KATHREEN C. JOSON, Ph.

D
Introduction to Counseling

Module 8

Counseling Families

Introduction
This unit deals with family counseling. The unit starts with evolution of family counseling
in terms of how developments in psychoanalysis, child guidance movement, marriage and group
counseling etc. This is followed by concepts of family life cycle, in which there is a discussion
about communication within families. Then we take up different approaches tom family
counseling and types of family counseling. This is followed by family counseling in relation to
individual counseling. Then we deal with family counseling processes. Then we deal with do’s
and don’ts in family counseling.

Learning Outcomes:
After reading this unit, you should be able to:

• Define family counseling;

• Describe the historical evolution of family counseling;
• Understand the concept of family life cycle;
• Understand the concept of adaptive and dysfunctional communication patterns;
• Familiarise with the different approaches to family counseling;

• Understand the different types of family counseling;

• Describe the process of family counseling in terms of laying down its aims and
objectives, process of assessment and the intervention process in family counseling;
• Describe the indications and contraindications for applying family counseling; and
• Critically analyse or evaluate the entire family counseling process.

Learning Content:

1. EVOLUTION OF THE CONCEPT OF FAMILY COUNSELING

Family counseling is a program of providing information and professional guidance to
members of a family concerning specific health matters, such as the care of a severely retarded
child or the risk of transmitting a known genetic defect. Family is a group of people related by
heredity, such as parents, children, and siblings. The term is sometimes broadened to include
related by marriage or those living in the same household, who are emotionally attached, interact

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regularly, and share concerns for the growth and development of the group and its individual
members.

Family counseling, is a program that consists of providing information and professional

guidance to members of a family concerning specific health matters

Legal Definition of family counselling

Family counselling is a process in which a family counsellor helps.

Family counseling is a process in which

1. a) one or more persons to deal with personal and interpersonal issues in relation to
marriage; or
2. b) one or more persons (including children) who are affected, or likely to be affected, by
separation or divorce to deal with either or both of the following:
1. i) Personal and interpersonal issues;
2. ii) Issues relating to the care of children.

Family therapy provides a safe environment and temporary structure for people during
these difficult times. People can re-build and create new ways of being that are more effective for
their current life.

Relationship counseling should be tailored to each person’s or family’s goals by using a

combination of techniques and styles that best suit their personality and needs. All facets of an
individual or a family are important to consider: mind, body, relationships, spirituality, and culture.
I always look at a client’s struggle in the context of their relationships. I help clients alter negative
thinking and behaviour patterns, and use relaxation techniques to relieve stress and anxiety.

Most people already know what they need to do, but need the motivation, support, and
feedback of a compassionate counselor to do it.

Family therapy is generally conducted by a therapist or team of therapists who are trained
and experienced in family and group therapy techniques. Therapists may be psychologists,
psychiatrists, social workers, or counselors. Family therapy involves multiple therapy sessions,
usually lasting at least one hour each, conducted at regular intervals (for example, once weekly)
for several months. Typically, family therapy is initiated to address a specific problem, such as an
adolescent with a psychological disorder or adjustment to a death in the family. However,
frequently, therapy sessions reveal additional problems in the family, such as communication
issues. In a therapy session, therapists seek to analyse the process of family interaction and
communication as a whole and do not take sides with specific family members. Therapists who
work as a team can model new behaviours for the family through their interactions with each other
during a session.

Family therapy is based on family systems theory, in which the family is viewed as a living
organism rather than just the sum of its individual members. Family therapy uses systems theory
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to evaluate family members in terms of their position or role within the system as a whole.
Problems are treated by changing the way the system works rather than trying to fix a specific
member. Family systems theory is based on several major concepts.

Concepts in Family Therapy

1) The identified client

The identified client is the family member with the symptom that has brought the family
into treatment. Children and adolescents are frequently the indentified client in family counseling.

The concept of the identified clinet is used by family counselors to keep the family from
scapegoating the client or using him or her as a way of avoiding problems in the rest of the system.

2) Homeostasis (Balance)

Homeostasis means that the family system seeks to maintain its customary organisation
and functioning over time, and it tends to resist change. The family counsellor can use the concept
of homeostasis to explain why a certain family symptom has surfaced at a given time, why a
specific member has become the client, and what is likely to happen when the family begins to
change.

3) The extended family field

The extended family field includes the immediate family and the network of grandparents
and other relatives of the family. This concept is used to explain the intergenerational transmission
of attitudes, problems, behaviours, and other issues. Children and adolescents often benefit from
family counseling that includes the extended family.

4) Differentiation

Differentiation refers to the ability of each family member to maintain his or her own sense
of self, while remaining emotionally connected to the family. One mark of a healthy family is its
capacity to allow members to differentiate, while family members still feel that they are members
in good standing of the family.

5) Triangular relationships

Family systems theory maintains that emotional relationships in families are usually
triangular. Whenever two members in the family system have problems with each other, they will
“triangle in” a third member as a way of stabilising their own relationship. The triangles in a family
system usually interlock in a way that maintains family homeostasis. Common family triangles
include a child and his or her parents; two children and one parent; a parent, a child, and a
grandparent; three siblings; or, husband, wife, and an in-law.

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In the early 2000s, a new systems theory, multisystemic therapy (MST), has been applied to
family counseling and is practiced most often in a home based setting for families of children and
adolescents with serious emotional disturbances. MST is frequently referred to as a “family-
ecological systems approach” because it views the family’s ecology, consisting of the various
systems with which the family and child interact (for example, home, school, and community).

Several clinical studies have shown that MST has improved family relations, decreased
adolescent psychiatric symptoms and substance use, increased school attendance, and decreased
re arrest rates for adolescents in trouble with the law. In addition, MST can reduce out of home
placement of disturbed adolescents.

