COUNSELLING IN FAMILY

SETTING
Presented by: Farsanamol MK
• The family is a complex entity comprising interlocking systems and subsystems. Family is a group of people who
are related by blood adoption or marriage and committed to each other.

• Our families shape us, influence our development, and model appropriate or inappropriate behaviour. It is only
within the context of the larger family system that the individual can be fully understood. It is the basic institution
and the primary group in the society.

Types of Families:

• Nuclear Family- consists of parent and children

• Extended or Joint family – consists of grandparents, parents and children. Two or more generation living together
in introduction.

• Single parent Family – consists of divorced or widowed parent and children.

• Reconstructed Family – consists of one biological parent, one step parent and children

• Re reconstructed Family – consists of both step parents and children (your, mine and ours).

• Childless Family – husband and wife, no children

• Therapists who work with couples and families take on many different roles: coach, consultant, model, teacher, or
collaborator who works with the family to facilitate change.
FAMILY THERAPY
• Family therapy is the branch of psychiatry which sees an individual's psychiatric symptoms as inseparably
related to the family in which he/she lives. Thus, the focus of treatment is not on the individual, but the
family.

• It refers to the joint treatment of two or more members of the same family in order to change unhealthy
patterns of communication and interaction.

• Family therapy can be especially helpful for dealing with problems that develop in response to a particular
event or situation, such as divorce or remarriage, or the birth of a new sibling.

• Duncan Santan(1988) states that “the couple and family counselling is a way of constructing human problems
that dictates certain action for their allevation.
• Wynne (1908) defines family therapy as a “psychotherapeutic approach that focuses on altering interactions
between a couple, within a nuclear family or extended family, or between a family and other interpersonal
systems, with the goal of alleviating problems initially presented by individual family members, family
subsystems, the family as a whole, or other referral sources.
GOALS OF FAMILY THERAPY
 To reduce dysfunctional behaviour of individual family members.

● To resolve or reduce intra family relationship conflicts.

● To improve family communication skills.

● To heighten awareness and sensitivity to other family members to meet their needs.

● To strengthen the family ability to cope with the major life stressors and traumatic events.

● To improve integration of the family system into the social system.

