Couple & Family Counselling PDF

14 Couple and Family Counseling Chapter Overview From this chapter you will learn about: Family life, the family life cycle, and the changing forms of families The nature of couple and family counseling The process of couple and family counseling As you read consider:...

14 Couple and Family Counseling Chapter Overview From this chapter you will learn about: Family life, the family life cycle, and the changing forms of families The nature of couple and family counseling The process of couple and family counseling As you read consider: How you might treat different family types and why The research associated Stockbyte/Getty Images with the various forms of family counseling The difference between At thirty-five, with wife and child working with families and a Ph.D. groups or individuals and hopes as bright as a full moon on a warm August night, He took a role as a healing man blending it with imagination, necessary change and common sense To make more than an image on an eye lens of a small figure running quickly up steps; Quietly he traveled like one who holds a candle to darkness and questions its power So that with heavy years, long walks, shared love, and additional births He became as a seasoned actor, who, forgetting his lines in the silence, stepped upstage and without prompting lived them. Reprinted from “Without Applause,” by S. T. Gladding, 1974, Personnel and Guidance Journal, 52, p. 586. © S. T. Gladding. 314  Chapter 14 Couple and Family Counseling 315 This chapter examines the genesis and development of couple and family counseling along with an overview of couple and family counseling organizations and research. It also describes the family life cycle and addresses how family counseling differs from individual and group counseling. The process of couple and family counseling from beginning to closure is looked at as well. Couple relationships and family life are rooted in antiquity. Whether arranged by a family or the couple themselves, men and women, and in more recent time same-sex partners, have paired together in unions sanctioned by religion and/or society for economic, societal, and procreation reasons for millennia. The terms couple and family have distinct connotations in different societ- ies. Marriage is generally seen as a socially or religiously sanctioned union between two adults for economic, social, and/or procreational reasons. The term couple is more informal and broader. It simply denotes two people in a relationship together. They may be married or not, intimate or not. Nevertheless, they are seen as linked together, that is, “bonded” in one or more ways. A family, on the other hand, consists of “those persons who are biologically and/or psy- chologically related … [through] historical, emotional, or economic bonds … and who perceive themselves as a part of a household” (Gladding, 2015b, p. 6). These definitions of marriage, cou- ple, and family allow for maximum flexibility and can encompass a wide variety of forms. Couple and family counseling is a popular pursuit of counselors. There are at least three reasons why. First is the realization that persons are directly affected by how their couple rela- tionship or families function (Goldenberg & Goldenberg, 2002). For instance, in family life, cha- otic families frequently produce offspring who have difficulty relating to others because of a lack of order or even knowledge of what to do, whereas enmeshed families have children who often have difficulty leaving home because they are overdependent on parents or other family members. A second reason couple and family counseling is attractive is a financial consideration. Problems can often be addressed more economically when a couple or family is seen together. Finally, the encompassing nature of couple and family counseling work makes it intrinsically appealing. There are multiple factors to be aware of and to address. Counselors who are engaged in helping marital units, couples, and families must constantly be active men- tally and even sometimes physically. The process itself can be exciting as well as rewarding when change takes place. Couple and family counseling attracts many clinicians who wish to work on complex, multifaceted levels in the most effective way possible. THE CHANGING FORMS OF FAMILY LIFE The strong interest in couple and family counseling today is partly due to the rapid change in American family life since World War II. In 1950, two types of families, which still exist, domi- nated American cultural life: the nuclear family, a core unit of husband, wife, and their children; and the multigenerational family, households that include at least three generations, such as a child/children, parent(s), and grandparent(s). This type of family sometimes includes unmarried relatives, such as aunts and uncles. After the war, a rising divorce rate made two more family types prevalent: the single-parent family, which includes one parent, either biological or adoptive, who is solely responsible for the care of self and a child/children; and the blended (i.e., remarried, step) family, a household created when two people marry and at least one of them has been previously married and has a child/children. 316 Part IV Counseling Specialties In addition, changes in societal norms and demographics since the 1950s have fostered the development and recognition of several other family forms besides those already mentioned, specifically, the dual-career family, in which both marital partners are engaged in work that is ­developmental in sequence and to which they have a high commitment; the childless family, which consists of couples who consciously decide not to have ­children or who remain childless as a result of chance or biological factors; the aging family, in which the head or heads of the household are age 65 or above; the gay/lesbian family, which is made up of same-sex couples with or without a child/children from either a previous union or as a result of artificial insemination or adoption; and the multicultural family, in which individuals from two different cultures unite and form a household that may or may not have children. Couples and families in the 21st century are quite varied. Those who choose to enter such relationships face a host of economic, social, and developmental challenges that demand their atten- tion daily. They also find a number of rewards in such unions including physical, financial, and psychological support. The drawbacks and impacts of couple and family life are great and some- times complicated. Professional counselors who work with couples and families must be attuned to a host of difficulties as well as possibilities. They must be ready to deal with extremely intricate and unsettling changes that developmentally or situationally may face these units (Napier, 1988). PERSONAL REFLECTION What type of family did you grow up in? What were its strengths? What were its weaknesses? What type of family listed previously would you prefer, if you could choose? Why? THE BEGINNINGS OF COUPLE AND FAMILY COUNSELING The profession of couple and family counseling is relatively new (Framo, 1996). Its substantial beginnings are traced to the 1940s and early 1950s, but its real growth occurred in the late 1970s and the 1980s (Nichols, 1993). It is interesting to note that the rise in popularity of couple and family counseling closely followed dramatic changes in the form, composition, structure, and emphasis of the American family noted earlier in this chapter (Markowitz, 1994). In this section, trends and personalities that influenced the development of the field will be noted, including some contemporary leaders. Trends At the end of World War II, the United States experienced