6) Preparation

In some instances the family may have been referred to a specialist in family therapy by
their pediatrician or other primary care provider. It is estimated that as many as 50 percent of office
visits to pediatricians have to do with developmental problems in children that are affecting their
families. Some family doctors use symptom checklists or psychological screeners to assess a
family’s need for counselling. For children and adolescents with a diagnosed psychological
disorder, family therapy may be added to individual therapy if family issues are identified as
contributing factors during individual therapy.

Family therapists may be either psychiatrists, clinical psychologists, or other professionals

certified by a specialty board in marriage and family therapy. They usually evaluate a family for
treatment by scheduling a series of interviews with the members of the immediate family,
including young children, and significant or symptomatic members of the extended family. This
process allows the therapist(s) to find out how each member of the family sees the problem, as
well as to form first impressions of the family’s functioning. Family therapists typically look for
the level and types of emotions expressed, patterns of dominance and submission, the roles played
by family members, communication styles, and the locations of emotional triangles. They also
note whether these patterns are rigid or relatively flexible.

Preparation also usually includes drawing a genogram, which is a diagram that depicts
significant persons and events in the family’s history. Genograms include annotations about the
medical history and major personality traits of each member. Genograms help uncover
intergenerational patterns of behaviour, marriage choices, family alliances and conflicts, the
existence of family secrets, and other information that sheds light on the family’s present situation.

Precautions: Individual therapy for one or more family members may be recommended to avoid
volatile interaction during a family therapy session. Some families are not considered suitable
candidates for family therapy. They include:

• families in which one, or both, of the parents is psychotic or has been diagnosed with
antisocial or paranoid personality disorder
• families whose cultural or religious values are opposed to, or suspicious of,
psychotherapy

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• families with members who cannot participate in treatment sessions because of physical
illness or similar limitations
• families with members with very rigid personality structures (Here, members might be at
risk for an emotional or psychological crisis.)
• families whose members cannot or will not be able to meet regularly for treatment.

Risks: The chief risk in family therapy is the possible unsettling of rigid personality
defenses in individuals or relationships that had been fragile before the beginning of
therapy. Intensive family therapy may also be difficult for family members with
diagnosed psychological disorders. Family therapy may be especially difficult and
stressful for children and adolescents who may not fully understand interactions that
occur during family therapy. Adding individual therapy to family therapy for children
and adolescents with the same therapist (if appropriate) or a therapist who is aware of the
family therapy can be helpful.

Normal Results:

Normal results vary, but in good circumstances, they include greater insight,
increased differentiation of individual family members, improved communication within
the family, loosening of previously automatic behaviour patterns, and resolution of the
problem that led the family to seek treatment.

Read more: http://www.answers.com/topic/family-therapy-2#ixzz1GXyBxJtV

When a member of a family develops a problem, everyone in the family is affected

as human beings have their existence integral to the family unit they belong to. In many
such instances, professional help is essentially recommended in the form of a counseling
process that involves the entire family so as to be able to grapple with the indefinite
transitions and changes that families have to go through during the course of its life cycle.

Family counseling is a therapeutic endeavour that seeks to alter interactions

between family members and role performance within families and aims, at the same time,
to improve the functioning of an individual member, for instance, a child who is referred
and identified as the principal client (Bentovim & Kinston, 1978). The approach usually
involves working with the family as a group although it can proceed with a subgroup of
the family with one person as the index client.

The current practice of family counseling has its roots in a variety of theoretical,
practical and research approaches to helping children, married couples, and individuals
with psychological problems. In understanding family counseling as it is now, it will be
essential to acknowledge the contributions of analytic therapists, child guidance clinics,
marriage counseling movement and studies on communication patterns within families in
helping families cope with the problems.

Thus, the actual initiation of family counseling movement dates back to 1950s with
the development of two important events— an influential book by Ackerman (1958) called
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The psychodynamics of family life, and the work on communication by Bateson and his
colleagues mentioned below. Thus, to summarise, the following different factors and
developments influenced the emergence of family counseling as an independent and
specialised approach within the domain of counseling and psychotherapy:

1.2.1 Developments in Psychoanalysis

Psychoanalytic therapists began to extend their approach to include family orientation in

the late 1940s. Infact, Freud (1909) was the first to include a parent in the psychoanalysis of a
child. He worked indirectly with ‘Little Hans’ phobic problems by communicating with the boy’s
father and also seeing them together. Beginning with Sigmund Freud who specifically focused on
intra-psychic processes during early childhood and started involving parents in the psychoanalysis
of adolescent cases, Alfred Adler too emphasised the development of social interest within the
family and initiated child guidance clinics in Vienna. Harry Stack Sullivan (1953) was
concerned not only with intra-psychic factors but also interpersonal relationships within the
family and with significant others. The works of Klien (1948) and Winnicott (1965) have also
been of specific significance in this regard. Eventually it was Nathan Ackerman, a child
psychiatrist who was trained in psychoanalysis and is considered as an initiator of family
counseling movement, who started involving the entire family in the process of diagnosis and
treatment. He was aware of conscious and unconscious issues within the individual and the
family, as well as the issues that affected the family as a whole. His writings, particularly his book
The Psychodynamics of Family Life, had an immense influence and many therapists thence forth
were drawn towards his engaging style and active approach to counseling.

1.2.2 Growth of Child Guidance Movement

A new pattern of treatment emerged with the evolution of the child guidance clinic in the
1920s and 1930s—— weekly sessions with the child in conjunction with regular case work with
one or the other parent initiated. Child guidance clinics, whose origins were based in Adlerian
theory, concentrated on both the treatment and prevention of emotional disorders in children
through an interdisciplinary approach. Parents, as well as children, were traditionally being worked
with in clinics by teams of specialists from the fields of psychiatry, psychology, and social work.
Although early research in this area tended to focus on such parental behaviour as maternal over
protectiveness (Levy, 1943), clinicians eventually began to concentrate on the family as a whole.