History of Family Therapy
• Marital counselling and child guidance were practiced for decades before family therapy was born.
• In 1929 marriage consultation centre was opened in New York, and in 1941, The American
Association of Marriage Counsellors was formed.
• The 20 years marked by 1950-1970 most of the major theoretical orientation in psychology
developed a family focused component.
• Through the pioneering work of Murray Bowen, Jay Haley, Virginia Satir, Carl Whitaker,
Salvador Minuchin and others, incorporated general system theory as well as first order
cybernetics.
• In the past two decades, newer types of family therapies have emerged that address what was
lacking in previous theories.
 Contributors to Family System Theory
• Major contributors are;
o Alfred Adler Murray Bowen Virginia Satir Carl Whitaker Salvador Minuchin Jay Haley
• Family system approach holds that individuals are best understood through assessing the interaction between and
among family members.
Adlerian Family Therapy
• Alfred Adler was the first psychologist of the modern erato do family therapy.
• Adlerian constructs such as birth order, sibling rivalry, inferiorities, and social interest implied that the individual
could only be understood in relation to the whole.
• Adler’s holistic approach introduced the following concepts to psychotherapy;
o the effect of the family constellation in individual and family functioning
o the idea that people must be viewed in their family, social, cultural contexts.
o A positive focus that emphasizes strengths, encouragement, empowerment and support
o the importance of establishing a collaborative therapeutic alliance.
o A focus away from pathology that is problems are normal part of life that provides
opportunity for growth
• Psycho education as part of the therapeutic process.
• Adlerian family therapy starts with forming a relationship based on mutual respect
• Assessment is based on subjective descriptions that family members use to define
themselves and the interaction that occur in everyday life.
• Here the therapist place the function of an educator motivational investigator
and collaborator
• Focus on formation of relationships based on mutual respect, investigation of birth
order and reduction of mistaken goals
Bowen’s Multigenerational Family therapy
Murray Bowen was among the first to combine psycho analysis with system theory.
According to Bowen family is an emotional unit a network of interlocking relationships best understood when analyzed within
a multigenerational or historical framework
• He argued that cause of an individual’s problems can be understood only by viewing the role of the family as an emotional
unit. Emotional problems will be transmitted from generations to generations until the unresolved emotional attachments
are dealt effectively
Key concepts
Differentiation of self
• Involves both psychological separation of intellect and emotion and independence of self from others
Triangulation
• When there is a stress between two people in a family, they maybe likely to bring another member into dilute the anxiety or
tension - called triangulation
• Bowen believed that the least differentiated person is likely to be drawn into the conflict to reduce tension
Nuclear family emotional system
• Bowen believed that it is a multi generational phenomenon that included not only the nuclear family that physically live
together but also affect of the extended family regardless of were family members reside or even if they are living or dead
• According to Bowen the only way to resolve current family problem is to differentiate from the family of origin and change
interactional patterns.
Family projection process
• When there are relatively low levels of differentiation in the marriage partners May project the stress on
to one child- the family projection process
Emotional cut off
• One or more children in a family, especially those who are least involved in the family projection process
is likely to escape from the family dysfunction by putting geographic or emotional distance between
themselves and their families.
• cut off occur in families in which high level of anxiety and dependence is present
Multigenerational transmission process
• In the concept of multigenerational transmission process the functioning of grandparents, great grand
parents, great aunts, great uncles and other relatives may play an important role in pathology of the
family
Sibling position
• Relying on the work of Toman he believed that the sibling position of marriage partners would affect
how they perform as parents
Societal regression
• Bowen’s theory of family structure goes beyond the immediate family system
• He extended his model of family system to social functioning
Goals
• The goal of Bowen’s family therapy is to reduce anxiety, increase differentiation of self and establish a
healthy emotional boundaries between family members and change the individual within the context of
the system
Techniques
Genograms
Genograms is a method of diagramming families and includes significant information about families
such as age, sex, marriage dates, death and geographical location
• Provides the opportunity to look for emotional patterns in each partner’s own extended family
Detriangulation
• Bow and try to separate parts of a triangle directly. In general Bowen preferred to work with the
healthiest member of the family the person who was most differentiated so that the person could make
changes in various stressful family relationship.
Structural Family Therapy
• Developed by Salvador Minuchin 1970s
• It focus on how families operate as a system and their structure within the system
Major concepts
Family structure
• the structure of the family refers to the rules that have been developed over the years to determine who interacts with
whom
Family subsystem
• Three subsystems of particular interest to structural family therapist
• Parental (those who are responsible for the children ) spousal ( maybe different than parental) and sibling( all related
children)
• Minuchin believed that membership in one subsystem shouldn't interfere with membership in another
Boundaries
• Boundaries provide a way to look at who is involved in each subsystem
• both system and subsystem have rules as to who can participate in interactions and how they can participate. This rules
of interaction or boundaries vary as to how flexible they are.
• highly permeable boundary would be found in enmeshed families, whereas non permeable or rigid boundaries would
be found in disengaged families

