Family System Therapy for Military Families: CBCT and SAT Models

This article discusses the use of family system therapy for military families dealing with PTSD and intimate relationship issues. It focuses on the Cognitive Behavioral Conjoint Therapy (CBCT) and Strategic Approach Therapy (SAT) models, their similarities and differences, and the role of the therapist. The article also explores beliefs about PTSD treatment and includes a case study of the Gibbons family. Written by Baron Lane from Simmons School of Social Work.

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Family System Therapy
Baron Lane
Simmons School of Social Work

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Abstract
According to the Census Bureau of the United States (Gates) nearly half of all the
Americans aged 15 and above are married. Literally, marriages come along with great
responsibilities that require lots of dedication from marriage partners to make it work well.
People marry for a better course; including better emotional health, the satisfaction of the
physical body and general companionship. However, this is not usually the case in all marriages.
Ultimately, marriage comes along with other problems. As a result, families are deemed to break
up if necessary precautions are not taken immediately.
One of the major remedies of family wrangles is going for professional counseling.
(Burford) The Gibbons family took a step of courage to take themselves for counseling.
Counseling involves the use of different therapeutic styles based on theories that are well proven
backed up by statistics. Specifically for the family, there are various family system therapy
models that have been proven to be effective for the client. Among the most commendable
family system therapy models, especially those viable for a military family like the Gibbons
Family are Cognitive Behavioral Conjoint Therapy(CBCT) and Strategic Approach
Therapy(SAT).
Cognitive Behavioral Conjoint Therapy (CBCT)
This therapeutic style is very helpful, especially for the military family who undergo
various traumatic events, that affects them psychologically or even physically. These events may
lead to Post Traumatic Stress Disorders (PTSD). In the long run, the PTSD may end up affecting
their intimate relationships. (Samuelson et al)The aim of this therapeutic style is to improve
recovery of the client from these kinds of psychological torture. Various studies over time have

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shown that Cognitive Behavioral Conjoint Therapy (CBCT) is effective when dealing with
PTSD and its effect on the intimate relationships. Central concepts of this therapy revolve around
techniques in reducing avoidance behavior, managing conflicts, modification of maladaptive
patterns of thinking and even improving the general communication behavior. (Macdonald et al)
The main tenets of CBCT are grouped in three stages or phases; First, Psychological
education on how PTSD has affected the intimate part of the relationship, including all the issues
related to safety and how to control emerging conflicts. The second phase involves
communication skills, as well as challenging avoidant behaviors that may arise, using behavioral
techniques and ‘vivo exposure’. The final part involves the therapist addressing the cognitions
that are considered negative, or may have a lasting harm to the relationship or the couples
directly. This model is very promising when used correctly by the therapist and is estimated to be
accomplished within fifteen sessions of therapy (Wagner et al)
Strategic Approach Therapy (SAT)
This family system therapy model focuses its base on the couples and the stress they
experience in order to help curb symptoms of PTSD. The couples develop and learn new ways
and techniques to curb stress that initially used to exist or still does in the marriage. These new
techniques can then be utilized to solve future similar stressful events; just in case they occur.
This form of therapy focuses on the deep problems the couples face as well as the mild ones that
are a major source of stress. This therapeutic style has been used successfully in several
instances, especially in the military families to improve emotions and communication in a
relationship (Weissman et al)

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This therapeutic intervention is classified into three phases; First, education part, which
aims at generating a rapport between the client and therapist, as well as among the clients
themselves. It also aims at the presentation and definition of the problem at hand, in order to
understand more about stressful experiences. This stage is vital as it informs the couples of the
effect of PTSD on their relationship. Many at times it is evident in a relationship with signs of
emotional numbness and avoidance. The other phase involves skills of emotional regulation and
communication. These skills are imparted by being put to practice in order for the client to
understand their rationale, in terms of their how they feel emotionally, as well as how they have
been affected by the trauma. The final phase involves applying the skills the clients learned in
the second phase by activating behavior. By doing joint activities the couples love, they tend to
show emotions that are positive in the healing process of PTSD. This therapeutic style is
estimated to take around twelve to fifteen sessions, for the client to be able to yield from it.
(DeVoe et al)
Comparison and Contrast between CBCT and SAT
Both Cognitive-Behavioral Conjoint Therapy (CBTC) and Strategic Approach Therapy
(SAT) are similar in a number of ways; First, they are all affected in three stages. For CBTC, the
stages are education, behavioral interventions, and cognitive interventions. On the other hand,
the SAT involves the three main phases including education, skills training, and application.
Another similarity is, both are vital for the treatment of PTSD. They all can be used as
intervention strategies to help a person or people suffering from PTSD. Additionally, it is noted
that education is emphasized in both SAT and CBTC. Psychological education is done in CBTC
while education is the first phase of the SAT. To add to that, communication is also vital to both
the two types of therapy. As SAT places importance on empathetic communication, CBTC place

