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Alexander & Parsons, 1982; Jacobson & Christensen, 1996) to accommodate a systems/ behavioral/cognitive perspective.2 Most cognitive-behavioral family therapists today continue to view family interactions as maintained by environmental events preceding and following each member’s behavior. These events or contingencies, together with mediating cognitions, are what determine the form as well as the frequency of each family member’s behavior (Epstein, Schlesinger, & Dryden, 1988).

THE KEY ROLE OF ASSESSMENT

Behavioral therapists and more cognitively oriented therapists share these features, according to Beck (1995):

They are empirical, present-centered, problem-oriented, and require explicit identification of problems and the situations in which they occur as well as the consequences resulting from them. (p. 232)

Behavioral family therapists strive for precision in identifying a problem, employ quantification to measure change, and conduct further research to validate their results. They design programs that emphasize a careful assessment of the presenting problem (a behavioral analysis of the family’s difficulties) and include some direct and pragmatic treatment techniques to alleviate symptoms and teach the family how to improve its skills in communication and self-management.

A behavioral analysis might include an objective recording of discrete acts engaged in by family members, along with the behaviors of others that serve as antecedent stimuli, as well as the interactional consequences of the problematic behavior (Epstein, Schlesinger, & Dryden, 1988). In doing so, the interviewer is attempting to pinpoint exactly which behavior needs to be altered, and what events precede and follow manifestation of the behavior. For instance, working with a distraught family in which the presenting problem is a four-year-old boy’s“temper tantrums,”the behavioral therapist might want to know exactly what the family means by “tantrums,” the frequency and duration of such behavior, the specific responses to the behavior by various family members, and especially the antecedent and consequent events associated with these outbursts. By means of this inquiry, the behavioral therapist attempts to gauge the extent of the problem and the environmental factors (such as the presence of a particular family member, a particular cue such as parents announcing bedtime, a particular time and place such as dinnertime at home) that maintain the problematic behavior. The assessment of environmental circumstances is especially crucial, since the behavioral therapist believes that all behavior (desirable and undesirable) is maintained by its consequences.

Similarly, cognitive-behaviorists use many of the same assessment and treatment techniques as other behavioral therapists, supplemented by special attention to belief systems and how couples, for example, process the same information. A typical

2A particularly interesting conversion involves Gerald Patterson, once a strict behaviorist, who modified many of his views after studying systems theory with Salvador Minuchin. James Alexander was another strict behaviorist who expanded his thinking to include strategic ideas when he developed functional family therapy. Jacobson and Christenson found traditional behavioral couples therapy too confining and developed a more integrative approach to treating couples in distress.

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individuals as interactive participants, interpreting, judging, and influencing each other’s behaviors. Typically, they gather such data using three main forms of clinical assessment: self-report questionnaires, individual and joint interviews, and direct behavioral observations of family interaction (Epstein & Baucom, 2002). As an example of a family self-report, parents complaining about their child’s resistance to a bedtime schedule might be asked to keep logs at home, monitoring and recording specific acts and their specific responses (“For the last four nights, our eight-year-old has gone from one of us to the other until his father finally agrees he can stay up past his bedtime and watch the TV program”). In the case of adult relationship problems, specific tests (for example, Eidelson and Epstein’s [1982] Relationship Belief Inventory or Fincham and Bradbury’s [1992] Relationship Attribution Measure) might be employed, tapping unrealistic beliefs about close relationships in the first example, or attributions (inferences about the cause of events in their relationship) such as a partner’s perceived overcriticalness (Dattilio, Epstein, & Baucom, 1998).

As for interview-based data, the therapist might probe automatic thoughts— beliefs (“He avoids talking to me at night”), expectancies (“I hate to make plans with friends because he’s always late”), or attributions (“The reason he acts as he does is because he doesn’t care about my feelings”) as clients report upsetting experiences with one another. Direct observations of couples, for example, might focus on a couple’s communication skills deficits as they are directed to plan a night out away from the children, or perhaps their deficits in negotiation skills as their failure to compromise escalates conflict. On the other hand, when asked by the therapist to solve a problem together in the therapist’s office, they may discover that they possess heretofore untapped problem-solving skills. Such structured tasks (for example, role-playing an adolescent’s request for a later curfew) are often used by cognitive-behavioral therapists to check on progress in reaching the desired changes in targeted behaviors (Epstein, Schlesinger, & Dryden, 1988). Box 13.2 offers various types of cognitive distortions frequently found among couples.

