Chapter 12



Chapter 12

Family Counseling

CHAPTER OVERVIEW

The focus of family counseling is on the family and its members’ interactions and relations. The family is defined as an organizational structure that is characterized by degrees of cohesiveness, love, loyalty and purpose as well as high levels of shared values, interests, activities, and attention to the needs of its members. Families may be considered a system, organized wholes or units made up of several interdependent and interacting parts. Family therapists work with the present relationships rather than the past. They are interested in the balance families maintain between bipolar extremes that characterize dysfunctional families.

CHAPTER OBJECTIVES

After completing this chapter, the student will be able to:

1. Explain the philosophical assumptions of the schools of family therapists.

2. Describe the view of human nature, innate drives, and tendencies among humans that are the beliefs of family therapists.

3. Explain the etiology of maladaptive behavior according to family counselors.

4. Discuss the necessary conditions under which psychological growth and/or behavior change occur in this approach to therapy.

5. Identify and demonstrate specific procedures and techniques that facilitate constructive change in family counseling procedures.

6. Compare and contrast family counseling with other approaches to therapy.

7. Outline the limitations and contributions of family counseling.

CHAPTER SUMMARY

The focus of family counseling is on the family and its members’ interactions and relationships. Family counseling almost always involves interventions to alter the way an entire family system operates. Family therapists use a circular causality diagnosis that considers roles each person plays in the problem situation.

The family is defined by an organizational structure that is characterized by degrees of cohesiveness, love, loyalty, and purpose as well as high levels of shared values, interests, activities, and attention to the needs of its members. Families may be considered a system, organized wholes or units made up of several interdependent and interacting parts. Each member has a significant influence on all other members. For positive change in an identified client, therefore, family members have to change the way they interact. Family therapists work with the present relationships rather than the past. They are interested in the balance families maintain between bipolar extremes that characterize dysfunctional families.

Murray Bowen, a family therapist, focused on how family members could maintain a healthy balance between being enmeshed (overly involved in each other’s lives) and being disengaged (too much detachment from each other). Self-differentiation was Bowen’s principal goal of family therapy. He focused on four ways of helping families develop individual identities for each member while maintaining a sense of closeness and togetherness with their families. Spousal relationships, de-triangulation, emotional systems, and differentiation are emphasized. Bowen paid attention to the spousal relationship and the definition and clarification of the couple's relationship. He also considered the de-triangulation of self from the family emotional system. Triangulation refers to the practice of two family members bringing a third family member into conflicts.

Understanding family emotional systems and how they work is central to Bowen's theory and he often assumed the role of educator in teaching people about family emotional systems. The nuclear emotional process refers to how the family system operates in a crisis. The family projection process refers to how parents pass good and bad things on to their children. The multigenerational transmission process refers to how a family passes its good and baggage between generations. In teaching clients about family systems and the intergenerational transmission process, Bowen used genograms and questions to move to intellectual levels. The genogram is a generational map of the family that describes who makes up the family, how they got to be family, when members arrived, what they did, what they valued and when they left the family. Finally Bowen would model differentiation to his clients by using "I" statements and taking ownership of his own thoughts, feelings, and behaviors. Self-differentiation was Bowen’s principal goal of family therapy

Structural family therapy also assumes that the individual should be treated within the context of the family system. The overall goal of structural family therapists is to alter the family structure to empower the family to move toward functional ways of conducting or transacting family business and communications. Functional families are characterized by each member's success in finding the healthy balance between belonging to a family and maintaining a separate identity. One way to find the balance between family and individual identity is to define and clarify the boundaries that exist between the subsystems. A family may have several subsystems such as a spouse, sibling, and parent-child subsystem. Each subsystem contains its own subject matter that is private and should remain within that subsystem. Boundaries between subsystems range from rigid to diffuse. Diffuse boundaries can lead to over-enmeshment. Rigid boundaries allow too little interaction between family members, which may result in disengagement. Families who understand and respect differences between healthy and unhealthy subsystem boundaries and rules function successfully. Families who do not understand and respect these differences find themselves in a dysfunctional state of conflict.

