Couple and Family

Therapy considerations
G E R A L D I N E M C K AY
Overview
• How is couple and family counselling is different to working with individuals
• Common elements in approaches to couples and families
• Importance of structure
• Establishing balance
• Tracking sequences and asking circular questions
• Challenges
• Questions and comments
What are you most
excited or nervous
about working with
couples and
families?
Individual vs Couple and Family
How to bring a couple and family
mindset to individual counselling

• Be relationally informed
• Common presenting problems in individual therapy
• Do a one-off consultation (accidental couple/family
session)
• Conceptualising in a relational way
What do couples bring?

Mismatched
goals, values Infidelity and Financial
Life transitions Intimacy Past traumas trust issues
or parenting conflict/stress
styles
What do families bring?

Relationship challenges

Mental Health

Drug or alcohol problems or misuse

Blended family issues

Dealing with grief and loss

Money issues
Making the shift to couple/family

• Joining with the client system (comprising more than one person)
• Both people are impacted both individually and relationally
• Focus on understanding the relationship between couple/family members
• Different set of ethical issues (couple/family therapist tend to face more ethical
challenges)
Some important principles
• No singular truth
• Circular rather than linear thinking
• Strengths over deficits
• Impact of context and social and cultural constructs
• Meaning making
• Facilitating and role modelling (e.g. deep listening)
• Awareness of our own biases
Roadmap – first session format

Exploration of Contracting
Pre-session Engagement Problem Problem
problem and session
hypothesising (joining) identification description
development closure

May 11 th , 2
 Roadmap - first interview format

Guides the therapist’s

exploration of the presenting
problem.

Exploration of Contracting
Pre-session Problem Problem
Engagement problem and session
hypothesising identification description
development closure

15 March, 2022 Introduction to family therapy 11

 Roadmap - first interview format

Guides the therapist’s

exploration of the presenting
problem.

Exploration of
Pre-session Engagement Problem Problem Contracting and
problem
hypothesising (joining) identification description session closure
development

Process by which the therapist

establishes a relationship with
each member.

15 March, 2022 Introduction to family therapy 12

 Roadmap - first interview format

Guides the therapist’s

exploration of the presenting
problem.

Exploration of
Pre-session Engagement Problem Problem Contracting and
problem
hypothesising (joining) identification description session closure
development

Process by which the therapist

establishes a relationship with
each member. Balance is crucial. Balance time with each person.

15 March, 2022 Introduction to family therapy 13

 Roadmap - first interview format
Guides the therapist’s
exploration of the presenting
problem.
The presenting or main
concerns are stated from both
perspectives without moving on
to a more in-depth description

Exploration of Contracting
Pre-session Problem Problem
Engagement problem and session
hypothesising identification description
development closure

Process by which the therapist

establishes a relationship with
each member.

15 March, 2022 Introduction to family therapy 14

 Roadmap - first interview format
Guides the therapist’s
exploration of the presenting
problem.
The presenting or main
concerns are stated from both
perspectives without moving on
to a more in-depth description.

Exploration of Contracting
Pre-session Problem Problem
Engagement problem and session
hypothesising identification description
development closure

Process by which the therapist Therapist explores what

establishes a relationship with happens when the problem
each member. occurs. A description of the
problem in interactional
behavioural terms.

15 March, 2022 Introduction to family therapy 15

 Roadmap - first interview format
Guides the therapist’s
exploration of the presenting
problem.
The presenting or main
concerns are stated from both
perspectives without moving on Evolution of the problem
to a more in-depth description. over time

Exploration of Contracting
Pre-session Problem Problem
Engagement problem and session
hypothesising identification description
development closure

Process by which the therapist Therapist explores what

establishes a relationship with happens when the problem
each member. occurs. A description of the
problem in interactional
behavioural terms.

15 March, 2022 Introduction to family therapy 16

 Roadmap - first interview format
Guides the therapist’s
exploration of the presenting
problem.
The presenting or main
concerns are stated from both
perspectives without moving on Evolution of the problem
to a more in-depth description. over time.

Exploration of Contracting
Pre-session Problem Problem
Engagement problem and session
hypothesising identification description
development closure

Process by which the therapist
establishes a relationship with
each member.
Therapist explores what
happens when the problem
occurs. A description of the
problem in interactional
behavioural terms.
Marks the end of the session
and any further discussion
about the problem.

15 March, 2022 Introduction to family therapy 17

 Balance
Helps the couple and family therapist to understand both partner’s experiences. We want both
partners/parties to experience that the therapist did not side with one person over the other.
Balance
To maintain the perception of equal connection with all parties the therapist needs to
ensure that:
1. Equal time is spent with all parties
2. An equal connection is maintained
3. Equal depth of exploration and intensity is developed when exploring issues (can
be challenging with couple/family work)
4. A safe space is created
5. Interruption from one client over another is prevented – turn taking
Sequences are useful to track because:

• They conceptualise interactional patterns between relationships

• They look at patterns of interactions rather than content
• They are a way of abstracting simple patterns from complex interactions
• They provide a starting point to exploring the meaning of behaviours for clients
• They provide circular rather than linear explanations
• Provide a basis of where to intervene so that the sequence may change, and more helpful
patterns emerge

19
 John walked in
after work, and
John asked Lisa
muttered under
what she had been
breath, threw bag
doing all day
down and went to
fridge to get a beer

Lisa couldn’t
believe he didn’t
even acknowledge
her and said:
“where’s my
hello?”

John said, “this

house is a bloody
mess!”

Lisa started to cry

and asked the kids
to get ready to do
their homework
Thinking systemically – the interview

Circularity

Circular questions

21
Therapeutic challenges
• Managing your own values and
beliefs
• Managing your own emotional
reactions
• Maintaining neutrality – impartial
interviewing position
• Recognition that partners may be
in a different emotional space
• Therapeutic ‘stuckness’
• Secrets, something undisclosed or
lies
• Intimidation or clients coming under
duress
• Facilitating communication without
escalating conflict
25
Questions
and
comments