Theory and Practice of Couples and Family Counseling. James Robert Bitter
two of the most important aspects of therapy. How we choose to live has a great deal to do with the kinds of personal and interpersonal support we bring to our work. It is important to ask yourself periodically whether you are living the way you want to live. Do you have more interests than your work? Are the relationships you have with family and friends meaningful? Are you contributing to your community and society in ways that fit you? Do you experience growth and development in your own life? Your life and your work can be recursive, each affecting and supporting the other and providing balance to your life and the experience of being grounded when you work.
Toward a Foundation for Integration
What I suggest in this book is that each theory or model brings certain perspectives to the practice of family counseling. One way to create a foundation for the integration of these models is to look at what we can learn by developing perspectives, assessments, and interventions across the various approaches. In 1992, Breunlin et al. (1997) introduced the concept of metaframeworks as a method for transcending the various approaches to family therapy. This model was recently updated by Pinsof and associates (2018). They identified five pillars to integrative systemic therapy and seven metaframeworks that are treated as core perspectives. I address this model more thoroughly in Chapter 18 on integration. For now, I simply want to note the seven perspectives or lenses that inform their model:
1 Organization of systems
2 Developmental processes (in individuals, families, and macrosystems)
3 Cultural perspectives
4 Mind as an avenue into internal experiences
5 Gender perspectives
6 Biology, wellness, and mental health
7 Spiritual perspective
I like to think of each metaframework as a different lens through which I can meet, learn about, and come to understand a family. With these seven lenses, Pinsof and associates (2018) provide a means of assessing families across models and developing multiple avenues for intervention in their “blueprint for therapy” (pp. 79–98). I recommend that you head to Chapter 18 on integration and read the description of each of the seven lenses provided there. You can read the chapter in detail later on.
As you read the theory chapters in this book (Part 2), think about what the various models might contribute to each of the seven lenses. I occasionally note certain contributions to these perspectives in the theory chapters, but you may discover contributions I have not mentioned. In my own work, the five pillars and seven lenses provide me with richer understandings and family descriptions than I would have using only one perspective. At various times, I use some lenses more than others. In most cases, the family members and the issues presented just seem to fit one subset of perspectives better. It is not uncommon, however, for me to consider all seven lenses at least initially. Any or all of them may have meaningful applications during the therapy process. As Pinsof et al. (2018) noted, there is a recursiveness to these perspectives, with each lens influencing and being influenced by the rest. The advantage of using these lenses in family practice is that they provide multiple perspectives for assessment as well as means for tailoring therapeutic interventions to the specific needs of the family (Carlson et al., 2005; H. Goldenberg & Goldenberg, 2002; I. Goldenberg et al., 2017). I believe that the seven metaframeworks provide a foundation for integrating most of the approaches that make up this book.
Gender and Multicultural Lenses
Because the early years of family counseling almost completely ignored the lenses of gender and culture, I believe that it is important to highlight these perspectives here. Like other institutions and practices in society, family counseling has all too often reflected and supported the dominant value system, ignoring the effects of oppression based on class, race, ethnicity, gender and gender identity, health/ability, religion, and sexual and affectional orientation. The very definition of family in the United States is based on a nuclear, middle-class family that is White, of mixed-European cultures, Protestant, healthy and able, and heterosexual; the father is an “absent” breadwinner and the mother stays at home raising two children (preferably one of each of only two genders, with the oldest being male). This description accounts for only 3% of the actual population in the United States (McGoldrick & Hardy, 2019). It is also an ideal that has not served women well, rendering the “mother … perpetually on call for everyone emotionally and physically” (p. 6). It is a patriarchal arrangement that reinforces gender stereotypes while minimizing or eliminating much-needed alternatives for the other 97% of the population.
Race, class, ethnicity, culture, gender, health and ability, and sexual and affectional orientation are dynamic parts of individuals and family systems. To know ourselves as individuals and family practitioners requires that we investigate our families of origin for the cultural experiences that relate to these dynamics. Before we can know the richness and diversity of other families, we must come to know our own heritage. Whether we are part of the dominant culture or of one or more marginalized cultures, both our values and our families have been organized in ways that shape these meanings in our lives.
Of all the discriminations people face in the world, sexism and the oppression of women are the oldest and most pervasive. Indeed, one of the most difficult aspects of working with multicultural families is balancing the need to be sensitive and appreciative of cultural differences when those differences still involve discrimination against women. Still, no society or culture lacks feminist voices. In the first decades of the 21st century, we have truly become a global village: Television and mass communication are joining people across borders. Women all over the world are supporting one another in their acquisition of freedom and equality.
What meanings do you attach to being male or female or some other gender identity? What pronouns are appropriate for you? What is your cultural heritage? How did these perspectives shape your life when you were young, and how do they shape it now? Who benefits from the definitions you attach to gender and culture? Who is privileged by these definitions? Who is marginalized? If you were going to make a special effort to be sensitive to and appreciate diversity, how would that effort affect your family practice? How would it affect your role with others? How would your words reflect your sensitivity and appreciation?
Because gender and cultural perspectives are so important to the field today, I give special consideration to these lenses at the end of each theory chapter—in addition to considering the lenses in more detail in Chapter 18 on integration. The most effective models and practitioners tailor their approach to fit the unique needs of families with a wide range of structures, cultures, economics, and genders. Family practitioners today are required to possess knowledge for working with various cultures and are called to a personal and professional consideration of their own gender heritage and cultural experiences. In an effort to prevent harm, they must learn the culturally sensitive skills needed to assist families with the realities of their individual cultures.
The Scholar-Practitioner in Family Counseling and Therapy
With few exceptions, the models of family therapy presented in this book emerged from the efforts of clinicians who wanted to understand family practice through engagement and action. Bowen at the National Institute of Mental Health and Georgetown University; Bateson, Jackson, and associates at the Mental Research Institute in Palo Alto, California; and Minuchin and colleagues at the Philadelphia Child Guidance Clinic studied families in an effort to see what worked. These men were, for the most part, scholar-practitioners determined to discover or create the interventions that would make a difference with some of the most severe problems encountered in physical and mental health. In many ways, they were qualitative and action researchers embedded in and connected with the very systems they sought to know and study.
Even practitioners in private practice such as Dreikurs, Satir,