1.2.3 Emergence of Marriage Counseling Movement

Sometime during 1950s, conjoint therapy, in which both the members of the couple were
seen together by one counselor became a common practice. As marriage counseling developed, it
focused more and more on attending to and working with the marriage relationship and less on the
individual issues of each client. Paul Popenoe and Emily Mudd, the early pioneers in marriage
counseling focused on the marital issues from a couple perspective and emphasised that there are
three entities in a marital discord that one needs to work with: the husband as an individual, the
wife as an individual and the couple as a unit.

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1.2.4 Initiation of Group Counseling

The innovative ideas of the 1940s and 1950s that emerged from small group behaviour
laboratories, such as the National Training Laboratory (NTL) in Bethel, Maine, and the Tavistock
Institute of Human Relations in London, England were especially important to the development of
marriage and family counseling. Some practitioners even started treating families as a group and
began the practice of couple and family group counseling, an approach that was found promising
and yielding the desired results (Corey & Corey, 1987; Ohlsen, 1979, 1982).

1.2.5 Influence of General Systems Theory

The general systems theory, as developed by Ludwig Von Bertalanffy (1968), a biologist,
viewed all living organisms, including couples and families, as interacting components that
mutually affect one another. The focus is on how the interaction of parts influences the operation
of the system as a whole. When his theoretical tenets were applied to psychological problems, it
indicated that a family cannot be understood without knowing how the family functions as a whole.
For example, if one person in the family is not functioning up to the capacity, the entire system
has difficulty in carrying out its tasks. One of the main concepts introduced by this theory is
circular causality, the idea that events area related to each other through a series of interacting
feedback loops. By viewing family operations in this way, the focus for family dysfunction is
shifted from an individual to the family unit itself.

1.2.6 Researches on Schizophrenia and Family Communication

Three main researchers conducted pioneer studies in the family dynamics and the etiology
of schizophrenia: the Gregory Bateson group (Bateson, Jackson, Haley & Weakland, 1956) at the
Mental Research Institute in Palo Alto, California; the Theodore Lidz group (Lidz, Cornelison,
Fleck & terry, 1957) at Yale; and the Murray Bowen and Lyman Wynne groups (Bowen, 1960;
Wynne, Ryckoff, Day & Hirsch, 1958) at the National Institute of Mental Health (NIMH). All
observed how couples and families functioned when a family member was diagnosed as
schizophrenic. Bateson and his group focused on the communication patterns within families of
persons with schizophrenia and specifically pointed towards the pattern of double bind
communication that involved providing contradictory messages to the child. Theodore Lidz and
his research team observed that when marriage partners fail to meet each other’s psychological
and emotional needs, one partner may form a pathological alliance with the child, ultimately
precipitating the child’s schizophrenia. Bowen (1960) too observed the schizophrenic patients who
lived with their parents in the ward for sustained period of time and concluded that not just the
patient but the entire family unit had pathogenic features. Ackerman (1958, 1966) reached similar
conclusions. These works had been important not only from the point of view that they provide
insight into the etiology of schizophrenia but also provided direct impetus and direction to the
family counseling movement.

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1.3 CONCEPTS OF ‘FAMILY LIFE CYCLE’ AND

‘COMMUNICATION PATTERN WITHIN FAMILIES’
Family Life Cycle

The family life cycle is the name given to the stages a family goes through as it evolves
over the years. Family life and the growth that take place within it and complement those in an
individual’s life as those suggested by Erikson, 1959; Levinson, 1978 in their theories discussing
the stages of development within an individual’s life. Those families that attain the stage-critical
tasks in time that are essential for individual as well as the family growth attain a better sense of
well-being and grow with greater adaptability to the inevitable transitions of life (Carter & Mc
Goldrick, 1988).

Table 1.1: Stages of the family life cycle

Stage Emotion Stage-critical tasks

a) Differentiation from family origin, b)
Unattached Accepting parent offspring
1. Development of peer relations,
adult separation
c) Initiation of career.
a) formation of marital system, b) Making room
2. Newly married Commitment to the marriage for spouse,
c) Adjusting career demands.
a) Adjusting marriage to make room for the child,

Accepting new members into the b) Taking on parental roles,

3. Childbearing
system c) Making room for parents who have turned

grandparents.
a) Adjusting to the specific needs of the child,
Pre-school age
4. Accepting the new personality b) Coping with energy drain and lack of privacy,
child
c) Taking time out to be a couple.
a) Extending family/ society interactions,
School age Allowing child to establish
5. b) Encouraging the child’se ducational progress,
child relationships outside the family
c) Dealing with increased activities.
1. a) Shifting the balance in parent child
relationship,
2. b) Refocusing on mid-life career and
Increasing flexibility of family
6. Teenage child marital issues,
boundaries toallow independence
3. c) Dealing with increasing concerns for
older generation.

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a) Releasing adult children into college, work, &

marriage,
Launching Accepting exits from and entries
7.
center into the family
b) Maintaining supportive home base, c)
welcoming children’s spouses.
a) Rebuilding the marriage,
b) Welcoming grandchildren into family,
Middle aged Letting go of children and facing
8. c) Dealing with aging or demise of ones own
adult each other
parents.
1. a) Maintaining individual and couple
functioning,
2. b) Supporting middle generation,
9. Retirement Accepting retirement and old age 3. c) Coping with death of parents or
spouse,
4. d) Closing or adapting family home.

Regardless of nature or type of family, all families have to invariably deal with family
cohesion (i.e. emotional bonding) and family adaptability (i.e. ability to be flexible and change)
(Olson, 1986). These two dimensions both with their four levels, as represented by Olson (1986)
in what is known as the ‘Circumplex Model of Marital and Family Systems’ are curvilinear, that
is to say, the families that are apparently very high or very low on these dimensions seem
dysfunctional, whereas families that are balanced seem to function more adequately (Maynard &
Olson, 1987). Families that are most successful, happy, and strong, are not only balanced but
according to researchers (Stinnett & DeFrain, 1985), they are: 1) committed, 2) appreciate each
other, 3) spend time together, 4) have good communication patterns, 5) have a high degree of
religious orientation, and 6) are able to deal with crisis in a positive manner.