an unsettling readjustment from war to peace that manifested itself in three trends that had an impact on the family, other than a rise in dif- ferent types of family forms (Walsh, 1993). One was a sharp rise in the divorce rate, which took place almost simultaneously with the baby boom beginning in 1946. Whereas divorce had been fairly uncommon up to that point, it rose dramatically thereafter and did not level out until the 1990s. The impact of this phenomenon was unsettling. Today, a large percentage (around 50%) of couples who marry eventually dissolve their unions (Maples & Abney, 2006; Whitehead, 1997). However, new Census data show the divorce rate for most age groups has been dropping  Chapter 14 Couple and Family Counseling 317 (Kreider & Ellis, 2011). The reason for the drop in divorce rates in recent years can be attributed to a number of factors, such as education, but perhaps the most significant one is that couples in the United States are waiting longer to get married and are therefore more mature when they do marry. A second trend that influenced the rise of couple and family counseling was the changing role of women. After World War II, more women sought employment outside the home. Many women became the breadwinners of their families as well as the bread makers. The women’s rights movement of the 1960s also fostered the development of new opportunities for women. Thus, traditions and expectations fell and/or were expanded for women. The results were unset- tling, as any major social change is, and both men and women in families and marriages needed help in making adequate adjustments. In 2015, 51% of women in the United States were unmar- ried and most women, including those who were married, worked outside the home. The expansion of the life span was the third event that had an impact on family life and made couple and family counseling more relevant to the American public. Couples found them- selves living with the same partners longer than at any previous time in history (Maples & Abney, 2006). Many were not sure exactly how to relate to their spouses, partners, or children over time because there were few previous models. Thus, the need to work with couples and individuals who were affected by these changes brought researchers, practitioners, and theorists together. They set the stage for an entirely new way of conceptualizing and working with married people, couples, and families. Couple and Family Therapy Pioneers and Contemporary Leaders A number of helping specialists advanced the field of couple and family counseling after World War II and up to the present—more than can be mentioned here. Some, like Nathan Ackerman and Virginia Satir, did it using the persuasive nature of their personalities. Others, such as Salvador Minuchin, John Gottman, and Sue Johnson, became important and notable because of the research they conducted. The work of Nathan Ackerman (1958), a New York City psychoanalyst, was especially critical in focusing the attention of a well-established form of therapy, psychoanalysis, on fami- lies. Before Ackerman, psychoanalysts had purposely excluded family members from the treat- ment of individual clients for fear that family involvement would be disruptive. Ackerman applied psychoanalytic practices to the treatment of families and made family therapy respected in the profession of psychiatry. Two other pioneers that emerged on a national level about the time of Ackerman were experiential in nature: Virginia Satir and Carl Whitaker. Both of these individuals had engaging personalities and a presence that commanded attention. Satir was an especially clear writer and presenter, whereas Whitaker was a maverick whose unorthodox style and creativity, such as fall- ing asleep during a session and having a dream, provoked considerable thought and discussion in the marriage and family field and in the couples and families with whom he worked. Jay Haley was probably the dominant figure of the early family therapists, however. Haley culled ideas from Milton Erickson, blended them with his own thoughts, and through persistence kept early family counselors in touch with one another and with developing ideas in the field. Haley also had a major role in developing strategic family therapy and influencing structural family therapy. Other pioneers worked in teams as researchers conducting exploratory studies in the area of family dynamics and the etiology of schizophrenia. Among the teams were the Gregory Bateson group (Bateson, Jackson, Haley, & Weakland, 1956) in Palo Alto, 318 Part IV Counseling Specialties California, and the Murray Bowen and Lyman Wynne groups (Bowen, 1960; Wynne, Ryckoff, Day, & Hirsch, 1958) at the National Institute of Mental Health (NIMH). They observed how couples and families functioned when a family member was diagnosed as schizophrenic. The Bateson group came up with a number of interesting concepts, such as the double bind, where a person receives two contradictory messages at the same time and, unable to follow both, develops physical and psychological symptoms as a way to lessen ten- sion and escape. Bowen went on to develop his own systemic form of treatment based on multigenerational considerations and originate a now widely popular clinical tool, the geno- gram (a three-generational visual representation of one’s family tree depicted in geometric figures, lines, and words). The group movement, especially in the 1960s, also had an impact on the emergence of couple and family counseling. Some practitioners, such as John Bell (e.g., Bell, 1975, 1976), even started treating families as a group and began the practice of couple/family group counsel- ing (Ohlsen, 1979, 1982). Foreign-born therapists have had a major influence on marriage, cou- ple, and family therapy since the 1960s. These include Salvador Minuchin, the originator of Structural Family Therapy; Mara Selvini Palazzoli, a creator of a form of strategic family ther- apy known as the Milan Approach; as well as (more recently) Michael White and David Epston, the founders of Narrative Therapy. Most recently there has been a Midwestern influx into the field led by Steve deShazer and Bill O’Hanlon, who developed brief therapeutic therapies that emphasize solutions and possi- bilities. In addition, Monica McGoldrick (McGoldrick, Giordano, & Garcia-Preto, 2005) has emphasized the importance of multicultural factors and cultural background in treating couples and families. Included in the idea of culture today are inherited cultures (e.g., ethnicity, nation- ality, religion, groupings such as baby boomers) and acquired cultures (learned habits, such as those of being a counselor) (Markowitz, 1994). Betty Carter and a host of others have also focused on an awakening in the couple and family counseling field to gender-sensitive issues, such as the overriding importance of power structures. Finally, exemplary researchers, such as John Gottman and Neil Jacobson, have helped practitioners understand better the dynamics within couples and families, especially factors related to domestic violence and higher function- ing marriage relationships (Peterson, 2002). ASSOCIATIONS, EDUCATION, AND RESEARCH Associations Four major professional associations attract marriage, couple, and family clinicians. The largest and oldest, which was established in 1942, is the American Association for Marriage and Family Therapy (AAMFT). The second group, the International Association of Marriage and Family Counselors (IAMFC), a division within the American Counseling Association (ACA), was chartered in 1986. The third association, Division 43 (Family Psychology), a division within the American Psychological Association (APA), was formed in 1984 and comprises psychologists who work with couples and families. The fourth association is the American Family Therapy Association (AFTA), formed in 1977. It is identified as an academy of advanced professionals interested in the exchange of ideas.  