Salvador Minuchin is considered the founder of structural family therapy as it is practiced today. Most of what he learned was by observation and in collaboration with colleagues at a school for delinquent boys. He has been praised for rescuing family therapy from intellectuality and mystery. His pragmatic approach contributed both to understanding how families function and to productive interventions for correcting malfunctions in the family system. His style was to get the family to talk briefly until he identified a central theme of concern and the leading and supporting roles in the theme. Next he examined boundaries or family rules that define the participants, the areas of responsibility, the decision making and privacy rules. The idea is to change the immediate context of the family situation and thereby change the family members’ positions. His approach was both active and directive. He would shift the family focus from the identified client to the therapist to allow the identified client to rejoin the family. When treatment is complete, the therapist moves outside the family structure and leaves the family intact and connected without the loss of individual family member identities.

Milton Erickson, Jay Haley, and Cloe Madanes are leaders of strategic family therapy. This type of family therapy is based on the assumption that family member behavior is ongoing and repetitive and can be understood only in the family context. Strategic refers to the development of a specific strategy, planned in advance by the therapist, to resolve the presenting problem as quickly and efficiently as possible. This brief therapy may be characterized by the highly active therapist who gives specific directives for behavior change that are carried out as homework assignments. Paradoxical interventions are often used to harness the strong resistance clients have to change and to taking directives. Clients may be asked to intensify the problem as one way of using paradox. Another way is for the therapists to take a "one-down" position, encouraging the client not to do too much too soon. Counselors must differentiate between first-order and second-order changes. First-order change occurs when the symptom is temporarily removed, only to reappear later because the family system has not been changed. Second-order change occurs when symptom and system are repaired and the need for the symptom does not reappear.

Communication approaches to family therapy include John Gottman's behavioral family therapy and Virginia Satir's conjoint family therapy. Family therapists following a communications approach to family therapy hold the view that accurate communication is the key to solving family problems. An open and honest manner of communicating rather than using phony or manipulative roles characterizes good problem-solving families. Gottman built his approach on matching intent and impact of communication. He used a behavioral interviewing method to teach people about what they are doing that is not working and to help them correct the situation by learning how to get the impact they want from their communication. His stages include 1) exploration, 2) identification of goals, 3) perceptions of issues, 4) selection of one issue for discussion, 5) an analysis of interactions, 6) negotiation of a contract.

Virginia Satir considered herself a detective who helps children figure out their parents. She thought 90% of what happens in a family is hidden. The family's needs, motives, and communication patterns are included in this 90%. She believed that whatever people are doing represents the best they are aware of and the best they can do. She considered people geared to surviving, growing, and developing close relationships with others. Self-esteem plays a prominent role in Satir's system. She viewed mature people as being in touch with their feelings, communicating clearly and effectively, and accepting differences in others as a chance to learn. She believed the four components in a family situation that are subject to change are the members' feelings of self-worth, the family's communication abilities, the system, and the rules of the family. The three keys to Satir’s system are to increase the self-esteem of all family member, help family members better understand their encounters and use experiential learning to improve interactions.

Communication is the most important factor in Satir's system and determines the kinds of relationships people have with one another and how people adjust. She discussed response patterns to which people resort as a reaction to anxiety. These universal response roles are the placater, the blamer, the computer, the distractor, and the leveler. Leveling helps people develop healthy personalities; all the others hide real feelings for fear of rejection. Satir divided families into two types: nurturing and troubled. Each type had varying degrees. Her main objective for her clients was recognition of their type and then change from type or degree. The counseling method of conjoint family therapy involves communication, interaction, and general information for the entire family. She used several techniques to reach her goals of establishing proper environments and assisting family members in clarifying what they want or hope for themselves and for the family. Her method is designed to help family members discover what patterns of communication do not work and how to understand and express their feelings in an open, level manner.

