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Comprehensive
Exam Review
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Helping
Relationships
Part 3
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Major Family
Counseling Theories
A “family” has been defined as a natural social
system with its own unique properties,
including:
evolved rules of behavior,
an organized power structure,
negotiating and problem-solving strategies,
shared history and perceptions, and
overt and covert modes of communication.
A family is characterized by economic,
physical, social, and emotional intra- and
interdependence among the members of the
unit.
Functional families are characterized (at least)
by reciprocal emotional attachments,
structural stability, effective coping skills,
interactive processes, open channels of
communication, and structural and
interactive flexibility to cope with the
demands of life.
The “family life cycle” is the series of stages
through which a family evolves over time.
Models of the family life cycle typically include
the following stages:
Independent adults
Marital dyad
Infant family
Pre-School family
Grade School family
Adolescent family
Launching family
Mentoring dyad
Retirement family
Elderly family
Family counseling is often considered within
the context of systems theory, which holds that
a family is composed of interacting components
(i.e., family members mutually affect one
another).
Family systems theory also holds that:
a. causality is interpersonal.
b. family systems are best understood as
repeated patterns of interpersonal
interactions.
c. symptomatic behaviors must be understood from an interactional viewpoint.
Basic family counseling concepts
Circular Causality is the idea that events
are related through a series of interacting
feedback loops.
Within the context of the circular causality
viewpoint, family or family member
dysfunctionality is shifted from any
individual(s) to the family unit as a whole.
Linear Causality is the antithesis of circular
causality, suggests that there is cause-and-effect
explanation of behavior.
Cohesion is the level of emotional bonding
among family members.
Adaptability is the level of the family’s ability
to be flexible and to change.
Enmeshment is a situation in which family
members are overly dependent upon and/or
undifferentiated from one another.
Triangulation is when one family member is
“pulled” in two different directions by the other
members of the triangle.
Paradigm Shift is a change in traditional or
habitual ways of thinking, with subsequent
change in behavior.
Identified Patient is the person who bears the
symptoms, although the problem is addressed
from a family systems perspective.
Subsystem is two or more (but not all) family
members who form a subsection of the family.
Homeostasis is a steady or balanced state of
being; families act to maintain homeostasis.
Equifinality is when the family uses or reaches
the same set of behaviors regardless of the
initial impetus for reaction.
Feedback is when informational interaction
among family members influences future
behaviors in a closed loop.
Morphogenesis is the ability of the family to
meet changing demands.
Boundary is the limit of possible input and/or
influence permitted.
Open System is a family with permeable
boundaries that allow for exchanges and/or
influence from the community outside the
family.
Disengaged is when a family member is
emotionally separate or distant from other
family members.
Experientialist Family Counseling
Virginia Satir, similar to other Experientialist
family counselors, believed that family problems are grounded in suppression of feelings,
emotional and/or behavioral rigidity, and lack
of awareness and sensitivity.
The goal of Experientialist family counseling is
to increase intrafamily communication.
Experientialist family counselors, unlike most
others, often describe family dysfunction using
an individual or dyad as the unit of analysis.
Satir described four nonproductive roles of
communication that family members may use
when under stress:
Placater - who agrees and tries to please
Blamer - who dominates and finds fault
Responsible Analyzer - who remains
emotionally detached and intellectualizes
Distractor - who interrupts and constantly
chatters about irrelevant topics
Another Experientialist, Carl Whittaker
advocates the use of a co-counselor to
prevent the counselor from becoming
enmeshed in the family.
Whittaker also emphasized the use of creative,
sometimes relatively radical, techniques in
family counseling.
Whittaker’s primary goals for family counseling
are to increase each person’s belongingness in
the family as well as individuality within the
family.
Psychoanalytic Family Counseling
Psychoanalytic family counseling is derived
from individual psychoanalytic theory, and
may be applied in a family or individual
context.
The primary goal of Psychoanalytic family
counseling is to bring to the conscious the
unconscious patterns from the family of
origin (object relations) through
transference and countertransference.
