Clinical Social Work Journal

Vol. 28, No. 1, Spring 2000

COGNITIVE-BEHAVIORAL FAMILY THERAPY

WITH A FAMILY IN HIGH-CONFLICT DIVORCE:
A CASE STUDY
Eileen Spillane-Grieco, DSW, LCSW

ABSTRACT: Children who live in families with high-conflict divorce situations are increasingly coming to the attention of clinicians. This paper explains
the nature of the impasse of high-conflict divorce. It presents a brief theoretical
overview of cognitive-behavioral family therapy as an effective approach to treatment for high-conflict divorce families. A case study that successfully utilized a
cognitive-behavioral approach to family therapy is presented. Specific techniques
such as parent training, communication and empathy skills, problem-solving
skills, assertiveness training, role-modeling on the part of the therapist and application of the concept of reciprocal inhibition were included in the cognitive-behavioral family treatment. An N=1 research design is graphically illustrated for
evaluation purposes.
KEY WORDS: high-conflict divorce; cognitive-behavioral family therapy; children of divorce.

As the century turns, it appears that the divorce rate has leveled off
to one out of every two marriages, approximately 50%. This figure is
no longer staggering to the American population. The idea of marriage
returning to its success rate of 70% that was true in the 1950s has been
all but abandoned. It appears the average American will marry at least
twice. If second marriages are the norm for the 21st century, people will
need to adjust emotionally to this change. Good divorces will need to take
precedent over bad divorces. Currently, at least one out of four divorces
are considered high-conflict divorce (Macoby & Mnookin, 1992). These
statistics have been criticized by some because they have been accrued
by clinicians in the mental health field working with parents and children
of high-conflict divorce situations. High-conflict divorce is a situation
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where the ex-spouses continue to be locked into a serious feud that at

times becomes physically violent. The children of these divorces continue
to experience tremendous turmoil throughout their lives. Two years is the
approximate time set-aside after divorce for the ex-spouses and children as
well as extended family members to adjust to a divorce. Many divorces,
however, continue to endure conflict well beyond two years (Hetherington,
1989).
The children of high-conflict divorce are visible to many people. Relatives, friends, teachers, neighbors, and other social acquaintances have
observed the saga of these children. These children are at-risk. A major
part of their social environment, their divorced parents, are in constant
conflict and therefore not providing the care and support the children
need to grow in an achieving capacity with self-esteem. They suffer from
depression, have difficulty with friendships and other intimate relationships, display acting out behaviors, develop substance abuse problems
and other problems of a clinical nature such as personality disorders.
This paper will give a short summary of the theoretical explanations
of why two people continue to invest in conflict years after the divorce in
the section, high-conflict parents. A short summary on cognitive-behavioral family therapy is included as an effective approach to treatment of
high-conflict divorce. Finally, a case study that had success using a cognitive-behavioral approach to family treatment with a family in high-conflict
divorce is presented.
HIGH-CONFLICT PARENTS
The people who are being described here are ex-spouses who are very
angry with each other. They continue to be in conflict with each other
years after the expectable time for this type of agitated behavior. Johnston
and Roseby, experts in this area, encapsulate this population as follows:
In sum, high-conflict parents are identified by multiple, overlapping criteria: high rates of litigation and relitigation, high degrees of
anger and distrust, incidents of verbal abuse, intermittent physical
aggression, and ongoing difficulty in communicating about and cooperating over the care of their children at least two to three years following
their separation. Probably most characteristic of this population of
failed divorces is that these parents have difficulty focusing on their
childrens needs as separate from their own and cannot protect their
children from their own emotional distress and anger or from their
ongoing disputes with each other. (Johnston & Roseby, 1997)

There are certain aspects of the separation itself that effect the divorce. For example, an abrupt ending of the marriage decided upon by
one spouse without the knowledge of the other spouse can be devastating