Simulated family games, systems games, and communication games are some of the methods she developed to deal with family behavior. The counselor's role in this model is of a facilitator who gives total commitment and attention to the process and the interactions. The counselor intervenes to assist leveling and taking responsibility for one's own actions and feelings.

Play therapy with families has the advantage of helping children communicate their story to the therapist. Dynamic family play therapy engages family members in creative activity by using natural play. The counselor’s goal is to help the family develop and increase spontaneity. Filial therapy is a play therapy method based on the principles of child-centered therapy. The goals of filial therapy are to reduce the child’s problem behaviors, to help parents gain the skills of child-centered therapist to use as the parents relate to their children and to improve the parent-child relationship. Strategic family play therapy is a form of counseling in which all family members and the counselor play. Theraplay is a treatment method modeled after the healthy parent-child interaction in which parents are involved first as observers and then as co-therapists.

All the schools of the various family therapies agree that families have interdependent parts in which one malfunction will affect all the other parts. Maintaining balance in ways that are healthy for all members is a common goal of the therapies. Counselors may help in determining safe ways to approach change. Finally, these approaches borrow from other approaches to counseling.

KEY CONCEPTS

1. The individual is considered as part of a family and the interactions and relationships within the family are the focus of therapy.

2. The systems approach to family therapy is focused on how family members can maintain a healthy balance between being enmeshed and being disengaged.

3. Structural family therapy is based on the idea that the family is an evolving, hierarchical organization made up of several subsystems with rules and behavior patterns for interacting across and within those subsystems.

4. According to structural theorists, defining and clarifying boundaries that exist between subsystems is imperative.

5. Minuchin's approach is directed toward changing the family structure or organization as a way of modifying family members' behavior.

6. Strategic family therapy is based on the assumption that the family's ineffective problem solving develops and maintains symptoms.

7. Conjoint family therapy is based on honest communication, members’ feelings of self-worth, and the rules of the family.

8. Some of the family play therapy approaches include dynamic family play therapy, filial therapy, strategic family play therapy and theraplay.

KEY TERMS, CONCEPTS, and PERSONALITIES

Blamer – According to Satir, a person who places blame on others and does not take responsibility for what is happening.

Bowen – A theorist who studied family relationships. Bowen’s task was to help family members integrate independence while maintaining a sense of familial unity.

Cloe Madanes – A leader of strategic family therapy.

Conjoint family therapy – The involvement of two or more members of a family in therapy at the same time.

Differentiation – The ability of an individual to separate rational and emotional selves.

Disengagement – Detachment among family members.

Enmeshment – Over involvement in the lives of family members.

Growth model – One of Satir’s games for training which assumes that an individual’s behavior changes due to interactions with other people.

Jay Haley – A leader of strategic family therapy.

Leveling – Communication in which genuine expression’s of one’s feelings are made in an appropriate context.

Medical model – One of Satir’s games for training which purports that the cause of the problem is an illness of the individual.

Milton Erickson – A leader of strategic family therapy.

Paradoxical intervention – A technique in which the therapist allows the family to do what they were going to do anyway as an attempt to lower familial resistance to therapy and increasing the possibility of change.

Placater - According to Satir, an individual who avoids conflict at the cost of his/her integrity.

Resistance – Anything that a family does to oppose or impair the therapeutic process.

Salvador Minuchin – The founder of structural family therapy.

Sculpting – An experiential technique in which family members are posed into positions which symbolize the actual relationship that members have with each other.

Sick model – One of Satir’s games for training which proposes that the individual’s thinking and attitudes are wrong and must be changed.

Strategic family therapy – Family therapy in which the focus is on changing behavior through manipulation.

Structural family therapy – Family therapy in which a member’s symptoms are best understood in the context of the entire family. A change in the family structure must take place in order to alleviate symptoms.

Triangulation – A situation in which two family members involve a third family member in a conflictual scenario.