Chapter 14 Couple and Family Counseling 319 Education Both the AAMFT and IAMFC have established guidelines for training professionals in working with couples and families. AAMFT standards are drawn up and administered by the Commission on Accreditation for Marriage and Family Therapy Education (CAMFTE); those for IAMFC are handled through the Council for Accreditation of Counseling and Related Educational Programs (CACREP). A minimum of a 60-semester-hour master’s degree is required for becoming a mar- riage, couple, and family counselor through a CACREP-accredited program. The exact content and sequencing of courses will vary from program to program but the courses in Table 14.1 are almost always included. Research Regardless of professional affiliation and curriculum background, professionals are attracted to couple and family counseling largely due to a societal need for the specialty and its growing research base. Gurman and Kniskern (1981) reported that approximately 50% of all problems brought to counselors are related to marriage and family issues. Unemployment, poor school performance, spouse abuse, depression, rebellion, and self-concept issues are just a few of the many situations that can be dealt with from this perspective. Individual development dovetails with family and career issues (Cavanaugh & Blanchard-Fields, 2015; Okun, 1984). Each one impacts the resolution of the other in a systemic manner. Bratcher (1982) comments on the inter- relatedness of career and family development, recommending the use of family systems theory for experienced counselors working with individuals seeking career counseling. TABLE 14.1 Example of Coursework Areas Required for a Master’s Degree in ­AAMFT- Accredited and CACREP-Accredited Programs CACREP Curriculum AAMFT Curriculum Human Growth and Development Introduction to Family/Child Development Social and Cultural Foundations Marital and Family Systems Helping Relationships Groups Dysfunctions in Marriage/Family Lifestyle and Career Development Advanced Child Development Appraisal/Assessment Assessment in Marital/Family Research and Evaluation Research Methods Child/Family Professional Orientation Professional Issues Family Theoretical Foundation MFT Theories of MFT Techniques/Treatment MFT Marriage/Family Pre-Practicum Clinical Practicum/Internship Clinical Practicum Substance Abuse Treatment Human Sexual Behavior Human Sexuality Thesis Electives Electives Source: From “The Training of Marriage and Family Counselors/Therapists: A ‘Systemic’ Controversy among Disciplines,” by Michael Baltimore, 1993, Alabama Counseling Association Journal, 19, p. 40. Copyright 1993, Alabama Counseling Association. Reprinted with permission. 320 Part IV Counseling Specialties Research studies summarized by Doherty and Simmons (1996), Gurman and Kniskern (1981), Haber (1983), Pinsof and Wynne (1995), and Wohlman and Stricker (1983) report a number of interesting findings: First, family counseling interventions are at least as effective as individual interven- tions for most client complaints and lead to significantly greater durability of change. Second, some forms of family counseling (e.g., using structural-strategic family ther- apy with substance abusers) are more effective in treating problems than other coun- seling approaches. Third, the presence of both parents, especially noncompliant fathers, in family coun- seling situations greatly improves the chances for success. Similarly, the effectiveness of marriage counseling when both partners meet conjointly with the counselor is nearly twice that of counselors working with just one spouse. Fourth, when marriage and family counseling services are not offered to couples con- jointly or to families systemically, the results of the intervention may be negative and problems may worsen. Finally, there is high client satisfaction from those who receive marital, couple, and family counseling services, with more than 97% rating the services they received from good to excellent. Overall, the basic argument for employing marriage and family counsel- ing is its proven efficiency. This form of treatment is logical, fast, satisfactory, and ­economical. CASE EXAMPLE Shasta Seeks a Marriage Counselor Shasta grew up in a single-parent family that was often strapped for money. Therefore Shasta learned to hoard food and to hide any valuables she might obtain. Later, she married Marcus who was financially quite successful. Still, she hoarded and hid items around the house to the point that it caused tension in the relationship. Shasta finally realized she needed help and sought out a marriage and family counselor. Do you think such a counselor could help her resolve her problem? If so, how? If not, why not? FAMILY LIFE AND THE FAMILY LIFE CYCLE Family life and the growth and developments that take place within it are at the heart of mar- riage, couple, and family counseling. The family life cycle is the name given to the stages a fam- ily goes through as it evolves over the years. These stages sometimes parallel and complement those in the individual life cycle, but often they are unique because of the number of people involved and the diversity of tasks to be accomplished. Becvar and Becvar (2013) outline a nine- stage cycle that begins with the unattached adult and continues through retirement (Table 14.2). Some families and family members are more “on time” in achieving stage-critical tasks that go with the family life cycle and their own personal cycle of growth. In such cases, a better sense of well-being is achieved (McGoldrick, Garcia-Preto, & Carter, 2016). Other families, such as those that are dysfunctional, never achieve stage-critical tasks, for instance, substance  Chapter 14 Couple and Family Counseling 321 TABLE 14.2 Stages of the Family Life Cycle Stage Emotion Stage-Critical Tasks 1. Unattached adult Accepting parent- a. Differentiation from family of origin offspring separation b. Development of peer relations c. Initiation of career 2. Newly married Commitment to the a. Formation of marital system marriage b. Making room for spouse with family and friends c. Adjusting career demands 3. Childbearing Accepting new members a. Adjusting marriage to make room for child into the system b. Taking on parenting roles 4. Preschool-age child Accepting the new a. Adjusting family to the needs of specific child(ren) personality b. Coping with energy drain and lack of privacy c. Taking time out to be a couple 5. School-age child Allowing child to a. Extending family/society interactions establish relationships b. Encouraging the child’s educational progress outside the family c. Dealing with increased activities and time demands 6. Teenage child Increasing flexibility of a. Shifting the balance in the parent-child relationship family boundaries to b. Refocusing on mid-life career and marital issues allow independence c. Dealing with increasing concerns for older generation 7. Launching center Accepting exits from a. Releasing adult children into work, college, marriage and entries into the b. Maintaining supportive home base family c. Accepting occasional returns of adult children 8. Middle-age adult Letting go of children a. Rebuilding the marriage and facing each other b. Welcoming children’s spouses, grandchildren into family c. Dealing with aging of one’s own parents 9. Retirement Accepting retirement a. Maintaining individual and couple functioning and old age b. Supporting middle generation c. Coping with death of parents, spouse d. Closing or adapting family home Source: From Family