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and can cause deep emotional resentment on the part of the unknowing
spouse. A sudden announcement of an affair or the decision of one spouse
to leave the other because he/she has fallen in love with another person
is especially difficult for the unknowing spouse. There is a tremendous
sense of betrayal. Many high-conflict divorces that come to the attention
of clinicians have ended in this way. The resentment and distrust is
carried over into the divorce situation for years.
The litigation over the divorce also causes anger and resentment that
contribute to high-conflict divorce. Allegations that were made and certain
things that were said at the time of the divorce proved to be very painful
and hurtful and are not forgotten. The time and the money involved in
the litigation can cause deep and lasting scars. Relitigation is often an
ongoing part of the ex-spouses relationship.
Johnston et. al. described the parental conflict as an impasse of divorce. They refer to three levels of the impasse: external-social; interactional and intrapsychic levels (Johnston et al., 1985). The external-social
level is fueled by the stress of external events (job loss, divorce settlements)
and social networks (friends, family, lawyers, court). The interactional
level is where the individuals have learned to provoke an interlocking
pathology which results in relitigation stalemates whenever they attempt
to make post-divorce plans for their children. The external-social and
interactional levels of impasse often occur concurrently with parents in
high-conflict divorce. Social networks, that is, lawyers, friends, family
members and the court often support the stalemates that the ex-spouses
get into. Each ex-spouse is empowered by his/her social supports and that
support network in turn intensifies the stalemate. The intrapsychic level
involves the pathology of the individual, such as mental illness and substance abuse. This level of impasse is much easier to assess because the
individuals symptoms and behaviors are readily observable to mental
health professionals and sometimes to the court; therefore in many cases
appropriate custody and visitation procedures can be put into place without continuous relitigation. The individuals who are locked into conflict
with each other years after the divorce appear separately as well adjusted
people and caring parents. It is their relationship with each other that
is pathological.

COGNITIVE-BEHAVIORAL FAMILY THERAPY

The cognitive-behavioral approach to families is concerned with the
cognitions, beliefs, perceptions and behaviors of individual family members, and how they influence the functioning of the family. Behavior,
cognition, and personal factors (emotion, motivation, physiology, and
physical factors) and social/environmental factors are considered to be

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interactive, overlapping, and mutually influential on human behavior

and family functioning (Granvold, 1994). This notion is referred to as
reciprocal determinism, a concept of systems theory. Cognitive-behavioral
family therapy is compatible with systems theory. It is apparent that
the conflict situations in high-conflict families are supported by many
extraneous environmental factors as well as internal factors of the family
and individual family members. Therefore a systemic form of treatment,
such as cognitive-behavioral family therapy is appropriate.
Cognitive-behavioral family therapy is concerned with the current
interactions of the family members. Within this framework, family relationships, cognitions, emotions, and behavior are viewed as exerting a
mutual influence on one another, so that a cognitive inference can evoke
emotion and behavior, and emotion and behavior can likewise influence
cognition (Nichols & Schwartz, 1998). While family history and the past
are not the focus of cognitive-behavioral family therapy, an individuals
development is reflected in the concept of cognitive structure or schemata.
How someone perceives an event is influenced by his/her development
and social/physical environment. How a person attaches meaning to an
event is based on previous experiences. A person has a structure or schemata for the arrangements of perceptions and beliefs. The structure or
schemata is initially formed during childhood. Elements of the impinging
environment help to shape the individuals schemata. Elements such as
race, ethnicity, culture, religion, class, gender, parent-child discipline, and
so on inform the individuals schemata. Events are then given meaning by
the individual based on this structure or schemata. Schemata can be
problematic if they are influenced by prejudices and/or misinformation,
such as the belief that women are inferior to men. If that belief is part
of the individuals schemata then the thought of any woman is that she
is inferior. Some schemata are held to very strongly by the individual
and some not so strongly, so they can be challenged.
A crucial piece to cognitive-behavioral therapy is measurement. Cognitive-behaviorists begin and end treatment with assessments and measurements. The measurement instruments and their outcomes often play
a vital part in the therapeutic process. This use of an observable measurement of the problem or the observable measure of the desired outcome is
not foreign to medicine. Taking a patients temperature, for example, or
cholesterol level and then intervening to bring down the temperature, or
bring down the cholesterol level with proper diet and medication, and
then measuring again allows the patient to be aware of the improvement
or lack of improvement. The patient with high cholesterol can be instructed in self-care in order to assist the doctor in effecting the desired
outcome. The patient joins the doctor in the treatment. Cognitive-behavioral family therapy includes the family in the treatment by using observ-