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a huge weight on communication skills by the clients involved. Another similarity is both are
widely used among the military as intervention therapy strategy to take care of PTSD. The
various therapist may recommend different therapeutic styles for different soldiers depending on
circumstances, but the two therapeutic interventions are vital for use when dealing with the army
men and women together with their families. Finally, both CBTC and SAT are focused on
couples as a unit. They are seen and treated as one team or group that needs help, rather than
single individuals who come for personal counseling against the psychological form of torture
they are undergoing. (Shepherd-Banigan et al)
However, CBTC and SAT are different in a number of ways; first, CBTC places much of
its focus on intimate relationships. On the other hand, the SAT focuses on reducing the effects or
the damage done by PTSD in that intimate relationship. In as much as both are vital depending
on the situation, they should be correctly used for proper results to be witnessed. Another great
difference is that the SAT is specifically designed to eliminate all kinds of avoidance symptoms
in the relationship, in order to make the relationship more intimate. On the other hand, CBTC
places more emphasis on client recovery from PTSD. SAT tends to reduce emotional numbness.
This is the major difference between the two. Another difference is the number of sessions; SAT
takes a relatively shorter period to be completely done compared to CBTC. When CBTC is
expected to take around 15 sessions, SAT can take around just 12 sessions. They are also
relatively shorter sessions, around sixty minutes, compared to CBTC which can take up to
seventy-five minutes per session. (Reinhardt et al )
The Role of the Therapist
A therapist is very important for diagnosis, assessment, and treatment for PTSD and
general psychological illnesses types. The client looks at the social worker or therapist as the first

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respondent in the treatment process. In the Gibbons family scenario, the social worker is seen as
the first respondent and an instrument of care. However, different people may have different
treatment styles hence the first role of the therapist is to decide the best treatment technique to
help the client fully recover from the illness.
In CBTC and SAT the therapist plays a vital role; first, he or she helps to understand as
well as change the thinking patterns of the client. Eventually, the therapist makes the patient
understand the consequences of the trauma. The therapist goal is to help the client understand the
symptoms and thoughts pertaining to the illness they are facing. Furthermore, the therapist has a
major role to play in terms of helping the client identify negative thoughts and feelings, then
make them have the right mindset to tackle the PTSD they are facing. Harmful thoughts may
prove to cause harm to the client and it is important for the therapist to get rid of them. (Straus)
Other than the above roles, the therapist plays other roles such as: directing the entire
therapy session, planning and scheduling for the next therapy session. Additionally, it is the
therapist that aids the patient experience some exposure therapy in order to help in the healing
process. For example, by talking about the issue affecting the Gibbons family, the clients
ultimately would gain control themselves about their fears, feelings, and thoughts on their
trauma. Just as demonstrated by the Gibbons family scenario, body language, and eye movement
are keenly watched by the social worker. It is the role of the therapist to observe involuntary
body activities and the entire body language. (Cleveland et al)
Beliefs about the problem
There exist several beliefs about problems related to PTSD treatment especially among
families living with members of the army. The first major problem is the late identification of the

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trauma. Many at times the client seek psychological intervention when they cannot handle
anymore the problem and they need urgent help. Many believe that mild trauma cannot cause
much damage and it is with this kind of ignorance that it piles up to alarming standards.
Furthermore, diverse views and arguments about the importance of therapy lead to an increase in
the number of cases that require urgent help. People continue to argue about whether it is
important before they transform into a psychiatric case. (Finley et al)
Types of models used and applied to the blended family and Evaluation
The Gibbons family case scenario involves the use of an eclectic approach with a special
focus on family system therapy. Other forms of therapy that could be used in this scenario
include parent management training, multifamily group psychoeducation, strategic approach
therapy, integrative couple’s psychotherapy and cognitive-behavioral conjoint therapy. (Leahy)
When applied to the Gibbons family case scenario, integrative couple’s psychotherapy
would not be all-inclusive as it focuses on the couples and not the entire family. The same case
applies to strategic approach therapy and CBCT. Therapeutic styles that deal with the entire
family would be more appropriate and fit the needs of the Gibbons family. As a social worker, I
find Family system therapy the most applicable in the Gibbons family case as it aims at being
inclusive on family roles and structure and also takes a relatively short period to work on; around
2 to 8 weeks. Goals are clearly defined at the beginning of the session allowing for a fast and
smooth transition of the family therapy (Krause)
Transference and Countertransference
The client in the therapy session may have unresolved conflict and feelings in his or her
unconscious to a person in the present like let’s say the therapist. This is countertransference and

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it is experienced a lot in families including the Gibbons family in the case scenario. Soldiers
have lots of unsolved pain especially after a mission and if they do not go for therapy they may
end up transferring their anger to the innocent family members. (Tsiantis)
Contrary, a client may experience some feelings towards the therapist because the
therapist may remind the client of an important phenomenon or person in their past life. This
unresolved conflict of feelings may either be positive or negative. Positive feeling towards the
therapist is referred to as positive transference while negative feeling towards the client is
negative transference. (Grinberg) In the Gibbons family, some members may have seen the
therapist as their mother because she reminded them of the care and concern of a mother. This is
a positive transference.
In a nutshell, Therapy is vital to help solve the various aspects of the helping process. The
therapist ensures that the patients understand that the experience he or she had was traumatic,
normal and could happen to anyone given the circumstances are the same as for the affected
person. Social workers are very important practitioners in the current world, and more should be
trained to help people deal with the ever-increasing world problems.

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