認知療法/認知行動療法セミナー  セミナー/研修/ワークショップ
ノーマン・B・エプスタイン博士の認知行動療法ワークショップ
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2011年セミナー
特別プログラム
エプスタイン博士のワークショップ
パデスキー博士のワークショップ
申し込み方法
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Workshop:
Enhanced Cognitive-Behavioral Therapy for Couples and Families


 Norman B. Epstein, Ph.D.


BRIEF BIOGRAPHY WORKSHOP DESCRIPTION Workshop Schedule
How to apply japanese

Day 1 Workshop Description


The Day 1 session will begin with an overview of the concepts of the enhanced cognitive-behavioral model of couple and family functioning developed by Dr. Epstein and his colleagues, involving (1) characteristics of the individual members of the relationship that influence the couple’s functioning, (2) constructive and problematic patterns of couple or family interaction, and (3) aspects of the couple’s or family’s social and physical environment that influence the quality of these close relationships. Next, behavioral, affective and cognitive factors involved in couple and family functioning will be described. Then, Dr. Epstein will focus on describing and demonstrating the typical sequence of clinical assessment and intervention methods used in cognitive-behavioral couple and family therapy, with an emphasis on couple therapy. Aspects of the therapist’s role in a CBT approach (e.g., degrees to which the therapist is active, directive, collaborative, self-disclosing, and supportive) will be described. Dr. Epstein will begin by discussing and demonstrating strategies for overcoming common roadblocks to engaging clients in joint therapy, as well as procedures for collaborating with the couple or family in setting therapy goals.  Forming therapeutic alliances with both members of a distressed couple often is complicated because the two partners have different goals and views of their problems. Dr. Epstein will discuss and demonstrate ways of reducing individuals’ concerns about participating in couple therapy and addressing twp partners’ agendas simultaneously. He also will describe decision-making concerning clinical issues such as when and how to refer one individual for concurrent individual therapy and how one should handle secrets that a member of a couple may want to reveal to the therapist.

Next, Dr. Epstein will describe assessment methods in detail involving interviews with the couple and individual partners, questionnaires, and behavioral observation of couple interactions. Outlines for the clinical assessment interviews with the couple and each partner will be presented, and Dr. Epstein will demonstrate interviewing regarding the history of the couple’s relationship and the personal histories of the two partners, as well as interviewing regarding the current functioning of the couple and individual partners. Methods for directly observing the process of the couple’s behavioral interaction patterns will be described. Next, Dr. Epstein will describe several questionnaires that can be helpful for assessing partners’ relationship cognitions, life stressors that affect the couple, and other aspects of the couple’s relationship functioning. Finally, Dr. Epstein will describe how to integrate the information collected during the assessment and use it in collaborating with the couple to set appropriate treatment goals. The use of continuous assessment and periodic evaluation with the couple regarding degree of progress toward achieving their therapy goals also will be described.

The next portion of the workshop will focus on specific types of interventions for modifying a couple’s problematic behavior, cognitions, and deficits or excesses in emotional responses. First, these types of interventions will be described, and then Dr. Epstein will explain and demonstrate how they are used to address a variety of specific presenting problems, through modeling and presentation of video examples. In a CBT approach, the therapist commonly integrates interventions to modify partners’ cognitions, emotional responses, and behavior, so Dr. Epstein will demonstrate how the therapist decides how to sequence interventions within sessions and from one session to the next.


Workshop Day 1 Objectives

Participants will be familiar with a cognitive-behavioral model that addresses characteristics of individual partners or family members, dyadic patterns between partners, and aspects of the environment that influence the couple or family.

Participants will be familiar with cognitive, affective, and behavioral aspects of couple and family relationship functioning within a cognitive-behavioral model.

Participants will know the characteristics of the therapist’s role within cognitive-behavioral couple and family therapy.

Participants will know strategies for overcoming common barriers to engaging couples and families in joint therapy.

Participants will be familiar with interview, questionnaire, and behavioral observation methods for assessing distressed couples.

Participants will be familiar with CBT intervention methods for modifying couples’ and families’ problematic cognitions, affective responses, and behavioral interactions.

Participants will gain knowledge of ways in which CBT interventions can be integrated with other theoretical approaches to couple and family therapy.


