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Theory and Practice of

Couples and

Family

Counseling James Robert Bitter

THIRD EDITION

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Library of Congress Cataloging-in-Publication DataNames: Bitter, James Robert, author. Title: Theory and practice of couples and family counseling / James Robert Bitter. Other titles: Theory and practice of family therapy and counseling Description: [Revised edition]. | Alexandria, VA: American Counseling Associa-

tion, [2020] | Updated revision of earlier edition: Theory and practice of family therapy and counseling. | Includes bibliographical references and index.

Identifiers: LCCN 2020016571 | ISBN 9781556203831 (paperback) Subjects: LCSH: Family counseling. | Family psychotherapy. | Couples—Coun-

seling of. | Couples therapy. Classification: LCC RC488.5 .B4932 2020 | DDC 616.89/156—dc23 LC record available at https://lccn.loc.gov/2020016571

Theory and Practice of

Couples and

Family

Counseling

THIRD EDITION

iii

DEDICATION

For my loving wife and partner, Lynn Williams, and our wonderful children, Alison and Nora—the real gifts of love

that I have in my life.

In loving memory of my parents, Greg and Betty Bitter, who adopted me when I was six months old and gave me a foundation

that has sustained me for seventy-four years.

For the couple and family practitioners who nurtured me as a person and a professional: Manford Sonstegard, Oscar Christensen,

and Virginia Satir.

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TABLE OF CONTENTS

Foreword vii Gerald Corey

Preface ix

About the Author xiii

Acknowledgments xv

PART 1 Basic Issues in the Practice of Couples and Family Counseling

CHAPTER 1 Introduction and Overview 3

CHAPTER 2 Genograms of Couples and Family Counseling 25

CHAPTER 3 The Couples and Family Practitioner as

Person and Professional 57

CHAPTER 4 Virtue, Ethics, and Legality in Couples and Family Practice 79 Mark Young, David Kleist, and James Robert Bitter

PART 2Theories and Practice in Couples and Family Counseling

Introduction to the Case of the Quest Family 105

CHAPTER 5 Object Relations Family Counseling 111

Table of Contents

vi

CHAPTER 6 Adlerian Family Counseling 137

CHAPTER 7 Multigenerational Family Counseling 161

CHAPTER 8 Human Validation Process Model 189

CHAPTER 9 Structural Family Counseling 217

CHAPTER 10 Strategic Family Counseling 241

CHAPTER 11 Solution-Focused and Solution-Oriented

Family Counseling 271

CHAPTER 12 Postmodernism, Social Construction, and

Narratives in Couples and Family Counseling 295

CHAPTER 13 Feminist Family Counseling 327

CHAPTER 14 Cognitive Behavioral Family Counseling 353

CHAPTER 15 The Science of Couples Counseling 381 Robert R. Freund, Jon Sperry, and James Robert Bitter

CHAPTER 16 Emotionally Focused Counseling With Couples 407

CHAPTER 17 Imago Relationship Counseling With Couples 433

PART 3From Self-Discovery to Family Practice

CHAPTER 18 Integration: Forming a Relationship,

Couple and Family Assessment, and Treatment 463

References 501

Index 531

vii

FOREWORD

In the 1960’s I went through my entire doctoral program thinking the best way to study counseling was to understand the dynamics of the individual. My friend and colleague, Dr. Jim Bitter, was one of the key people to introduce me to a

couples, family, and systemic approach to counseling and psychotherapy. Being exposed to a systemic perspective broadened my view of individual counseling and working with individuals in group counseling. I appreciate his emphasis on knowing the role of an individual’s family of origin if we hope to effectively counsel a person.

Dr. Bitter has given workshops in Canada, England, Greece, Ireland, South Korea, New Zealand, and Peru as well as throughout the United States. He is an exception-ally gifted therapist who is a master at doing live presentations. He demonstrates respect, curiosity, interest, compassion, and a deep understanding of individuals in a family in his workshops. His presence encourages the family he is working with to reveal themselves in significant ways, and genuine encounters occur. His style as a person and as a practitioner is evident in this book. He draws from his practical experience to give this book an applied slant. This textbook is written in a scholarly manner, yet it is also personal and conversational. The theories come to life, and you are likely to have a sense that you are not just seeing them presented in a textbook but observing them being demonstrated. You are invited to reflect on your own family-of-origin experiences as you read each theory. In this way, reading and reflecting on the chapters is somewhat akin to having a therapeutic experience.