Therapy: A Systematic Integration (pp. 128–129), by Dorothy Stroh Becvar and Raphael J. Becvar. © 1993 by Allyn & Bacon. All rights reserved. Reprinted with permission. abuse families. In these families substance abuse behavior is promoted or enabled. Thus, chil- dren “from homes in which parents are chemically dependent or abuse alcohol or other drugs (CDs) are at risk for a wide range of developmental problems” (Buelow, 1995, p. 327). Many families that abuse alcohol, for example, tend to be isolated and children within them conse- quently suffer from a lack of positive role models. As children get older, they seem to be particu- larly affected for the worse from growing up in these families. Substance abuse is used by these young people as a way to relieve stress, reduce anxiety, and structure time (Robinson, 1995). It is also an attempt by young adults to protect and stabilize dysfunctional families by keeping their attention off overall dynamics and on predictable prob- lematic behaviors (Stanton & Todd, 1982). Substance abuse may serve as a substitute for sex as 322 Part IV Counseling Specialties well and promote pseudo-individuation (a false sense of self). These complex and interrelated factors make it difficult to help families caught up in substance abuse patterns to change behav- iors without an intensive social action approach designed to change dysfunctional systems (Lee & Walz, 1998; Margolis & Zweben, 2011). Families often organize themselves around substance abuse in a systemic way and enable family members to drink excessively (Bateson, 1971; Steinglass, 1979). In the alcoholic family system, there is an overresponsible–underresponsible phenomenon, with the overresponsible person(s) being a so-called codependent (Berenson, 1992). “An essential characteristic of some- one who is codependent is that they continually invest their self-esteem in the ability to control and influence behavior and feelings in others as well as in themselves, even when faced with adverse consequences such as feelings of inadequacy after failure” (Springer, Britt, & Schlenker, 1998, p. 141). In such a situation, it is easier and more productive to work with the overfunction- ing person(s) and modify that phenomenon than to try to get the underfunctioning person(s) to change. Regardless of functionality, all families have to deal with family cohesion (emotional bonding) and family adaptability (ability to be flexible and change). These two dimensions each have four levels, represented by Olson (1986) in the circumplex model of marital and family systems (Figure 14.1). “The two dimensions are curvilinear in that families that appar- ently are very high or very low on both dimensions seem dysfunctional, whereas families that are balanced seem to function more adequately” (Maynard & Olson, 1987, p. 502). For instance, a family that is high in cohesion is enmeshed (extremely close sometimes to the point of not being well differentiated). If the same family is also high in adaptability they will also be chaotic (dis- organized). This combination results in a family that is chaotically enmeshed, very close but not able to function effectively, with the result being that they are unbalanced. In examining the circumplex model, ideals for family functioning are close to the center with less functional ways of working closest to the outside. In reality, even the most dysfunctional families execute well at times and vice versa. Also, families move around on the circumplex model during their life cycles. For instance, the death of a family member may send a family that is flexibly separated into one that is rigidly disengaged as individuals drift apart and grieve separately. Families that are most successful, functional, happy, and strong are not only balanced but also committed to one another, appreciate each other, spend time together (both qualitatively and quantitatively), have good communication patterns, have a high degree of religious/spiritual orientation, and are able to deal with crisis in a positive manner (Gladding, 2015b; Stinnett, 1998; Stinnett & DeFrain, 1985). According to Wilcoxon (1985), couple and family counselors need to be aware of the dif- ferent stages within the family while staying attuned to the developmental tasks of individual members. When counselors are sensitive to individual family members and the family as a whole, they are able to realize that some individual manifestations, such as depression (Stevenson, 2007), career indecisiveness (Kinnier, Brigman, & Noble, 1990), and substance abuse (Edwards, 2012), are related to family structure and functioning. Consequently, they are able to be more inclusive in their treatment plans. When evaluating family patterns and the mental health of everyone involved, it is ­crucial that an assessment be based on the form and developmental stage of the family  Chapter 14 Couple and Family Counseling 323 Low COHESION High REVISED PERCENTAGE Disengaged Separated Connected Enmeshed SCORE 0 10 20 30 40 50 60 70 80 90 100 100 Chaotically Chaotically disengaged enmeshed Chaotic 90 Chaotically Chaotically separated connected 80 High 70 Flexible Flexibly Flexibly Flexibly Flexibly 60 disengaged separated connected enmeshed ADAPTABILITY 50 40 Structurally Structurally Structurally Structurally Structured disengaged separated connected enmeshed 30 Low 20 Rigidly Rigidly Rigid separated connected 10 Rigidly Rigidly disengaged enmeshed 0 Balanced Midrange Unbalanced FIGURE 14.1 The circumplex model Source: From Prepare/Enrich, Inc., David H. Olson, president, Minneapolis, MN. © 1979 (rev. 1986). Reprinted with permission. PREPARE/ENRICH, 2660 Arthur St., Roseville, MN 55113. https://www.prepare-enrich.com. c­ onstellation. To facilitate this process, McGoldrick and colleagues (2016) propose sets of developmental tasks for traditional and nontraditional families, such as those headed by sin- gle parents or blended families. It is important to note that nontraditional families are not pathological because of their differences; they are merely on a different schedule of growth and development. Today, more than 4 in 10 American adults have at least one step relative in their family— either a stepparent, a step or half sibling, or a stepchild. People with step relatives are just as likely as others to say that family is the most important element of their life. Seven in 10 adults who have at least one step relative say they are very satisfied with their family life. Those who do not have any step relatives register slightly higher levels of family satisfaction (78% very satisfied) (Parker, 2011). Bowen (1978) suggests terms such as “enmeshment” and “triangulation” to describe fam- ily dysfunctionality regardless of the family form. (Enmeshment refers to family environments 324 Part IV Counseling Specialties in which members are overly dependent on each other or are undifferentiated. Triangulation describes family fusion situations in which the other members of the triangle pull a person in two different directions.) Counselors who effectively work with couples and families have guidelines for determining how, where, when, or whether to intervene in the family process. They do not fail to act (e.g., neglect to engage everyone in the therapeutic process), nor do they overreact (perhaps place too much emphasis on verbal expression). PERSONAL REFLECTION Who were you closest to in your family of origin? Who were you most distant from? What factors or events brought you together? What factors or events distanced you from one another? COUPLE/FAMILY COUNSELING VERSUS INDIVIDUAL/GROUP COUNSELING There are similarities and differences in the approaches to couple or family counseling and indi- vidual or group counseling (Gladding, 2015b; Hines, 