Alignments and coalitions

• Alignments refer to the ways that family members join with each other or oppose each other in dealing with an activity
• Coalition refer to aliens between family members against another family member
Goals
• The goals of Structural family therapy is two fold
• Reduce symptoms of dysfunctions and bring about structural change within the system
by modifying the families transactional rules and developing more appropriate
boundaries
Treatment process
• The process of change consists of three phases as outlined by Minuchin
• In the first Phase therapist joins with the family and assumes a leadership position
• Second phase therapist determines the families structure and in the third phase therapist
work to change the structure
Techniques
Joining
• Minuchin describe how he sometimes becomes like a distant uncle and join with the family
system by committing the family style using their language and terminology respectfully joining
with them in their myths and stories and adopting their affective style
• Through this process, the structure of the family system is revealed to the therapist
Re-framing
• Re framing places the original event or situation into a different context the goal is to relabel the
event. It is used to change the family perceptions and as a result provide more options and
explanations based on a new way of looking at the situation
Enactment
• Through the process of enactment that therapist brings an issue of family conflict into here and
now of the therapy session to that hierarchies and family dynamics can be mapped and the
alternative transmission patterns can be introduced
Family maps
• Structural family therapist use family mapping as a tool to illustrate the family relationships.
Maps similar to genograms visually represent family subsystem boundaries hierarchies and
alliances.
• Minuchin has applied structural family therapy in his work with anorexia ,diabetes, asthma and
other chronic disorders
Experiential Family Therapy
• Experiential family therapy grown out of the humanistic, existential tradition and incorporated elements of person
centered , gestalt and process - experiential theories that emphasize affect and expression of feelings.
• In experiential family therapy, the process, growth and action are emphasized while background and historical
information are considered less important.
• Virginia Satir and Carl Whitaker are regarded to be early pioneers of experiential family therapy.
Human Validation Theory of Virginia Satir
• Satir noted that people speak with their entire bodies. More than just an expression of words communication
includes body language, tone, posture, facial expression and other subtle indications of affect.
• Words and body language are in conflict when people say one thing while their facial expression and body language
reveal something completely different
• This incongruence sends out mixed messages. Satir underscored the importance of Congruence in all
communication
• She believed that all relationships are built on trust and when that trust is threatened, stress results.
• Under stress a person retreats into survival mode and will communicate from one of five survival strategies;
placating, blaming, super reasonable, irrelevant or congruent
Placating
the placator’s survival strategy is to get along. Regardless of that true feelings under threat or stress placators will
agree with the other person even at the expense of their own true opinion
Blaming
regardless of who is right or wrong the blamer will always take on an angry “I am the boss” stance whenever he or she
feel threatened or stressed. The underlying need is for power and for the other person to back down
Super reasonable the super reasonable person will respond under stress as impassive, logical and correct in writing
only on a cognitive level this person will never give away his or her how they feel super disable people are likely to
respond within what dating
• Under stress some people will respond with communication that is unrelated to the context of what is
going on around them. This extraneous communication is designed to change the subject, avoid conflict or
deny that anything is wrong.
Congruent
• the final form of communication identified by Satir is congruence. People who respond congruently have
no discrepancy between what they are feeling and what they say.
• Of these 5 communication stances only the congruent stance is healthy and leads to improved
communication and connections between people.
• Satir stressed that all communication stances are learned behaviors and can be changed
Treatment process
The role of therapist in Satir transformational systemic therapy is to help family members to experience and
communicate their emotions and to recognize the communications they leave out
• Satir was an active and directive therapist who believed in equality among family members
• This type of therapy includes a blend of the Gestalt, psycho-drama, role plays, modeling family sculpting,
video tapes or other exercises or games to reenact all the wounds and help family members develop new
awareness, change miss perceptions and foster empathy for each other
• As people become more aware of their dysfunctional communication styles they learn to express
themselves on a deeper emotional level
 Experiential therapy of Carl Whitaker
• Carl Whitaker (1 91 2-1995) was a psychiatrist who became an influential pioneer in the development of family therapy.
Even more than Virginia Satir, Carl Whitaker used his personality in the service of psychotherapy.
• In his intuitive approach to families, Whitaker (1976) listened for impulses and symbols of unconscious behavior.
Sometimes he responded consciously to feelings or family members’ ways of relating; at other times he would be
