Family therapy techniques
Counselling Therapy Technique
This Eric Digest article provides an excellent summary of counseling therapy techniques used in marriage and family sessions.
It is a great place to start for someone seeking information.
I always think it is important to add in how communication and interpretation are impacted by nonverbal communication.
Paul Ekman provides an excellent discussion of that in his work.
And John Gottman provides an excellent discussion of how the expressions of contempt, stonewalling, criticism, and defensiveness can undermine any relationship. Gottman has been studying marriages for three decades and has refined his observations with a wide array of diagnostic tools, including physiological.
I would love to visit the Gottman 'love lab' and be a fly on the wall as they work with couples.
Those non-verbal expressions happen very rapidly, in about 1/18th second, and my physiological response can happen just as fast, so I might create the feeling of hurt and then anger faster than my pre-frontal cortex can make me aware of an observation, such as, "My, that was a strong look of disgust".
I may already be acting out of my hurt/anger physiology, which will be in a defensive or victim physiology probably, allowing me to 'correct' your inadequate understanding in a loud and aggrssive voice, for example.
Gottman actually teaches couples to monitor their pulse rate, and if it goes over 100 beats per minute, then they are to calm down for at least 20 minutes before continuing the discussion.
ERIC Identifier: ED350526 Publication Date: 1992-04-15 Author: Smith, Robert L. - Stevens-Smith, Patricia Source: ERIC Clearinghouse on Counseling and Personnel Services Ann Arbor MI.
(Link at end of article)
Basic Techniques in Marriage and Family Counseling and Therapy. ERIC Digest.
The area of marriage and family counseling/therapy has exploded over the past decade.
Counselors at all levels are expected to work effectively with couples and families experiencing a wide variety of issues and problems.
Structural, strategic, and transgenerational family therapists at times may seem to be operating alike, using similar interventions with a family.
Differences might become clear when the therapist explains a certain technique or intervention.
Most of today's practicing family therapists go far beyond the limited number of techniques usually associated with a single theory.
The following select techniques have been used in working with couples and families to stimulate change or gain greater information about the family system.
Each technique should be judiciously applied and viewed as not a cure, but rather a method to help mobilize the family.
The when, where, and how of each intervention always rests with the therapist's professional judgment and personal skills.
The genogram, a technique often used early in family therapy, provides a graphic picture of the family history. The genogram reveals the family's basic structure and demographics. (McGoldrick & Gerson, 1985).
Through symbols, it offers a picture of three generations.
Names, dates of marriage, divorce, death, and other relevant facts are included in the genogram.
It provides an enormous amount of data and insight for the therapist and family members early in therapy.
As an informational and diagnostic tool, the genogram is developed by the therapist in conjunction with the family.
THE FAMILY FLOOR PLAN
The family floor plan technique has several variations. Parents might be asked to draw the family floor plan for the family of origin.
Information across generations is therefore gathered in a nonthreatening manner.
Points of discussion bring out meaningful issues related to one's past.
Another adaptation of this technique is to have members draw the floor plan for their nuclear family.
The importance of space and territory is often inferred as a result of the family floor plan.
Levels of comfort between family members, space accommodations, and rules are often revealed.
Indications of differentiation, operating family triangles, and subsystems often become evident.
Used early in therapy, this technique can serve as an excellent diagnostic tool (Coppersmith, 1980).
Most family therapists use reframing as a method to both join with the family and offer a different perspective on presenting problems.
Specifically, reframing involves taking something out of its logical class and placing it in another category (Sherman & Fredman, 1986).
For example, a mother's repeated questioning of her daughter's behavior after a date can be seen as genuine caring and concern rather than that of a nontrusting parent.
Through reframing, a negative often can be reframed into a positive.
Most family therapists use tracking. Structural family therapists (Minuchin & Fishman, 1981) see tracking as an essential part of the therapist's joining process with the family.
During the tracking process the therapist listens intently to family stories and carefully records events and their sequence.
Through tracking, the family therapist is able to identify the sequence of events operating in a system to keep it the way it is.
What happens between point A and point B or C to create D can be helpful when designing interventions.
COMMUNICATION SKILL-BUILDING TECHNIQUES
Communication patterns and processes are often major factors in preventing healthy family functioning.
Faulty communication methods and systems are readily observed within one or two family sessions.
A variety of techniques can be implemented to focus directly on communication skill building between a couple or between family members.
Listening techniques including restatement of content, reflection of feelings, taking turns expressing feelings, and nonjudgmental brainstorming are some of the methods utilized in communication skill building.
In some instances the
therapist may attempt to teach a couple how to fight fair, to listen, or may instruct other family members how to express themselves with adults.
