Cognitive-behavioural family therapy

Domain V · Systemic, relational, group & community · Frank M. Dattilio · 2010

What it is

CBFT is not a single licensed protocol. It is a family-therapy school: a family of approaches that bring behavioural methods (social exchange, operant learning, communication and problem-solving training, contracting) and cognitive methods (Beck/Ellis restructuring) into a systemic frame.…

Format

• Notes on format. Dattilio prefers to see all relevant members. If some refuse, work proceeds with those who come, accepting that the system is incomplete. For example, with an absent adolescent you begin with the parents, including how they will motivate the teenager to attend. The phases overlap:…
• BFT format (Meriden). Engagement, assessment of each member and the family, formulation, information sharing, communication skills, structured problem solving, early-warning-signs work and a family staying-well plan. Delivery is flexible and often in the home. Sessions ran from 20-minute brief…

Who practises it, and how they are trained or regulated

• Dattilio's book runs from mechanics of change, to schemas, to neurobiology, to assessment, to techniques, then special topics and enhancements (acceptance, mindfulness, emotion regulation). The sources publish no numbered phase protocol, no fixed session count and no formal criteria for moving between phases. The phases below follow the book's logic; the session estimates and transition criteria are my own.
• Training and licensing. No certification or licence is required to practise Dattilio-style CBFT, which is a general approach. Training is through books, video and workshops. BFT is taught by the Meriden Family Programme through courses of one to five days with guided practice. Ongoing supervision supports fidelity, and a cascade model trains local trainers and supervisors.
• What it is. CBFT is not a single licensed protocol. It is a family-therapy school: a family of approaches that bring behavioural methods (social exchange, operant learning, communication and problem-solving training, contracting) and cognitive methods (Beck/Ellis restructuring) into a systemic frame. Dattilio's version puts family schemas, emotion and circular interaction at the centre.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• acceptance must never be applied to abuse or violence.
• one member doing all the homework. Give each person a part.
• requests for "just a quick word alone" at the end of sessions.
• one member's column filling with blame. Keep columns balanced.
• labels used to score points. Enforce the own-thoughts-only rule.

Problems the guide addresses

• Stuck: rigid beliefs about the other person and about change
• Resistance: "fix them, not me"
• Non-attendance by key members
• Homework non-adherence
• Overwhelm and escalation in session
• Ruptures, alliance splits and triangulation
• Violence, coercive control and safety
• Secrets and confidential disclosures (e.g., affairs)
• Requests for parallel individual therapy
• Serious mental illness and high expressed emotion

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.