unaware of why he was responding the way he was.
• Relating symbolically, he often suggested clients fantasize about an experience. This may lead to understanding the
absurdity of a situation. Situations are viewed in ways that emphasize choice and experience rather than sickness or
pathology
• He believed that fear of loss, either real or imagined, is the primary driving force in families.
• He identified three types of loss: (1) loss of order and meaning, (2) loss of family spirit, and (3) ultimately,
the fear of death
• Whitaker believed that all family members should attend counseling sessions, including grandparents and
even ex-spouses.
• Multigenerational support was necessary, he believed, to the effectiveness of counseling
• The therapist should be very directive within the session and become an authority figure to the family, which
allows the family to act out their dysfunctional communication patterns. Early in therapy, even with the first
phone call, Whitaker began to tip the balance of power and assert his authority.
 Types of Family Therapy
Individual family therapy:
• In individual family therapy, each family members has a single therapist. The whole family may
meet occasionally with one or two of the therapists to see how the members are relating to one another
and work out specific issues that have been defined by the individual members.
Conjoint family therapy:
The most common type of family therapy is the single-family group, or conjoint family therapy. The
nuclear family is seen, and the issues and problems raised by the family are the ones addressed by the
therapist. The way in which the family interacts is observed and becomes the focus of therapy. The
therapist helps the family deal more effectively with problems as they arise and are defined.
Couples therapy:
Couples are often seen by the therapist together. The couple may be experiencing difficulties in their
marriage, and in therapy, they are helped to work together to seek a resolution for their problems.
Family patterns, interaction and the communication styles, and each partner's goals, hopes and
expectations are examined in therapy. This examination enables the couple to find a common ground
for resolving conflicts by recognizing and respecting each other's similarities and differences .
Multiple family group therapy:
In multiple family group therapy, 4 or 5 families meet weekly confront and deal with the problems
or issues they have in common. Ability or inability to function well in the home and community
fearing of talking to or relating to others, abuse, anger, neglect, the development of social skills,
and responsibility for oneself are some of the issues on which these group focus. The multiple
family group become the support for all the families. The network also encourages each person to
reach out from new relationships outside the group.
Multiple impact therapy:
In multiple impact therapy, several therapists come together with families in a community setting.
They live together and deal with pertinent issues for each family member within the context of the
group. Multiple impact therapy is similar to multiple family group therapy except that it is more
intense and time limited. Like multiple family group therapy, it focuses on developing skills or
working together as a family and with other families.
Network therapy:
Network therapy is conducted in people's homes. All individuals interested or invested in a problem
or crisis that particular person or persons in a family are experiencing take part. This gathering
includes family, friends, neighbors, professional groups or persons, and anyone in the community
who has an investment in the outcome of the current crisis. People who form the network generally
know each other and interact on a regular basis in each other's lives. Thus a network may include as
many as 40 to 60 people.
Counselling Process
• In most cases of family counseling, the families themselves often do not enter in the process of
counseling to seek intervention for the family as a whole rather they often land up with a problem
behaviour in the child or an adolescent member to be dealt with that is a matter of concern for the
whole family.
• Or in certain cases, a family counselor may be approached if there is an adult family member with a
known psychopathology or disorder that is interfering with the family functioning, or in few other
cases, there could be an apparent dispute or conflict among the family members that is causing
significant distress to one or more of the family members and affecting the functioning of the family as
a whole.
• Thus, under most instances of family counseling, the family has to be psycho-educated about the need
for family counseling, and therefore, has to be adequately prepared and encouraged for involvement in
the process so as to grapple with the entire problem and the issue of concern
Circular causality:
Family approaches stress the structural causality: the idea that events are related through a series of
interacting feedback loops. Concepts Related to Circular Causality are
Nonsummativity: The family is greater than the sum of its parts. It indicates that it is necessary to see the
patterns rather than the actions of any specific members alone.
Equifinality: Families that experience a natural disaster may become stronger or weaker as a result.
Likewise, healthy families may have quite dissimilar backgrounds. Therefore, the focus of treatment is on
interactional family patterns rather than particular conditions or events.
Communication: It is important to attend to the two functions of interpersonal messages: content (factual
information) and relationship (how the message is to be conveyed).