Psychoanalytic family counseling attempts to
improve relationships by breaking fixations
from an earlier stage of development.
The interfering fixations constitute an
intrapsychic structure known as an introject.
Psychoanalytic family counselors attempt to
establish effective object relations wherein an
individual can have an effective relationship
with another (i.e., object) by removing the
introjects.
Behavioral Family Counseling
Major underlying principles of Behavioral
family counseling include that:
a. behavior is maintained or eliminated by
consequences
b. adaptive behaviors can be learned
c. maladaptive behaviors can be unlearned
or changed
d. cognitions can be rational or irrational,
but can be changed.
Behavioral family counseling often involves
cognitive change or mediation as a concurrent strategy.
Behavioral family counseling is often criticized
as being linear in nature; that is, that problems
are viewed as individual, not systemic, and that
problems can be solved through logical
applications of behaviorism.
Behavioral family counseling is used most
frequently for treatment of sexual dysfunction
between spousal partners.
Structural Family Counseling
Salvador Minuchin is usually acknowledged as
the founder of Structural family counseling.
The primary goal of Structural family counseling is to “resolve” presenting problems.
Resolution of presenting problems typically
results from or in change in the underlying
family structure (i.e., pattern of intrafamily
interactions).
Structural family counseling is actionoriented; the counselor plays a very active role
in the therapeutic process.
Structural family counseling is based on the
idea that family functioning involves family
structure, subsystems, and boundaries.
The primary goals of Structural family
counseling are to resolve problems by “bringing
them out into the open” and to facilitate
structural changes such as those related to
organizational patterns and action sequences.
Primary Structural counseling techniques
include:
Joining, in which the counselor helps to act out
the mood of the family.
Enactive Formulation, in which the counselor
acts to slow down a family interaction.
Challenging the Communication Rules of the
Family, in which the counselor imposes new
communication rules for the family.
Reframing, in which a positive connotation is
applied to a negative behavior.
Relabeling, in which a positive descriptive
adjective is used to replace a negative one.
Challenging the Structure of the Family, in
which the counselor points out ineffective
patterns of behavior and/or interaction.
Restructuring, in which the counselor
intentionally modifies a family’s
typical way of interacting.
Task Setting, in which the counselor gives a
specific homework assignment intended to
extend what has gone on in counseling.
Making Boundaries, in which the counselor
helps family members establish more effective
boundaries, usually by placing limitations on
specific behaviors.
Shaping Competence, in which the counselor
helps family members to develop and be
recognized as having new competencies.
Strategic Family Counseling
Jay Haley is recognized as the foremost
proponent of Strategic family counseling.
Cloe Madanes, another important Strategic
family counseling theorist, is noted for her
analyses of power in the family.
The primary goal of Strategic family counseling
is to resolve presenting problems as rapidly as
possible, often in terms of behavioral goals and
minimizing insights, using action-oriented
techniques.
Strategic family counseling is intended to be
simple and pragmatic, and to focus on
changing symptomatic behaviors and rigid
rules.
Haley was particularly concerned with family
life cycle transitions, suggesting that if the
family does not adapt to change or stress
effectively, one or more family members will
become symptomatic.
A primary Strategic family counseling technique is the use of directives (aka prescriptions), which are “orders” the counselor gives
directly or indirectly to the family to achieve
compliance or its opposite, rebellion.
Key concepts in Strategic family counseling
include:
The Perverse Triangle, which is a situation in
which two family members at different levels of
the family hierarchy align against a third
member.
Double Bind, in which no matter what the
person does or says, the person cannot “win.”
Power in the Family, which is the authority to
make or enforce rules or decisions; power
becomes most important in transition or
problematic situations.
Incongruous Dual Hierarchy, in which a family
member holds both a superior and inferior
position of power in the family.
The Symptom as Metaphor, in which a
“symptom” serves as a metaphor for the
problem being experienced by another member
of the family.
Cyclical Variation Maintaining Incongruous
Dual Hierarchies, in which the symptoms
come and go in cycles but the incongruous
hierarchies remain.