Thus, counselors are required to be sensitive to the current stage of development of a family
life cycle and be concurrently attuned to the developmental tasks and individual growth of each of
its individual family members in understanding the pathology of a particular family member or
that of the family constellation as a whole. A comprehensive assessment of the same should be
done in a comprehensive manner. Consequently, they can be more inclusive in their intervention
plan.

Communication Pattern within Families

From the time of its origins in the work on schizophrenia in 1950s, family counseling has
emphasised communication patterns within families. From this work emerged the concepts that
describe dysfunctional ways of relating within a family: the double bind, marital schism, marital
skew, and pseudomutuality.

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1) Double bind: Various researchers (Bateson, Palo Alto, Jackson, Haley, 1956) while
working with the families of persons with schizophrenia observed a pattern of
communication in which a person receives two related but contradictory messages. One
may be relatively clear and the other may be unclear, creating a “no-win” paradox. For
example, a father might encourage his child to always stand for his rights or whatever is
considered as right and justified, and the same father may often curb the child’s expression
by telling him “Don’t question my authority”.

2) Marital schism and marital skew: In their work with individuals who had been
hospitalised with schizophrenia, Lidz and his colleagues found unusual patterns of family
communications between parents and their children which they termed as marital schism
and marital skew.

In marital schism, one parent would undermine the worth of the other parent by competing
for support and sympathy from children. That is to say, one parent would form an alliance
with one of the children and would indulge in frequent criticism, rejection and
argumentation with the other parent. For example, if the father did not value the mother,
he would be afraid that the child would grow up like the mother, so he would often despise
and criticise her in front of the children and involve them in the same process.

In marital skew, one of the parents dominate the family dynamics and decision making
process of the home so much so that it involves complete neglect of the other parent’s
perspective and wishes. However, the neglected parent accepts the situation, and
indicates to the children that everything is fine and the home is normal, thus distorting
reality to the children.

In both of these situations, a pressure is being placed on the children to normalise the family
dynamics. A child is in a state of bind, particularly in marital schism as by pleasing on
parent, he would be invariably displeasing the other.

3) Pseudomutuality: Lyman Wynne (1958) and his colleagues observed that in families
of children with schizophrenia, there was often a conflict between the child’s need to
maintain a separate identity and to maintain intimate relationships with family members.
There is lack of open, authentic interactions between family members along with
heightened emotional expression and reactivity at times. Family members may relate in
limited or superficial ways to each other and may perceive their relationships as open that
would invariably conceal the distant pattern in relationships within the family.

1.4 APPROACHES TO FAMILY COUNSELING

1. a) Psychodynamic Approach: Psychoanalytically oriented family counseling focuses on
object relations. Object relations is concerned with the way people form attachments to
others and things around them. The theory assumes that the basis of preferences for certain
objects as opposed to others is developed in early childhood in parent-child interactions.
Individuals bring these unconscious forces into a relationship with other members in the

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family. Skynner (1991) emphasised ways in which the childhood experiences of a parent
affects the ways that they relate to their own children; for example, a mother who received
no adequate mothering or neglect may develop a ‘projective system’, i.e. expectations from
the child shaped by her own childhood experiences rather than current reality and needs of
her own child. Projective systems affect the parents’ ways of relating to one another as well
as to the children. By identifying these systems, the counselor helps the family resolve
conflicts. In doing so, the counselor helps the family members to gain insight into their
own unconscious conflicts and help them understand how their own problems interact with
those of other members in the family. The fundamental goals are insight, integration, and
adaptive functioning. Thus, in other words, the focus is laid on both the family members as
individuals with their early attachment patterns (Byng-Hall, 1991) and underlying conflicts
and also on to the family group with its typical mode of functioning (Zinner & Shapiro,
1974) and continuing conflict stemming from a common traumatic experience.

2. b) Systemic Approach: Under the rubric of general systems theory, the concepts were
originally developed by Von Bertalanffy (1962) in response to dissatisfaction with
reductionism that saw events confined to cause and effect chain like that in psychodynamic
model that saw past events as causal of subsequent ways of behaving. Von Bertalanffy’s
work in biology and medicine explored the inter-relationships of parts to each other and to
the whole system. According to him, a family cannot be understood without knowing how
the family functions as a whole unit as each family is a part of a larger system, a
neighbourhood, which is again a part of a larger system, a town and so forth. Individuals
themselves are wholes that comprise smaller systems as organs, tissues, cells and so forth.
If any part of the system changes, the whole system reflects a change. Important concepts
in understanding the systemic perspective is through understanding the communication
pattern within the family system. This implies that the pathology is typically seen as a
failure of communication among family members. The emphasis is not on the past
experiences or on purported intrapsychic conflicts of each member or that of the family a
whole but on present functioning of the family system in terms of the communication
pattern and manner of feedback among the family members as a unit thereby facilitating
the attainment of homeostasis within the system.

Thus, in order to understand the concept of systems approach to family counseling, one
must familiarise with the concepts of feedback and homeostasis, which deals with ways
in which family systems and their units function.

Feedback: Feedback, in this context, refers to the communication pattern within the units of a
system. There are two basic patterns of communication: linear and circular. The linear approach
shows that the communication occurs in a single direction, moving from A to B to C to D. In a
system with circular feedback, each unit may change and thus affect any of the other units. For
example, in a family context, a mother may feel her alcohol dependence is caused by son’s insolent
behaviour and the son may feel that his reactive behaviour towards his mother is due to her alcohol
abuse. In this way, the feedback of the mother affects the feedback of the son and the feedback of
the son affects the feedback of the mother. Thus, in family systems theory, a circular feedback

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interaction is observed and the blame is not placed on either mother or son. In other words, the
emphasis is on the process rather than the content.

