emphasizes changing the clients context, versus changing the client themselves (Corsini & Wedding, 2011). Despite the difference in focus, both cognitive theory and family systems theory shine a wide spotlight on the aspects of an individuals life that contribute to their current circumstances and that need to be considered in order to facilitate change. Both theories agree on the importance of considering the context in which an individual exists, including their living situation, relationships, culture and previous life experiences (Corsini & Wedding, 2011). The Nature of Change Theories of counseling need to consider the nature of change in a client, which is where fundamental differences between theories are often found. In cognitive theory, the focus is on cognitions, with the belief that individuals change through identification and modification of biased, and maladaptive, thought processes (Corsini & Wedding, 2011). In cognitive theory, dysfunction is believed to be rooted in an individuals distorted processing of both external and internal stimuli (Beck, 2005). This distorted processing is due to misinterpretations, misperceptions and other cognitive errors, which are grounded in an individuals life experiences as well as biological, developmental and environmental factors (Beck, 2005; Corsini & Wedding, 2011). A basic assumption is that an individual is able to consciously attend to, analyze, and then modify their cognitive processes, and that there is a reciprocal nature between cognition and behavior (Corsini & Wedding, 2011). In family systems theory, the nature of change is believed to lie in relationships. Similar to cognitive theory, consideration is given to identifying and modifying maladaptive processes, but in family systems theory, the focus is on relationship patterns, rather than cognitions (Corsini & Wedding, 2011). Dysfunction is believed to be rooted

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in the family unit as a whole, with the individual simply reflecting that family dysfunction (Corsini & Wedding, 2011). Change occurs within the social context, and it is the interaction between family members that is analyzed, rather than the thought process behind those interactions (Corsini & Wedding, 2011). Cause of Dysfunction In order to facilitate these changes within a client, attention must be given to the causes of dysfunction. Both cognitive theory and family systems theory agree that the cause of dysfunction is complex, influenced by personal, environmental and relational factors, and grounded in sets of beliefs that are relatively enduring, stable and difficult to modify (Beck, 2005). Both theories assume that different individuals view and react to situations based on their own, personal perspective and that there is a cause and effect relationship involved in any conflict (Corsini & Wedding, 2011). However, the theories diverge in their explanation of this cause and effect relationship. In cognitive theory, the relationship is linear and based within the individuals own cognitive processing system (Corsini & Wedding, 2011). External events activate an individuals information processing system, which cognitive therapists believe is inherently biased (Beck, 2005; (Corsini & Wedding, 2011). This leads individuals to distort their interpretations of these events, and in turn, react in dysfunctional ways (Beck & Beck, 2011). Family systems theory takes a different perspective. While family system therapists agree that there is a cause and effect relationship, they believe that relationship is circular and rooted in the interaction between individuals (Corsini & Wedding, 2011). In this system of circular causality, therapists do not search for the beginning of conflict, but rather acknowledge that conflict is a function of repetitive interaction between individuals (Corsini & Wedding, 2011). These differences in the causes of dysfunction lead to different theoretical explanations and constructs.

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Descriptive Element View of Psychopathology

In order for there to be a need for change, some type of dysfunction or psychopathology needs to exist. A good counseling theory needs to account for how this dysfunction occurs and explain the range human experiences (Magnusson, Henry & McBride, 2006). Both cognitive theory and family systems theory take the viewpoint that dysfunction is best addressed by looking at present circumstances, with the hope that change in the present will also affect future circumstances (Corsini & Wedding, 2011). Despite this focus on the present, both theories also acknowledge the significance of past life experiences and learning opportunities, and believe that lasting change comes through recognizing the patterns of thoughts, feelings and behaviors that are woven into the framework of the past (Bowers, 2001). While family systems theory places a much larger emphasis on the pattern of past relationships, cognitive theory also considers the importance of what an individual learned from significant others in their past (Corsini & Wedding, 2011). Despite these similarities, these two theories diverge when it comes to accounting for how dysfunction develops, and is therefore changed. In cognitive theory, dysfunction is explained as faulty information processing, wherein the individual applies incorrect meaning and interpretations to life events based on their underlying core beliefs and personal schemas (Corsini & Wedding, 2011). Cognitive therapists believe this faulty information processing system is rooted in system of dysfunctional beliefs, which manifests as maladaptive behaviors and emotions (Corsini & Wedding, 2011). Cognitive change leads to behavioral change, which in turn can help to reinforce and validate new belief systems (Corsini & Wedding, 2011). Family systems theory however, believes that individuals develop based on social connections and the source of dysfunction is in found in the context of relationships (Corsini & Wedding, 2011). While people express this dysfunction individually, the dysfunction arises out of maladaptive