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able measures and interventions that can be taught and practiced in the
family therapy situation.
Cognitive-behavioral family treatment seemed to be the correct approach with this family for several reasons. There was a conflict between
Mr. Pello and his thirteen year-old daughter that stemmed from his background as an American-Italian male. His view of women and how women
were to be treated in the 90s and his daughters view were literally a
generation apart, maybe more. Mr. Pello was very conservative in his
thoughts about women, their place in society, and the bringing up of
daughters in contemporary society.
Cognitive-behavioral therapists believe that attribution shifts are
necessary to make behavior change possible, but that, in turn, behavior
change is necessary to reinforce new and more productive attributions
(Nichols and Schwartz, 1998). Attributions can be explained as causes
for human behavior. With the linear thinking notion, people look for why
something occurs. They assume that there is a reason for the behavior,
and they like to discover the cause and label it as something. Madelyn
viewed her father as conservative and dictatorial, therefore she attributed
his behaviors and opinions to his conservatism. Mr. Pello viewed Madelyn
as disobedient with poor impulse control. He added, shes a lot like her
mother. Therefore he attributed her behaviors and opinions to her impulsiveness and her being just like her mother. Madelyn and her father
attributed causes to each others behaviors that precluded change or improvement. Their views needed to be challenged for behaviors to change
and for family functioning to improve.
This family, as is often the case with many families, lacked good
communication skills. Communication skills, the ability to talk, empathy
and the ability to be empathic are behaviors that are crucial to healthy
family functioning. Family members are taught in cognitive-behavioral
family therapy to be specific, phrase requests in positive terms, respond
directly to criticism instead of cross-complaining, talk about the present
and future rather than the past, listen without interruption, minimize
punitive statements, and eliminate questions that sound like declarations
(OLeary & Turkewitz, 1978). They are encouraged to think about what
an event means to another person, to put themselves in the shoes of the
others, to empathize.
Problem-solving skills are especially important to cognitive-behavioral family therapy. To be able to focus on the problems at hand and to
develop goals and strategies to reach these goals is extremely important.
Family members are supported in communicating their feelings and
thoughts about behaviors of other family members, and they are allowed
to request changes in behaviors of other family members. They are encouraged to express their feelings as requests rather than attacks, successful

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family members listen to other family members points-of-view and attempt to understand whats being said (Nichols & Schwartz, 1998).
The cognitive-behavioral family therapist is attempting to restructure distorted beliefs and increase successful behaviors for family functioning. She is utilizing techniques, such as challenging views with specific questions, feedback, information giving, modeling, role-playing, and
evaluation.