1988; Trotzer, 1988). A major similarity centers on theories. Some theories used in individual or group counseling (e.g., person-centered, Adlerian, reality therapy, behavioral) are used with couples and families (Horne, 2000). Other approaches (e.g., structural, strategic, solution-focused family therapy) are unique to couple and family counseling and are systemic in nature. Counselors must learn about these additional theo- ries as well as new applications of previous theories to become skilled at working with couples or families. Couple or family counseling and individual counseling share a number of assumptions. For instance, both recognize the importance the family plays in the individual’s life, both focus on problem behaviors and conflicts between the individual and the environment, and both are developmental. A difference is that individual counseling usually treats the person outside his or her family, whereas couple or family counseling generally includes the involvement of oth- ers, usually family members. Further, couple and family counseling works at resolving issues within the family as a way of helping individual members better cope with the environment (Nichols, 2013). Couple and family counseling sessions are similar to group counseling sessions in orga- nization, basic dynamics, and stage development. Furthermore, both types of counseling have an interpersonal emphasis. However, the family is not like a typical group, although knowl- edge of the group process may be useful. For example, family members are not equal in status and power. In addition, families may perpetuate myths, whereas groups are initially more objective in dealing with events. More emotional baggage is also carried among family mem- bers than members of another type of group because the arrangement in a family is not limited in time and is related to sex roles and affective bonds that have a long history (Becvar, 1982). Although the family may be a group, it is not well suited to work that takes place only through group theory. Finally, the emphasis of couple and family counseling is generally on dynamics as opposed to linear causality as in much individual and some group counseling. In other words, the dynam- ics behind couple and family counseling generally differ from the other two types of counseling. In making the transition from an individual perspective to a family orientation, Resnikoff (1981)  Chapter 14 Couple and Family Counseling 325 stresses specific questions that counselors should ask themselves to understand family function- ing and dynamics. By asking the right questions, the counselor becomes more attuned to the family as a client and how best to work with it. What is the outward appearance of the family? What repetitive, nonproductive sequences are noticeable; that is, what is the family’s dance? What is the basic feeling state in the family, and who carries it? What individual roles reinforce family resistance, and what are the most prevalent family defenses? How are family members differentiated from one another, and what are the subgroup boundaries? What part of the life cycle is the family experiencing, and what are its problem-solving methods? Whether working with families or with couples, counselors ask many of these same ­questions. OVERVIEW OF COUPLE AND FAMILY COUNSELING Couple Counseling Early pioneers in couple counseling focused on the couple relationship rather than just the indi- viduals involved. The new emphasis meant that three entities were considered in such relation- ships: two individuals and one couple. Thus, from its beginning couple counselors set a precedent for seeing couples together in conjoint sessions, a practice that continues today. Couples seek relationship counseling for a wide variety of reasons, including finances, children, fidelity, communication, and compatibility (Long & Young, 2007). Almost any situa- tion can serve as the impetus to seek help. Regardless of who initiates the request, it is crucial that the counselor see both members of the couple from the beginning if at all possible. Whitaker (1977) notes that if a counselor is not able to structure the situation in this way, he or she will probably not help the couple and may do harm. Trying to treat one partner alone for even one or two sessions increases the other’s resistance to counseling and his or her anxiety. Moreover, if one member of a couple tries to change without the other’s knowledge or support, conflict is bound to ensue. If both partners decide to enter couple counseling, the counselor may take a variety of approaches. Seven of the main counseling theories used are object relational, behavioral, cogni- tive–behavioral, Bowen systems (i.e., transgenerational), structural, emotionally focused, and narrative (Gurman, Lebow, & Snyder, 2015). All of these theoretical perspectives have their strengths. The two strongest, however, are the emotionally focused approach of Susan Johnson and the behavioral approach of John Gottman. The reason is that both are heavily research based. Family Counseling Families enter counseling for a number of reasons. Usually, there is an identified patient (IP)— an individual who is seen as the cause of trouble within the family structure—whom family members use as their ticket of entry. Most family counseling practitioners do not view one mem- ber of a family as the problem but instead work with the whole family system. Occasionally, family therapy is done from an individual perspective but with the hope that changes in the 326 Part IV Counseling Specialties p­ erson will have a ripple effect (an influence generated from the center outward) and positively impact a family (Nichols, 1988). Family counseling has expanded rapidly since the mid-1970s and encompasses many aspects of couples counseling. Although a few family counselors, such as behaviorist, narrative, or solution-focused therapists, are primarily linear and work on a cause-and-effect or a construc- tivist perspective, most are not. Rather, the majority of counselors operate from a general sys- tems framework and conceptualize the family as an open system that evolves over the family life cycle in a sociocultural context. Functional families follow rules and are flexible in meeting the demands of family members and outside agencies. Family systems counselors stress the idea of circular causality. They also emphasize the following concepts: Nonsummativity. The family is greater than the sum of its parts. It is necessary to exam- ine the patterns within a family rather than the actions of any specific member alone. Equifinality. The same origin may lead to different outcomes, and the same outcome may result from different origins. Thus, the family that experiences a natural disaster may become stronger or weaker as a result. Likewise, healthy families may have quite dissimi- lar backgrounds. Therefore, treatment focuses on interactional family patterns rather than particular conditions or events. Communication. All behavior is seen as communicative. It is important to attend to the two functions of interpersonal messages: content (factual information) and relationship (how the message is to be understood). The what of a message is conveyed by how it is delivered. Family rules. A family’s functioning is based on explicit and implicit rules. Family rules provide expectations about roles and actions that govern family life. Most families operate on a small set of predictable rules, a pattern known as the redundancy principle. To help families change dysfunctional ways of working, family counselors have to help them define or expand the rules under which they operate. Morphogenesis. The ability of the family to modify its functioning to meet the changing demands of internal