Chapter 11 Marriage and Family Counseling

1. Chapter 11 Marriage and Family Counseling George Gharibian, M.S.

2. Marriage and Family Counseling Family Systems Theories • The family systems model based on the general systems developed by biologist Ludvig von Bertalanffy (1974) • Humans are living systems composed of subsystems that are connected together & are dependent on one another; • Any change in one subsystem produces change in the other; much like a dance. • The whole system is greater than the sum of its parts. • Family subsystems • Marriage & family Counselors • Attend to current problems in the family dynamics. • Explore relationships, alliances, & conflicts within the family • Differ the way they work with a family

3. Marriage and Family Counseling Object Relations Theory • Roots in psychoanalytic of ego psychology. • An object isa significant other (mother) with whom children form an emotional bond. • Internalized good & bad characteristics • Early Psychosocial influence rather than psychosexual • Families foster individual development in way that they have worked through their own development in their families of origin. • Treatment is a combination of working with the whole family, the subgroups & individual members. • Often a man and woman co-therapists. • “Identified patient,” is identified. • Agreed treatment goals are quite specific. • Awareness of transference & resistance by the family members. • Unresolved feelings of anxiety or anger blocked by either the nuclear family of the parent’s families of origin. • Therapists observe & interpret family rules & transactions that are causing family breakdown.

4. Marriage and Family Counseling • Bowen’s Family Systems • Murray Bowen originated the term family systems in the 1950s when he developed his theory of family therapy. • An emotional system exists within a family & that this system influences the degree of separateness (differentiation of self) & togetherness (fusion). • Major goal: To develop differentiation, or independence, among family members. • Differentiation of self : Crucial for the effective functioning of each family member & the family as a whole. Members of a dysfunctional family fuse identities, become emotionally dependent on one another, & lose their individual selves. • Family projection process • One spouse has a problem (addictions: drinking, drugs, gambling; adultery) • Serious marital discord exists • A child’s behavior is disrupting the marriage & family harmony

5. Marriage and Family Counseling Bowen’s Family Systems continued • Multigenerational transmission process: Patterns of differentiation, fusing, triangulation, & projection are passed from generation to generation. • Dysfunctional patterns are traced, through the use of a genogram, which demonstrates 3 generations of family structure, triangulations, & alignments. • Genogram: A structural chart showing the relationship of family members, including dates of birth & death, marriages, & divorces, & numbers & gender of siblings. • Differentiation by helping family members to understand the pervasive fusing & triangulation. • Triangles are interlocking, a change in one triangle will cause a change in all triangles, much like dance – if one partner stops dancing the other must decide to either continue with the dance alone or also stops.

6. Marriage and Family Counseling Adlerian Family Therapy • Alfred Adler (1920s), the originator of family counseling & therapy. • It helped counselors to be more socially conscious • moves beyond treating the family in isolation, • is based on the context of their social-cultural environment. • Adlerian counselors & therapists act as teachers, advisers, & facilitators helping families understand the dynamics of family transactions & the ways each member contributes to the family problems. • Help family members recognize their mutual interdependence by directing them to attend to one another’s needs & cooperate in constructive give-and-take relationships.

7. Marriage and Family Counseling Satir’s Process Model • Family dysfunction results from faulty communication, a condition directly related to each individual’s feelings of low self-esteem. • Originally called conjoint therapy (1967): The therapist works with the total nuclear family in counseling sessions. • Evolved by combining Gestalt therapy, altered states of consciousness, body therapies, and sensory awareness into the process model of family therapy. • Emphasis was also changed from pathology to maintaining the healthiness of normally functioning individuals & wholeness in the family. • Another emphasis is to help family members improve communication styles & feelings of worth.

8. Satir’s Process Model cont’d • The Goals: • To help each of the family members develop their own individual self-esteem • To enable them to grow independently from the family • Allow the family to grow as a unit. • Therapists work to change or correct 4 elements in a family: • Feelings of self-worth • Communication skills • The system of alliances & coalitions • Rules governing the family No one is blamed for the family disturbance; the focus is on the multiple interactions in families. When parents are in conflict, a child often becomes the third angel in a family triangle, & the child must take sides with one parent or another to avoid unbearable conflict. Satir’s classification of styles of communication & their use in her counseling: • The placater – Tries to smooth things over, takes blame, apologizes, & tries to please so that others persons do not get angry • The blamer – Accuses other & finds fault in order to appear strong • The computer – Gives intellectual reasons, is super-reasonable in order to be immune to threats • The leveler – Tries to be genuine & straightforward in communicating with others, helps resolve conflict.