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family patterns, and it is these family interactions that need to be modified in order for lasting change to occur (Corsini & Wedding, 2011). Conceptual Frameworks At the heart of each counseling theory lie the conceptual frameworks on which the theory is founded. These frameworks explain the organization and relationship between core

concepts in order to further the understanding and utility of the theory. Both cognitive theory and family systems theory are grounded in well-fashioned frameworks which provide conceptual foundations and highlight mechanisms for change. Despite the difference in focus between the two conceptual frameworks (cognition versus relationship), both frameworks acknowledge that multi-level, multi-faceted processes are at work (Corsini & Wedding, 2011). In both cases therapy initially focuses on the immediate, present level, and lasting change is believed to occur at the deeper levels of processing (Corsini & Wedding, 2011). Cognitive theory is based on the concept of a hierarchical structure of cognition. At the base of this structure are an individuals core beliefs (Beck & Beck, 2011; Corsini & Wedding, 2011). These beliefs are developed through a lifetime of experiences and are often unarticulated (Corsini & Wedding, 2011). They represent what an individual considers to be absolute truths and incorporate ideas about themselves, others and the world around them (Beck & Beck, 2011; Corsini & Wedding, 2011). These beliefs can be dormant, only coming to the surface when external events activate them, or they can operate as a regular part of an individuals information processing (Beck & Beck, 2011; Corsini & Wedding, 2011). From these core beliefs come automatic thoughts, which arise out of an individuals assumptions and attitudes about a situation (Beck & Beck, 2011; Corsini & Wedding, 2011). As the word automatic would suggest, these thoughts happen without deliberation and do not allow time for logical reasoning, which can lead to biased, illogical and maladaptive interpretations of the circumstances (Beck & Beck, 2011). Just as core beliefs vary from individual to individual, so too do automatic thoughts, which can lead to different people interpreting the same event in

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vastly different ways (Corsini & Wedding, 2011). Cognitive theory believes these differences lie at the heart of cognitive specificity, which postulates that different psychological disorders have different cognitive profiles (Corsini & Wedding, 2011). These cognitive profiles represent cognitive vulnerabilities, which are related to personality and cognitive schemas, which work together to predispose an individual to specific types of psychological distress (Corsini & Wedding, 2011). Cognitive schemas can be adaptive or maladaptive, and represent how the individual views the world (Corsini & Wedding, 2011). They are shaped by life experience, memories, learning and future goals and expectations (Beck & Beck, 2011, Corsini & Wedding, 2011). This cognitive framework provides the basis for understanding and facilitating change. In family systems theory, the framework is based on a family system, which is made up

of three subsystems: the spousal subsystem, the parental subsystem and the sibling subsystem (Corsini & Wedding, 2011). The spousal subsystem is considered most important and provides security and lessons regarding commitment (Corsini & Wedding, 2011). The parental subsystem provides child care, guidance, and discipline, while the sibling subsystem teaches negotiation, co-operation, competition and attachment (Corsini & Wedding, 2011). Each family has boundaries, which can range from rigid to diffuse, which distinguish insiders from outsiders, govern the subsystems and allow for the flow of information (Corsini & Wedding, 2011). How these boundaries operate whether they are open or closed have implications for interactions with the outside world, individual and family attitudes, and relational problem solving (Corsini & Wedding, 2011). Similar to cognitive theorys cognitive vulnerabilities, family systems theorists believe that certain combinations of boundaries, family narratives and family paradigms may predispose families to certain types of dysfunctions (Corsini & Wedding, 2011). While they are based on very different frameworks, both cognitive theory and family systems theory believe that two levels of change are ultimately necessary when treating dysfunction (Corsini & Wedding, 2011). In cognitive theory, these two levels are based on the cognitive hierarchy. Automatic thoughts, which are more easily accessed, are addressed and