Pretending, in which one family member is
instructed to pretend to have a symptom
while others react to it.
Solution-Focused (Brief) Family Counseling
The primary goal of Solution-Focused family
counseling is to change behavior in a relatively
brief period of time, particularly by changing
family rules (i.e., the governing principles that
organize family life).
The primary proponents of Solution-Focused
family counseling include Don Jackson, Paul
Watzlawick, and Steve de Shazer.
Jackson focused on changing the interactional
patterns among family members using
“recalibration,” which is changing or
redefining the family rules, such as through:
Quid Pro Quo, in which family members are
asked what is needed and what can be given,
and then change is negotiated.
Prescribing the Symptom, in which the family
is directed to intensify the symptomatic
behavior toward having them rebel and
actually reduce the behavior.
Watzlawick described first-order change as
change of the structure or system, but with no
change in the rules, and second-order change
as change in the structure or system with
associated change in the rules.
Watzlawick viewed the goal of Solutionfocused family counseling to be second-order
change (i.e., removal of symptoms through
behavior change).
Watzlawick advocated the use of paradoxical
interventions in which the family is instructed to implement contradictory behaviors.
Steve de Shazer suggested that the ecosystem
(e.g., family) is the survival unit, not the
individual.
de Shazer focused on “ecosystemic epistemology” suggesting that family members
reciprocally gain knowledge and evolve their
own reality.
de Shazer advocated (but did not require) use of
family counseling teams, often with the team
behind a one-way mirror and being brought in
when therapeutically appropriate.
Techniques associated with de Shazer include:
Clue, which is an intervention that mirrors
family behavior, such as a counterparadox in
response to double-bind behavior.
Compliment, which is a written message that
praises family behavior and relabels previous
family behavior.
Confusion, in which the counselor admits to
confusion about possible resolution
following a detailed description of each family
member’s behaviors.
Past Successes, in which the counselor
compliments past successful behaviors
but does not directly relate them to current
situations.
Skeleton Keys, which are “stock interventions”
that work in a variety of circumstances.
Intergenerational Family Counseling
Murray Bowen is the foremost proponent of
Intergenerational family counseling.
Self-differentiation is the degree to which people
can separate cognitions and emotions to
function effectively.
The primary goal of Intergenerational family
counseling is to assist one or more family
members to achieve greater self-differentiation.
Triangulation is the process of involving a third
person in a dyad, particularly when the dyad
is stressed or confronting a problem.
The Nuclear Family Emotional System is the
pattern of emotional interchange among family
members in a single generation.
Multigenerational Transmission Process is the
mechanism whereby emotional adjustment is
transmitted across generations in a family.
Bowen developed genograms to represent the
process and structure of at least three
generations of a family.
Genograms are used to help family members
understand the multigenerational
transmission process.
Detriangling is a technique to help family
members share thoughts and feelings without
becoming defensive or putting others down.
Ivan Boszormenyi-Nagy developed several
Intergenerational family counseling concepts
and techniques, including:
Ledger of Merit, which is the multigenerational
structure of expectations and actions
reflecting debts and merits accumulated on each
side of a dyadic relationship.
Entitlement, which is merit for caring.
Delegation, which is the expectation parents or
grandparents have for children to conduct
the mission of the family.
Siding, in which the counselor sides with each
family member in expounding on the
member’s contributions to the family.
Rejunction, in which family members dialogue
to obtain entitlement.
Crediting, in which the counselor helps to
acknowledge various family member’s positive
contributions to the family.
Consultation
Consultation is a helping process in which a
counselor works with one or more other
professionals, who in turn work with one or
more clients.
Thus, in consultation, counselors have only
an indirect relationship with clients (service
recipients).
The consultation process usually occurs
across several stages.
The first stage is called the Entry Stage,
because it is the point at which the consultant
enters the organization and/or relationship.
The relationship is built during the Entry
Stage, the problem and its parameters are
defined, and a mutually-agreed upon
contract is made with the consultees.
Typically, there are four phases in the Entry
Stage.