9. Minuchin’s Structural Family Therapy • Salvador Minuchin (1970s): The Philadelphia Child Guidance Clinic. • Emphasis on how members of families interact & how faulty communication-repetitive & highly rigid patterns & habits-contributes to family dysfunction. • The family is a social system that develops transactional patterns, or family rules, which determines • How each member relates to other family members & • under what conditions or • at what times certain transactional patterns occur. • 3 factors involved in transactions: • Boundaries: The rules determining who will participate in a family interaction or transaction & what role each member will play. • Alignments: How various family members form coalitions or alliances join or oppose another member of a subsystem. • Power: The degree of influence each person has on the family systems.

10. Minuchin’s Structural Family Therapy cont’d • A healthy, functioning family has clearly defined generational boundaries; parents are the executives in the family ensuring that children will not take over parental functions & that grandparents will not interfere. • In a healthy family, boundaries & alliances are flexible, & the family can adapt to inevitable changes, such as births, deaths, marriages, or job changes. • Alignmentsare also clear between parents on crucial issues such as discipline; & rules about power are defined so that children know that parents’ orders will be enforced.

11. Strategic Therapy is defined as “a family therapy in which the therapist devises & initiates strategies for solving the family’s presenting problem.” • The therapist gives family members directives or orders to carry out certain strategies or tasks that the therapist believes will eliminate the presenting problems. • Strategic therapy is best represented in the work of Jay Haley (1987), a pioneer in family therapy. • Problem-solving therapy; • Thee goal is to solve the family’s presenting problem by using specific techniques & skills within the family structure. • Restructuring the family system by re-establishing boundaries, changing hierarchies of power & family triangulations, & improving family communications. • Two forms of directives: straightforward & paradoxical. • Straightforward directives:positive cooperative tasks: they are based on what the therapist has learned about the family, with the expectations that the family members will carry out the tasks & profit from completing them. • Paradoxical directives:negative cooperative tasks: used on families highly resistant to following the therapist’s directives. “The directives are paradoxical because the therapist has told the family that he wants to help them change but at the same time he is asking them not to change.”

12. Strategic Therapy continued • Reframing the symptoms: Relabeling the problem behavior in a positive way. Ex: To describe a child who refuses to do his assigned household chores as someone who may be expressing an urge for independence, a desire that has not been sufficiently recognized. If the child’s needs are recognized, then he/she will probably be willing to do the chores • Escalating: By prescribing the symptom: the client is told to increase the behavior that is presented as a problem. Ex: If a child is lying, the child is told to continue lying at every opportunity, to make up bigger & better lies, & to keep a chart indicating success. If spouses are continually bickering, they are directed to bicker only at a certain time of day, every day, & to continue bickering without stopping for, say, 2 hours. Clients find it impossible to carry out these directives & end up reducing or giving up the problem behavior.

13. Social Learning Family Therapy: • focuses on learning that occurs within a social context. People learn by observing others’ behavior, particularly through behaviors of family members • 2 types of parent-child interactions are observed most frequently: reciprocity & coercion. • Reciprocity : One person’s behavior that is followed by a similar behavior from another person. A positive move elicits a positive response; a negative action is followed by a negative response. • Coercion: Situations that involve either punishment or negative reinforcement. A parent spanks a child who later hits a younger or weaker sibling. The aggressive behavior of the parent serves as a model for the child, & the child imitates it. • Identify a specific behavior that needs to be changed.

14. Social Learning Family Therapy continued • baseline data, • a program of intervention, or change, in which all positive or desirable behavior is reinforced. • Goals are specific & are limited to changing precise behavior or eliminating presenting symptoms. • Behaviorist counselors teach skills to parents & train them in reinforcement techniques. • Parents are taught to be trainers of child behavior; • Behaviors to be targeted are specific such as lying, stealing, or the bullying siblings. • Parents monitor the child & give rewards & punishment. • The counselor does a follow-up after therapy is completed.

15. Cognitive-Behavioral Family Therapy • Cognitive-behavioral therapists follow 3 stages in the family counseling process: • Assessing – therapists observe how each family member perceives the problem & how everyone relates to one another. • Facilitating change in the family – therapists interpret & clarify family dynamics, reduce blaming & encourage listening to one another. • Maintaining changes – families are taught communication skills, ways of monitoring their behaviors, & methods of positive interactions.

