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
74
(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’
75
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 firstorder 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
76
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 childcentered 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.
2.
3.
4.
5.
The individual is considered as part of a family and the interactions and relationships
within the family are the focus of therapy.
The systems approach to family therapy is focused on how family members can maintain
a healthy balance between being enmeshed and being disengaged.
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.
According to structural theorists, defining and clarifying boundaries that exist between
subsystems is imperative.
Minuchin's approach is directed toward changing the family structure or organization as a
way of modifying family members' behavior.
77
6.
7.
8.
Strategic family therapy is based on the assumption that the family's ineffective problem
solving develops and maintains symptoms.
Conjoint family therapy is based on honest communication, members’ feelings of selfworth, and the rules of the family.
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.
78
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
other’s lives, and
, or over-involvement in each
, 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.
79
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.
80
9. Which of the following is not one of the components of family situations Virginia Satir
believed could be changed and corrected?
A. communication
B. family rules
C. family roles
D. 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
81
14.
Bowen focused on the
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
aspect of family relations, while Satir focused on
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.
2. 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.
82