and external factors is known as morphogenesis. Morphogenesis usu- ally requires a second-order change (the ability to make an entirely new response) rather than a first-order change (continuing to do more of the same things that have worked previously) (Watzlawick, Weakland, & Fisch, 1974). Instead of just talking, family mem- bers may need to try new ways of behaving. Homeostasis. Like biological organisms, families have a tendency to remain in a steady, stable state of equilibrium unless otherwise forced to change. When a family member unbalances the family through his or her actions, other members quickly try to rectify the situation through negative feedback. The model of functioning can be compared to a fur- nace, which comes on when a house falls below a set temperature and cuts off once the temperature is reached. Sometimes homeostasis can be advantageous in helping a family achieve life-cycle goals, but often it prevents the family from moving on to another stage in its development. Counselors who operate from a family systems approach work according to the concepts just listed. For instance, if family rules are covert and cause confusion, the counselor helps the family make these regulations overt and clear. All members of the family are engaged in the process so that communication channels are opened. Often, a genogram is constructed to help family members and the counselor detect intergenerational patterns of family functioning that have an impact on the present (McGoldrick, 2011; McGoldrick, Gerson, & Petry, 2008).  Chapter 14 Couple and Family Counseling 327 For a genogram, three generations of the family should be drawn. (See Chapter 8 for an example of a genogram). Names, dates of birth, marriage, separation, and divorce should be indi- cated, along with basic information such as current age and occupation. A genogram can also be used in a multicultural context to assess the worldview and cultural factors that often influence family members’ behaviors (Thomas, 1998). Overall, “the genogram appears to provide an effec- tive and personally meaningful strategy to facilitate systems thinking,” especially by new client families and counselors who are just beginning to work with families (Pistole, 1997b, p. 339). THE PROCESS OF COUPLE AND FAMILY COUNSELING The process of couple and family counseling is based on several premises. One is that persons conducting the counseling are psychologically healthy and understand their own families of ori- gin well. When such is the case, counselors are able to clearly focus on their client families and not contaminate sessions with material from their own family life that they have not resolved. A second premise of working with families is that counselors will not overemphasize or underemphasize possible aspects or interventions in the therapeutic process (Gladding, 2015b). In other words, counselors will balance what they do. Such a process means not being overly concerned about making family members happy but at the same time engaging members in a personable way. A third component of conducting couple and family counseling is for the counselor to win the battle for structure (i.e., establish the parameters under which counseling is conducted) while letting the family win the battle for initiative (i.e., motivation to make needed changes) (Napier & Whitaker, 1978). The battle for structure is won when counselors inform clients about ways they will work with them, including important but mundane facts about how often they will meet, for how long, and who is to be involved. A good part of structure can be included in a professional disclosure statement that the counselor has the couple or family read and sign before counseling begins. Initiative in the therapeutic process must come from couples and families themselves; however, once counselors listen and outline what they see as possibilities, couple or family members often pull together toward common goals. Fourth, couple and family counselors need to be able to see the couple or family difficul- ties in the context in which they are occurring. Thus, the counselor needs to be developmentally sophisticated on multiple levels of life and have some life experiences including resolving toxic or adversarial conditions in less than ideal conditions. Such skills and insights bring to counsel- ors an understanding of how couples and families become either more together or apart when faced with different life stages, cultural norms, or situational circumstances. Presession Planning Before a couple or family is seen for counseling, several matters should be addressed. One is the expectation(s) the caller has for an initial session or for treatment in general. The person who calls gives a rationale for seeking therapy that may or may not be the reason anyone else in the couple or family relationship has for wanting or not wanting counseling. Nevertheless, the coun- selor must listen carefully and obtain essential clinical information—such as a concise descrip- tion of the problem—and factual information—such as the caller’s name, address, and phone number. In gathering this information, the counselor should listen for what is conveyed as well as what is not said. In doing so, the counselor can begin to hypothesize about issues that are prevalent in certain family life stages and cultural traditions as they may relate to the caller’s 328 Part IV Counseling Specialties family. For example, a family with adolescents may expect to have boundary problems; how- ever, the way they are handled in a traditional Italian American family versus a traditional British American family may be quite different. Regardless, by the end of the initial phone call, an appointment should be scheduled. Initial Session(s) Research indicates that the first few sessions are the most critical in regard to whether counselors have success therapeutically with couples and families (Odell & Quinn, 1998). Therefore, get- ting off to a good start is essential. One way a good beginning can be fostered is for the counselor to establish rapport with each person attending and the couple or family unit as a whole. This type of bonding, in which trust, a working relationship, and a shared agenda evolve, is known as a therapeutic alliance. It can be created through a number of means such as Maintenance—as the counselor confirms or supports a couple’s or family member’s ­position; Tracking—when a counselor, through a series of clarifying questions, tracks or follows a sequence of events; and Mimesis—when a counselor adopts a couple’s or family’s style or tempo of communica- tion, such as being jovial with a lighthearted couple or family or serious with a couple or family that is somber. In establishing a therapeutic alliance, it is important for the counselor to engage the couple or family and its members enough to gain a perspective on how individuals view the presenting problem, person, or situation. This perspective is called a frame. The counselor may challenge the frame of the couple or family members to gain a clearer perspective of what is happening in the relationship or to give the couple or family another option by which they can perceive their situation (i.e., reframe). PERSONAL REFLECTION How would you frame how your family of origin functioned when you were growing up? How do you think another member of your family would have framed it? How might it be reframed? For example, “family members were always moving about but were connected like a spinning top” ver- sus “family members were always doing a variety of activities like members of a marching band, in harmony but different.” In the initial session or sessions, the counselor is also an observer. He or she looks for a phenomenon called the couple or family dance, which is the way a couple or family typically interacts on either a verbal or nonverbal level (Napier & Whitaker, 1978). If the counselor misses this interaction at first, he or she need not worry, for the pattern will repeat itself. It is important in observing the family dance to see whether some member or members of the family are being scapegoated (i.e., blamed for the family’s problems). For instance, a family may accuse its teen- age son of being a lazy troublemaker because the adolescent sleeps late whenever possible and gets into mischief when he is out on the town with his friends. Although it may be true that the son has some problems, it is more likely that he is not the main cause of the family’s problems. Thus, again, the counselor will need to probe and even challenge the family members’ percep- tions of where difficulties are located such as a lack of boundaries, vague or dysfunctional com- munication, a failure to support one another, and so on.  