TREATING A FAMILY IN HIGH CONFLICT DIVORCE

A CASE STUDY
Presenting Problem
The family consists of a father who was immersed in a moderately severe
divorce conflict with his ex-wife for over five years and his two daughters. Moderately severe is the fourth category of conflict divorce as rated on a scale (Conflict
Assessment Scale) developed by Garrity and Baris (1994) that utilizes five categories in determining the extent of conflict in divorces. The scale is rated from the
least amount of conflict between parents to the most severe; the first category is
minimal conflict, and the fifth is severe conflict. The fourth category, moderately
severe, describes the child as not being in direct danger, but the parents are
endangering to each other, threatening violence, slamming doors, and throwing
things. They are verbally threatening harm or kidnapping of the child, and there
are attempts to form a permanent or standing coalition with the child against the
other parent. Contrary to Garrity and Baris opinion, professionals are currently
evaluating the probable existence of danger for the child with moderately severe
conflicting parents, even though it appears either parent is not directly threatening
the child. The father, Mr. Pello, made the appointment for Madelyn, his daughter,
to see me. Madelyn was thirteen years old. She was from an upper-middle class
family, Italian-American ethnicity and Catholic. She had been living with her
mother for the past five years after her parents divorce. She recently moved in
with her father, and he said he wanted her to be able to discuss her situation
with a clinical person. He wanted her to be sure she was making the right decision
to come and live with him. The marriage between her father and her mother had
ended abruptly when the mother left her husband for another man. The mother
married this man and divorced him within the next five years. She remained
entangled in conflict with her first husband. While Mr. Pellos motivation for
counseling for his daughter was to help her think through her decision to live
with him, he was also interested in having his daughter speak to a professional
person, who at a later date might be subpoenaed to court with information and
expert opinions that could be used to support his side of the conflict with his exwife.
Madelyn has a younger sister, Maggie who was nine at the time of this case.
Maggie and Madelyn share the same biological parents. The parents did not have
any other children. At the time that Madelyn began counseling, her mother was
living with her boyfriend who was soon to become her mothers third husband. I
told Mr. Pello that I would like to see the family, because I saw this situation as
a family crisis. I asked him to come and bring both of his daughters. I also told

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him that I would like Madelyns mother involved in the treatment. He did not
have a problem with the family treatment, but he asked that his ex-wife come at
different appointment times than his. I thought that was reasonable since their
relationship was hostile, and I did not think it would be therapeutic to allow their
conflict to be acted out in another place. My experience with bringing high-conflict
ex-spouses together is that their uncontrollable impulses to argue and fight erupt
almost instantaneously and their fight takes precedence over any concerns or
issues about their children. Mrs. Smith, the mother, was not interested in coming
in for sessions with her daughters when I asked her. She thought her oldest
daughter had been brainwashed by her father. She did not object, however, to
my seeing her daughters.

Ecological Assessment
At the first meeting, I interviewed Madelyn for a while by herself so that
she could feel free to explain her situation to me. Madelyns problems included
difficulties living in her mothers home with her mother and her mothers boyfriend
constantly saying demeaning things about her father. The children, Madelyn and
Maggie, were in a joint custody situation with primary residential custody being
with the mother. Madelyn also complained of having to endure embarrassing
situations at her school when there were parent conferences or school games
because of her parents hostile behaviors toward each other. She was a cheerleader
and basketball player. She wanted only one of her parents to be able to attend
her games and conferences. Because of her disillusionment with her mothers new
relationship with her boyfriend, Madelyns preference at this time was to have
her father present. Madelyn attended a private, Catholic school where she experienced a good deal of success. So her relationship to school was a strong one as
compared to other systems in her life.
Madelyn felt her life had been unstable because of the environment in her
mothers house. No one there apparently supervised homework. In the past month
that she was living at her fathers house, her grades had improved. She said the
constant put-downs of her father by her mother and her mothers boyfriend were
very hurtful. She reported that her mother slept much of the time, and her
boyfriend told the girls that their mother was sick mostly due to the strained
relationship with their father. This made Madelyn feel guilty and increased her
feelings of responsibility for her mothers well being. Maggie, the younger sister
was cared for in the home by the maternal grandmother. Madelyn reported, Its
not as bad for Maggie because they dont tell her as much, and Grandma treats
her like a baby.
Madelyn loved her mother. She also feared for her safety. Madelyn thought
her mother was taking too much prescription medicine. Madelyn felt helpless and
wanted to continue to live at her fathers house in order to have a normal life.
She wanted to visit her mother every other weekend, like a normal divorce.
When I asked the father to join us I learned that there were many relitigation
disputes between the father and mother over the past five years. The police in
both towns where the parents lived had been called many times to alleviate the
trouble caused by conflicting parents when they met in order to transfer the girls
for the sake of visitation. Each parent had a restraining order on the other parent.
Madelyn was allowed to move in with her father, mostly because the mother felt
helpless to stop her. She resented her daughter for this transfer of environment
that she saw as a transfer of loyalty. The mothers reaction included a tighter

