An overview of Marriage and Family Counseling

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An overview ofMarriage and Family Counseling

• Dr. Scott Sparrow

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Systems Theory

• A person is himself or herself in the context of
  relationships. The usual focus on a persons
  feelings, thoughts, and internal struggles will
  not reveal the relationship forces that create
  distress or health
• A relationship is governed by feedback, or
  circular causality, in which each person
  continually responds to the other in predictable
  ways that sustain patterns of interacting in the
  system.

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Systems Theory

• Problems originate in, and are perpetuated by
  relationship dynamics. Solutions can be found in
  changing relationship dynamics.
• Systemic change can occur by intervening or
  restructuring the patterns of interacting between
  members

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School of Family Therapy

• MRI Cybernetics -- Bateson, Haley, Jackson
• grant to study schizophrenic families
• feedback loops
• circular causality
• rules
• Bowen
• studied schizophrenic families -- mother child
  fusion
• three-generation model, genogram
• fusion and differentiation
• triangulation

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School of Family Therapy, cont.

• Strategic -- Haley and Mandanes
• paradoxical directives
• highly directive without explaining reasons
• insight not necessary, still working under the
  assumption that families resist change
• presenting problem needs to be the focus. Once it
  is resolved, therapy is over
• Structural -- Minuchin
• boundaries
• hiercharchies
• enactments
• more collaborative than Strategic -- teaching and
  coaching
• presenting problem may mask more important
  issues, esp. marital

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School of Family Therapy, cont.

• Human Validation Process -- Satir
• nurturing
• family sculpting, parts party, concrete symbols,
  touching
• focused on teaching direct communication
• Experiential Family Therapy -- Whitaker
• therapists personal involvement essential
• highly experimental, playful, creative
• confrontive
• existentialist

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Families in Distress

• All families face two types of stressors
• Developmental stressors
• Environmental stressors
• Families in distress are not sick, but have been
  unable to adjust to the stressors

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Developmental Stressors

• marriage
• 1st child
• 1st teenager
• gender role changes
• death of parent
• children leave home

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Environmental Stressors

• fire
• injury
• war
• new job or job loss
• economic recession
• storm losses

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Why Families Enter Therapy

• Stressors -- environmental and developmental --
  arise in the normal course of a familys life.
• The failure of its members to accommodate to
  stressors leads members to disengage from some
  members, and become enmeshed with others
• Indirectness of communication and anxiety ensues,
  with triangular relationships substituting for
  direct encounter and the pursuit of intimacy.
• Identified patient is usually reason for entering
  therapy, but often only the symptom of family
  distress..

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A distressed family

• Is often unwilling to take responsibility
• Interprets problems from a linear causality
  perspective, rather than a circular perspective.
• Suffers a confusion of levels (children and
  parents)
• Forms coalitions (a parent and a child against
  another parent)
• Appoints children to quasi-adult roles (a child
  taking on the role of one parents confidant)

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Rules Matter

• Families have rules that determine how balance is
  reinstated. If something violates the rules, then
  one of two things happen
• Members reassert the rules.
• The family changes the rules.

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Values Matter

• Families have values that assign meaning to
  various events. It is important to understand
  those values in working with families.
• Values are a function of family and cultural
  origins.

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Language Matters

• Families have ways of describing people and
  situations that reflect their values and rules.
• It is important to understand the way the family
  uses language, in order to effectively reframe
  people and situations whenever a more positive
  viewpoint is possible.
• Reframing is using language to describe a person
  or a situation in a more positive way.

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A Step-by-Step Approach to Family Therapy -- the
Initial phase

• 1) Inviting entire family to session
• 2) Joining and building a collaborative
  relationship
• 3) Assessing problem from multiple perspectives
• 4) Assessing family rules, values, language
  patterns, and goals (teleological lens)
• 5) Assessing cultural issues (multicultural
  lens), and family of origin for patterns across
  the generations (developmental lens) -- genogram

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A Step-by-Step Approach to Family Therapy
--Interventions