BEHAVIORALLY INFLUENCED FORMS OF FAMILY THERAPY

The behaviorally oriented family therapist is more likely than most systems-based family therapists to use distinct clinical procedures (such as skills training) and not to insist on participation of the entire family. Sometimes the family is brought in when individual procedures fail, or when behavioral observation suggests that family members are helping maintain the individual’s symptomatic behavior; the family is excused after that phase of therapy is completed, and the therapist continues to implement individually oriented procedures.

Extended family members are far less likely to be involved in behavioral therapy. In general, behavioral family therapists view the family as burdened by the patient, or perhaps as unwittingly responding in ways that support and maintain his or her problem behavior, while most systems-oriented family therapists assume that family involvement is always present and plays an active part in symptom maintenance (Todd, 1988).

Moreover, as noted earlier, purely behavioral family therapists tend to adopt a linear rather than a circular outlook on causality. For instance, a parent’s inappropriate, inconsistent, or otherwise flawed response to a temper tantrum is believed to cause as well as maintain a child’s behavioral problem (contrary to the more commonly held

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Stuart (1969) developed a set of therapeutic procedures he called operant interpersonal therapy, especially the use of contingency contracting, to try to get couples to maximize the exchange of positive behaviors. He argued that successful marriages can be differentiated from unsuccessful ones by the frequency and range of reciprocal positive reinforcements the partners exchange (“I’ll be glad to entertain your parents this weekend if you accompany me to the baseball game [or ballet performance] next month”). Although this technique today is considered by most family therapists to be an oversimplified, heavy-handed, and mechanical approach to a complex marital exchange, Stuart was beginning to blend Skinner’s operant learning principles with social exchange theory (Thibaut & Kelley, 1959). Relationship satisfaction was recast as reward-cost ratios: If missing but potentially rewarding events can be identified and maximized and displeasing events occurring in excess can be identified and minimized, then the reward-cost ratio should increase greatly, and each partner should not only feel more satisfied but also be more willing to provide more rewards for the other partner. As part of Stuart’s approach, he had each partner record the number of instances and the type of caring behavior he or she offers each day. Table 13.1 offers a sample of such“caring days”requests.3

The use of contingency contracting and the teaching of behavioral exchange strategies characterized the approach of behavioral marital therapists during the 1970s, particularly Jacobson and Margolin (1979). Contingency contracting remained the focal point of the approach, both to enhance the quality and quantity of mutually pleasing interactions and, by nonreinforcement, to diminish the frequency of arguments, provocations, and generally negative communication sequences (Falloon & Lillie, 1988).

From Reinforcements to Skill Building

Communication/problem-solving training was often introduced in the 1980s with the intent of teaching couples to negotiate resolutions of their conflicts (present and future) in noncoercive ways, thus creating positive relationship changes. In some cases, therapeutic contracts—written agreements between spouses stipulating specific behavioral changes—were negotiated. Here, each spouse explicitly states what behavior he or she wants increased, thus avoiding the all-too-familiar marital plea for mind reading:“If you really loved me, you’d know what I want.”Note how the agreement developed by Stuart (1980) in Table 13.2 offers each partner a range of constructive choices, any one of which can satisfy their reciprocal obligations. By not creating the expectation that reciprocation should be forthcoming immediately (“I’ll do this if you do that”), a contract can increase the likelihood of spontaneous reciprocation. Stated briefly, the dynamic interplay of any couple’s behavior is often overlooked (Atkins, Dimidjian, & Christensen, 2003).