Virginia Satir – Founder of family communications theory and conjoint family therapy.

REVIEW QUESTIONS

1. A system is defined as:

A. the way people relate to other people and institutions outside the family.

B. the feelings and beliefs family members hold about one another.

C. an organized whole or unit made up of several interdependent and interacting parts.

D. the interaction between a therapist and the members of a family.

2. Families struggle to find a balance between , or over-involvement in each other’s lives, and , or too much detachment from each other.

3. Murray Bowen focused on all of the following except:

A. knowledge of emotional systems.

B. parenting skills.

C. detriangulation of self.

D. spousal relationships.

4. Match the following terms with their definitions:

a. differentiation within self

b. triangulation

c. modeling

d. tracking

e. paradoxical intent

A. Technique in which therapist uses client’s resistance to bring about changes in behavior.

B. Process in which two family members bring a third member into conflict situations.

C. The ability to separate feelings from thoughts.

D. Technique in which therapist demonstrates an interest in the family by asking questions relating to topics they bring up.

E. Technique in which therapist’s actions provide an example of appropriate interactions for the family.

5. In the space beside his or her names, write the family therapy approach each person is associated with.

A. Virginia Satir

B. Cloe Madanes

C. Salvador Minuchin

D. Murray Bowen

E. Jay Haley

6. The ultimate goal of structural family therapy is:

A. to help the individual come to terms with the family.

B. to alter the family structure so as to enable the family to move towards more effective coping mechanisms.

C. to diagnose the family’s problems and prescribe a solution.

D. to raise the self-esteem of all family members so as to facilitate better communication and relationships.

7. was instrumental in developing family therapy as it is known today.

8. When both the symptom of the problem and the family system are repaired, this is known as:

A. brief therapy.

B. first-order change.

C. second-order change.

D. communication.

9. Which of the following is not one of the components of family situations Virginia Satir believed could be changed and corrected?

1 communication

A. family rules

B. family roles

C. self-esteem

10. Match the response patterns below with their descriptions.

a. placater

b. blamer ______

c. distractor ____

d. computer ____

e. leveler __________

A. Guilt-inducer; tries to make others obey them by directing and finding fault

B. Evades the issue in the hope that the problem will go away

C. Super-reasonable; shows no feelings

D. Tries to please everyone- “peace at any price”

E. Consistent, congruent, effective communicator

11. Which of the following is not a characteristic of a healthy family, according to Satir?

A. Family members are comfortable touching each other and showing affection.

B. Family members feel free to express their feelings to each other.

C. Family members value individual rights above all else.

D. Children are valued as important people in their own right.

12. When diagnosing a family’s situation, family therapists utilize:

A. linear causality.

B. cause-and-effect.

C. circular causality.

D. none of the above

13. A family is:

A. a group of people related by blood.

B. made up of a father, a mother, and at least one child.

C. a group of people characterized by organizational structure, cohesiveness, and shared values and interests.

D. none of the above

14. Bowen focused on the aspect of family relations, while Satir focused on the aspect.

A. cognitive

B. behavioral

C. situational

D. affective

15. Before any meaningful change can occur within a family, Satir believed that _______________ must be established.

A. boundaries

B. trust

C. acceptance

D. guidelines

ESSAY QUESTIONS

1. Compare and contrast the following: structural family therapy, strategic family therapy, and conjoint family therapy, with a focus on fundamental theoretical views and specific techniques.

1. Although the theories examined in this chapter utilize different approaches in treating families, all have similar views on the characteristics of healthy families. Based upon what you’ve read, describe the healthy, functioning family.

ACTIVITIES

1. Think of a fictional family (from TV, a movie or a book). Utilizing at least two of the family therapy models. For each model identify the family’s core issue(s) and outline the approach you would take as a therapist subscribing to this model.

2. Using Satir’s five communication types, draw a five-person family in which each communication type is represented. Include specific postures as well as words or statements that describe each type.

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