In this third edition of Theory and Practice of Couples and Family Counseling, sev-eral new topics and theories are introduced. New to this edition are

• a focus on couples counseling (three new chapters and sections in each of the earlier family chapters);

• an emphasis on wellness and resiliency;• an expanded history of the profession; and• the case example of the Quest family, a part of each of the theory chapters,

which involves a blended family with two children from a different culture.

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Foreword

A number of features make this book unique among couples and family coun-seling textbooks. Dr. Bitter uses a common format to organize each of the theory chapters, which will make your job of comparing these approaches easier. The first four chapters give you a fine introduction to the field and to the rest of the book; in two of these chapters, you get a real sense of Jim Bitter the person, the author, the teacher, and the couples and family counselor. Each of the theory chapters has exceptionally clear sections on key concepts, goals, and techniques. You will be introduced to the Quest family and then follow this family for each of the theory chapters. This case example gives a concrete illustration of how each theory can be applied to counseling the same family. The personal exercises that appear at the end of each chapter will assist you in personalizing your learning and help you apply what you are reading to gain a fuller understanding of how your family background influences you personally and professionally. The chapter on integra-tive approaches aims to assist you in thinking about your own personal synthesis. Dr. Bitter does an excellent job of guiding you through the process of learning how to focus on aspects of various theories that fit the person you are.

I found the summary sections to be very helpful in pulling together the key ideas of each chapter; furthermore, the sections on multicultural and gender concerns are most useful for seeing practical applications. You will find numerous sugges-tions for where to go beyond the chapter if you want to learn more about any theory. This text will challenge you to think and to reflect on what you are read-ing. I trust that you will feel encouraged in your own quest to better understand how your family history impacts you and your journey to becoming a relational practitioner. I have read this book several times, and it has been instrumental in helping me gain a deeper understanding of family counseling. My hope is that you too will be enlightened and encouraged to do what it takes to become an ef-fective relational practitioner—and that this book will be a part of that experience.

Although other family therapy textbooks are available, in my view Theory and Practice of Couples and Family Counseling is the most personal and well written, and it is my choice for a text for a family therapy course.

—Gerald Corey, EdD, ABPP

Professor Emeritus, Human Services and CounselingCalifornia State University, Fullerton

ix

PREFACE

Theory and Practice of Couples and Family Counseling is intended for undergradu-ate and graduate students interested in the field of couples and family counsel-ing. Although this book is designed especially for counselors—both those in

training as well as those currently practicing as licensed professional counselors—it also accommodates students and practitioners in family studies, human servic-es, marriage and family therapy, nursing, pastoral counseling, psychiatry, psy-chology, and social work. My overall goal in writing this book was to survey the major theories and practices of contemporary relational counseling as well as support the development of personal, professional, and ethical couples and fam-ily practice. Most important, the book provides a model for a successful integra-tion of multiple points of view.

I had several goals in writing this book. I wanted to

• address the use of theoretical models across several fields, giving as much con-sideration to health, growth, and resiliency as I did to assessment and reme-diation;

• present some models that are absent from other textbooks; • provide real examples of quality work for each approach as well as work with

a single couple or family system that could be used for comparison across models;

• focus on personal as well as professional development; and • write in the kind of conversational tone that has made other textbooks so suc-

cessful.

This book is a thoroughly updated version of my previous textbook Theory and Practice of Family Therapy and Counseling (2nd ed.). The most significant change in this edition is the emphasis on couples counseling. Here is the complete set of changes:

• The history of couples and family counseling based on the genograms of couples and family counseling has been completely updated and revised to include the discipline of couples counseling.

Preface

x

• The Quest family, which is used for comparison purposes throughout the text, has been revised to include a multicultural dimension, as has every the-oretical model.

• All previous family chapters have been updated generally and specifically to include a section on working with couples.

• Three new chapters on couples counseling have been added, featuring the models of John and Julie Gottman, Susan Johnson, and Harville Hendrix and Helen Lakelly Hunt; each of these chapters has a section on working with families.