• 6) Observing, or tracking interactional patterns
  -- asking process questions (Bowen)
• educates the family about circular causality
• I-position encourages taking responsibility and
  ending of blame
• 7) Observing and encouraging typical dynamics --
  enactments (Minuchin). Therapist may use
• Reframing, stroke and a kick
• Assigning tasks
• boundary adjustments
• eliciting and supporting competencies

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Restructuring Concepts

• Supporting parents (hierarchies)
• Insulating parents from their own families of
  origins
• Insulating parents from children
• Establishing direct communication or
  De-triangulating
• Nurturing competencies through reframing symptoms
  as strengths and assigning tasks
• Redefining relationships one-to-one with family
  of origin

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Classic Problems

• Critical/enmeshed parent in-law
• Acting out teenager
• Affairs

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Classic ProblemsCritical/enmeshed parent in-law

• unwillingness of adult child to assert boundaries
• unwillingness of son/daughter in-law to confront
  parent directly
• can lead to carryover of anger of adult child to
  spouse

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Interventions Critical/enmeshed parent in-law

• Establish better boundaries and privacy between
  couple and parent
• Confront in-law by adult child
• Establish direct relationship between
  son/daughter in-law and parent in-law
  (de-triangulation)

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Classic ProblemsActing out teenager

• Usually one parent is disengaged from the family
• The other parent is usually over-involved in the
  problem childs life.
• There is a lack of intimacy between couple due to
  preoccupation with child.
• There is often a neglect of other childrens needs

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Interventions Acting Out Teenager

• Get couple to work together to resolve
  differences, clarify rules, and express
  expectations
• Reframe teenagers behavior if possible
• Encourage direct communication between teenager
  and disengaged parent(s) without interference

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Classic Problems Infidelity

• Usually occurs during major developmental or
  environmental stressors, which disrupt
  communication and intimacy between spouses
• Can be due to lifelong suppression of ones needs
  in the context of a marital relationship
• Can be due to lack of intimacy due to family
  pressures

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Interventions--Affairs

• Establish that it takes two for an affair to
  happen.
• Need to communicate unspoken needs
• perhaps too much difference or complementarity
• perhaps not enough similarity, and quality time
• explore unexpressed dreams

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Tools for All Seasons

• Focus on process (how) rather than content (what)
• Focus on interpersonal dynamics, rather than
  personal feelings and thoughts
• Focus on here and now, vs. there and then

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Tools for All Seasons

• Teach Circular Causality/Reciprocity
• Ask process questions that encourage linking
  ones own behavior to the effects on others,
  example What effect does it have on her when
  you withdraw and watch TV? or Have you tried to
  talk with him about it rather than giving him the
  silent treatment?
• Encouraging I-position, not talking about others
• Explore cross-generational patterns

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Tools for All Seasons

• De-triangulating
• Getting people to talk directly without
  interruptions
• Role playing direct communication
• Having everyone present for meeting
• Acknowledging competencies and putting them to
  work
• Reframing -- Stroke and Kick -- Reframe and
  redirect
• Genograms for cross-generational patterns

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Quiz

• On a scale of 1-10, where 1 is not at all, and
  10 is very much or very often, answer the
  following
• 1. I get along with my partner.
• 2. I respect my partner.
• 3. My partner shows respect for me.
• 4. When I get upset with my partner, I speak my
  mind openly even if I have to get mad.

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Quiz

• 5. My partner and I have a lot in common.
• 6. My partner and I have different things that we
  are good at.
• 7. I have resolved most of my issues with my
  parents.
• 8. I find it difficult to take responsibility for
  my part when things go wrong between me and my
  partner.
• 9. There are things in my familys past that I
  have a hard time talking about.
• 10. I tend to be the one that my family comes to
  when they have a problem with someone else.

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Quiz

• Give yourself one point on every question from
  question 1-7 that you gave yourself a 6 or
  higher on.
• Give yourself one point on every question from
  8-10 that you gave yourself a 4 or less.
• So, how healthy are you in relationship?
• 8-10 very healthy in relationships
• 5-7 doing pretty well, could use targeted work
• 3-4 counseling recommended
• 0-2 counseling strongly recommended

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Thank you!
An overview ofMarriage and Family Counseling

• Dr. Scott Sparrow