3In Helping Couples Change, Stuart (1980) spelled out in greater detail his“caring days”technique for building commitment in a faltering marriage. All requests must meet the following criteria: (1) they must be positive (“Please ask how I spent my day” rather than “Don’t ignore me so much”); (2) they must be specific (“Come home at 6 p.m. for dinner”rather than“Show some consideration for your family”); (3) they must be small instances of behavior that can be demonstrated at least once daily (“Please line up the children’s bikes along the back wall of the garage when you get home”rather than“Please train the children to keep their bikes in the proper place”); and (4) they must not have been the subject of recent intense conflict (since neither spouse is likely to concede major points at this stage of treatment).

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Despite modifications from its earlier exclusive focus on behavior, the basic premises and practices of behavioral marital therapy, as outlined by Liberman and Stuart, remained tied to basic learning principles. However, critics charged that some of its earlier assumptions were too simplistic: that both partners, as rational adults, will not resist change but will follow the therapist’s suggestions; that a focus on overt behavior change is sufficient, without attending to underlying perceptual processes and interpersonal conflicts; that marital disharmony derives from the same sources, such as insufficient reciprocity, throughout the marital life cycle; that displeasing behavior, such as anger, should simply be held in check without exploring the covert reasons for conflict; that the couple-therapist relationship can be ignored (Gurman & Knudson, 1978).

Increasingly based on social learning theory (learning that occurs due to interaction with other people) as well as behavioral-exchange principles, behavioral couples therapy became less technological and more flexible over time. In addition to encouraging the increased exchange of pleasing behaviors (and the diminution of aversive behaviors), therapists such as Jacobson and Margolin (1979) also aimed to reduce problems by teaching couples more effective problem-solving skills. Such problem solving is broken down into two separate phases: problem definition (learning to state problems in clear, specific, non-blaming ways; learning to acknowledge one’s own role in creating or perpetuating the problem; attempting to paraphrase the other’s view, even if it is inconsistent with one’s own); and problem resolution. Brainstorming solutions together and negotiating compromises (which later may be put in writing) often facilitate problem resolution. Rather than the accusatory “You don’t love me anymore,” the therapists suggest that couples use the more concrete, less provocative, more self-revealing statement,“When you let a week go by without initiating sex, I feel rejected”( Jacobson & Margolin, 1979, p. 230).

Recognizing that behavior changes will lead to greater marital satisfaction, practitioners of behavioral couples therapy attempt to create behavior change in two ways:

(a) by encouraging partners to define the specific behaviors they wish their partners to exhibit, then instructing them in how to increase the frequency of those behaviors; and (b) by teaching couples communication and problem-solving skills so that they can produce those changes (Eldridge, Christensen, & Jacobson, 1999).

Broadening the Outlook: The Cognitive Perspective

As cognitive-behavioral therapy gained prominence during the late 1980s its proponents began to argue that distress and conflict in a relationship are influenced by an interaction of cognitive, behavioral, and affective factors, and that a strictly behavioral approach is too linear and does not fully address such dynamic interplay (Epstein, Schlesinger, & Dryden, 1988). Consequently, they contended, behavior change alone is insufficient in effecting permanent resolution of conflict between partners, particularly if that conflict is intense and ongoing. To resolve the likely escalating antagonistic and provocative behavior between them, couples need to acquire skills for recognizing and defining problems clearly, identifying mutually acceptable problem-solving strategies, and implementing these solutions quickly and effectively (Dattilio, Epstein, & Baucom, 1998).

Cognitive-behavioral family therapy is directed at restructuring distorted beliefs (schemas) learned early in life from the family of origin, cultural traditions, the mass media, and relationship experiences growing up. In turn, these schema affect automatic

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Integrative Couples Therapy

Neil Jacobson (at the University of Washington) and UCLA’s Andrew Christensen ( Jacobson & Christensen, 1996; Christensen, Jacobson, & Babcock, 1995; Eldridge, Christensen, & Jacobson, 1999) developed behaviorally based therapeutic strategies for promoting more accommodating and collaborative attitudes—”partner acceptance”— in addition to the more traditional behavioral techniques for helping couples attain behavior change. Jacobson (1991) described the therapeutic process directed at helping couples achieve interactional or contextual change as follows:

