As is well known, the pioneer of family therapy, Virginia Satir, said: "If we can heal the family, we can heal the world."
Satir believed that the family was the “factory” in which all people were made. She was one of the first to advocate an idea that is now widely recognized by consultants: a person's family of origin and family relationships influence that person's health, personality, and life pattern – and deliver when examined in therapy, a more comprehensive picture that she can use to help the client. This understanding can be further expanded if the individual agrees to involve family members in counseling sessions.
When considering whether it is appropriate to involve a client's family in counseling, "I'm looking at the focus of our work," said Esther Benoit, a licensed professional counselor (LPC) with a private practice in Newport News, Virginia. "If the main focus is on relational [issues]I want to invite as many people as possible to meetings."
Regardless of whether professional clinical counselors work with family groups, couples, or individuals, an examination of family problems can provide a more holistic picture of clients and what contributes to their presentation problems.
Heather Ehinger, a licensed marriage and family therapist in Connecticut, encourages practitioners to ask questions that address the traditions, limits, and roles in the family systems in which clients operate. For example, customers may perceive their role in their family as that of troublemaker or placater. How did you get this role? Is it a role you want to live in
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"The use of a family system lens to treat people is very important," says Ehinger. "Even if you only treat individuals … [using] a holistic lens, a lens for family systems, in your opinion … will enrich any advice that does not yet include this."
Trauma and Transitions
Although discussing a client's family background or involving family members in counseling sessions can improve work with clients regardless of what brought them to counseling, there are a number of issues that family work is particularly useful for can be. The consultants interviewed for this article report that problems related to trauma and transitions – such as the merging of two families after a second marriage – occur repeatedly when working with families.
Traumas, including past sexual, physical or emotional abuse, can often lead to family attachment issues, notes James Robert Bitter, a counselor educator who is a graduate student at East Tennessee State University (ETSU) the campus oversees community counseling clinic. There is also the trauma of separation. Bitter says that several of the students he supervises advise young clients who are in care or being raised by grandparents because their parents are imprisoned or have to deal with addiction.
“[In] Family Therapy Nowadays we don't work as much with children and families in our region because they are structurally misaligned or have difficulties with psychiatric disorders. We work much more with trauma and families to make their child rearing more effective, ”says Bitter, professor of counseling and human services, who specializes in family counseling and the Adlerian method. “When there is a break in attachment issues, it is difficult to help customers [relearn attachment] in a compassionate way. The people who have been traumatized are far beyond the natural bond. "
Kristy A. Brumfield, LPC in a group practice in Philadelphia, notes that working with families in groups can often help those struggling with transitions such as the arrival of a new baby, moving house, or the details of working together -Parenting after a divorce.
Transition problems can also occur naturally as families grow and age, Benoit adds. For example, families may find that previously established patterns that used to work well in discipline and boundaries create friction when children become teenagers. Professional counselors can serve as valuable sources of support and guidance when families step back and examine the patterns in their systems, says Benoit, who specializes in relationship work with individuals, couples, and families across the life span.
"The work on development matters is enormous [with families] as is the commitment and concentration on relationship patterns," says Benoit. "Also transition points. Whenever a family system is expanded or reduced, people often seek help. It can be a birth, death, divorce, or a family merger. Sometimes what worked before doesn't work anymore. "
Gathering together
The term “family counseling” can evoke thoughts about the traditional nuclear family, in which young children and parents sit together and speak to a clinician. This regulation can and does, but family counseling also includes groups outside the immediate or traditional family unit. It can be any constellation of family members who are willing to participate, who are relevant to or involved in the family's presentation problem and who could benefit from working on communication patterns and relationship problems.
When involving multiple people in counseling sessions, advisors must first determine who the customer is and what that includes, including privacy issues. In some cases, the person who first sought advice is the client; In other cases, a couple or the entire family group is the customer. (For more information on this important discussion, see the ACA Code of Ethics 2014, including Standards A.8. And B.4.b., at Counseling.org/knowledge-center/ethics/code-of-ethics-resources.)
Benoit says that she always begins advising family groups by fully explaining and defining the therapy relationship and letting the family decide whether they are happy with a group format. "I like putting the ball on the client's playing field and giving him the opportunity to decide whether that modality feels right and what he wants in the consultation," said Benoit, member of the American Counseling Association.