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hold on Maggie. Maggie who was also present at the interview reported that now
she started to hear the negative statements about her father. Madelyn voluntarily
told her father that at his house, she was tired of hearing how sick her mother
was. Madelyn was functioning well at school in the midst of all this family chaos,
and she was able to maintain friendships. She reported having many friends.
Friends were never invited, however, to either of the homes of her parents. Madelyn went to visit her friends, and she reported that she never spoke about her
parents to her friends. Her friends, she said, understood how terrible her life was
with her parents. Maggie agreed that her friends were not invited over either
because it could be embarrassing.
According to Piaget, Madelyn had reached the final cognitive stage of development, formal operations (Piaget & Inhelder, 1969). This stage begins to appear
in puberty from about 12 to 15 years of age. An adolescent can now think conceptually and abstractly. Madelyn was able to recognize that her parents behaviors
were inappropriate. She could understand that some of their decisions concerning
her and her sister had more to do with their conflict than the girls well being.
For example, Madelyn had a midweek visitation with her mother and sister. Often
her mothers boyfriend would pick her up and take her to her mothers house.
Conflict began right there because neither Madelyn nor her father wanted her to
be in the car with her mothers boyfriend. Her mother would not be feeling well,
and she would stay in bed during the time of the visit. The two sisters would
watch TV and eat pizza. Madelyn complained that she would rather stay home
and do homework or take care of other things in order to get ready for school if
her mother didnt feel well and needed to rest. Madelyn understood that her
mother would not allow her to stay at her fathers house on these evenings even
if she was sick. Because, to her mother, that would mean, giving her father
more time to be with Madelyn. Madelyn argued that it was really giving her time
to do what she needed to do for school, but neither parent could see her point-ofview on these issues due to their embroiled hostility and conflict.
Maggie at nine years of age was not yet thinking on this level. She was still
at the concrete operational level. She would watch TV and eat pizza. She seemed
to accept the terms and the atmosphere provided by both parents. She just didnt
like talking about it, the divorce. She also didnt like the scenes when the
police would have to come. She didnt like seeing either of her parents standing
in the office at her school, although she wasnt thinking about why they were
there. She just didnt like seeing them there because no one elses parent goes
to the office. It made her different. She wanted to be like everyone else.
Madelyn was conceptually aware of the extent of the anger and hostility
her parents had for each other. She had tried for years to help work things out.
She had come to the rightful conclusion that she could not stop the turmoil between her parents. She rarely took sides, except when she felt she had to. She
displayed a good deal of emotional intelligence, and I supported this strength
(Saleeby, 1996). Madelyn had many friends, and she cared about her friends. She
displayed emotional intelligence in this area of her life as well (Goleman, 1995).
Her friends often talked things over with her, and she could patch up fights
between friends.

Method of Evaluation
Madelyn had been feeling depressed for more than a year. While feeling
depressed, she had symptoms of overeating and feelings of hopelessness. No major

