Theory and Practice of Couples and Family Counseling. James Robert Bitter
involved in family practice. Courage frees family practitioners to listen and allows them to stay calm and relaxed while observing family dynamics and interactions. There is always a risk in any new therapeutic relationship; family counseling involves taking reasonable risks in the service of better or preferred lives.
Adaptability (openness to change). Family counseling rarely progresses in a linear fashion. Families move forward and then fall back; they take in, but they also block. Family systems are like any living organism: They require constant adaptation within the process of change. Effective family practitioners come to expect the ebbs and flows of therapeutic process. Adapting to the needs of the situation is not just an option in family counseling: It is a necessity.
Listening teleologically. Teleology is the study of final causes, an intended future, or purposes and goals. Both human beings and families intend the future. Everything that people do is in the service of some envisioned end or goal. Knowing the goals and desired outcomes of a person or a family directly impacts the process of therapy. As Satir and Baldwin (1983) noted, every complaint also contains a hope: This is the basis for reframing, which we consider in later chapters.Adlerians are perhaps the most teleologically oriented (Carlson & Englar-Carlson, 2017; Carlson et al., 2006; O. C. Christensen, 2004). They tend to transform all problem statements into interactions by asking, “When was the last time this problem occurred? How did it go?” It is in the interaction that Adlerians discover the goals, motives, and purposes that individuals and families intend with their behaviors.
Working in patterns and holism. Patterns occur across the human experience. Both individuals and families establish patterns to organize their lives and bring a certain level of consistency and predictability to what they do. To understand individuals and families is to understand the patterns that they have chosen to enact. Holism is an understanding of human patterns and processes within the social contexts that support them (Smuts, 1926/1996). Individuals grow and function within family systems, and family systems exist within communities and cultures that are further influenced by nations and even global considerations. Getting to know people and their families requires a very wide focus that includes an assessment of the impact that larger systems play in the lives of clients.
Appreciating the influence of diversity. Most of us grow up in a given part of the world in a certain community within a family that has influencing, if unrecognized, cultures and a socioeconomic status. We absorb both the attributes and the evaluations of the life situations in which we grow up. Slowly we come to recognize that other people in other parts of the world are different from us. Family practitioners, like other members of the helping professions, realize that tolerating differences is not enough; today’s counselors need to be sensitive to and actually understand and appreciate differences in social class, race, ethnicity, creed, gender, health and ability, and sexual and affectional orientation and to bring this understanding and appreciation right into the middle of their work.
Having a sincere interest in the welfare of others. What effective family practitioners initially bring to counseling is a focused interest on the family and its members. They want to get to know the family, to feel their way in as Carl Whitaker suggested (Whitaker & Bumberry, 1988). Eventually they may come to care about the family members they see, but even before that caring develops, they are interested in the welfare of their clients. Effective family practitioners know that the kind of relationship they form with the family and its members has a greater impact than whatever techniques or interventions are used (Carlson et al., 2005).
Tending the spirit of the family and its members. Tending the spirit is about creating and maintaining meaning and the connections among family members that support that meaning. Harry Aponte (1994) has most directly integrated meaning, spirit, and family systems interventions, but we can also find an emphasis on tending the spirit of the family in the family violence work of Cloe Madanes (1990). Adlerians emphasize the development of a community feeling and social interest in families. Feminists remind us of the importance of the female spirit, and social constructionists emphasize the meaning that is coconstructed in counseling and therapy as well as in family life. Tending to the spirit of the family is part of the evolution of the field that has reinserted human issues into the processes of family systems work.
Involvement, engagement, and satisfaction in working with families. Effective family practitioners love the involvement and engagement of working with the family as a unit. They find satisfaction in working with the issues of intimacy, contact, rituals, and routines of family life. They see families and the world in terms of the interactions and transactions that take place. They see family life as developmental and are prepared to facilitate family transitions. In short, family practitioners are effective because they are interested in and excited about the possibilities for wellness and resilience that family work provides.
The Process of Change and Therapeutic Process
In one sense, change is inevitable: It is life. From the moment we are conceived until long after we die, we change. Where there is no change, there is simply no life. Change is also something that happens both internally and externally. When we talk about changing internally, we are considering the human capacities for adapting, adjusting, and taking a different stance. But change also happens in the world, and it has real effects on the lives of people. External change and its effects may be easiest to see in natural disasters when, for example, certain structures or places we have come to know and trust are simply wiped out of existence (as in a tornado or a hurricane). In families, losing a job, divorcing, adding children, moving to a new location, starting school, and leaving home are all examples of changes that affect the family and its members.
Each of the models we will study approaches the process of change somewhat differently. All of them contribute something to an understanding of how change occurs and how people adapt to changes in their lives. For now, however, let me use Satir’s description of the process of change to orient us to what can happen in family counseling. Satir believed that the patterns and routines people create to make their lives functional achieve a kind of normalcy she called the family’s status quo. People tend to stay in their patterns and routines until their lives are disrupted by an outside force she called a foreign element. It is the disruption of our patterns and routines that sends both the family and its members into chaos, the feeling that comes with being disoriented and unable to focus. In chaos, everything seems overwhelming, unsafe, and out of balance. If people are able to regain a sense of balance and safety, if they are able to right themselves and feel their feet back on the ground, they often are able to create or discover new possibilities, to change course, or to adapt. Whatever works will, over time, become a new integration, a new set of patterns and routines, and a new status quo (Pelonis, 2002; Satir & Baldwin, 1983; Satir et al., 1991).
Of course, family practitioners tend to meet families when they are in chaos. The family may want to make major decisions in an effort to reduce the pain of the problems they face, but this is usually a mistake. In the beginning, exploration is usually a much more important intervention than problem-solving. Discovering who the people are and why they are seeking help provides focus as well as goals for counseling. I believe the single most important thing that you can do when a family is in chaos is stay present and listen. The first tasks of family practice are almost always to form a relationship with the family and begin an assessment. Monica McGoldrick (2016), for example, is highly effective at using genograms as an avenue to forming an exploratory relationship with couples and families (see McGoldrick, 2018).
Although the ultimate end of counseling may be the facilitation of change, each model will have different ways of achieving that end. In the chapters that follow, you will read about change processes that involve coaching, nurturing, sculpting, educating, experiencing, enacting, directing and indirecting, focusing on solutions, coconstructing preferred outcomes, and even training for more effective living. Almost none of the models we will study advocate change for the sake of change. The ends these approaches seek may be varied in description and process, but there are some general guidelines:
It is better for families to rediscover their connections than to be left in disarray and disengagement.
It is better