Benoit recently received a call from a couple seeking advice for their twin teenagers struggling with high school stress. The twins were both gifted and very smart. Benoit first met with the parents without twins to learn more about the situation and explore family dynamics. She quickly saw that the family relationship was strong and healthy, which meant that this was not a problem. Instead, the twins needed space to process some complicated emotions – they felt tight and supportive, and sometimes competed with one another in academic, athletic, and extracurricular activities.
When Benoit had her first meeting with the twins, she talked to them about different options: individual work with different advisors, meeting with her or involving the whole family in counseling. Benoit emphasized that if the twins decided to come to her for therapy, they would have to stay together for sessions. She gave the twins time to think about it between their first and second sessions.
"Because of the uniqueness [of their situation] and their connection, they thought it was most appropriate to be seen together," recalls Benoit. "Ultimately, they decided that this was the best option [for them]."
Benoit emphasizes that this process will look different for each customer and must be tailored to the needs of each customer and pose problems. For example, she has another group of young siblings in her number of cases, which they see separately as individual customers. Her presentation topics are very different and her consulting work does not overlap, so that individual sessions work best for her, she explains.
The symptom carrier
Ehinger has a group counseling practice for families with two locations in Connecticut. Your team of therapists is able to work together and treat family groups and individuals within families who need advice on various topics at the same time.
In families there is often an identified person who is symptomatic and causes the family to seek advice, e.g. B. A teenager with an eating disorder or a child with attention deficit / hyperactivity disorder. Nevertheless, the problem often goes deeper and affects the whole family. "The idea is that a person has symptoms, but it's not the only problem within the family system," says Ehinger, an ACA member with a doctorate in counseling, education, and supervision.
This is particularly common when couples have an unhealthy relationship or divorce, she says. Your child may be symptomatic, but the problem lies in the parents. “The child may be afraid to go to elementary school and be very afraid. The parents spoke to the school and found that it is not academic and the child is not bullied, ”says Ehinger. "Then we could find out from the parents that the father left two months ago, there are many fights and lawyers are involved. They could say:" We are not fighting in front of the children. "[But] Whether they are fighting in front of the children or not, this child absorbs the energy and knows that something is going on. "
Ehinger and a colleague in their practice together treated a family in which a young son was identified as symptomatic. The parents first sought advice for the 16-year-old because they said that he was grumpy and defiant, stayed away from the curfew, skipped classes and experimented with substance use.
The young son started an individual consultation with a male clinician in Ehingers practice. Since the practice specializes in familial system problems, the clinician viewed the problems of the teenager from a system perspective and soon discovered a bigger challenge. The answers the teenager gave to questions about his family life showed that there was tension at home and that his parents had problems.
The family also had a daughter who was a freshman. When she got home on vacation, she refused to go back to school and showed defiant behavior and some of the other symptoms her brother had shown. As these challenges developed, Ehinger began to work with the parents while her colleague was working with her children. Sometimes everyone gathered for meetings with four family members and two clinicians in the same room.
Ehinger's discussions with the parents during the counseling showed that the couple had an infertility problem and that both children had been adopted. The couple hadn't gotten over their infertility grief, which contributed to the fact that they had to struggle with their adoptive children to gain independence and "start" from home, says Ehinger.
Within a few months, the symptomatic teenager was no longer "the problem" – the couple's marriage was, says Ehinger. The son's symptoms disappeared as the counseling helped him find autonomy, and he then stopped acting as often.
The problem of this family was due to problems with the bond, explains Ehinger. "The parents weren't really sad about losing their ability to have children of their own. They were extremely sensitive to being" perfect "parents. They felt like failure if they weren't perfect parents for these adopted children and out of frustration pointed their fingers at each other. "
The problem was exacerbated, recalls Ehinger, because the parents had large large families with many children, making them feel inappropriate and inadequate compared to their relatives.
Ehinger worked with the mother to strengthen her self-esteem and to process her infertility pain in individual sessions. With the couple, Ehinger also focused on processing grief and looking for security in their relationship. They talked about "how to deal with each other on purpose, how to relate, what their idea of marriage is and how they [could] are more concerned about getting there," she says. She also taught psychoeducationally why transitions, including the development of the teenage child, are so difficult for families.
