The world of the Counselor An introduction to the counseling profession 5e chapter 6

Chapter 6: Family Counseling
Chapter 7: Group Work
Chapter 8: Consultation and Supervision

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Couples and Family Counseling

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1800s: Charity Organization Societies and “Friendly Visitors”
worked with poor family
 Led to “social casework” –first time people were viewed
systemically
 Also, around same time, Alfred Adler began to see families
and believed education could help alleviate problems in
children
 Until 1940s, families were generally not seen together due
to pressure placed on therapist from the developing
“individual approaches” to counseling

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A number of approaches developed around the 1950s:
 Psychodyanmic: Ackerman; Boszormeyi-Nagy
 Multigenerational: Bowen
 Palo Alto: Bateson hired Haley, Weakland, Jackson, & Fry
 Looked at communication in systems
 Double-bind theory
 Applied principles of systems and cybernetics
 Out of Palo Alto came MRI
 Jackson, Haley, Satir, Madanes
 Focused on communication and family process

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Soon, people developed own theories
 Satir: Human validation process model
 Haley and Madanes: Strategic therapy
 Whitaker: Experiential approach
 Minuchin: Structural family therapy
 1966: within MRI: Brief Family Therapy Center
 Eventually led to solution-focused family therapy

 1970s: Milan Group
 More recently: Narrative family therapy (White and Epston)

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Today
 Over 50 states have marriage and family licensure
 Two main associations: AAMT and IAMFC (a division of
ACA)
 Accreditation Bodies
▪ COAMFTE
▪ CACREP
Efficacy of family therapy now shown

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Twelve Assumptions Held by Most Family
Counselors (see pp. 192-193)

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Bertalanffy

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Explains the interaction of all types of systems
 Suprasystems
 Subsystems
 Interaction in one system affects all other systems

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Cybernetics
 Control mechanism in systems
 Regulatory process
 Used to avoid disequilibrium in systems
 Acts like thermostat
 See Box 6.1, p. 195

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Boundaries and Information Flow in Family Systems
 Healthy system has semi-permeable boundaries
 Unhealthy: rigid or diffuse boundaries
 (See Box 6.2, p. 196)
 American culture allows for much variability in boundaries
 However, as Box 6.2 shows, too much rigidity or
permeability leads to dysfunction

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Rules and Hierarchy
 Universal rules
 Idiosyncratic rules
 Rules can be overt or covert
 Rules often related to hierarchical structure

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Communication theory
 Watzlawick and others researched communication theory
 See 10 communication tenets, p. 197

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All couples bring unfinished business to relationship
Unfinished business can lead to discontent as couples blame
each other for their projected problems
Family members will sometimes focus on one member
(rather than own problems)
This takes focus off of self or relationship
Families will often bring in the “scapegoat” or IP and state
they “have” the problem

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Stress
 Stressful contact of one member with extrafamilial forces
(e.g., difficulty at work)
 Stressful contact of the whole family with extrafamilial
forces (e.g., a natural disaster such as a hurricane)
 Stress at transitional or developmental points in the family
(e.g., puberty, midlife crises, retirement, aging)
 Idiosyncratic (situational) stress (e.g., unexpected illness)
 See Box 6.3
Developmental Issues: See Table 6.1

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Believes that systems theory and cybernetics places too much
emphasis on causal factors
Social constructionists believe that couples and families “coconstruct” their understanding of who they are
Construction of self occurs through ongoing dialogue and

nonverbal interactions among people and broader culture
Change, therefore occurs through conversation with counselor
Together, counselor and clients co-construct a new meaningmaking system

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Virginia Satir
Humanist, one of the major theorists of 20th century
Primary survival triad
Four universal communication patterns: placater, blamer,
computer, distracter
Congruent, respectful, and caring parents yield healthy
children
Two well-known techniques
 Complete a family life facto chronology
 Family Sculpting

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Salvadore Minuchin
Interactional and Transactional Rules
Boundaries
Structure and Hierarchy
Some Techniques
 Joining
 Mapping
 Restructuring
See Box 6.4, p. 203

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Arose out of Palo Alto Group and work of Milton Erickson
Theorists: Jay Haley, Cloé Madanes, Milan group
Focused on changing communication sequences
No focus on feelings (except to help people feel better)
Concerned with how power is dispersed in families
Focuses mostly on presenting problem
Haley's Stages: social, problem, interaction, goal-setting
Some techniques
 Telling client what to do when (when client will do it)
 Telling them what to do when knowing client will rebel
 Giving a metaphor (see quote, bottom of p. 205)

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Boszormenyi-Nagy
• Ways of relating passed down
• Loyalties, Ledger of indebtedness and entitlements
 Murray Bowen
• Differentiation of self
• Nuclear family emotional system
• Undifferentiated ego mass (we pick people of same
psychological health –see Box 6.5, p. 209)
• Family projection system

• Individuals get triangulated
• Used genograms (see Figure 6.1, p. 208)
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Whitaker
 Says he has no theory, but see basic tenets (p. 209)
 I-Thou relationship
 Become genuine through interactions in therapy
 See quotes top and middle of page 210

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Robin Skynner and Nathan Ackerman
Emphasis: How parents assist children through

developmental stages
Problems in each parent reflected through unconscious
Couple explores how behaviors related to their own
childhood
Unfinished, unconscious problems become projected on
family

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Focused on symptom relief
Highly structured
Focus on behaviors and cognitions
 Operant conditioning
 Classical conditioning
 Social learning (modeling)
 Changing negative automatic thoughts
 Integrates how problems get infused in family through the
system
A number of common elements in all that do this approach
(see pp. 212)

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Michael White and David Epston
Goal: To recreate how family comes to understand itself
Based on postmodernism, social constructivism, and
narrative reasoning
Deconstruct past narrative and construct new ones
General guidelines, see p. 213

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Insoo Kim Bert and Steve de Shazer
A pragmatic and future-oriented approach
Based on social constructionism and post-modernism
Assumes that clients can change quickly
Focuses on solutions and use of problem free language
See underlying assumptions, p. 214

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Points to consider when working with couples and families
from nondominant groups—see p. 215

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Why are professional associations not being inclusive?
 American Association of Marriage and Family Counselors
 International Association of Marriage and Family
Counselors

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Withholding treatment in order to see “whole” family
Informed for “whole” family
Confidentiality –can you assure it?
Multiple (Dual) relationships—seeing a member individually
and in the family?
Individual or family counseling—which is better?
Professional Associations: AAMFT, IAMFC
Accreditation: CACREP; COAMFTE
Credentialing: LMFT; NCA
Knowing the law: child, spousal, family abuse; custody
Insurance fraud: e.g., saying you’re seeing “1” member in
family when you actually see whole family

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