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depressive episode had been present over the past two years. Her ability to perform
in school and maintain friends showed that she was not in a major depression. I
decided to focus on increasing hope rather than focus on overeating. Her eating
habits were not entirely out of control, and I thought that focusing on eating
with a thirteen-year-old might increase the symptom rather than decrease the
symptom. The notion of equifinality, that is, the tendency towards a characteristic
final state from different initial states (Bertalanffy, 1968), lent support to my
thinking that if Madelyn could feel more hopeful she would gain more control of
her eating habits. I had Madelyn take the (HSC) Hopelessness Scales for Children
(Kazdin et al., 1983). The scores for this self-test range from 017, with the higher
score indicating greater hopelessness and depression. Madelyns score at this time
was 12. Twelve is indicative of extensive feelings of hopelessness.
Her father revealed that Madelyn acted out occasionally with self-destructive
habits. She smoked cigarettes and stole small things from stores. She always
got caught. Mr. Pello was a second generation American-Italian. He had rules
and regulations and was very protective of his daughters. Madelyn would sit on
the roof of her house just above her bedroom window and smoke a cigarette. Mr.
Pello would pull in the driveway from work and see her. She was angry with her
father about the divorce situation and some of his rules, but talking to him had
never helped. She was doing things to annoy him. Another example of her acting
out to annoy her father was that Madelyn was caught shoplifting by her fathers
girlfriend, Nancy. Nancy took Madelyn shopping and, she saw her put a package
of gum in her bag that she did not pay for. Nancy, of course, told Madelyns father.
He was furious.
It was apparent that there were problems between the father and his daughter. I decided that one focus of therapy would be to foster better communication
between them so that Madelyn would primarily be able to talk to her father and
secondarily eliminate the self-destructive behavior. In an attempt to make a more
accurate assessment and to be able to explain the method of treatment to the
family with empirical support, I asked both Madelyn and Maggie to fill out the
(CAF) Child Attitude Toward Father Scale (Hudson, 1992), and I asked Mr. Pello
to fill out the (IPA) Index of Parental Attitudes (Hudson, 1992). Madelyns score
on the CAF scale showed that she had difficulties with her relationship with her
father. Her first score was 52. Maggies score was 25. It did not indicate difficulty.
Mr. Pellos scores on the IPA did not reveal any difficulties with his daughters.
The scores on both these instruments range from 0100, the higher scores are
indicative of problems in the parent child relationship. Scores of 30 (plus or minus
5 points) and less indicate absence of a clinically significant problem in this area.
Mr. Pellos scores were 13 on his parental attitudes toward Madelyn and 11 on
his parental attitudes toward Maggie. His responses showed that he valued his
daughters, and he valued his relationship with them. He had a strong commitment
to his daughters. This evidence of a very favorable parental attitude toward his
daughters by the father contradicted some of his verbal communication, at least
with Madelyn.
As well as using self-report evaluative methods of measurement, I collected
data on certain behaviors. The behaviors that were monitored included: Madelyns
self reporting on her smoking habits, monitoring of her grades in order to observe
continued performance in school, Mr. Pellos positive or benign interactions with
his ex-wife as well as his conflicting interactions with his ex-wife. Another measurement was both girls evaluation of their ability to be assertive with each of
their parents. More than one method of measurement is required to evaluate
effectiveness.

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Intervention
I decided to use the very positive outcome for Mr. Pello on the measurement
instrument (IPA) as part of the therapeutic treatment. It became my hypothesis
that he could not love and care for his daughters to the degree that he apparently
did at the same time that he was investing energy into the pathological relationship with his ex-wife, the notion of reciprocal inhibition (Wolpe, 1969). I explained
the concept of reciprocal inhibition to Mr. Pello. Basically I explained that a person
could not experience two directly opposing thoughts and feelings at the same
time, in his case love and disdain. The theory states the more positive thought will
become dominant, and the person therefore will eliminate the negative thought. He
agreed intentionally to try to shift his thinking from intense feelings of betrayal
and anger toward his ex-wife to his intense feelings of love and caring that he
had for his daughters. His outstanding scores on Hudsons parental attitude scales
were objective pieces of evidence of his commitment as a parent.
It was important for Mr. Pello to understand that being a good parent to his
daughters meant more than providing for them materially. Using the concepts
from social learning theory, I sometimes taught Mr. Pello parenting skills and
often modeled the behaviors (Bandura, 1977). He was well aware that their family
situation was dysfunctional, however, he was not assuming enough responsibility
for his share of the turmoil. Rather than emphasizing what he was doing wrong,
I taught him what he could do that was right and reinforced everything he was
doing that was right. I talked to him about effective parenting (Polster, 1989).
Specifically, I emphasized such parental behaviors as making requests when
Madelyn or Maggie were paying attention, not for example, when they were
talking with friends or watching TV, making eye contact with them, requesting
rather than demanding, explaining why and reinforcing the desired behavior.
Often a parent will request something of a child or require a certain behavior
from a child based on a value that the parent believes to be important. When
children understand why the parent is requesting the behavior, they learn values.
For example, if the parent requests Bs in school performance, it is because the
parent values education. If the parent requires the child tell the truth, it is because
the parent values honesty. Explanations give children feelings of importance and
allow them to learn values. I also explained to Mr. Pello that the best reinforcers
are social reinforcers. His approval shown by a hug, his time, attention, or praise
from him is far more reinforcing than material items.
I used myself as a role model for good listening skills and negotiating with
a teenager. I had the family focus on empathic understanding as a dynamic in
healthy relationships (Rogers, 1980). We practiced empathy skills. I asked the
girls questions such as, how do you think your father feels right now? Can you
put yourself in his place and talk about how he must be feeling? Or to Mr. Pello,
how do you think Madelyn felt when her parents engaged in an argument at
McDonalds that resulted in the police being called? Can you talk about what that
must have been like for her?
In the family sessions, Madelyn and Maggie were encouraged to speak assertively to their father. The girls needed him to listen, and he needed to hear them,
particularly Madelyn at this point in time because she had more to say than
Maggie did, and she was beginning to lose her voice (Gilligan, 1982). Studies
from Harvard University conducted by Gilligan and her colleagues have demonstrated that girls who at younger ages are opinionated and assertive begin to lose