The family therapist constantly looks for faulty communication patterns that can disrupt the system.
Developed by Duhl, Kantor, and Duhl (1973), family sculpting provides for recreation of the family system, representing family members relationships to one another at a specific period of time.
The family therapist can use sculpting at any time in therapy by asking family members to physically arrange the family. Adolescents often make good family sculptors as they are provided with a chance to nonverbally communicate thoughts and feelings about the family.
Family sculpting is a sound diagnostic tool and provides the opportunity for future therapeutic interventions.
The family photos technique has the potential to provide a wealth of information about past and present functioning. One use of family photos is to go through the family album together.
Verbal and nonverbal responses to pictures and events are often quite revealing.
Adaptations of this method include asking members to bring in significant family photos and discuss reasons for bringing them, and locating pictures that represent past generations.
Through discussion of photos, the therapist often more clearly sees family relationships, rituals, structure, roles, and communication patterns.
SPECIAL DAYS, MINI-VACATIONS, SPECIAL OUTINGS
Couples and families that are stuck frequently exhibit predictable behavior cycles.
Boredom is present, and family members take little time with each other. In such cases, family members feel unappreciated and taken for granted.
"Caring Days" can be set aside when couples are asked to show caring for each other. Specific times for caring can be arranged with certain actions in mind (Stuart, 1980).
THE EMPTY CHAIR
The empty chair technique, most often utilized by Gestalt therapists (Perls, Hefferline, & Goodman, 1985), has been adapted to family therapy.
In one scenario, a partner may express his or her feelings to a spouse (empty chair), then play the role of the spouse and carry on a dialogue. Expressions to absent family, parents, and children can be arranged through utilizing this technique.
In family choreography, arrangements go beyond initial sculpting; family members are asked to position themselves as to how they see the family and then to show how they would like the family situation to be.
Family members may be asked to reenact a family scene and possibly resculpt it to a preferred scenario. This technique can help a stuck family and create a lively situation.
FAMILY COUNCIL MEETINGS
Family council meetings are organized to provide specific times for the family to meet and share with one another.
The therapist might prescribe council meetings as homework, in which case a time is set and rules are outlined. The council should encompass the entire family, and any absent members would have to abide by decisions.
The agenda may include any concerns of the family. Attacking others during this time is not acceptable.
Family council meetings help provide structure for the family, encourage full family participation, and facilitate communication.
This technique, often used by strategic family therapists, involves meeting with one member of the family as a supportive means of helping that person change.
Individual change is expected to affect the entire family system. The individual is often asked to behave or respond in a different manner.
This technique attempts to disrupt a circular system or behavior pattern.
The stress level of couples and families often is exacerbated by a faulty decision-making process. Decisions not made in these cases become problematic in themselves.
When straightforward interventions fail, paradoxical interventions often can produce change or relieve symptoms of stress.
Such is the case with prescribing indecision. The indecisive behavior is reframed as an example of caring or taking appropriate time on important matters affecting the family.
A directive is given to not rush into anything or make hasty decisions. The couple is to follow this directive to the letter.
PUTTING THE CLIENT IN CONTROL OF THE SYMPTOM
This technique, widely used by strategic family therapists, attempts to place control in the hands of the individual or system.
The therapist may recommend, for example, the continuation of a symptom such as anxiety or worry.
Specific directives are given as to when, where, and with whom, and for what amount of time one should do these things.
As the client follows this paradoxical directive, a sense of control over the symptom often develops, resulting in subsequent change.
The techniques suggested here are examples from those that family therapists practice. Counselors will customize them according to presenting problems.
With the focus on healthy family functioning, therapists cannot allow themselves to be limited to a prescribed operational procedure, a rigid set of techniques or set of hypotheses.
Therefore, creative judgment and personalization of application are encouraged.
REFERENCESCoppersmith, E. (1980). The family floor plan: A tool of training, assessment, and intervention in family therapy. Journal of Marital & Family Therapy, 6, 141-145. Duhl, F. S. Kantor, D. & Duhl, B. S. (1973). Learning Space and action in family therapy: A primer of sculpting. In D. Bloch (Ed.), Techniques of family psychotherapy: A primer. New York: Grune & Stratton.
McColdrick, M. & Gerson, R. (1985). Genograms in family assessment. New York: Norton.
Minuchin, S. & Fishman, H. (1981). Techniques of family therapy. Cambridge, MA: Harvard University Press.
Perls, F. S. Hefferline, R. F. & Goodman, P. (1951). Gestalt therapy. New York: Julian Press.
Sherman, R. & Fredman, N. (1986). Handbook of structural techniques in marriage and family therapy. New York: Brunner/Mazel.
Stuart, R. (1989). Helping couples change. New York: Guildford Press.