Ehinger often uses family narrative therapy, and in this case it was particularly helpful. In this family, the narrative was that the husband and wife felt like "bad parents", the son was the "troublemaker" and the daughter had always been the "good" one, although she later had trouble when she left college Came home.
“We worked to change this story: the parents weren't bad, but they were hypervigilant. We taught them about teenage attachment and normal rebellion and helped them recreate their family's story, ”says Ehinger. "We talked about roles: How did [the son] get the role of troublemaker? Did he want to keep it? Did he ask about it? Who would resist losing that role? What other role could he become [and other family members]? "
Uncovering patterns
Benoit finds structural family therapy and experimental family therapy helpful in working with family clients. Both modalities focus on patterns of interaction within family groups.
“The entire systemic interaction pattern of a family can be shifted by changing small behaviors. This is why it is so important to identify these patterns, ”says Benoit, a full-time faculty member who teaches online at Southern New Hampshire University.
One way counselors can encourage families to change long-held and unhealthy patterns is to raise family members' awareness of the role they play within the system. "For example, sometimes there is a member of the family harmonizer who smoothes out any conflict," says Benoit. “These roles often determine how members interact in everyday interactions, but also in conflicts and transitions. Understanding the roles that are played and how they influence interactions can help challenge family members, explore alternatives, and try new roles as their family systems grow and change over time. "
Benoit's focus on patterns includes careful listening and close observation of the way family members speak and interact verbally and non-verbally in sessions. This includes body language, as well as the tone and subtext of what is said verbally. "I record everything," she says.
For example, family members may always sit in the same order at each session, or a child may always sit with one parent and distance themselves from the other, or the children may always look at their mother before saying anything. Families often do not even notice that these patterns occur or that they could have a deeper meaning, says Benoit.
Her method is to gently draw the family's attention to these patterns, framed by curiosity. Her approach doesn't necessarily paint the behaviors as bad, just as something to ask and collect more information about.
"With family counseling, families come to us for information and feedback so that it can be helpful to show patterns," says Benoit. "Over time, I could point this out to the family [a pattern] and say," This is what I see. Help me understand where this comes from and how it helps in your relationship. … Tell me what this behavior means for your family. "
For example, a child can always sit between his mother and stepfather. What could symbolize this? Is it a physical representation of the bridge building role that the child plays in the family? Benoit brought up this observation and formulated it as a question or as an invitation to tell me more.
"It's something to explore. It doesn't always mean something, but it's worth asking," she says. "And I misunderstand it all the time. Sometimes the family says" Gosh, no! "And then it only helps me to learn more information about the family system.
Behavioral patterns within families can also be rooted in culture or context, adds Benoit. For example, a small child who is always resisting his parents or waiting to speak in counseling sessions can show a sign of respect that is taught within the family or culture.
Exposing patterns and their meanings requires that practitioners are present and focus on every moment in the session. It also requires an inquisitive attitude, says Benoit. "One of the reasons I love relationship counseling is that you don't work with one person, but with several people. But more importantly, you work on the space between people," she says. "It's really a dynamic and powerful work. "
Processing trauma
Bitter advises clients with internship and internship students that he supervises in the ETSU advisory clinic on campus, the members of the community, many of whom have minimal or no health insurance coverage, offer free services. Bitter says he is starting to think of other family members who may be involved in counseling in the first session with a client. In his view, all problems that bring clients to counseling are, in one way or another, family problems.
"Everything is a family problem," says Bitter, who will publish a third edition of his book "Theory and Practice of Couples and Family Counseling" in autumn with ACA. "Instead of family or couples [counseling]a broader term could be relationship counseling. From the moment we are born, we are in a relationship. We cannot survive without them. "
Bitter remembers a client whom he advised for several years (starting at 14 years), with various consulting interns also being involved at intervals of one semester. First, the client's aunt contacted the ETSU counseling center to request help for her nephew.
The client's mother struggled with addiction and was married four times, in addition to several other relationships that were all immersed in drug culture. The youngster – the second of his mother's five sons – had "seen a constant stream of drug dealers and men with whom his mother had relationships in his young life," says Bitter. When the boy was 5 or 6 years old, he had taken on the role of an unofficial parent and caretaker for his younger brothers. He would get up and dress them in the morning and make sure they had something to eat, and he would clean the house.