Homeostasis: In general, systems have a tendency to seek stability and equilibrium referred to as
homeostasis (Goldenberg & Goldenberg, 2004). For example, a thermostat is being used to
regulate the temperature so that the room does not become too hot or too cold. Likewise, the family
system attempts to regulate itself so that stability and equilibrium can be maintained through
positive and negative feedback interaction. Thus, the positive and negative feedback are related to
changing the system or maintaining stability in the system. In positive feedback, change occurs in
the system; in negative feedback, equilibrium is achieved. For example, if a parent talks to the
child about the undesired behaviour pattern on the child’s part and works with him to bring about
the desired change without getting accusative, then the negative feedback interaction is said to be
operational to bring about the equilibrium. While in this particular example, if the parent chooses
to be more aggressive and accusative with the child, the child may choose to stay out late more
often and not participate in the family functioning, then in that case positive feedback may be said
to be operational that might change the functioning of the system but in a destructive manner.
However, depending upon the nature of the problem, the positive feedback processes might create
the desired change in the family system as well.

One influential systemic approach to family counseling is Milan’s approach. In Milan approach
(Palazzoli, 1978), circular questioning is often used to assess the conflicting views among
members in the family. Following approach is applied in this technique, a) one person is asked to
comment on the relationships of others, for example, the mother may be asked how her husband
relates to their son and others are asked to comment on her response, b) based on this, a hypothesis
may be constructed about the dysfunctional pattern within the family and is presented to the family,
c) finally, the family may be asked to adopt newer adaptive ways of communicating and behaving
with each other.

The limitation of Milan’s approach is that it refutes the impact of past traumatic experiences that
the family might have gone through and also ignores the effects of certain realistic and social
concerns such as unemployment and poverty.

c) Bowen’s Intergenerational Approach: Murray Bowen’s (1960) approach to family counseling

is rooted in systems approach to family counseling. However, it substantially differs from other
systemic approaches in terms of its emphasis on family’s emotional system and the history of this
system as it may be traced through the dynamics of the parents’ families and even grand parents’
families. His theory laid specific emphasis on how families projected their own emotionality onto
a particular family member, that member’s reaction to other family members and how individuals
cope with stress put on them by the way other family members cope with their anxieties. He is
particularly concerned with the ways children distance themselves emotionally and physically
from their families. Finally, one of the most significant aspects of Bowen’s theory is how families
transmit psychological characteristics that affect the interaction over several generations.
Important concepts emanating from Bowen’s theoretical perspective are: enmeshment,

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triangulation, family projection process, emotional cut off, multigenerational transmission process,
sibling position and societal regression.

 Enmeshment refers to family environment where members are overly dependent on each
other or have undifferentiated roles and ego boundaries. One should be able to differentiate one’s
intellectual processes from one’s feelings. When thoughts and feelings are not distinguished,
fusion occurs. In a family conflict, people who are able to differentiate their own emotions and
intellects are able to stand up for themselves and not be dominated by the feelings of others,
whereas those whose feelings and thoughts are fused may express a pseudo-self rather than their
own values and opinions. If two enmeshed people, that is, with low level of differentiation
marry, it is likely that as a couple they will become highly fused, as will their family when they
have children.

• Triangulation refers to family fusion situations where a third person or family member is
pulled in to resolve conflict between some two members in the family. For Bowen, a two
person system is unstable, and when there is stress, joining with a third person reduces the
tension in the relationship between the original two people. However, bringing a third
person into a conflict (triangulation) does not always reduce the tension, and depends, in
part, on the differentiation level of the members involved.

• Family projection process refers to the parents’ tendency to project their own stress onto
one child, particularly if they have low levels of differentiation within themselves.

• Emotional cut off refers to the child’s tendency to emotionally and physically withdraw
from the family due to excessive stress caused by emotional overinvolvement. Their
interaction with the parents is likely to be brief and superficial. In general, higher the level
of anxiety and dependence, the more likely children are to experience an emotional cut off
in a family.
• Bowen contended that not only the current family but the enmeshment among family
members or their differentiation levels at previous generations may play an important role
in family pathology, a concept referred to as multigenerational transmission process.
• In sibling position, Bowen emphasised that the birth order and the way child functioned
in the family with respect to other siblings, determined how one functions as a parent.

Bowen extended his model of family systems to societal functioning to develop the concept
to societal regression and suggested that certain societies that are regressed with enmeshed
identities of its inhabitants may move towards mature differentiation through the
development of differentiated selves of its members.

Techniques used in this approach focus on ways to differentiate one’s self from one’s
extended family of origin. In the process, there is an attempt to create an individuated
person with a healthy self concept who does not experience undue anxiety every time the
relationship becomes stressful. Ways of achieving this goal include assessment of self

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through the use of a genogram (a three generational family tree) and a focus on cognitively
evaluating events and interactions (Bowen, 1976). The sequencing and pacing of this
process differs from family to family and the exact nature of problem of concern being
experienced by the family members.

d) Structural Approach: Structural approach, developed by Salvador Minuchin, helps families

by dealing with problems as they affect current interactions of family members. To Minuchin, the
term family structure refers to a set of unspoken rules that organise the ways in which family
members relate to one another and the rules that determine the hierarchy of authority, responsibility
and cooperation among family members. Of particular interest are boundaries between family
members and the permeability in boundaries of systems and subsystems within the family.

Permeability refers to the level of permissibility in a family or a family system with regard
to other people or members seeking expression or alignment with it. High permeability would be
found in enmeshed families whereas non-permeability or rigid boundaries would be found in
disengaged families.