• To make room for the new chapters, I have updated two chapters from the previous edition and made them available at www.jamesrobertbitter.com. These two chapters are on Carl Whitaker’s symbolic-experiential model and effective parenting.

This book is divided into three parts. Part 1 deals with the language, concep-tualizations, history, and issues that are the foundation for couples and family practice. Chapter 1 provides an overview of the book and of the field of couples and family counseling. It defines the language and thinking associated with family systems theory. In Chapter 1, I also tell you a little bit about my own family history and how it relates to both my personal and professional development. I hope this brief biography can serve as a model for students who may be starting their own personal explorations in preparation for a career in the helping professions.

Chapter 2 uses the genogram of couples and family counseling, presented at the end of the chapter, as a structure for considering the history of the field of couples and family counseling. Four interlocking histories are presented in this chapter: (a) a history of the pioneering individuals who first introduced family and systems concepts to the field of psychotherapy as well as their offspring and supporters; (b) the development of the structural, strategic, and solution-focused/solution-oriented models of family counseling; (c) the evolution of postmodern, social constructionist, and feminist models of couples and family counseling; and (d) evidence-based counseling approaches to couples and family counseling, in-cluding three couples counseling models that are brand new to this edition and that are discussed at length in the next part of the book.

Chapter 3 more directly addresses personal and professional development. In this chapter, I use some of the processes I learned from 10 years of training with Virginia Satir, a late, great pioneer of family counseling and therapy. They are de-signed to help you discover self in family context and consider the tremendous in-fluence family systems have on each of us as growing counselors and therapists. I also list some personal and professional characteristics that are particularly useful in relational practice: some ideas for how to get started with couples and families, the relationship of scholarship to practice in the field of family counseling, and a first look at a model for integration that is more fully developed in Part 3.

Chapter 4 introduces you to the ethical, professional, and legal issues that have shaped the development of family practice. This chapter on applied ethics has been completely updated and coauthored with my friends and colleagues David Kleist and Mark Young. We focus on learning to think about ethical issues from the perspectives of virtue, professional ethics codes, and legal requirements in the field. This chapter takes into account the guidance and mandates of multiple ethics

Preface

xi

codes, including those developed by the American Association for Marriage and Family Therapy, the American Counseling Association, the American Psychologi-cal Association, the International Association of Marriage and Family Counselors, and the National Board for Certified Counselors.

Part 2 is devoted to a consideration of 13 models of couples and family counsel-ing. It starts with a presentation of the biography and genogram of the Quest fami-ly, a family that is part of each of the theory chapters. The 13 theory chapters have a consistent organization so that you can compare and contrast the various models. Each chapter starts with an introduction to the model that defines its major charac-teristics and identifies its founders. The introduction is followed by a transcript of an actual couples or family counseling session, usually featuring a major contribu-tor to that approach. I want you to have these sessions in mind when you consider the key concepts, counseling goals, counselor’s role and function, and process and interventions that follow. Toward the end of each chapter, I present another coun-seling session with the Quest family using the model presented in that chapter. I end each of the theory chapters with a summary of the chapter, a consideration of cultural and gender issues, and suggested readings and videos. Each of these chapters has been updated with the latest ideas and references for the model. The three chapters on couples counseling are brand new from start to finish.

Part 3 addresses the integration and application of models. Chapter 18 on in-tegration is designed to help you discover a model or set of models that fits your worldview and perspectives on family practice. An emphasis is placed on assess-ing personal values and beliefs and using videotapes of initial work for reflec-tion and development as a family counselor or therapist-in-training. A four-stage process for conducting couples and family sessions is also described: forming re-lationships, performing relational assessments, hypothesizing and sharing mean-ing, and facilitating change. An emphasis is placed on resiliency work, tailoring treatment to individual families, and methods for ensuring treatment adherence and relapse prevention. Finally, the integrative model is applied one last time to the Quest family.