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their voices by prepuberty because the dictates of society both verbal and nonverbal
encourage them to be socialized into more subservient positions in society. As
they grow, girls begin to say what they are expected to say in order to be considered
a desirable female in society (Brown & Gilligan, 1992). Many women do not
understand the dynamics of this process, but experts in social justice consider it
a form of socialization into oppression (Guiterrez, 1996). Guiterrez cites women
as one of four major oppressed groups in society. I encouraged Madelyn and
Maggie to speak without blaming or apologizing, to speak assertively. They needed
their father to acknowledge their voices in order to help them continue to develop
self-worth and be assertive. Although Maggie did not claim to be experiencing
Madelyns struggles with their parents, I knew that facilitating a better relationship between Madelyn and her father would have a positive reverberating effect
on Maggie and her relationships in the family as well (Bevcar & Bevcar, 1996).
It was difficult for Madelyn to talk with her father. He was a successful
businessman, smart and somewhat chauvinistic. He was the only son of a first
generation Italian-American family who was named after his father. His father
died when Mr. Pello was thirty-eight years old. He was forty-three at this time.
He took care of his mother and sister. He owned his own business. His girlfriend
worked in his office. For a contemporary man his thinking about women was old
fashioned and very much influenced by his Italian-American cultural background
and ethnicity (McGoldrick et al., 1982). I challenged his thinking or schemata by
asking him questions about his daughters opinions, and whether their opinions
were important to him? He replied that they were important. He also had high
hopes for their futures; for example, college educated women with careers. He
began to see that some of his current thinking did not support his hopes for their
futures. His daughter, Madelyn, was a challenge for him. Madelyn would get
frustrated trying to express her thoughts and feelings. The family therapy sessions
reinforced her efforts. Sometimes father and daughter would lock into an argument
and neither would back down. Mr. Pello started to see his own stubborn trait in
his daughter. He was proud of her stubbornness. He began to listen. He learned
to hear her. He understood the concepts that were being presented in the family
therapy treatment. He was a businessman who was interested in outcomes, and
he could see that things were changing for the better. He knew the skills being
emphasized in the family treatment were making a positive difference with his
family.
We discussed problem-solving skills and practiced them. We used a basic
problem-solving model of defining the problem, specifying a goal, generating different solutions, and then trying out each solution for the problem with respect to
the desired goal. For example, Madelyn and Maggie were complaining that their
mother expected them to call her every evening. The girls said that they felt guilty
if they did not, but often their mother would get on the phone and complain,
and they did not always want to be subjected to her complaints. Mr. Pello was
encouraging them to call their mother. He said it was respectful. So the problem
was specified as the daily phone calls to their mother were upsetting to the girls.
The goal was to be able to communicate with the mother and be respectful. They
generated different ideas for solutions and tried out each idea, deciding whether
that solution would allow them to communicate with mother and be respectful.
Madelyn and Maggie decided to alternate nights calling their mother. Madelyn
said she would talk to her mother about not complaining each time one of them
called. She asked her mother to focus on what the girls were doing and to try to
stay positive.