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modified first, but lasting change only comes from modifying the underlying core belief system

(Corsini & Wedding, 2011). In family systems theory, first-order changes are those that address immediate, practical concerns but do not alter the organization of the system itself (Corsini & Wedding, 2011). Lasting change occurs based on second-order changes, which target the underlying system and makes fundamental changes to the organization and function of that system (Corsini & Wedding, 2011). In both types of therapy, the first level of change is generally targeted in the initially stages of therapy, and the second level follows, and includes a look at patterns of past behaviors, cognitions and reactions (Corsini & Wedding, 2011). Client Considerations In reality, no counseling theory will be effective for all individuals in all situations. However, a good theory seeks to explain a range of possible human experiences and includes consideration of individual factors such as gender, culture and age (Magnusson et al., 2006). Both cognitive and family therapy have demonstrated efficacy for use with individuals, couples and families, and in both outpatient and inpatient settings (Bowers, 2001; Corsini & Wedding, 2011). Both types of therapy require a certain level of cognitive development. Cognitive theory requires individuals to be able to adequately test reality, and have good concentration and memory (Corsini & Wedding, 2011). Family systems theory requires significant cognitive development for family members to be able to focus on problem causes and solutions, but allows that within a family system, different levels of cognitive development may need to be accommodated (Diamond, Liddle, Hogue & Dakof, 1999). Both theories also take into consideration differences in gender, culture, age and ethnicity, and how these factors can influence beliefs and patterns of behavior (Corsini & Wedding, 2011). Since cognitive theory focuses on individual thoughts and perspectives, it naturally allows room for these factors. As the process of identifying dysfunctional beliefs proceeds, it is the patient who makes the decision regarding the utility or dysfunction of specific beliefs, which limits therapist bias (Corsini & Wedding, 2011). In family systems theory, the therapist is trained to consider each individual

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family members position both in the family and in society, and to take into account ethnic values, gender differences and cultural beliefs, while working intentionally not to reinforce stereotypes (Corsini & Wedding, 2011). While both of these theories offer a wide lens from which to view experience, care must still be taken to ensure a goodness of fit between the therapist, the patient and the presenting problem. Both cognitive and family therapy are also often viewed, or used, in combination with other types of therapy, though in slightly different manners. Cognitive therapy is often used in

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conjunction with other therapies, most commonly behavioral therapy (Corsini & Wedding, 2011). It may work alongside another therapy (such as in an inpatient situation where a patient participates in multiple forms of therapy), or be included as part of an eclectic therapeutic process (Corsini & Wedding, 2011). Family therapy is considered an integrated approach, and while the family framework lies at the core of the theory, different theoretical viewpoints have led to eight (current) family therapy approaches: object relations family therapy, experiential family therapy, transgenerational family therapy, structural family therapy, strategic family therapy, cognitive-behavior family therapy, social constructionist family therapy and narrative therapy (Corsini & Wedding, 2011). These approaches vary greatly in their viewpoints, from the psychodynamic view of object relations family therapy, to the organized, rule-governed structural family therapy, to the now familiar cognitive-behavior family therapy (Corsini & Wedding, 2011). Cognitive therapy is primarily used for disorders which involve distorted thinking, including depression, anxiety and eating disorders (Beck & Beck, 2011; Corsini & Wedding, 2011; Weinrach, 1988). There is some concern about its use with for the treatment of psychoses, and is not used as a sole treatment for such disorders (Corsini & Wedding, 2011). Family therapy is used for a variety of problems that are thought to occur as a result of intergenerational conflict or marital discord, but is not recommended in situations where one of the members of the family may be too emotionally disturbed to function in a working, therapeutic

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relationship (Corsini & Wedding, 2011). The exact nature of the disorders addressed is