Workshop Day 1 Schedule
Morning:
Why Couple and Family Therapy Is So Important

A Contextual Approach to Understanding and Treating Couples and Families:  The Characteristics of Individuals (e.g., personality traits, psychopathology), the Dyad or Family (e.g., mutual avoidance, escalation of aggressive behavior, boundary issues), and Their Physical and Interpersonal Environment (e.g., children, extended family, job, national economic problems)

Behavioral Factors in Couple and Family Functioning

  • Micro (moment-to-moment) interactions vs. macro-level patterns
  • Primary versus secondary distress
  • Communication behavior
  • Instrumental and expressive “non-communication” behavior
  • Problem-solving behavior

Affective Factors in Couple and Family Functioning

  • Individuals’ levels of awareness of their emotions
  • Individuals’ regulation of their emotional states
  • Skills for expressing emotions in constructive ways

Cognitive Factors in Couple and Family Functioning

  • Degree of awareness of one’s cognitions versus “automatic processing”
  • Types of cognitions involved in relationship functioning: selective perception, attributions, expectancies, assumptions, and standards

Common Barriers to Engaging Couples in Couple Therapy and Strategies to Overcome Them

Afternoon:

Assessment of Couples

  • Goals of assessment
  • Modalities of assessment (interviews, questionnaires, behavioral observation)
  • Joint interview with the couple
  • Individual interviews with the partners (including assessment of normal human motives, unresolved personal history issues such as insecure attachment or child abuse, and psychopathology such as depression)
  • Strategies for observations of process in couple interactions
  • Assessment of sensitive topics (domestic abuse, prior traumas, substance abuse, sexuality)
  • Assessment of factors in the couple’s or family’s physical and interpersonal environment (e.g., extended family relationships, job responsibilities) that place stress on their relationship

Setting Therapy Goals with the Couple

  • Balancing the two partners’ priorities and views of problems
  • Including the therapist’s assessment in setting goals
  • Planning for ongoing assessment and periodic evaluation of progress

Behavioral Interventions

  • Balancing behavioral interventions with the two partners
  • Communication and problem-solving skills training ? when and how to use them
  • Guided behavior change (e.g., blocking/decreasing negative interactions; increasing mutual social support behavior) ? when and how to introduce them to the couple and consistently use them to change couple behavior
  • Enhancing positive couple and family interactions

Interventions to Modify Cognitions

  • How soon to use cognitive interventions in couple therapy
  • How to encourage an individual to consider alternative ways of thinking during joint couple sessions, in the presence of the other member of the couple
  • When to intervene with cognition in order to facilitate changes in behavior
  • When to intervene with behavior in order to facilitate changes in cognition
  • Use of logic; considering advantages versus disadvantages of a cognition
  • Guiding partners in examining relevant evidence and in considering other possible meanings

Interventions to Modify Emotions

  • Teaching emotion regulation skills ? when and how to do it
  • Interventions to reduce unregulated emotions in daily life
  • Interventions to increase individuals’ awareness of their emotions, and their relation to internal and external events; helping partners use emotions as clues to identify important underlying issues
  • Reducing cognitive avoidance of “uncomfortable” emotions

Ways in Which Therapists Who Use Other Couple and Family Therapy Theoretical Models Can Apply CBT Interventions


Day 2 Workshop Description

This session focuses on application of the CBT model to assessment and treatment of a number of significant problems that couples and families commonly bring to therapy. First, Dr. Epstein will describe methods for assessing and treating problems of psychologically and physically abusive behavior in couple interactions. Research findings regarding risk factors for intimate partner violence will be summarized, and a program of interventions designed to reduce these risk factors will be described. Ways to intervene without increasing the risk of partner violence will be discussed. Next, Dr. Epstein will cover CBT approaches to treatment of couples who have experienced infidelity. Clinical strategies for managing emotional upheaval and negative couple interactions will be described, and ways of assisting couples in understanding risk factors for infidelity within their relationship and possible approaches to reducing them will be covered.  Dr. Epstein will demonstrate techniques for helping partners make decisions about the future of their relationship. Finally, Dr. Epstein will describe CBT approaches for working with couples who are parents, regarding parent-child conflicts and child behavior problems.