When he was 9 years old, the boy and his older brother lived with their father, who had alcoholism. There the customer also took care of the housework for his brother and partly for his father. Bitter notes that the boy has to repeatedly ask his father for money to buy household groceries.
At some point the youngster called his aunt and asked if he could stay with her. The aunt took him in and called the ETSU advice center for help. Initially, Bitter saw the teenager as a single customer (at the teenager's request). But in sessions, the adolescent would claim that he was "well" and that he would never get anything to talk about.
"The trauma and neglect in this boy's life made him depressed but also very secret. It was very, very difficult for him to tell me what was going on in his life," recalls Bitter , an ACA member. "When you grow up as a little boy who has to take care of everyone else, you have to look really good to the rest of the world and learn to pretend everything is fine until it doesn't more so. "
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Finally, Bitter worked with the teenagers to involve his aunt and grandmother – the most supportive family members in the client's life – in counseling sessions. In their work together, Bitter focused on ways to rebuild the teenager's broken family while giving up the care role he had taken on for so many years. "I asked the adults to be a family, and the aunt and grandmother were ready," said Bitter.
A year and a half later, counseling began to focus on the teenage boy who moved from living with his aunt to moving with his father, who had worked to become sober and secure a job as a landscaper. "The counseling center helped with this transition and the revival of the relationship and also reversed the pattern of the trauma [in the family]," says Bitter. “We helped him to live as a child again and to rely on the adults in his life. Now he has an aunt, grandmother and father who take care of him functionally. "
The teenager will soon be 17 years old. He's fine, but "he's still careful and careful in relationships," says Bitter. "He has two good friends and really can't handle it anymore."
The teenager and family recovered "after two years [counselors] of constant encounter with this family, encouragement, and literal instruction on how to talk to each other and how to help them respond," says Bitter.
Effective parenthood
In addition to coping with an unresolved trauma, Bitter also changes unhealthy parenting patterns when advising families. Parents often come to the counseling clinic with their children at the end of their minds due to behavior problems.
The world has changed dramatically in the last century, but parenting styles on the whole have not, Bitter claims. With what counselors know about attachment and the benefits of using borders instead of punishing children, practitioners are well equipped to offer psychoeducation to parents who have problems, he says.
“The majority of people who are parents today when we are in top form sometimes have better parents than our parents, but when we are worst we are all parents at about the same level as ours Parents – and we have to assume that they did the same, ”says Bitter. "Most of parenthood teaches [clients] how to make really good connections with children and help them grow and develop."
Bitter says that the role of a counselor is to give guidance rather than explicit instructions or commands to parents. “I wait for the customer to say what they have done and then ask: 'Did that work for you? How did it go? "If you had to beat up your child [multiple] once a week, it won't work. Let's talk about what could work [instead]."
Counseling can also normalize parents' challenges and send the message that they are not alone in their struggles. "You see that they are like any other family. If you have children, you will make a mistake every day," says Bitter. “Often parents do a pretty good job, but they only need [extra] help. But those who deal with trauma or a bond between a child and a parent that needs to be reconnected need time and patience. "
Bitter relies on a number of methods to help parents, including Jane Nelsen's positive discipline approach, Michael Popkin's active parenting system, Systematic Training for Effective Parenting (STEP), and James Lehman's Total Transformation Training for Parents . Bitter, however, emphasizes the concept of "natural consequences" in relation to child discipline.
Bitter hated Brussels sprouts as a child, but his father loved them, so the spicy vegetables often appeared on the family table. This often escalated to verbal fighting, with his father insisting that Bitter would eat Brussels sprouts and Bitter insisting on doing something else. The use of the philosophy of natural consequences can circumvent such parent-child power struggles.
"Now we know that a child will make good decisions over time if parents offer a variety of things and a balanced diet," says Bitter. "If you provide food [healthy]a child will eat it. I recommend parents to model good eating habits, but not to argue about what the child eats or does not eat. [When a child refuses to eat something] say "OK, don't eat this". The natural consequence is that the child becomes hungry. If they say "I don't have breakfast" [with the rest of the family] one parent should say "OK". The child comes back at 10 a.m. and says, "I'm hungry." The parent can answer [by saying]. , & # 39; OK, lunch will be served at noon and you will make it by then. & # 39; ”
If these types of patterns are repeated often enough, children learn from their experiences and recognize the natural consequences of their decisions, Bitter emphasizes.