In responding to crises or dealing with daily events, families may have typical ways that
subsystems within the family react. Alignments, according to this approach, refer to the ways in
which the family members join each other or oppose each other in dealing with an activity.
Coalitions refer to alliances between family members against one another. Sometimes, they are
flexible and sometimes they are fixed, such as when a mother and daughter work together to
control a disruptive father. Minuchin uses the term triangle more specifically than does Bowen to
describe a coalition in which “each parent demands that the child side with him against the other
parent”. Thus, the power within the family shifts, depending upon alignments and coalitions.

The goal of this kind of counseling is to alter the current family structure by working on
the coalitions and alliances within the family based on the hypotheses about the structure and the
nature of the problem. Families are helped to develop communication and social skills. They also
work to establish boundaries within the family that are neither too rigid nor too flexible. By
supporting the parental subsystem as the decision-making system that is responsible for the family,
counselors work to help the family system use power in a way that functions well. The techniques
that family counselors use in this kind of an approach are: family mapping that involves using
diagrams to describe current ways in which the families relate, enactment of the conflict, intensity
involves altering the way and content of the messages that are given to each other in the family,
changing boundaries that involves marking boundaries between members in the family and
reframing involves altering the perception of a given event or situation in the family thereby
altering the reaction pattern associated with it. These techniques are active and highly attuned to
family functioning.

Minuchin (1974) and his colleagues have deployed their methods for behavioural problems
and psychosomatic states such as diabetes, asthma, and anorexia nervosa. The aim in this approach
has always been to restructure a family’s rigid patterns that both trigger and maintain damaging
patterns and even potentially threatening states.

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e) Strategic Approach: Concerned with treating symptoms that families present, Haley (1973)
and his colleagues developed an approach that emphasises problem solution rather than
generating an insight about the nature of problem or developing any hypothetical constructs
around it.

Haley’s work with Minuchin was important in developing his theoretical approach to
family counseling, although, his work is not as developed as that of Minuchin. Thus, what
differentiates strategic from structural approach is the attention given by strategic family
counselors to symptoms. For Haley, symptoms are an unacknowledged way of communicating
within the system, usually when there is no other solution to a problem.

In his approach, Haley observes the interaction among family members focusing
particularly on power relationships and to the ways parents deal with power. Viewing relationships
as power struggles, Haley (1976) is interested in understanding how relationships are defined.
Thus, a communication from one person to another is an act that defines the relationship (Haley,
1963). Important to Haley, as well as to Minuchin, is the concept of hierarchy, in which the parents
are in a superior position to the children in terms of making decisions and adhering to family
responsibilities. Like Minuchin, he is concerned with family triangles such as those in which one
parent is over involved with the child and the other is under involved.

The goal in strategic approach to family counseling is to reduce anxiety and balance the
power dynamics within the family system by stating concrete intermediate and final goals to the
counseling process. There must be sufficient information available to the counselor to plan
strategies to reach goals. For each goal, specific methods for accomplishing them are designed by
the counselor.

Since, the presenting problem is the focus of strategic counseling, tasks to alleviate the
problem or symptom are its cornerstone. While working with the family, the counselor must select
and design tasks that are appropriate to the family and to the nature of its problems, and also help
the family complete them. Generally, tasks are of two types: straightforward tasks, where the
counselor makes directions and suggestions to the family, and paradoxical tasks, for families that
may resist change.

Each strategic family counseling intervention is different, depending on the counselor’s

observation of the family structure. Interventions whether using straightforward technique or
paradoxical technique are thought out and executed clearly and carefully with the ultimate purpose
of correcting the family’s power struggle and coalitions.

f) Behavioural and Cognitive Behavioural Approach: Some counselors and researchers

(Liberman, 1970; Patterson, 1971) have viewed family relations in terms of reinforcement
contingencies. The role of the counselor is to generate a behavioural analysis of family problems.
This analysis helps identify the behaviours whose frequency should be increased or decreased as
well as the rewards that are maintaining undesirable behaviours or that will enhance undesired
behaviours. Behavioural family counseling then becomes a process of inducing family members
to dispense the appropriate reinforcements to one another for the desired behaviours. Indeed, some
counselors (Stuart, 1969) even have family members use tokens for this purpose. For example, a

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husband might earn four tokens if he does not watch television the whole day on a week end and
instead helps his children with their home assignments and take them for an outing. Likewise,
other family members may also earn tokens for exhibiting the desired behaviours that is fulfilling
for other family members and contributes towards the growth of the family as a unit. Of course,
the tokens so earned, may later be exchanged for the desired rewards that should have been decided
in advance. The principle underlying is that the desired behaviours initially performed to earn
tokens and rewards are later replaced by choicefully taken up conscious behaviour patterns that
would ensure integrity, harmony and growth in the family.

Given the recent developments in cognitive behavioural counseling, it is not surprising that
this approach has found its way into the family counseling enterprise. Similar to cognitive
behavioural counseling for the individual, the family approach also involves teaching individual
family members to self monitor problematic behaviours and patterns of thinking, to develop new
skills (communication, problem resolution, negotiation, managing conflict), and to challenge
interpretations of family events and reframe these interpretations if necessary (Carlson, Sperry, &
Lewis, 1997; Epstein, Schlesinger, & Dryden, 1988).

TYPES OF FAMILY COUNSELING

Conjoint family counseling:

In conjoint family counseling, the entire family is seen at the same time by one counselor. In some
varieties of this approach, the counselor plays a rather passive, non-directive role while in certain
others he might take the role of an active force, direct the conversation, assign tasks to various
family members, impart direct instruction regarding human relations, and so on. Satir (1967) used
such an approach and regarded the family counselor as a resource person and a communicator who
observes the family process in action and then becomes a model of communication to the family
through clear and crisp communication, thus illustrating the family members how to communicate
better and bring about more satisfying relationships.

