between thoughts, feelings, and actions. As clients learn to think in more realistic, flexible ways, they may experience fewer negative emotions and behave in a more adaptive and flexible manner. Usually, cognitive therapists incorporate elements of behavior therapy into their treatments. Cognitive–behavioral therapy (CBT) refers to the integrated use of cognitive and behavioral approaches to treatment (Beidel & Reinecke, 2016).
Interpersonal Therapy
Interpersonal therapy focuses primarily on the quality of clients’ relationships with others and their ability to cope with changes in those relationships over time. The therapy was originally developed by Gerald Klerman and Myrna Weissman as a treatment for depression (Weissman, 2020). It is based on the theories of John Bowlby and Harry Stack Sullivan. Recall that Bowlby (1969, 1973) believed that people form internal working models of caregivers and other significant individuals in their lives. Internal working models built on trust and expectations for care promote later social–emotional competence. However, models based on mistrust and inconsistent care can interfere with the development of future relationships. Sullivan (1953) believed that interpersonal relationships are essential for mental health. Friendships in childhood help youngsters develop a sense of identity and self-worth and form the basis for more intimate relationships in adulthood. Problems in interpersonal relationships can interfere with social–emotional functioning and self-concept.
Interpersonal therapists believe that problems occur when people experience disruptions in their relationships (Weissman, Markowitz, & Klerman, 2018). Four types of disruptions are especially important. First, interpersonal relationships can be disrupted due to death or loss of a loved one. Second, relationship problems can arise when a person experiences an interpersonal transition or change in social roles (e.g., problems adjusting from middle school to high school). Third, problems can occur when a person experiences an interpersonal dispute—that is, when her social role conflicts with the expectations of others (e.g., parents and adolescents disagree about dating or the importance of attending college). Finally, problems can occur when an individual has interpersonal deficits that interfere with his ability to make and keep friends (e.g., excessive shyness or lack of social skills).
An interpersonal therapist attempts to identify and correct relationship difficulties that might contribute to the child’s presenting problem. The strategies that the therapist selects depend on the nature of the client’s interpersonal disruption. For example, a therapist might help an adolescent cope with the death of a parent by giving her time to mourn during the therapy session. Then, the therapist might help the client find ways to cope with the absence of the parent in her life. Alternatively, a therapist might help an excessively shy adolescent develop social skills so that he can expand his peer network and social support system (Lipsitz & Markowitz, 2018).
An interpersonal therapist might notice that Anna’s eating problems occurred shortly after her father changed jobs and the family moved to a new neighborhood and school district. The therapist might interpret Anna’s eating disorder as a maladaptive attempt to lose weight, appear attractive to others, and gain acceptance by peers at her new school. Her rigid eating could also be seen as a way for Anna to take control of her life despite the changes occurring in her relationships. Through a combination of support and suggestions, the therapist would help Anna grieve the loss of her old neighborhood and friends, cope with her move to a new school, and find more effective ways to build new relationships in her current setting (Rudolph, Lansford, & Rodkin, 2016).
Family Systems Therapy
Family systems therapy seeks to improve patterns of communication and the quality of interaction among family members (Bitter, 2013). Although there are many types of family therapies, all family therapists view the family as a system—that is, a network of connected individuals who influence and partially direct each other’s behavior. Viewing the family as a system has several implications for therapy. First, no member of the family can be understood in isolation. A family member’s behavior is best understood in the context of all other members of the family. Second, family therapists see the entire family as their “client,” not just the person with the identified problem. Finally, a systems approach to treatment assumes that change in one member of the family will necessarily affect all members of the family. Consequently, family therapists believe that helping one or two family members improve their functioning can lead to symptom reduction in the family member with the identified problem (Kerig, 2016).
The family therapist Salvador Minuchin (1974) developed structural family therapy. Structural family therapists are chiefly concerned with the structure of the relationships between family members and between the family and the outside world. In healthy families, parents form strong social–emotional bonds, or alliances, with each other that are based on mutual respect and open lines of communication. Furthermore, in healthy families, parents form boundaries between themselves and their children. Specifically, parents respect children’s developing autonomy and provide for their social–emotional needs, but they also remain figures of authority.
In unhealthy families, alliances are formed between one parent and the children, leaving the other parent disconnected or estranged from the rest of the family. For example, a mother might encourage her daughter to form an alliance against her father because of the father’s excessive alcohol use. The alliance between the mother and daughter might leave the father feeling alienated from his family, while the mother and daughter might grow to resent the father. This phenomenon is sometimes called triangulation, because an alliance is formed between two family members, leaving a third member feeling isolated or rejected (Sexton & Stanton, 2018).
Furthermore, in unhealthy families, boundaries between parents and children are often overly rigid or excessively diffuse. Disengaged families are characterized by overly rigid boundaries, in which open communication between family members is stifled, and members feel disconnected from one another. In contrast, enmeshed families are characterized by diffuse boundaries where family members lack autonomy and constantly intrude into each other’s lives (Wendel & Gouze, 2015).
Adlerian family therapy is an alternative, contemporary approach to family systems therapy that helps parents manage their children’s behavior problems (Sherman & Dinkmeyer, 2014). An Adlerian family therapist believes that all family members, including children, seek lives based on meaning, effectiveness, and purpose. They view children’s behavior problems as a maladaptive attempt to achieve meaning or purpose in the family. Specifically, misbehavior can occur for four reasons: (1) to gain attention, (2) to assert autonomy from parents, (3) to extract revenge or “to get even,” and (4) to avoid responsibilities and be left alone. The therapist’s task is to identify the purpose of the child’s misbehavior and help parents find a more adaptive role in the family.
Family therapists would insist on seeing Anna and her parents together, for at least part of treatment. The therapist would likely pay attention to alliances and boundaries in Anna’s family and the way Anna’s eating disorder might help to maintain the family system in a maladaptive way. For example, the therapist might discover that Anna’s parents frequently argue with one another and are considering a divorce. The therapist might notice that the onset of Anna’s symptoms coincided with her parents’ marital problems. The therapist might hypothesize that Anna’s eating symptoms serve to maintain the family’s structure by distracting her parents from their marital disputes (Wendel & Gouze, 2015).
A family therapist might also notice that Anna’s parents are overprotective and excessively demanding. The therapist might interpret Anna’s desire to lose weight as a maladaptive attempt to gain the approval of her parents. The therapist might refer Anna’s parents to a marriage counselor to help them improve the quality of their relationship. At the same time, the therapist might work with Anna and her parents to improve communication at home. One goal of therapy might be to help Anna’s parents give her more autonomy