By promoting an intimate conversation about the differences between them that make desired changes impossible, the partners are getting much of what they need from the conversation itself, and thus the original problem becomes less important. (p. 444)

In this eclectic approach, strategic techniques (reframing) and humanistic/ experiential techniques (empathic joining of the couple around the problem, selfcare) are added to the more traditional behavioral methods (use of assessment instruments, therapist modeling, behavioral exchange interventions, communication/problemsolving training) in an effort to promote intimacy and understanding in place of anger and blame ( Jacobson & Christensen, 1996). Combinations of these techniques are directed at overcoming each participant’s tendency to see the problem between them as emanating exclusively from the other person, and subsequently attempting (unsuccessfully) to change that person’s behavior where changes are not feasible. Instead, integrative couples therapy delineates various procedures designed to help couples see certain differences between them as inevitable, helping foster tolerance (rather than resignation) concerning perceived negative behaviors in a partner, and acceptance of those behaviors especially resistant to change. By acknowledging each other’s emotional vulnerabilities and personality differences, Christensen and Jacobson (1999) contend that couples have taken a large step toward active acceptance of each other’s feelings and actions, and as a consequence have moved away from blaming and toward reconcilable differences. Two key themes in this therapeutic approach involve promoting acceptance and promoting change ( Jones, Christensen, & Jacobson, 2000).

Integrative couples therapy represents a return to a more traditional behavioral emphasis on the functional analysis and external determinants of behavior (Christensen, Jacobson, & Babcock, 1995). However, its therapeutic interventions represent a departure from traditional behavioral couples therapy. Historically, those approaches have focused on achieving change, since excesses or deficits in the behavior of one partner were considered to be the causes of distress in the other. Such change was typically generated by behavioral exchange strategies or communication/ problem-solving techniques, directed at helping couples change the rules of their behavior (the husband learns to kiss his wife upon arriving home since the therapist instructed him to increase positive behaviors leading to the wife’s greater satisfaction).

Unfortunately, the underlying theme of the problem—that he still “doesn’t get it” about being generally more attentive and caring, and that she finds that intolerable— does not get addressed, since it would be impossible to review every one of their interactions where change is desired. In other cases, the rule-governed behavior feels fake or contrived or insincere, so it backfires and is abandoned. Rule-governed processes may lead to change, argue these therapists, but additional strategies are

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needed when the couples are unable or unwilling to make the changes the other desires.

Emotional acceptance refers to situations where behavior change either fails to occur, or else occurs but not to the extent the partner would like. Instead of demanding more of what was deemed insufficient (or less of what was excessive), here the partners are urged to alter their reactions to the behavior previously seen as intolerable or unacceptable in their partner, in effect balancing change with acceptance of those behaviors not open to change. Acceptance may be enhanced in two ways: (a) by experiencing the problem in a new way, say as a common enemy (from joint empathic understanding of the problem or perhaps from detachment from the problem so it becomes less offensive); or (b) by reducing the aversiveness of the partner’s actions, either through greater tolerance of those actions or through the increased ability to take care of oneself when confronted with the partner’s negative behaviors (Christensen, Jacobson, & Babcock, 1995). The partner may still not like the behavior or wish it were different, but nevertheless learn to consider it a part of the package of qualities (many appealing, some bothersome) in their mate. In effect, instead of seeking to change aversive behavior in order to achieve relationship satisfaction, this approach also fosters acceptance of that behavior where change is unattainable, so that it is experienced in a new way, as less aversive (Eldridge, Christensen, & Jacobson, 1999).

Behavioral Research in Couples Therapy

Behavioral couples therapy is arguably the most studied approach in couples’ therapy (Sexton, Robbins, Holliman, Mease, & Mayorga, 2003). Howard Markman (1992), a psychologist who focuses his longitudinal research with couples on what causes marital distress, concludes that it is not so much the differences between people that matter, but rather how those differences are handled (that is, how couples learn to communicate and manage conflict). In a fourto five-year follow-up of a marital distress prevention program directed at teaching more effective communication and conflict management skills, Markman and colleagues (Markman, Renick, Floyd, Stanley, & Clements, 1993) found that those couples functioning at a higher level had maintained more positive communication patterns while those functioning more poorly exchanged more negative communication and showed greater marital violence.