Concurrent family counseling:

In concurrent family counseling, one counselor sees all family members but in individual sessions.
The overall goal is the same as that in conjoint family counseling. In some instances, the counselor
may conduct traditional psychotherapy with the index client and might also see other family
members intermittently.

Collaborative family counseling:

In collaborative family counseling, each family member sees a different counselor. The counselors
then get together to discuss their respective clients and the family as a whole. In variation of this
approach, a counselor might assign his collaborates as co-therapists who then deal with specific

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Introduction to Counseling

family members under the supervision of the principal counselor and each member as well as the
family is being discussed to work out the intervention goals and strategies.

FAMILY COUNSELING IN RELATION TO INDIVIDUAL

COUNSELING
Certain aspects of family counseling differentiate it from the customary individual
counseling as it involves dealing with a group of people instead of an individual who are otherwise
related to each other and yet have difficulty in connecting with each other adequately. At the same
time, the family counseling involves a group of individuals who have by and large shared a frame
of reference, a common history, and a shared language of connotations for whatever transpires
among them. The counselor has to understand the roles of various family members within the
family unit, their liaisoning and relatedness with each other, level of expression and
communication within the family and also about the idiosyncratic subculture of the family.

At the same time, it is essential that the counselor must remain detached and does not
become overly identified with one section of the family at the expense of another. This can be
difficult and challenging as the family members would often try to involve the counselor in their
power struggle or in their defenses against open communication.

1.7 FAMILY COUNSELING 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 psychoeducated 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.

Aims and objectives of family counseling

In a family counseling process, irrespective of who all constitute the family and its socio-
cultural and educational background, and whosoever be the index client and the nature of problem
concerned, the goal of the counseling process is to improve family functioning, and so to help the
identified client. Whatever their method, family counselors have the following goals for family
counseling:

• Improved communication,
• Improved autonomy for each member,
• Improved agreement about roles,
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Introduction to Counseling

• Reduced conflict, and

• Reduced distress in the index client

Assessment in family counseling

The history taking and assessment process is a typical part of family counseling. A family
counselor needs to understand a particular family with regard to its socio-cultural and
educational background. The counselor also needs to be aware of the underpinnings,
beliefs and values that are rooted in different cultural contexts.

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:

1. A) Structure and History of the Family

• Structure and configuration of the family: The basic structure and configuration
of the family needs to be explored as it has existed in the past and also as it exists
in the present. 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 relationship/s: The counselor always explore the nature of relationships
within the family structure such as being close, distant, loving, conflictual, reserved
etc. which is necessary to understand the overall family atmosphere and cohesion
within the family.
• Boundaries: As mentioned earlier, families consist of subsystems divided by
boundaries that is to say, the boundaries between egos and self concepts. In a well
functioning family, these are permeable enough to facilitate easy communication
between subsystems but yet sufficiently intact to allow their autonomy. 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. Although many of these listed may occur in a family atmosphere at given

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Introduction to Counseling

points in time but a constellation usually tends to predominate that is essential for
a counselor to understand.
2. 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, the level of burden perceived by each
member with regard to his/ her role to be performed in the family and their levels
of satisfaction with regard to their duties and contributions made towards other
family members.
• Decision making and power struggle: Families have different trends with regard
to decision making and expression of right and authority. Some families are
balanced wherein members have the right to express and make choices for
themselves in various matters. In fact, all members are involved in the process of
decision making of common interest. While certain other families have skewed
patterns, that is, the power and the right to take decisions rests in the hands of one
or two members while others have to simply follow or obey that. 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: The family members

communicate with one another both verbally and non-verbally, the latter often
exerting the greater impact. 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. Pattern of interaction involving two or more family
members usually varies from being expressive, selectively expressive or
unexpressive; being overly critical or being overly involved or guiding. Often, an
incongruity between what is stated and what is expressed non-verbally is an
obvious indicator of family dysfunction.
• 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: Every family has its own unique sense of solidarity, belongingness,
and loyalty— a sense of members working together to enhance their welfare.
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. The family also respects the rules that govern relationships between
subsystems and the internal process of each of them.
• Family operations: Every family has a pattern of operating to resolve conflicts,
to reach decisions, to face problems, and to deal with changes inherent in the
family life cycle. Some families are adaptive and may deal with transitions,

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Introduction to Counseling

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: Certain
families may have a pattern of posing excessive demand/s on one or two family
member/s for the interest of others. 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 or members that might become frustrating for those member/s
thereby creating dysfunctional trend in the long run.

C) Value System, Socialisation 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 socialisation accepted and encouraged in a family
• Pattern of seeking entertainment and recreation within a family.

Several kinds of questioning may be used: circular questioning; questions about the
roles of the members such as who takes care of the others, who worries most, who decides
etc.; questions about triadic relationships such as what does A do when B criticises C; and
about responses to a previous change e.g. the death of a grand parent or an important family
member.

Through the entire process of history taking and exploration, the counselor must try
to derive answers to two questions: a) how does the family function and performs its various
operations and roles, and b) are family factors involved in the index client’s problems that
is, are the family members overly reactive, overly critical, overly involved or supportive to
the client with regard to his/ her problem behaviour?

The answers to these questions lead to a hypothesis about what should and can be
changed in the family structure, its current functioning, relatedness pattern as well as the
factors that might be contributing to its pathology.

Intervention process in family counseling

The counselor encourages the family to describe the presenting problem in substantial
detail in order to arrive at an understanding and formulation about the nature of the current
problem. The counselor also elicits the family’s own explanations of the problem which
helps him understand maintaining factors. During the initial few sessions, he also gets an
opportunity to observe directly the ways in which problem behaviours manifest, like: what
provokes a child’s angry outburst, what sets off an argument between siblings or between
parents, what alliances exist and so on. He may discreetly provoke characteristic ways of
relating by directing group discussion, instructing the family to perform certain tasks, or
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Introduction to Counseling

issuing a paradoxical injunction that would simply show the characteristic ways of
behaving and reacting to challenging or undesirable life situations by different family
members.