With this structure in place, we are now ready to begin a journey together. It is my hope that you will enter the field of couples and family counseling and find an exciting place for yourself as a relational practitioner. Couples and family practice is very much a growing and developing field. Only 70 years ago, the field was still in its infancy. I hope you will feel yourself grow into couples and family practice as you consider the different models presented in this book.

xiii

ABOUT THE AUTHOR

James Robert (Jim) Bitter, EdD, is professor of counseling and human ser-vices at East Tennessee State University in Johnson City. He is a nationally certi-fied counselor, an Adlerian family counselor, and a former officer of the North American Society of Adlerian Psychology. He is also a former editor of the Jour-nal of Individual Psychology and a Diplomate in Adlerian Psychology. He is a reviewer for the American Journal of Family Therapy and has served in the past in a similar role for The Family Journal and the Journal of Counseling & Development. He received his doctorate in counselor education from Idaho State University in Pocatello in 1975.

Jim has received awards for outstanding teaching in the College of Hu-man Development and Community Service at California State University, Ful-lerton, and for outstanding scholarship in the Clemmer College of Education at East Tennessee State University. In 2015, Jim won the American Counseling Association’s Don Dinkmeyer Social Interest Award. He has taught in graduate counseling programs in three universities and has authored or coauthored four books as well as more than 60 articles and chapters.

Jim is the featured expert on Adlerian family therapy in the Allyn & Ba-con/Psychotherapy.net series Family Therapy With the Experts, and he has of-fered workshops in Canada, England, Greece, Ireland, South Korea, New Zea-land, and Peru as well as throughout the United States. He was introduced to Adlerian family counseling by Manford A. Sonstegard, with whom he worked for more than 30 years.

Jim studied and worked for 10 years with one of the pioneers of family therapy, Virginia Satir. He was a trainer in her Process communities for three of those years and published an article and a number of chapters with her before her death in 1989. He is a past president of AVANTA, Satir’s training network.

Jim currently sees couples and families together with graduate students at East Tennessee State University’s community counseling clinic. He continues to develop Adlerian counseling models for individuals, groups, couples, and

xiv

About the Author

families. His focus on a fully present relationship in all forms of counseling is an integration of Adlerian counseling and the work of Virginia Satir, Erv and Miriam Polster, and Michael White, all of whom have trained Jim in the past.

Jim has been married to Lynn Williams for 37 years; they have two grown daughters, Alison and Nora Williams. In his leisure time, Jim likes to travel, collect stamps, play basketball, and read.

xv

ACKNOWLEDGMENTS

No one writes a textbook like this without a lot of help, and I have had wonderful support from the very beginning, starting with Carolyn Baker, Nancy Driver, and the rest of the team at the American Counseling As-

sociation. Special thanks to Beth Ciha for copyediting the project, and also to my daughter, Alison Williams, who carefully proofread every page of this book. In many ways, this is the third edition of a textbook I wrote back in 2009. Sherry Cormier served as a developmental editor, friend, and confidant for that first edition. Her wisdom is still in every chapter. And of course, this book would never have been started without the kindness, support, and constant encouragement of Jerry Corey.

Special thanks are extended to the chapter reviewers who provided consulta-tion and detailed critiques. Their recommendations have been incorporated into this text:

• Chapters 1–4 : Gerald and Marianne Corey • Chapter 4: David Kleist and I cowrote the original chapter, and Mark Young

updated and improved it• Chapter 5: Jill Scharff • Chapter 6: Jon Carlson (now deceased and much missed) and

Richard E. Watts • Chapter 7: Betty Carter and Monica McGoldrick • Chapter 8: Jean McLendon and John Banmen• Chapter 9: Harry Aponte • Chapter 10: Madeleine Richeport-Haley • Chapter 11: Jane Peller • Chapter 12: Don Bubenzer and John West; and J. Graham Disque• Chapter 13: Roberta Nutt and Patricia E. Robertson• Chapter 14: Frank Dattilio • Chapter 15: Rob Freund and Jon Sperry

xvi

Acknowledgments

• Chapter 16: Brent Morrow• Chapter 17: Harville Hendrix• Chapter 18: Gerald and Marianne Corey

I also want to thank the students in the couples and family counseling concen-tration of the Counseling Program at East Tennessee State University who gave this text an initial trial run and offered many helpful additions and corrections.

To each and every person who contributed to the completion of this book, my heartfelt thanks.