Because the CBT approaches to assessing and treating couples and families were developed primarily in Western cultures, it is important to consider ways in which CBT should be modified so that it will be culturally sensitive and appropriate for the values and traditions of Japanese couples and families. Differences between Japanese and Western marriages and families will be discussed, and implications for (1) the roles of the therapist and clients in therapy, (2) methods for assessing relationships, (3) goal-setting, and (4) choices of interventions will be described.

Day 2 Workshop Objectives

Participants will be familiar with CBT methods for assessing and treating problems of psychologically and physically abusive behavior in couple relationships.

Participants will be familiar with CBT methods for assessing and treating infidelity.

Participants will be familiar with CBT methods for assessing and treating problems that couples experience as parents, including parent-child conflicts and child behavior problems.

Day 2 Workshop Schedule

Morning:

Assessment and Intervention with Psychologically and Physically Abusive Behavior

  • Forms of psychological and physical abuse
  • Impacts of abusive behavior on the partners and couple (and their children)
  • Risk factors for abuse
  • Clinical/ethical decisions regarding joint couple treatment
  • Limitations of treatments focused on the individual
  • Assessment methods (interviews, self-report questionnaires)
  • A structured cognitive-behavioral program of couple therapy for abusive behavior
      ・Psychoeducation regarding forms of abusive behavior and risk factors
      Modification of cognitions that contribute to aggressive behavior
      Anger management training
      Communication skills training
      Problem-solving training
      Resolution of damages done to attachment and trust in the relationship
      Enhancing strengths in the couple’s relationship
      Relapse prevention

Afternoon:

Assessment and Intervention for Infidelity
  • Risk factors for infidelity
  • Impact of disclosure of infidelity on the two partners
  • Crisis intervention; damage control
  • Interventions with the participating partner and the betrayed partner
  • Helping partners understand risk factors for the infidelity and decide what to do about them (interventions to reduce risk factors)
  • Helping partners reach a decision about the future of their relationship and work toward either a constructive separation or rebuilding of their relationship

Assessment & Intervention for Parenting Problems: Parent-child Conflicts and Behavior Problems of Children and Adolescents

  • Individual, family, and environmental factors that influence child and adolescent emotional and behavioral responses
  • Educating parents about factors that influence the functioning of children and adolescents, parenting styles, and how parents can adapt to changes due to child development
  • Interventions to increase parents’ ability to take a systemic view of parent-child relationships and child behavior
  • Interventions to help parents collaborate as a parenting team
  • Cognitive-behavioral family therapy interventions to reduce parent-child conflict and increase the family’s ability to cope with external stressors such as academic pressures on children

Adapting Western-Developed Couple and Family Therapy Models for Application with Japanese Families

Aspects of Japanese Marital and Family Structure that Therapy model Must Consider
Husband’s and wife’s roles inside and outside the home
Amount of daily conversation between spouses; degree of overt expression of    affection; degree of shared social life
Degree to which decrease in initial romance affects the stability of the marriage
Long-distance marriages when man gets transferred for job and moves by self,   commutes to be with family on weekend
More recent development of men more committed to family life and setting limit on time at job
Husband and wife viewed as team; if one makes social error, other is expected to apologize for him/her or be viewed as equally ill-mannered
Patriarchal leadership of family, even with move toward more democratic           relationships; continuation of family line is important
Parent-child relationships higher priority than marital relationship; closest relationships in family are between mother and children; with fathers not present much, mothers take on both nurturing and disciplinary roles
Recently, very close relationships between mother and children has been viewed as risk factor for social problems of Japanese youth such as “shut-ins” and increase in family violence
Focus on educating children for academic success
Less discipline with young children than in Western countries; raising children according to collectivist values (e.g., being considerate, cooperative, empathic)
Adolescents’ time either in studying or electronic socializing with friends ? little family time
Parents often support college graduates and do not encourage independence; in turn, parents often still expect oldest son (when possible) to care for them in old age;however, this has been changing, with parents planning on being independent, and women increasingly refusing to live with mother-in-law; increase in woman and husband moving in with her parents; three-generation families less common in urban areas
Low divorce rate, by international standards
Marked decrease in birth rate and family size; later ages at marriage
Overall indirect communication style among family members; avoidance of direct conflict

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