Markman, a prominent longitudinal researcher, has, along with his colleagues, investigated the impact of couples’ exchange of negative affect before parenthood on their later marital and family functioning (Lindahl, Clements, & Markman, 1997). Observing and coding the communication patterns of 25 couples before becoming parents and again five years later, these researchers wanted to know how the couples’ earlier ability to handle marital conflict predicted how they would handle the competing needs of children and deal with later marital conflict. Using behavioral observations and videotapes of mother-child and father-child interactions, results indicated that the way in which couples handle negative affect with one another after parenthood is a more salient factor in how they manage and regulate negative affect with their children than would have been predicted from pre-child marital functioning. However, the husband’s pre-child angry and conflictual behavior and the couples’ negative escalation were predictive of marital conflict and the triangulation of the child into their discord. In general, how couples regulate negative affect early in marriage, while not decisive in itself, appears to set the tone for future parent-child interactions. We’ll

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return to the work of Markman and his associates (Floyd, Markman, Kelly, Blumberg, & Stanley, 1995; Silliman, Stanley, Coffin, Markman, & Jordan, 2002) on preventive intervention and relationship enhancement when we discuss psychoeducational programs for couples and families.

John Gottman, perhaps today’s most prolific marriage researcher, has been especially active in attempting to develop a scientific basis for helping couples in conflict (Gottman, Ryan, Carrere, & Erley, 2002). Beyond his academic credentials at the University of Washington, he is the founder and director of the Gottman Institute in Seattle, a marriage clinic in which intake procedures, treatment plans, and follow-up methods are employed to test out his empirically research-based conclusions regarding the components of a happy and successful marriage.

Gottman (1994) has offered several studies on those aspects of marital interactive processes that discriminate between happily married and unhappily married couples. Using video cameras, EKG monitors, galvanometer sensors, and specially designed observational instruments, Gottman and his research team (Gottman & Krokoff, 1989; Gottman, Coan, Carrere, & Swanson, 1998) compared how couples communicate, both verbally and nonverbally, microsecond by microsecond. In their sequential analysis, the researchers studied such indicators as body movements, facial expressions, gestures, even the couple’s heart rates during conflict with one another, attempting to identify those behavioral and physiological responses essential to a stable marriage as well as those that predict the couple is headed for divorce (Gottman, 1996).

According to Gottman’s findings, and contrary to popular opinion, it is not the exchange of anger that predicts divorce, but rather four forms of negativity that Gottman calls“The Four Horsemen of the Apocalypse”—criticism (attacking a spouse’s character), defensiveness (denying responsibility for certain behavior), contempt (insulting, abusive attitudes toward a spouse), and stonewalling (a withdrawal and unwillingness to listen to one’s partner). In a typical demand-withdrawal transaction, women were found more likely to criticize while men were likelier than women to stonewall. Using these four variables, Gottman and his associates were able to increase their prediction of marriage dissolution by 85 percent. In addition, a second distance and isolation cascade (emotionally flooding, viewing problems as severe, not wanting to work out problems with a spouse, living parallel lives, and experiencing loneliness) increase the prediction of dissolution to more than 90 percent (Gottman, Ryan, Carrere, & Erley, 2002). Clearly it is positive affect that plays a pivotal role in the development of satisfying and lasting relationships.

According to Gottman (1994), there are three types of stable couples: (a) volatile couples (those who are emotionally expressive, may bicker frequently and passionately, but are more romantic and affectionate than most couples); (b) validating couples (harmonious but less emotionally expressive, these couples listen to one another and try to understand each other’s viewpoint); and (c) conflict-avoiding couples (those low in emotional expressiveness, who typically resolve problems by minimizing or avoiding them, emphasizing the positive aspects of their relationship and accepting negative aspects as unchangeable).