1

PART 1

Basic Issues in the Practice of

Couples and FamilyCounseling

CHAPTER 1 Introduction and Overview

CHAPTER 2 Genograms of Couples and Family Counseling

CHAPTER 3 The Couples and Family Practitioner as Person and Professional

CHAPTER 4 Virtue, Ethics, and Legality in Couples and Family Practice• • •

3

CHAPTER 1

Introduction and Overview

Fifty years ago, family practice promised greater effectiveness than had been achieved with either individual or group counseling. Because these relational approaches sought to change the very systems in which individuals actually

lived, many professionals hoped that the changes enacted would endure and that both individual and system relapse would disappear. Although these hopes have not been fully realized, family practice has had enormous success, and it is now a fully integrated part of most treatment programs.

Couples and family practice is fundamentally different from individual coun-seling. Although both couples and family systems share some similarities with groups, their intimacy and intensity make them a treatment unit unlike any other. Perhaps the hardest task for those trained to work with individuals is learning assessment and interventions with couples and families from multiple systemic perspectives. I will say more about this later. In the meantime, this book provides you with an invitation to experience the thinking of the pioneers and leaders who have shaped systemic approaches in the field of couples and family practice.

This book surveys 13 approaches to family counseling and practice, highlight-ing key concepts, therapy goals, techniques, process, and application. Two addi-tional chapters that were part of an earlier edition of this book have been updated and are available on my website (www.jamesrobertbitter.com). These chapters are on symbolic-experiential family therapy (Carl Whitaker’s model) and effective ap-proaches to parenting. I hope you will read this book with the goal of learning the breadth and depth of each counseling orientation. The models presented here sometimes have a great deal of similarity and sometimes are quite different and even contradict one another. Consider not only the ideas and interventions of each

Basic Issues in the Practice of Couples and Family Counseling

4

model but also the worldview espoused by both the founders of the theory and the practitioners who currently contribute to its development.

Each of these models will, most likely, have some relevance to your own family of origin. The family of origin is often a good place to start the personal explora-tion that is so essential to couples and family practice. It is almost axiomatic these days that family practitioners-in-training must consider the impact that their fami-lies of origin have had on their personal development (see McGoldrick, 2011a). If we do not make this journey into our own histories, we are in danger of trying to work out our personal family issues with every new family we encounter.

Over time, various ideas and models will start to appeal to you: They will fit with your values and beliefs and, in some cases, they will even enhance or broaden your worldview. You will start to create a foundation for your work, and you will find that parts of different models will integrate into that foundation. This is not a process that happens quickly. It will certainly not happen at the end of a course or two on the theories and practices of marriage and family counseling. This is a lifelong journey.

You might start by asking yourself the following questions:

• What beliefs do these theorists and practitioners have about families in general? • Do I hold these same beliefs, ideas, or values, or do other values and posi-

tions seem more important to me? • If I were bringing my family of origin and/or my current family members to

counseling with me, would I want to go to a family practitioner, counselor, or therapist using this approach? Why or why not? What would my expectations be? What goals would I have for the work I was contemplating in counseling?

• What kind of relationship would I want to have with the family practitioner? What would contribute to my trust, comfort, willingness to work, determi-nation to change, and feeling of accomplishment at the end?

There are useful parts to every theory and model we will consider in this book. None of the approaches considered here holds a claim to absolute truth, however, or even to the right way to do family practice. Each theory is built on a perspective and provides a different kind of lens through which families may be viewed and understood. And each of these perspectives inevitably has continually developing implications for family practice.

Finding a model or models that work for you is an important first step as a pro-fessional. Such a discovery provides a framework for working with the multitude of diverse families you will encounter—families that are often facing very compli-cated and even severe problems. Family practice is supposed to be a challenge. It is supposed to engage your mind and your heart. It will endlessly change you as a person, and it will require you to reflect on your use of self in counseling as much as your use of skills and techniques. Family counseling and practice will test your strengths, poke at your weaknesses, and enlarge your view of life. Ultimately, it can be one of the most rewarding careers in the helping professions.