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dependent on the complementing theoretical viewpoint that is used in the therapy. The nature of the disorders involved also informs the therapeutic practices involved in each theory. Prescriptive Elements Therapeutic Goals A necessary component in any therapeutic process is the clarification and setting of therapeutic goals. Goals provide a focus for the course of therapy, offer a means by which to measure the efficacy of an intervention and are important in signally the end of the therapeutic process (Corsini & Wedding, 2011). In cognitive therapy, goals are centered on identifying and modifying misconceptions in cognition (Beck & Beck, 2011; Corsini & Wedding, 2011). Throughout the course of therapy, the individual is guided to identify their underlying schemas and core beliefs, recognize automatic thinking and assumptions, and examine how these cognitive processes work in response to external stimuli and events (Corsini & Wedding, 2011). Together the therapist and client test hypotheses regarding beliefs, plan behavioral assignments and monitor and examine thoughts, both in therapy and between sessions all with the goal of changing and modifying maladaptive and dysfunctional schemas, assumptions and core beliefs (Corsini & Wedding, 2011). The goals of family therapy are based on changing the dysfunctional or maladaptive patterns used in family interactions. Clients are given support to construct new, alternative views of themselves, to consider new options and possibilities for the future, and to work together to focus on their family interactions. The family therapist works with all family members to assess and define the family subsystems, boundaries and family narrative, while also fleshing out the societal context in which the family operates. However, due to the integrative nature of the family systems theory, specific therapeutic goals will depend on the therapists theoretical viewpoint, and may vary between family members (Corey, 2009; Diamond et al., 1999). In both theories, goals are centered on recognizing dysfunction, and working collaboratively to modify the concepts underlying those dysfunctions (Corsini & Wedding, 2011).

COGNITIVE VS. FAMILY SYSTEMS

The Therapeutic Relationship While the theoretical basis for therapy is an important foundation for any type of therapeutic change, the person of the therapist is considered more influential than either the specific theory or the specific interventions (Corsini & Wedding, 2011). Both cognitive theory and family systems theory require collaborative relationships between the therapist and the client(s), and expect therapists to demonstrate warmth, openness, mutual respect and an

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interest in the each individual persons point of view (Corey, 2009; Corsini & Wedding, 2011). In cognitive therapy, the therapist may take a more active, directive role in the initial stages of therapy as they work towards helping the individual identify and understand their belief system, and how it affects their attitudes and behaviors (Corsini & Wedding, 2011). The cognitive therapist remains flexible, keeping in mind their patients level of comfort, the nature of the targeted systems, and the patients therapeutic process (Corsini & Wedding, 2011). As therapy progresses, the cognitive therapist may allow, or require, the patient to take a more active role in their own therapy, including setting goals, planning homework tasks and summarizing discussions (Corsini & Wedding, 2011). In family therapy, the therapist must take care to form connections and alliances with all members, and to actively work to develop goals and strategies in cooperation with all family members (Corey, 2009; Diamond et al., 1999). When working with adolescents, care is taken to help to build adolescent autonomy, which involves helping the youth to work out their own solutions, to formulate meaningful goals and to develop strategies to reach those goals (Diamond et al., 1999). The family therapist is also careful to ensure that blame for dysfunction does not fall on either individual family members, or the family unit, and ensures that families continue to consider the effect outside forces and systems have on their family unit (Corey, 2009). For the family therapist, the focus of questions is on how, versus other w questions which can lead the family to focus too much on the content of their conflict or distress (Corey, 2009). In both cognitive therapy and family therapy, the therapist pays close attention to their own biases and values, and allows the patient to come to their own