He gives another example: Perhaps a mother who is struggling with a defiant adolescent finds that the child pushes back his instructions to get out of the mall at 3pm to be picked up, even though he is on the way Shopping with friends was canceled hours earlier. Bitter says he would ask the customer: "What would happen if at 3:00 p.m. [when the child isn’t there] You just accelerated in your car and drove away? “If the child calls to ask why mom is not there to pick it up, she can explain that she was there at 3:00 p.m. but it wasn't the child. Now mom has other things to do, but will return to fetch the child if she can, says Bitter.
The essence of this method is that parents learn to control themselves, Bitter says. Once they learn and find control, their child (s) will follow.
“This is not difficult stuff. It is difficult to put into practice, but easy to understand. Part of that is just helping couples and families get there, ”says Bitter. “It takes patience on the part of the parents. The parents we see are extremely frustrated because what they are doing is not working. … If you put this [concepts] into practice, [parents] will lead a more harmonious life with your children. It's just a question of getting started. "
Playing together
Brumfield is a registered supervisor of game therapy and has been using game therapy not only for children but also for adults and families for 18 years. While childrens play therapy is largely not conducted, Brumfield offers adults and families prompts and gentle guidance on their fall burden, often in the form of games and activities. Dies kann beinhalten, dass eine Familie gebeten wird, ein Puppenspiel zu erstellen oder eine Geschichte mit Puppen in der Sitzung zu spielen. Zu den vielen Vorteilen dieses Ansatzes gehört laut Brumfield die Unterstützung von Erwachsenen, „sich wieder mit den spielerischen Teilen ihrer selbst zu verbinden“.
Brumfield, ein Mitglied von ACA, verwendet Musik und Kunst auch in ihrer Arbeit mit Familien. Zum Beispiel könnte sie Familienmitglieder bitten, ihre Antwort auf eine Beratungsaufforderung zu ziehen. Oder sie verteilt Rhythmusinstrumente und lässt die kleinen Kinder ein Muster schlagen, während die Eltern ermutigt werden, es zu ergänzen oder es den Kindern auf ihren eigenen Instrumenten zu wiederholen.
Die Beobachtung, wie die Familie während dieser Aktivitäten interagiert, sagt Brumfield viel über die Beziehungen, Muster und Rollen innerhalb der Familie aus. Ist zum Beispiel eine Person dominant und leitet den gesamten Plan für das Familienpuppenspiel? Oder arbeitet jeder daran, alleine zu zeichnen, fast so, als wäre niemand anderes im Raum? "Während ich ihnen bei der Interaktion zuschaue, sehe ich die Lücken und Orte, an denen die Familie wachsen könnte", erklärt Brumfield, der auch Beraterpädagoge an der Immaculata University in Pennsylvania ist.
Zusätzlich zu den Aktivitäten in der Sitzung ermutigt Brumfield Familien, sich Zeit für gemeinsame Aktivitäten zu Hause zu nehmen. Diese können von einem Versteckspiel über eine Radtour mit der Familie bis hin zu Brettspielen und Rätseln reichen. Sie empfiehlt Spiele, die zur Konversation anregen und eher kooperativ als wettbewerbsfähig sind. Einer ihrer persönlichen Favoriten ist das Ungame, ein Brettspiel, das die Spieler anweist, verschiedene Fragen zu beantworten, um die Konversation anzuregen, aber keinen Gewinner hat. In ähnlicher Weise können Familien ein Konversationskartenspiel verwenden, von dem einige online verfügbar sind, um zu den Mahlzeiten eine gesunde Diskussion zu entfachen.
Wenn es darum geht, Familienaktivitäten außerhalb der Sitzung zuzuweisen, möchte Brumfield, dass jedes Familienmitglied über drei Dinge nachdenkt, die es gemeinsam tun möchte. „Kinder haben oft leicht Ideen, und die Kinder sind wirklich diejenigen, die die Eltern unterrichten. Ich bitte die Eltern, über ihre eigene Kindheit nachzudenken und darüber, was sie genossen oder was sie sich als Kind gewünscht haben “, sagt Brumfield. "Das Hauptziel ist es, sich zu verbinden und ihnen zu helfen, kohärenter zu sein und zusammenzuarbeiten."