Gottman’s findings indicate a greater climate of agreement in these happily married couples: in all three stable couples, the researchers observed the exchange of five positive responses to one negative response, while the positive-to-negative ratio in unstable marriages was 0.8:1 (that is, more negativity than positivity). Gottman and Krokoff (1989), in a well-designed longitudinal study, found that while conflict engagement (that

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Parent skills training has many practical features to recommend it. It is cost effective in the sense that less time is needed for assessing and developing a specific intervention procedure, because the treatment plan is standardized. Its focus is on family empowerment. It minimizes the family’s reliance on qualified professional therapists, who may be in short supply. Skills learned with one child may be applicable to his or her siblings should similar conditions arise. Without diminishing parental authority, the training process, if successful, builds competence and a feeling of confidence in parents. Intervention generally begins early, correcting an established problem; parent training thus has a preventive aspect. Perhaps most important, parents possess the greatest potential for generating behavior change because they have the greatest control over the significant aspects of the child’s natural environment (Gordon & Davidson, 1981). The use of parents as trainers makes it easier for children to actually use the new behavior they learn, since they do not have to go through the process of transferring what they have acquired from a therapist to their home situation.

The initial request for treatment rarely if ever comes from the child. It is likely to be the parents who are concerned about their child’s disturbed (and disturbing) behavior (see Table 13.3) or failure to behave in ways appropriate to his or her age or sex.

According to Patterson and Reid (1970), a faulty parent-child interaction pattern has probably developed and been maintained through reciprocity (a child responding negatively to a negative parental input) and coercion (parents influencing behavior through the use of punishment). BPT intervention aims to change this mutually destructive pattern of interaction, usually by training parents to observe and measure the child’s problematic behavior and then to apply social learning techniques for accelerating desirable behavior, decelerating undesirable behavior, and maintaining the consequent cognitive and behavioral changes.

As is true of all cognitive or behavioral interventions, parent training begins with an extensive assessment procedure. Before teaching parenting skills, the behavioral therapist relies on interviews, questionnaires, behavioral checklists, and naturalistic observations of parent-child interactions in order to identify the specific problem behavior along with its antecedent and consequent events. Through such a behavioral analysis, the therapist is able to pinpoint the problem more exactly; evaluate the form, frequency, and extent of its impact on the family; and systematically train parents to use social learning principles to replace the targeted behavior with more positive, mutually reinforcing interaction.

The actual training of parents in skills acquisition and knowledge of behavioral principles may be as direct as instructing them, individually or in parent groups, by written material (books, instructional pamphlets), lectures, computer software programs, videotapes, or role-playing demonstrations (Dangel,Yu, Slot, & Fashimpar, 1994). Such focused education is apt to emphasize how, when, and under what circumstances to

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enforce rules or act consistent, or how to apply behavioral deceleration procedures such as time out from positive reinforcement, or acceleration procedures such as home token economy techniques (Gordon & Davidson, 1981).

In Families, Patterson (1971) first outlined procedures for parents to acquire “behavior management skills” geared toward more effective child management. Presumably, many adults come by these skills“naturally,”that is, without deliberately following a prescribed program. For less well-equipped parents, Patterson spelled out a plan for observing a child’s behavior to establish a baseline, pinpointing the specific behavior the parents wish to change, observing and graphing their own behavior, negotiating a contract with the child, and so on. Figure 13.1 represents a checklist constructed for a boy who displayed a wide range of out-of-control behavior. The parent-child contract, jointly negotiated, stipulated that the parent would check with the teachers daily to get the necessary information and would regulate the consequences for the child’s behavior. These consequences included mild but fair punishment for continued problem behavior, in addition to “payoffs” (such as no dishwashing chores, permission to watch TV) for adaptive behavior. In establishing the contract, the child helps set the “price” in points for each item, sees the results daily (the program is posted in a conspicuous place at home, such as the refrigerator door), and negotiates the backup reinforcers (for example, TV programs) for the accumulated points.