Why I Became a Couples and Family CounselorLike most people who are attracted to the helping professions, I came from a fam-ily that had its happy times and its struggles. You can probably say the same thing


5

about your family. In my particular case, my father was a man who kept a lot in-side himself and was somewhat aloof and distant, not really knowing what to do with children and leaving us to be raised by my mother. My mother was a warm, gregarious woman who loved her life as a homemaker and community volunteer. My mother and father were both devout Catholics; they also believed that they were soulmates, and they were committed to a marriage that was to last forever. They adopted me when I was 6 months old. Two years later, they would adopt my 6-week-old sister, Jo Ellen. We were a working-class nuclear family of the 1950s, seeking the promise of a better life through hard work and dedication. We lived in a small town in central Washington known for its production of apples and its traditional values, with little or no diversity acknowledged or appreciated in the community. In short, we were what the world called a “normal” family. Manners were important, faith was important, hard work was important, and extended family and community were important and intertwined. Contributing to others and making a difference in the world were expected and valued.

My grandfather died when I was 9, and my grandmother came to live with us. She and my mother were very close, and they loved being together. My grand-mother was respectful of the relationship between my father and mother, and she helped everyone when she could, but she also had her own life and interests. I re-member having long talks with my grandmother and being amazed by her stories of being a schoolteacher in Wisconsin before she met and married my grandfather. Having Grandma with us in the family seemed as natural to me as having parents. In a short period of time, it was as if she had always been in our home.

Then, when I was 14, my mother died from cancer. Both of my parents were heavy smokers, and both were addicted to it long before the Surgeon General started putting warnings on the sides of cigarette packages. My mother’s death turned everything upside down. Both my father and my grandmother met my basic needs and those of my sister, but both were grieving, crying with a sadness that seemed as though it would never end. Within a year, I would distance my-self from the pain in the family by heading off to a Catholic boarding school. My sister would not be able to find such a convenient way out: She led a troubled life throughout high school and, as soon as possible, she started a lifelong search for her “real” parents.

This is a relatively short synopsis of my early life. When you read it, what issues do you think have been part of my own development as a person and as a coun-selor? What is emphasized in my life? What do you think I left out? Do you have any guesses about how I have approached women and men? Do you think the limited experience and traditional values that were part of my upbringing had an effect on how I view race, diverse cultures, gender issues, and roles and functions in the family? Do you think that coming of age in the 1960s had any effect on how I see people and life? What effect do you think adoption has had on me—and on my sister? Do you think the two of us are more alike or different? What would lead you to your conclusions? If you had to write your own autobiography, what facts, interpretations, values, and beliefs would you emphasize? What parts would you choose to forget or simply not mention?

Here is a little more information about how my educational and professional experiences began. My father dedicated the proceeds from my mother’s life in-surance to sending his children to college. I was blessed with a great education


6

(academically as well as in life) at Gonzaga University in Spokane, Washington. I majored in English literature with a minor in philosophy. It turned out, however, that my father was right: There really were not any jobs waiting for a person with a degree in English literature and philosophy. For a year after I graduated, I worked in a gas station and tried to figure out what I wanted to do with my life.

I had many of the common developmental difficulties that occur in late adoles-cence and early adulthood. If it was possible to engage in life the hard way, I usu-ally did. It was the counselors at Gonzaga who really helped me begin the process of growing up. They were the people who, it seemed to me, had a handle on kind-ness, caring, and stability as well as a moral and ethical life. It was their modeling of effective engagement that led me to want to become a counselor.

In 1970, I headed off to Idaho State University in Pocatello to get a master’s de-gree in counseling. At that time in the history of the counseling profession, the skills and interventions associated with Rogerian or person-centered therapy made up the majority of our training. We spent hours learning to do reflections and active listening, continually paraphrasing content and feelings, hoping that it would all become second nature to us. For many of my peers, it did become second nature, but I struggled. I always had more questions I wanted to ask: How did everything fit together? Who said what to whom? How did people react when my clients did one thing or another? What were the different parts that made up the personalities of the individuals I was seeing, and how did those parts work for people or against them? I was also far more directive in my interventions than would make any of my supervisors comfortable, because I genuinely wanted to help people find solutions to their problems. In the early days of my training, I seldom felt that I was effective and, in truth, I am sure that I was not.