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Evaluation
Cognitive-behavioral family therapy is an effective treatment particularly in
regard to the time constrictions with managed care. The time limit with this
family was eight sessions. I administered the Hopelessness Scale and CAF Scale
to Madelyn two more times, at four weeks and at the last session. Her scores
went down as can be seen on graphs 1 and 2, indicating improvement. The purpose
of the first family session was to do an ecological assessment (Germain & Gitterman, 1996). Assessment is always an ongoing process and continued into the
second session, but the cognitive-behavioral interventions also began in the second
session. In the graph, B (intervention) begins in the second week. Madelyns scores
on the Hopelessness Scale improved. She went from twelve on the feeling of
hopelessness to a six. This improvement is significant; however, six does not
suggest that she is feeling very hopeful all the time. My clinical impression is
that Madelyn was feeling more hopeful, but she proceeded with caution. She had
been part of an embroiled high-conflict divorce for five years, and six to eight
weeks of change was not a long enough time for her to feel confidently hopeful.
Her behaviors of smoking and shoplifting had terminated. From self-reports from
the girls and observations from Mr. Pello, both Madelyn and Maggie were more
assertive with their father and mother.
Madelyns attitude toward her father as indicated on the CAF had improved.
She went from a high score of 52 to 35 and then 28. Mr. Pello reported that he
had stopped all litigation against his ex-wife. He was encouraging Madelyn to
call her mother on a daily basis. He and his daughters reported that he was not
engaging in any hostile exchanges of remarks at the time of visitation. Mr. Pello
retained his disciplinarian parental role, while allowing his daughters, particularly his teenage daughter, Madelyn to negotiate on different issues.

Graph 1 Hopelessness Scale.

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Graph 2 Childs Attitude Toward Father.

CONCLUSION
I think the primary issue for a clinician in trying to help families
that are involved in high-conflict divorce situations is to focus on the
clinical issues of family development. The family needs to reestablish
itself after the divorce process. The process involves disorganizing the
nuclear family and reorganizing it into a binuclear family. The binuclear
family consists of two households or subsystems, maternal and paternal,
which then form the nuclei of the childs family of orientation (Ahrons,
1979). The bonds created by families joined through marriage are similar
to the bonds of the divorced family. In both types of families, a child gives
rise to the continuing bond. The style of relationship within the divorced
family is usually based on the nature of the relationship between the
divorced spouses (Ahrons, 1999). The clinician is sometimes enticed to
get involved in the parents ongoing conflict, but very often then the
clinician becomes another person who adds to the conflict in one form or
another. The bottom line here is that each of the parents will always be
a parent to the child. Even after the years that the child is in a custodial
relationship with the parents, the parent-child relationship will continue.
This issue is important for the ex-spouses to keep in mind. The child
should not be put in the position of making a decision of one parent over
the other. Each parent is part of the childs family, and those relationships
need to be nurtured through the difficult period of time of the divorce
into the next phase of the binuclear family.
From this case study, it appears that cognitive-behavioral family
therapy is an effective treatment for families involved in high-conflict
divorce. Having the parent substitute positive thoughts concerning his

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love for his children for negative thoughts concerning the ex-spouse was
effective in this case. The notion of reciprocal inhibition proved to be
effective in this situation. Having one parent disengage from the conflict
resulted in the conflict subsiding. The feelings of hopelessness experienced
by Madelyn decreased with her parents ability to behave more appropriately toward each other. The family therapy sessions that focused on
effective communication, empathic understanding and negotiation had a
demonstrable effect on the level of functioning of the family members.

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Eileen Spillane-Grieco, DSW, LCSW

2530 Algonkin Trail
Manasquan, NJ 08736