Um die familiäre Verbindung zu stärken, muss Brumfield in der Regel eine Pause von der Technologie einlegen. Sie bittet Kunden häufig, bei Familienaktivitäten den Netzstecker zu ziehen. Eine Ausnahme ist, wenn die Technologie zu Bindungen führt, z. B. wenn ein Teenager seine Eltern einlädt, gemeinsam ein gewaltfreies Videospiel zu spielen.
Playful activity — inside and outside of counseling sessions — helps families to be less guarded with one another, Brumfield notes. It also boosts communication, joy and vulnerability. Parents might feel silly at first, and that’s a good thing, Brumfield asserts. She reassures parents that letting their guard down to play does not lessen their authority or diminish boundaries.
“When family members are more vulnerable, they’re more able to be seen. It can increase [the family’s] understanding of one another,” Brumfield says. “The children can see their parents differently — as more human. The parents are able to feel reconnected and able to have fun with their children, which can help balance more challenging times for families. … For younger children, mastery can be learned. It can be a confidence boost to be able to participate and learn to be a part of their family. For parents, they’re able to see the things that their children are capable of. Parents often want to do everything for a child, [and play] helps them discover what they can do for themselves.”
Brumfield encourages counselor practitioners to remember the power of play, regardless of whether they specialize in play therapy. “We all — counselors and clients alike — need to be connected with the playful parts of ourselves,” she says. “Remember the importance of humor in our work. It can even be a form of self-care. Think of play as a way to release, stay centered and help in other facets of life.”
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Families and technology
Heather Ehinger, a licensed marriage and family therapist in Connecticut, says conflict over technology use comes up over and over again in her work with families.
This includes fighting between parents and children (and among couples) about which technology is being used and how often. In addition, a couple may have differing views over the age at which their children should have access to technology (such as their own cellphone) or whether they should be allowed to have a computer or video game system in their bedroom.
The conflict that arises over one or more family members’ use — or abuse — of technology can be a flashpoint or an indicator of deeper issues. Technology isn’t necessarily what brings a family in to counseling, Ehinger says, but it’s often a contributor to their presenting issue.
“Technology is not the problem exactly, but it is part of the problem. It feeds into authority issues and discipline,” Ehinger says. “Technology is like a thorn in the family’s side, but it actually turns into the lens through which we see whether the family is functioning or not.”
Ehinger worked with one family who had a son in fourth grade. He was acting out at home, having tantrums and pushing back against boundaries with his mother, who was a stay-at-home mom. He wanted to play Fortnite all the time and would sneak his mother’s cell phone away from her to do so. She would find her son upstairs, still in his pajamas, playing the online video game when it was time to leave for school in the mornings.
This was partly a problem of overstimulation and obsession on the son’s part, but there was also a disconnect on the part of the mother, Ehinger says. Sometimes, disagreements over technology use are generational. In this case, the mother didn’t realize that her son was using the game as a way to socialize and communicate with peers. Adding to her frustration was the fact that she had previously worked in a corporate environment and was used to people listening to her, Ehinger observes. Now, as a stay-at-home mom, she was locked in a battle of wits with her young son.
When it comes to addressing issues of technology use, Ehinger says that psychoeducation about family roles and setting boundaries can be particularly helpful for families in counseling. She often talks with parents about setting limits, taking televisions out of children’s bedrooms, and establishing regular “no tech” nights, when the home’s Wi-Fi is switched off for the evening, to spend time together as a family.
Ehinger also moderates conversations with couples in counseling to get them on the same page regarding their family’s technology use.
“Often, it turns out to be a couple’s problem,” Ehinger says. “They need to define roles when it comes to discipline and boundary-setting — which is all affected by their family of origin. They have to create an ‘our way’ [instead of ‘my way’] and stop bickering and fighting with each other.”
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Contact the counselors interviewed for this article:
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Find out more about family counseling from the International Association of Marriage and Family Counselors, a division of ACA, at iamfconline.org.
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