The parents are rehearsed and then supervised in the use of these procedures; additional performance training, such as demonstrations by the therapists, may be

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provided for those having difficulties in carrying out the program. Gordon and Davidson (1981), surveying the literature on the usefulness of the procedure, concluded that “it is an effective intervention for discrete, well-specified behavior problems. In cases of more complex deviant behavior syndromes, the research is encouraging but not conclusive”(p. 547). A major concern, of course, is how long therapeutic changes are maintained after treatment ceases; longer-range follow-up studies are indicated.

The behavioral therapist may also work through the parents when the target for intervention is an adolescent’s behavior. By observing the natural interaction between family members (sometimes in a home visit, as popularized by TV’s Super Nanny), the therapist performs a functional analysis of the problem behavior, determining what elicits it, what reinforces and maintains it, and how the family members’ interaction reflects their efforts to deal with it (passive acceptance, resignation, anger, bribes, encouragement, and so forth). Such an analysis calls for systematic observation of family behavior, typically recording concrete instances of which behaviors were displayed by which family members in response to which other bits of behavior. Behavioral intervention strategies chosen by the therapist are apt to be specific and directed at helping to resolve or eliminate the problem.

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Constructing Contingency Contracts

Contingency contracting, based on operant conditioning principles, may be a particularly useful“give to get”technique in reducing parent-adolescent problems. The technique is simple and straightforward, usually involving a formally written agreement or contract spelling out in advance the exchange of positively rewarding behaviors between the teenager and his or her parents. Although initially offered by Stuart (1969) in the treatment of marital discord, this reciprocity concept seems especially applicable to parent-adolescent conflict where the previous excessive use of aversive controls by parents (nagging, demanding, threatening) has been met by equally unpleasant responses from the adolescent. The goal here is to acknowledge the power of both sets of participants to reverse this persistent negative exchange by means of a mutual exchange of positive and cooperative giving of pleasurable behavior (Falloon, 1991).

A contract is negotiated wherein each participant specifies who is to do what for whom, under which circumstances, times, and places. Negotiations are open and free from coercion; the contract terms are expressed in clear and explicit statements. For example, a contract negotiated between parents and an adolescent with poor grades specifies that she will“earn a grade of ‘C’or better on her weekly quiz”rather than“do better in school.”The second statement is too vague and open to different interpretations by the participants; by that kind of definition the adolescent may believe she has done better and fulfilled her part of the agreement, while the parents believe the gain is insignificant, so the conflict between them over school performance remains unresolved. By the same token, the rewards must be specific (“We will give you $15 toward the purchase of new clothes for each week your quiz grade is ‘C’ or better”) and not general or ambiguous (“We’ll be more generous about buying you clothing if you get good grades”). The point here is that each participant must know exactly what is expected of him or her, and what may be gained in return.

A contract (Figure 13.2) is an opportunity for success, accomplishment, and reward. However, the desired behavior, such as a “C” grade, must be realistic and within the grasp of the contractor. In addition, each member must accept the idea that privileges are rewards made contingent on the performance of responsibilities. Behavioral therapists believe that a family member will exchange maladaptive behavior for adaptive behavior in anticipation of a positive consequence, a desired change in the behavior of the other. The teenager’s responsibility (that is, better grades) is the parents’reinforcer, and the parents’responsibility (money) is the teenager’s reinforcer. BPT helps a family set up a monitoring or record-keeping system that enables the contractors and the therapist to assess the reciprocal fulfillment of the contract terms. Bonuses are given for consistent fulfillment of the terms, and penalties are imposed for failure to adhere to them. Note that as in all behavioral procedures, the success of treatment can be measured by the extent to which the contract works for all parties.

Contingency contracting is not an end in itself, but merely one motivating and structuring device among a variety of family intervention techniques (for example, modeling, shaping, time out, use of tokens, and other operant reinforcement strategies) used in the BPT approach. Contracting may open up communication within a family and help members express for the first time what each would like from the others. In some cases, the contracting process even makes family members aware of wishes or desires they had not previously recognized within themselves. Finally, an important aspect of this approach is its focus on goals and accomplishments. Contingency