16. Family Life Cycle: Families going through developmental stages which they should adopt to disequilibrium and conflicts. Family Counseling & Therapy in Practice • Family counseling relationships follow predictable stages: • Initial stage – developing a relationship & assessing the family problem • Middle stage – developing emotional awareness & acceptance of dysfunctional family patterns • Last stage – learning how to change the family system • Termination – separating from therapy

17. Marriage & Couples Counseling Theories • Family counseling & marriage or couples counseling overlap considerably. • Relational Recovery Therapy (RRT), in which couples attend a 3-day intensive workshop to understand that they will either stay with the marriage or divorce. • Real (2002) claims that couples counseling, as practiced in traditional psychotherapy is, ineffective with most couples.

18. Changing Family & Marriage Patterns: Dual-Career Families • In 2006, 60% of women were working or looking for work => less time with their children, & men are expected to spend more time with them. • Women’s stress is greater because of expectations that women should continue to handle more domestic responsibilities than men. • Conflicts in managing the dual role of homemakers & out-of-home worker have made it especially difficult for women to meet their own needs. • Children are regularly left unsupervised while their parents are at work or away for other reasons. • Counselors be Aware: • Gender roles & to the stress resulting from a lack of adequate & affordable child care. • Family conflicts are exacerbated because the marketplace & communities have not made allowances for dual-career families.

19. Changing Family & Marriage Patterns: Single-Parent Families • Single parents one third of all families. • Divorce is by far the leading reason, followed by death of a spouse (14%) & never-married women (10%). • 90% are headed by women. • Low income, • societal disapproval, • Lack of another parent to help with domestic chores, discipline, & child welfare in general. • Assume the roles of both parents, • Financial worries are usually worse, • Children may be expected to assume more responsibilities, • Child care services are increasingly necessary. • feelings of abandonment, • Treatment: Develop social support groups, & when possible, work toward & maintaining civil & respectful contact with former spouses for the benefit of the child or children.

20. Changing Family & Marriage Patterns: Stepfamilies • Stepfamilies • Between 40% & 50% of recent marriages will end in divorce, with 80% of men, & 75% of women remarrying within a few years. • Families will be reconstituted into ones in which multiple parents, stepparents, grandparents, & stepsiblings interact. • Because mothers usually gain custody of their children, the stepfamily in which the children live with their mothers & her new husband is most common. • The family patterns by complex relationships & roles in remarried families. • Role conflicts often occur between the realigned members, such as who is to disciple which children and how will the family finances be dispersed.

21. Changing Family & Marriage Patterns: Child Abuse & Neglect • The major types of child abuse are: • Physical abuse • Psychological maltreatment (emotional abuse) • Sexual abuse • Neglect • In 2005, approximately 3.3 million cases of child abuse & neglect were reported to child protective services. • Approximately 62% were child neglect • Approximately 16% were physical abuse • Approximately 9% were sexual abuse • Approximately 7% were psychological maltreatment

22. Changing Family & Marriage Patterns: The Characteristics of Abuse • The majority of abused children are under age 3 • Parents and/or stepparents may be the abuser • Families in which abuse takes place are often isolated & have poor relationships with extended family & others in the household. • Relationships within the family may be strained, negative, or in conflict • Abusers in a family are often substance abusers – nearly 50% • Additional causes for abuse in families may be financial problems, unemployment, illness, family break-ups • If counseling interventions for abused children & their families are not provided, the children can develop serious emotional disorders that carry into adulthood. • These disorders include depression & anxieties, eating disorders, learning disorders, multiple personalities, & substance abuse. • Posttraumatic stress disorder, including nightmares & flashbacks, may develop & continue into adulthood. • The risk increases that abused children, when they grow up, will abuse their children. • Emotionally abused children also maintain low self-esteem & gravitate to those who confirm their feelings of worthlessness.

23. Counseling Families in Which Abuse Has Occurred • With families in which parents have been shown to be abusive, treatment often focuses initially on individual family members. • Physically abusive or neglectful parents are frequently referred to anger management or parenting classes in addition to individual counseling. • Parents who sexually abuse their child(ren) are viewed as criminal offenders & may be convicted of a sex crime & sentenced to prison &/or probation. • Treatment for sex offenders is specialized & usually occurs in outpatient programs after the offender is released from prison. • Abused children who are removed from the family home should receive counseling to help process the traumatic experiences & work through the shame, guilt, anger, or grief.