In addition to this, it is important to note that seeking the detailed family history
in the presence of all family members during which the family problem is placed in the
larger context of information about the parents’ origins and their early life and marriage,
children can often attain better understanding and insight into what circumstances and
distresses their parents, grand parents or other elders in the family have gone through in
the course of their lives. Laying out the entire panorama of family history—its extended
members and their goals, aspirations, fear, and frailties can lead to deeper understanding,
empathy, and tolerance. This larger context can promote a shred frame of reference and a
platform for each member to understand the other in his/ her individual life context
independent of being a part to the family.

In a family counseling process, the counselor must focus on altering the

communication pattern and exchange of information in the family, emotional expression
and reactivity of various family members, general atmosphere and cohesiveness within the
family, the pattern of boundaries within the family and the family operations in terms of
the tasks or roles being taken up by each family member. The counselor should also focus
on and encourage healthy socialisation and recreation pattern to be developed and adopted
by the family as a unit. Simultaneously, the family counselor should also work on rectifying
the dysfunctional communication and behaviour patterns adopted by various family
members.

Techniques to be used may involve expression through dialogue, writing or

drawing; role playing; enactment of distressful situations; forming alliances and
performing tasks with family sub units; and taking up paradoxical injunctions.

The time interval between sessions and duration of intervention depends largely on
the model adopted, the pattern of intervention planned beforehand, and the nature of the
problem to be grappled with. Usually a convenient timing that suits all or most family
members with weekly follow up sessions is encouraged in a typical family counseling
venture. Though, with the achieving targets and goals set for a family, the counselor may
increase the time interval between follow up sessions.

Depending on his approach, the family counselor has a choice of working solo or
with a co-therapist, ideally of an opposite sex as it provides the advantage of each member
conveniently disclosing personal issues and concerns with the counselor of the same sex.
The group of counselors involved in dealing with a family may then share impressions and
reflections with each other while progressing with the process of counseling.

Termination is usually smoother when the counselor/s and his co-therapist are clear
about the final and intermediate objectives and goals of the counseling process to be
attained, the target problems to be ameliorated and the techniques to be used. If the
counselor has negotiated a specific number of sessions with the family at the outset, the

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Introduction to Counseling

termination is relatively straightforward. He might, however, need to constantly encourage

certain family members, in particular, about the need and plan for the sessions to follow.
If the family has shown commitment in maintaining regular follow-ups, the counselor
should regularly review the goals to be achieved in planning the final phase. The
termination process should always be followed by the booster sessions and intermittent
review with the family together or open for any of the members to seek session as per need.

1.8 INDICATIONS AND CONTRAINDICATIONS FOR FAMILY

COUNSELING
Though, there are no hard and fast rules as to when family counseling is appropriate and
when it is not, most of the times, family counseling begins with an adolescent as the index client
for intervention or in dealing with the problems of young people living with their parents. These
problems are often related to difficulties in communication between members of the family, their
role conflicts and associated problems, or other behavioural problems related to substance or
alcohol abuse, liaisoning with anti-social people or social misconduct by the young family
member. In many such cases without involving the entire family in the process of counseling,
adequate intervention may not be planned.

In other cases, the client’s problems have so involved or threatened the fabric of family
that it seems wise to counsel the family as a whole. Sometimes, family crises, such as the death of
a family member, propel the entire family unit into pathology. While in some other families, there
are conflicts over values as to what and how much is permissible to children and what is acceptable
to children from the parents. In such cases as well, family counseling is a logical course. Finally,
certain marital conflicts and issues between married couples with children also need to be dealt
with through the process of family counseling.

However, family counseling is not a cure-all, and it is not always appropriate. It sometimes
happens that a family is so disrupted that such intervention would clearly be doomed to fail. In
some instances, it may also happen, that one or more family members may simply refuse to
cooperate. In some cases, where family violence or sexual abuse have occurred, family counseling
is contra- indicated since the presence of other family members may impede or restrict an open
expression on the part of the child or the person abused. Likewise, in infantile autism, intellectual
handicap and disability in which biological factors contribute to the child’s problem, a family
approach is unlikely to be relevant. Moreover, in certain instances, families simply do not possess
the psychological strength or resources to cope with the emotionally charging and mutually
accusing material that is expressed during the sessions. Thus, deciding when to use family
counseling and when not to is often a difficult matter that requires careful assessment and a great
deal of sensitivity.

1.9 LET US SUM UP

Family counseling has developed substantially since the 1950s. Many different models have
existed for family counseling and compete for their attention till date. A number of research on
family counseling and therapy have found family counseling to be useful for a variety of

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Introduction to Counseling

problems and to be at least as effective as other types of counseling approaches (Friedlander &
Tauson, 2000; Henggeler, Borduin, & Mann, 1993; Nicholas & Schwartz, 2001). Trainers and
novice counselors need to familiarise themselves with these models and select one they can
apply comfortably. Whatever approach they choose to conform to, they should try to be open and
not restrict themselves by setting up rigid theoretical boundaries. Integrative approaches to
family counseling are becoming increasingly common, and several counselors and therapists
have described ways to incorporate them (Scharf, 2000). Thus, typically integrative approaches
are theoretically sound, show efficacious results and can be conveniently adopted for practice.

References:

Ackerman, N.W. (1958). The Psychodynamics of Family Life. New York: Basic Books.

Ackerman, N.W. (1966 b). Treating the Troubled Family. New York: Basic Books. Goldenberg,
I., & Goldenberg, H., (2004). Family Therapy: An Overview. (7th

ed.). Pacific Grove, CA: Brooks/ Cole.

Scharf, R. S. (2001). Theories of Psychotherapy & Counseling: Concepts and Cases. (3rd ed.).
Thomson, Brooks/Cole.

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