Chapter 14 Couple and Family Counseling 329 One way of broadly defining or clarifying what is happening in the couple or family is to ask circular questions—that is, questions that focus attention on couple or family connections and highlight differences among members. For instance, in a family the father might be asked how his daughter responds when verbally attacked by his wife and how other members of the family react as well, including himself. Such a strategy helps counselors and the families they work with see more of the dynamics involved in family life and may well take pressure off the person who has been seen as the problem. This type of questioning may also help the counselor and family see if triangulation is taking place (i.e., the drawing in of a third person or party into a dyadic conflict, such as the mother enlisting the father’s support whenever she has an argument with the daughter). In addition to these aspects of engaging the couple or family, it is crucial that the counselor develop the capacity to draw some initial conclusions in regard to the way the couple or family behaves (e.g., in a family, who talks to whom and who sits next to whom). In this way the coun- selor can gauge the dimensions of boundaries (i.e., those that allow closeness and caregiving versus ones that may be intrusive, such as a parent speaking for a child who is capable of speak- ing for himself or herself) (Worden, 2003). Intimacy and power can also be determined in this way. Essentially, through observation and engagement of the couple or family in conversation, the counselor becomes attuned to the dynamics within the couple or family, which in the long run are usually as important as, if not more important than, the content of conversations that occur within the counseling process. Overall, a first session(s) usually is one in which a counselor evaluates how the couple or family is functioning and what may need to be done to help the relationship run more smoothly. Tentative goals are set as well, and a return appointment is made. CASE EXAMPLE Cleo Takes the Intake Call Cleo had worked at family services for some time, but the call she received from a distraught mother at 2 a.m. confirmed the importance of listening to details. Helena, the mother, who was sobbing, told Cleo that she would like to make an appointment for her family because of abuses occurring within it. Cleo carefully probed and found out there was no immediate danger, but still something felt wrong. She then took the names and addresses of family members and their relationship to one another as well as other details. Finally, she said to Helena, “I can see your family in my office at 9 a.m. tomorrow morning,” to which Helena responded, “I hope you can straighten them out for me.” Cleo then realized what was happening. Helena was not planning to come to the session but instead was going to send her family to the therapist to be “fixed.” What would be your response to Helena at this point? What would you hope to accomplish by responding to her in this way? What difficulties might arise if the referring members of a fam- ily did not come to a session? The Middle Phase of Couple and Family Counseling The middle phase of couple and family counseling consists of those sessions between the initial session(s) and termination. This part of treatment is where the couple or family will most likely make needed changes in themselves, if they change at all. 330 Part IV Counseling Specialties During this time, couples or families and the counselor explore new behaviors and take chances. Couples and families that are not sure if they wish to change will often make only superficial alterations in what they do. This type of change is known as a first-order change. An example is parents setting a curfew back by an hour without any real discussion about it or the importance of a teenage daughter accepting responsibility for her actions. Second-order change, where structured rules are altered, is quite different and is the type of change that is hoped for in a couple or family undergoing therapy. An example of second-order change is a rigid, authoritar- ian family becoming more democratic by adopting new rules regarding family interactions after everyone has had a chance to make suggestions and give input in regard to them during a family meeting (Watzlawick et al., 1974). In fostering change within the couple or family, the counselor stays active mentally, ver- bally, and behaviorally (Friedlander, Wildman, Heatherington, & Skowron, 1994). The coun- selor also makes sure the couple or family goes beyond merely understanding what they need to do because cognitive knowledge alone seldom produces change. In addition, during the middle phase of counseling, the counselor links the couple or family with appropriate outside agencies, if possible. For example, in working with a family that has one or more members who are abus- ers of alcohol, the counselor makes sure they find out information about Alcoholics Anonymous (AA) (an organization of individuals who help one another stay sober), Al-Anon (a self-help organization for adult relatives and friends of people with drinking problems), and/or Alateen (a similar program to Al-Anon but for younger people, usually ages 12 to 19). Throughout the middle phase of treatment, there is a continuous focus on the process of what is happening within the couple or family. In many cases, couples and families make the easiest changes first. Consequently, counselors must press the couple or family for greater change if treatment is going to have any significance for them in a lasting way. The press is manifested in concentrating on cognitions, as well as their affective responses and behaviors (Worden, 2003). Sometimes this action is done in a straightforward manner, whereas at other times it is accomplished through injecting humor into the therapeutic process, a right that a counselor has to earn through first showing care and developing trust. An example of using humor in treatment to promote change can be seen in the following mother and daughter interaction: Mother to Daughter: I will just die if you repeat that behavior again. Daughter to Mother: You will not. You’re just trying to make me feel guilty. Counselor: Sounds like this plan has worked before. Daughter: It has. But she never dies and I just get mad and frustrated. Mother: I tell you, if you do it one more time, I will die! Counselor to Mother: So your daughter is pretty powerful. She can end your life with an action? Mother (Dramatically): Yes. Counselor to Daughter: And you have said before that you love your mother. Daughter: I do. But I’m tired of her reactions to what I do. They are just so overdone. Counselor to Daughter: But your mother says you are powerful and could kill her. Since you love her, I know you wouldn’t do that. However, since you have so much power I wonder if you would ever consider paralyzing one of her arms with a lesser behavior? Mother: What?!  