In Phase 1, the consultant explores the
organization’s needs in regard to questions such
as Should consultation take place?; Why am I
here?; Who are you?; What is likely to
happen?; What will be the result?; and What
can go wrong?
In Phase 2, a contract is developed to agree
upon consultation procedures, fees,
expectations of participants, and deadlines.
The elements of a contract typically include
consultation goals, time frame, consultant's
responsibilities, agency's responsibilities,
consultant's boundaries, and arrangements for
periodic review and evaluation of the
consultant's work.
In Phase 3, the consultant physically spends
time working with consultees.
In Phase 4, the consultant psychologically
enters consultee’s system by establishing the
relationship and minimizing resistance to
change.
The second stage in consultation is the
Diagnosis Stage, in which the problem is
examined in depth and the consultant and
consultee establish goals and generate
methods to meet the goals.
The Diagnosis Stage also typically has four
phases, including (a) gathering information,
(b) defining the problem, (c) setting goals, and
(d) generating interventions.
The third stage is the Implementation Stage, in
which the emphasis is on planning and taking
action.
The typical four phases of the Implementation
Stage include (a) choosing an intervention, (b)
formulating a plan, (c) implementing the plan,
and (d) evaluating the plan.
The fourth stage is the Disengagement Stage,
in which there is gradual reduction in the
activity and dependency on the consultant.
The typical four phases of the Disengagement
Stage include (a) evaluating the consulting
process, (b) planning for post-consultation
concerns, (c) reducing involvement, and (d)
termination.
Organizational consultation involves a
counseling professional working either inside
or outside an organization to provide technical,
diagnostic, prescriptive, or facilitative
assistance to individuals or groups from the
organization seeking to change, maintain, or
enhance the organization's effectiveness.
A variety of models of organizational
consultation have been presented in the
professional counseling literature.
Blake and Mouton proposed the “Consul-cube”
as a model containing 100 cubes to explain the
relationships among units of change (i.e.,
clients), kinds of interventions, and focal issues
(i.e., problems).
Schein proposed several models of organizational consultation.
In Schein’s Purchase of Expertise Model, the
consultee knows what the problem is, how to
solve it, and who can be of help, and so just
hires an appropriate consultant to achieve the
desired result.
In Schein’s Doctor-Patient Model, the
consultee knows that something is wrong, but
cannot identify it and so engages a consultant
to diagnose the problem and prescribe a
solution.
In Schein’s Process Model, the consultant and
consultee form a team to define the problem and
explore solutions to the problem.
Mental health consultation is process consulting
between professionals to assist in the mental
health aspects of work-related problems that
concern the client or the organization.
Caplan’s models of mental health consultation
are based on a psychodynamic orientation in
which behavior is the product of unconscious
motivation. Therefore, many issues are dealt with
indirectly.
In Caplan’s models, the consultant and the
counselor are essentially peers trying to help
the counselor’s client, and in doing so improve
the counselor’s job performance.
A major focus of Caplan’s model of mental
health consultation is transfer of effect, in
which something learned in one situation will
be transferred or used in other similar
situations.
In Client-Centered Case Consultation, the goal
is to help the consultee to develop intervention
plans and gain information and/or skills to
help in future similar cases.
In Consultee-Centered Case Consultation, the
goal is to help the consultee to overcome shortcomings in working with a particular type or
class of clients.
In Consultee-Centered Administrative
Consultation, the consultant works with the
organization's administrative-level personnel to
solve problems in personnel management or
implementation of organizational policy.
Behavioral Consultation is much like other
forms of consultation with the exception that
the consultant uses techniques taken from
behavior therapy, with focus on problem
solving using behavioral interventions such as
modeling, social learning, or token economies.
Key concepts of behavioral consultation
include focus on the scientific view of behavior,
influences on behavior, and principles of
behavioral change.
In School-Based Consultation, the consultant
typically works with school administrators
using methods such as case-centered or
organizational consultation, usually in the
context of a systems- and/or organizational
development-based approach.
This concludes Part 3 of the
presentation on
Helping Relationships