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. To help families change dysfunctional ways of
working, family counselors have to help them define or expand 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. Instead of just talking, family members may need
to try new ways of behaving.
Homeostasis: Like biological organisms, families have a tendency to remain in a 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
Assessment
The entire process of assessment and history taking begins with taking a brief account of the current
concerns or, so to say, the presenting problem. The presenting problem must be clearly understood and
concretely stated by the counselor. It is often interesting and important to see how different family
members construe the same problem in quite divergent ways. As a part of the assessment process, it is
essential to analyse and assess further:
A) Structure and History of the Family
• Structure and configuration of the family: Structure recorded in the genogram includes information
regarding single parent, a step parent, number and ages of the siblings etc. For this, usually a family
history has to be taken at a three generational level depicted through a family genogram using
conventional symbols.
• Transitional events in family cycle: Changes and events such as births, deaths, departures, and
financial problems that have taken place in the past or recent past and divergent reactions of various
family members to all these transitions or crises situations in the family life need to be discussed and
recorded in detail.
• Nature of relationships: The counselor always explore the nature of relationships within the family
structure such as being close, distant, loving, conflictual, reserved etc.
• Boundaries:The counselor needs to assess, if in a given family, the boundaries between family
members are so enmeshed that they are overly involved with each other and fail to maintain individual
thought processes and reaction patterns or if the boundaries are too rigid that the members act as
totally separate persons who merely seem to share the same household.
• Family atmosphere: Every family has a distinct atmosphere: authoritative, chaotic, panicky, over-excited,
apathetic, critical, aggressive, humorous or balanced that is essential for a counselor to understand .
B) Roles, Functioning and Pathological Trends in a Family
• Role performance: Counselors need to explore the different roles being taken up, assigned or enforced on
different family members; the level of efficacy with which the roles are performed by each member
• Decision making and power struggle: A family counselor needs to identify the trend that exits in a given
family and its impact on other family members before planning any intervention.
• Pattern of communication and exchange of information: Communication varies greatly in terms of whether it
actually occurs or not, how clear, how open and direct, and how responsive family members are to one
another.
• Emotional reactivity: Pattern of emotional reaction among family members that might involve some
members being too impulsive, aggressive, irritable or frustrated in their reactions, some might be too docile
or emotionally unreactive, some might expect undue pampering or dependence on others while some family
members appear to be overly involved with enmeshed ego boundaries with others and would always keep
worrying about others or trivial issues in the family, and would remain overly anxious thereby contributing
to the family’s problems and pathology.
• • Cohesiveness: Cohesiveness is threatened when alliances form which exclude some members, when
discord develops between two or more members, and a child or a parent is typically scapegoated or blamed
for anything or everything that goes wrong in the family .
• Family operations: Some families are adaptive and may deal with transitions, conflicts and changes in an
appropriate and mutually supportive manner while other families may show dysfunctional patterns.
• Liabilities and pattern of individual growth of family members:. The counselor needs to explore if the
family pattern is adaptive and places appropriate levels of liabilities and burdens on every individual member
and encourages the individual growth of each of its members or it creates impediments in the individual
growth and development of a particular member
• Socialization and Recreation Pattern within the Family; A family counselor must also explore with adequate
clarity:
• Nature and pattern of value and moral system of a family
• Pattern and level of religious and spiritual orientation within a family
• Pattern and level of socialization accepted and encouraged in a family
• Pattern of seeking entertainment and recreation within a family .
Benefits of Family therapy
• A better understanding of healthy boundaries and family patterns and dynamics.
• Enhanced communication.
• Improved problem solving.
• Deeper empathy.
• Reduced conflict and better anger management skills.
• Bringing the family together, after a crisis.
• Creating honesty between family members.
• Instilling trust in family members.
• Developing a supportive family environment.
• Reducing sources of tension and stress within the family.
• Helping family members forgive each other.
• Conflict resolution for family members. Bringing back family members who have been isolated.
References
• Sharf,R.S.(2012).Theories of Psychotherapy and Counselling Concepts and Cases. Brooks/Cole,
Cengage Learning
• Corey,G.(2013).Theory and Practice of Counselling and Psychotherapy. Brooks/Cole, Cengage
Learning
• Seligman,L., & Reichenberg,L.W.(2001). Theories Of Counseling And Psychotherapy, Systems,
Strategies And Skills. Pearson
• Capuzzi,D., & Gross, D. R.(2017). Introduction To The Counselling Profession(7th ed).Routledge