In early 1971, one of my professors went to a conference in which a man named Ray Lowe demonstrated Adlerian family counseling. My professor brought back tapes and books, and later he even brought Ray Lowe himself to our campus. I ab-sorbed everything I could about the Adlerian model. The more I read about Adlerian psychology, the more at home I felt. Alfred Adler was systemic before we even had such a word in our profession. He saw people as socially embedded; he took into ac-count the effects of birth order, the family constellation, and family atmosphere; and he considered interaction and doing central to understanding human motivation and behavior. Discovering the works of Adler and Rudolf Dreikurs helped me to make sense out of my own life as well as the lives of the clients entrusted to my care.

I was part of a team that opened up the first public (open-forum) family educa-tion center at Idaho State University. I even conducted the first family counseling interview ever done there. I had lots of support and was given lots of room to make mistakes—and to learn. But I had found my approach. As graduate students, we ran parent study groups, held weekly family counseling sessions, and carried what we were learning into local area schools and community agencies. I stayed at Idaho State University to get my doctorate in counselor education. In 1974, we held a con-ference on Adlerian psychology that featured, once again, Ray Lowe and such mas-ters as Heinz Ansbacher, Don Dinkmeyer, and the man who was to become my best friend and colleague for the second half of my life, Manford Sonstegard.

Sonstegard was simply the best family and group counselor I had ever seen in action. He had an enormously calm manner that reflected what Murray Bowen called a differentiated self. He listened very carefully to the positions and counterposi-


7

tions taken in families and groups, and he always stayed focused on redirecting mo-tivation. When I graduated later that year (1974), I was able to get a position in the counseling program of which Sonstegard was the chair. Over the next 13 years, we established and conducted Adlerian family counseling sessions in multiple states in the mid-Atlantic region of the United States from our base in West Virginia.

Adler (1927/1957) had called his approach individual psychology, but it was anything but oriented toward the individual. He used the term “individual” to emphasize the necessity of understanding the whole person (rather than just parts of people) within that person’s social contexts. Adler focused on the individual’s movement through life (one’s style of living) and how that style was enacted with others. He spoke of having a “psychology of use” rather than possession. From Adler’s perspective, people had a purpose and use for the symptoms he encountered in counseling. Others in the clients’ life generally reacted in ways that maintained the very problems for which the indi-viduals sought help. Without question, Adler was a systemic thinker, and working with systems was part of his therapy back in the 1920s. A fuller presentation of Adler’s model is presented in Chapter 6, but I mention his work here because it fit so well with how I saw individuals, groups, couples, and families. I did not have the language of systemic thought when I first read Adler, but the ideas were all there, and his psychol-ogy has served as a wonderful foundation for me for more than 45 years.

In 1979, I had the opportunity to attend a monthlong training seminar called a Process Community led by Virginia Satir and two of her trainers. The training pro-gram focused on applications of her human validation process model to individuals, groups, couples, and families. Centered in her now-famous focus on communica-tion and self-esteem, it was as much a personal growth experience as it was a learn-ing experience for family practitioners. More than 100 participants were accepted for the program held just north of Montreal, Quebec, in Canada. Half of the participants spoke only English, and half of the participants had a primary language of French, so every word was offered in both languages. The power of Satir’s work in this cross-cultural experience was overwhelming. I came away from the month with a new dedication to experiential teaching and learning and a determination to inte-grate Satir’s human validation process model with the Adlerian principles I used in clinical practice (see Bitter, 1987, 1988, 1993a; Satir et al., 1988).

In 1980, I became a member of Satir’s AVANTA Network, an association of Satir-trained practitioners who used her methods and processes and were engaged in training others to do the same. For the next 9 years, until her death, I was privi-leged to work with Satir during three more Process Communities; to coauthor an article and a chapter with her; and to spend at least a week each year learning the newest ideas, hopes, and dreams of one of the most creative family systems thera-pists ever to have graced our planet.

Virginia Satir taught me the power of congruence in communication as well as the forms that metacommunications often take in relationships. She introduced sculpting to my work and gave me processes for creating transformative experi-ences with families. Her emphasis on touch, nurturance, presence, and vulner-ability put my heart as a person and a counselor on the line, but it also opened up avenues of trust and caring that had been missing in my work before. Satir taught me how to join with families and still not get lost in them. When she died, it was as if I had lost a mother, a father, a sister, and a brother all rolled into one. I had certainly lost one of the best teachers in my life.