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understanding of which of their beliefs or relationships need modification (Corey, 2009; Corsini & Wedding, 2011). The therapist acts as a teacher of concepts and a guide through the process, but in both cognitive and family therapy, it is the patient who ultimately needs to recognize the need for, and the nature of, any necessary change (Corsini & Wedding, 2011). The Therapeutic Process The therapeutic process represents the steps taken by the therapist to facilitate change with their clients. In both cognitive therapy, and family therapy, the therapeutic process is present-centered and time-limited, with the expectation that successful treatment will allow the individuals involved to move forward with the ability to utilize the skills and strategies learned throughout therapy on their own (Corsini & Wedding, 2011; Weinrach, 1988). Therapeutic goals set the parameters for progress, and therapy works to lessen distress, to minimize dysfunctional symptoms, and to offer new hope for future, healthier reactions and relationships (Corsini & Wedding, 2011). In both types of therapy, initial sessions are focused on the surface, or firstorder changes, while subsequent therapy focuses on deeper levels of, hopefully, longer-lasting change (Corsini & Wedding, 2011). However, a significant difference between cognitive theory and family systems theory is the focus of the therapeutic process. Cognitive therapy focuses on the problem, while family therapy focuses on the relationship (Corsini & Wedding, 2011; Weinrach, 1988). These differences yield different strategies and treatment processes. In a typical cognitive therapy treatment, the process involves three phases. In the first phase, the therapist and client work together to identify, and to prioritize a list of problems (Corsini & Wedding, 2011; Liddle, Dakof, Turner, Henderson & Greenbaum, 2008). This initial stage is also used to build rapport, to gather essential background information and to provide immediate symptom relief (Corsini & Wedding, 2011). The middle phase involves the core of the cognitive therapy, where the client is given the support needed to gain competence and to reduce maladaptive behaviors (Liddle et al., 2008). This is accomplished through the use of a number of strategies, including self-monitoring, communication skills training, homework

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assignments, training regarding the cognitive framework, problem-solving training and support

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to recognize cognitive distortions (Liddle et al., 2008). Highest priority problems are tackled first and the emphasis moves from a behavioral focus to a greater cognitive focus as the client progresses through therapy (Corsini & Wedding, 2011; Liddle et al., 2008). The final phase involves relapse prevention, and the therapist works to ensure that the client has the tools and skills necessary to navigate future situations (Corsini & Wedding, 2011; Liddle et al., 2008). The collaborative process includes working with the client through strategies such as role-rehearsal and problem solving to ensure competence before ending treatment (Liddle et al., 2008). With family systems theory, therapy is not as easily outlined. The therapeutic process is influenced by the therapists theoretical viewpoint, but within each viewpoint, there are recognized frameworks of therapy. One such framework is found in multi-dimensional family therapy (MDTF), which is designed for work with families with adolescents. As expected within the family systems theory, MDTF is focused on relationships. This particular therapeutic process involves working with the family across four relational domains: adolescent, parent, interactional and extrafamilial (Liddle et al., 2008). As a part of the adolescent domain, the therapist focuses on supporting the teen to engage in the therapeutic process and works with them to develop communication, coping, emotional regulation and problem solving skills (Liddle et al., 2008). In the parent domain, the therapist works on engaging the parents and encourages them to increase their involvement with their child, while providing training in parenting skills (Liddle et al., 2008). The therapist also works to recognize and support each parent as an individual, including addressing any functional disorders they are struggling with personally (Liddle et al., 2008). The interactional domain is focused on decreasing family conflict, and improving communication and emotional attachments (Liddle et al., 2008). Finally, the extrafamilial domain works to help the family develop increased competence in coping with, and operating within, the larger societal framework (Liddle et al., 2008). Throughout this process, the therapist meets with family members individually, as a parental unit and as a whole family (Corsini & Wedding, 2011;

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Liddle et al., 2008). As in cognitive therapy, the process moves through different stages as the therapy unfolds, with the initial stage focused on rapport building and goal setting, the middle stage centered on teaching and employing specific therapeutic techniques, and the final stage focused on ensuring the family is ready to move forward, productively, without therapeutic support (Corsini & Wedding, 2011; Liddle et al., 2008). Evaluative Elements Subjective Evaluation Both cognitive theory and family systems theory offer intriguing looks into how to facilitate change within individuals. On the surface, both theories are relatable and operate from a position easily understood by the evaluator. As one reads through the conceptual frameworks each postulates, it is easy to overlay those frameworks into our personal lives, and to envision how change may occur. A discussion of core beliefs, assumptions and schemas can be personalized, and the description of family subsets quickly allows for an evaluation of ones own family unit. As the two theories are laid side-by-side, a comparison reveals underlying similarities and recognizable connections between the two, offer further support to the utility of various components of each theory. Objective Evaluation Regardless of how good a theory sounds, the true test is how well it can be tested and assessed using process such as descriptive studies, experimental designs and validity studies (Magnusson et al., 2006). Both cognitive theory and family systems theory have been the basis of numerous research studies designed to determine the efficacy of the theories as a whole, and in relation to specific interventions for specific disorders (Beck, 2005; Bowers, 2001; Corsini & Wedding, 2011). Cognitive theory is well researched in the areas of depression, anxiety and eating disorders. Studies have shown significant reductions in relapses in eating disorders and depression, and have validated the idea of different cognitive profiles for different disorders (such as anorexia nervosa, obsessional-compulsive disorder and panic disorder) (Beck, 2005;