Chapter 14 Couple and Family Counseling 331 Daughter (Laughing): Well, it might get her to stop harping at me and give us a chance to talk. Counselor (to Mother Maybe that chance is now and no one has to suffer and Daughter): physically if we do it right. The counselor in this case addressed a pressing issue of power and drama in a serious but some- what humorous way that got the attention of the two individuals most involved in the struggle, broke a dysfunctional pattern, and set up an opportunity for real dialogue and new interactions to emerge. In addition to the previous ways of working, the counselor must look for evidence of sta- bility of change such as a couple or family accommodating more to one another through subtle as well as obvious means. For instance, seating patterns, the names family members call each other, or even the tone individuals use when addressing one another are all signs that somewhat permanent change has occurred in the couple or family if they differ greatly from where they were when the therapeutic process began. In the case of a couple or family that is changing, the tone of addressing one another might go from harsh to inviting. PERSONAL REFLECTION Many people today carry cell phones. What do you notice about their ring tones? Are some more appealing than others? Could the same kind of linkage be made in regard to the tones family mem- bers use with each other? How would you react if your ring tone always conveyed a harsh sound? In the middle phase of couple and family counseling, it is crucial that the counselor not get ahead of the couple or family members. Should that happen, therapeutic progress will end because the couple or family will not be invested. Therefore, staying on task and on target requires the counselor to keep balanced and push only so far. A way to help couples and families stay engaged and make progress is to give them homework (i.e., tasks to complete outside the counseling ses- sions such as setting aside time for a conversation) and psychoeducational assignments (i.e., reading a book or viewing a video) to complete together so that they are literally learning more and interacting together. For example, the family might watch some episodes from the comedy televi- sion show The Addams Family of the 1960s or the 2015s comedy hit Modern Family. They could then come back and talk about how they are like and unlike in regard to the family they viewed. Such a way of working gives family members even more in common than would otherwise be the case, may draw them closer psychologically, and helps them clarify who they are and what they do. Termination/Closure Termination can be considered to be a misnomer in couple or family counseling since “from a family systems perspective, the therapist-family therapeutic system has reached an end point, but the family system certainly continues” (Worden, 2003, p. 187). Regardless, termination (includ- ing follow-up) is the final phase of treatment in working with couples and families. The couple or family, the counselor, or both may initiate termination. There is no one person who should start the process or one single way that closure should be conducted. However, termina- tion should not be sudden and should not be seen as the highlight of counseling (Gladding, 2015b). Rather, termination is designed to provide a counselor and a couple or family with closure. It should be a means to assess whether couple or family goals have been reached. Thus, in beginning termination, the counselor and couple or family should ask themselves why they are entering this phase. One reason may be that enough progress has been made that 332 Part IV Counseling Specialties the couple or family is now able to function on its own better than ever before. Likewise, every- one involved may agree that the couple or family has accomplished what it set out to do and that to continue would not be a wise investment in time and effort. Whatever the reason for terminating, the counselor should make sure that the work the couple or family has done is summarized and celebrated (if appropriate) so that the couple or fam- ily leaves counseling more aware and feeling stronger in realizing what they accomplished. In addition to summarization, another aspect of termination is deciding on long-term goals, such as creating a calm household where members are open to one another. This projective process gives couple and family members something to think about and plan out (sometimes with the counsel- or’s input). A part of many termination sessions involves predicting setbacks as well, so that couples and families do not become too upset when they fail to achieve their goals as planned. A final part of termination is follow-up (i.e., checking up on the couple or family following treatment after a period of time). Follow-up conveys care and lets couples and families know that they can return to counseling to finish anything they began there or to work on other issues. Client couples and families often do better when they have follow-up because they become aware that their progress is being monitored both within and outside the context in which they live. Summary and Conclusion American families have changed over the years those who work with couples and families need to from a few dominant forms to a great many variet- know the life cycle of families in order to assess ies. These changes were brought about by a number whether a marriage or family problem is develop- of forces within society such as the women’s move- mental or situational. Couple and family counselors ment, global and regional wars, and federal legisla- also need to be aware of systems theories and the tion. With these changes has come a greater need ways that couples and families work systemically. for working with married and unmarried couples as The field of couple counseling is sometimes well as families. The profession of couple and fam- incorporated into family counseling models, but pro- ily counseling has grown rapidly since the 1950s fessionals in this specialty need to be aware of the for a number of reasons, including theory develop- theories and processes that are used in each area. ment and proven research effectiveness. It has pros- They must also realize how individual or group theo- pered also because it has had strong advocates and ries may complement or detract from work with has generated a number of unique and effective families. Finally, couple and family counselors need approaches for a variety of couple and family forms. to be well schooled in the stages that family counsel- Professionals who enter the couple and family ing entails—preplanning, initial session(s), the mid- counseling field align with at least four associations, dle phase, and termination—and the general depending on their background and philosophy. Most techniques and emphasis within each. counselors join the International Association for Overall, working with couples and families is Marriage and Family Counseling (IAMFC) because a dynamic and exciting way of helping people. of its affiliation with the ACA, but some affiliate Because of its complexity and the intricacies of the with the American Association for Marriage and process, it is not for everyone but it is an entity that Family Therapy (AAMFT), the largest marriage and many counselors seem to enjoy and from which family therapy association. Regardless of affiliation, many people in society benefit. MyCounselingLab® for Introduction to Counseling Try the Topic 8 Assignments: Family Counseling.