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Bowers, 2001; Corsini & Wedding, 2011; McGinn, 2000; Schmidt et al., 2007). Since one of the basic assumptions of cognitive theory is that beliefs can be changed by treating them as testable hypothesis, the theory in general lends itself very well to objective evaluation (Corsini & Wedding, 2011). However, another key aspect of cognitive theory is cognitive specificity, so care must be taken to not over-generalize and assume that efficacy of treatment of one disorder implies efficacy of the theory for other disorders. Research into family systems theory has had an interesting reciprocal relationship with the practice of family therapy (Dallos, 2010). Research has arisen out of the evaluation of the practice of therapy, and some of the ideas for practice within family therapy, such as understanding communication processes, have arisen out of research (Dallos, 2010). Due to the integrated nature of this theory, much of the research that is currently conducted is very specific in regards to treatment for various disorders (Dallos, 2010). For example, Schmidt et al., (2007) have demonstrated the efficacy of using family therapy for treating adolescents with anorexia nervosa and bulimia nervosa. This same study found that cognitive therapy works better for treating adults with bulimia nervosa (Schmidt et al., 2007). One challenge in this type of research is to determine if it is the family systems theory that is actually being evaluated, or the accompanying theoretical viewpoint. Therefore, like cognitive theory, it is important that efficacy of treatment is valid for the disorder that is being treated. Concluding Remarks Cognitive theory and family systems theory both offer structured, multi-faceted perspectives from which to view the nature of individuals and the process of change. After a careful comparison of these two theories, one of the most intriguing aspects is the integration of these two theories into cognitive-behavior family therapy. Despite having different theoretical elements interwoven into each of them, it is their similarities that allow these two theories to work together to provide a cohesive system of therapy.

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References Beck, A. T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62, 953-959. Beck, J. & Beck, A. (2011). Cognitive Therapy: Basics and Beyond (2nd ed.) [ebrary Reader version]. New York, NY: Guilford Press. Bowers, W.A. (2001). Basic principles for applying cognitive-behavioral therapy to anorexia nervosa. Eating Disorders, 24 (2), 293-303. doi: 10.1016/S0192-953X(05)7022502 Corsini, R. J. & Wedding, D. (2011). Current psychotherapies (9th ed.). Belmont, CA: Thomson Brooks/Cole. Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thomson Brooks/Cole. Dallos, R. (2010). An introduction to family therapy: Systemic theory and practice (3rd ed.) [ebrary Reader version]. Berkshire, England: Open University Press. Diamond, G.M., Liddle, H.A., Hogue, A., & Dakof, G.A. (1999). Alliance-building interventions with adolescents in family therapy: A process study. Psychotherapy: Theory, Research, Practice, Training, 36(4), 355-368. doi: 10.1037/h0087729 Liddle, H. A., Dakof, G.A., Turner, R.M., Henderson, C.E., & Greenbaum, P.E. (2008). Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103, 1660-1670. doi:10.1111/j.13600443.2008.02274.x . Magnusson, K., Henry, J., & McBride, D. (2006). The nature of theory. [Lecture notes]. Calgary, AB: University of Calgary, CAAP 601. McGinn, L. K. (2000). Cognitive behavioral therapy of depression: theory, treatment, and empirical status. American Journal of Psychotherapy, 54(2), 257-262.

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Schmidt, U., Lee, S., Beecham, J., Perkins, S., Treasure, J., Yi, I., Winn, S., Robinson, P., Murphy, R., Keville, S., Johnson-Sabine, E., Jenkins, M., Frost, S., Dodge, L., Berelowitz,

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M., & Eisler, I. (2007). A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders. American Journal of Psychiatry, 164(4), 591-508. Weinrach, S. G. (1988). Cognitive Therapist: A Dialogue with Aaron Beck. Journal of Counseling & Development, 67(3), 159-164.