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In the 1990s, I had two opportunities to do monthlong training programs with Erving and Miriam Polster, the master Gestalt therapists. Their emphasis on aware-ness, contact, and experiment in counseling fit wonderfully with the decade’s worth of knowledge I had received from Satir. The Polsters also had the same kind of great heart that Satir had. Whether working with individuals, couples, or families, both Satir and the Polsters demonstrated the importance of an authentic and nurturing relationship in facilitating change. At the heart of both models was a dedication to experiential counseling and learning through experiment and en-actment. Even today, when I walk into a room to meet a family, I feel the wisdom of these great therapists with me (see Bitter, 2004).

As you can see, I have been gifted with great teachers in my lifetime. They have welcomed me into learning situations that I would not trade for anything in the world. Watching great masters at work has provided me with ideas and mod-els for effective interventions that I never would have discovered on my own. To tell the truth, I often found myself imitating them initially in very concrete ways, sometimes using the exact words and interventions that I had seen them create spontaneously. Over time, I would begin to feel a more authentic integration of their influences in my life and work, and I let these influences inform my own creativity in family practice.

I have become fascinated by the flow and rhythms of therapeutic relationships. The two most important aspects of family practice are still the client and the prac-titioner, with the latter being in the best position to influence the process. I cur-rently think in terms of four aspects of therapeutic movement: purpose, aware-ness, contact, and experience (Bitter, 2004; Bitter & Nicoll, 2004). You may already have noticed that the acronym for these words is PACE. In both my personal and professional lives, paying attention to purpose, awareness, contact, and experi-ence brings a useful pace to human engagement and provides me with enough structure to support creativity in my interventions.

Purposefulness has always been a central aspect of Adlerian counseling and provides a sense of directionality and meaning to life (Sweeney, 2019). Awareness and contact are most clearly defined in the Polsters’ Gestalt practice. I consider both of these aspects to be critical to an enlivened and energized life. They make being present sufficient as a catalyst for movement and change. Awareness and contact are also essential to more fully realized human experiences. They allow both the client and the practitioner to touch the authentic within them and to find expressions that flow from their hearts. Such experiences are a natural part of Vir-ginia Satir’s work. The therapeutic experiments and enactments common to sys-temic family counseling are just one form of such experiences.

Although I like the integration of thinking and practice that currently marks my own work, I began by absorbing as much of the great masters as I could, often imi-tating them until their processes became natural within me. I would recommend a similar process to you. If family systems theory and practice is what you want to do, find a model or set of models that seem to fit you. Then watch as many tapes and DVDs that feature your chosen approach as you can.1

1I especially like the series of videotapes produced by Jon Carlson and Diane Kjos (1998a) under the title Family Therapy With the Experts. You can purchase these as DVDs and many more outside of this series at www.psychotherapy.net/video/family-therapy-series. Also, many of the master family therapists are on videotapes produced by the American Association for Marriage and Family Therapy.


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Each theory chapter in Part 2 of this book has a transcript of an actual family counseling session right after the model is introduced. I have tried to pick couples or family practitioners who represent the most current development of each ap-proach and who are still working and clinically active today. I have also created a fictitious family I call the Quests, which is a conglomerate of several real couples and families I have worked with over the years. I use this created family to demon-strate how each theoretical perspective might work with them. As you read about both the actual family and the fictitious family in each chapter, think about which approach you like best, what you would want to do or use yourself, and what you cannot imagine yourself doing. This is one way to begin to narrow down the choices to the systems perspectives that best fit you.

Thinking systemically about clients is one perspective—or I should say, set of perspectives—that provides a framework for therapeutic practice. For me, think-ing systemically just fits the way I see human process and the social world in which we all live. We are social beings. We interact with others every day. We are influenced by the people in our lives, and we return that influence to them. In truth, we are very seldom alone, and even when we are, we are often thinking about and reflecting on life with others. Even the act of giving help involves at least two people, and in my mind, counselors join with even single clients to form a new system. I believe in family systems counseling because it is a reflection of the way we live. And at its best, intervening in systems increases the likelihood that when change is enacted, it will be supported and maintained.

An Overview of the BookFamily counseling was initiated in the early part of the 20th century, but it was in the latter half of that century that the practice of working with families really came into its own. That is when the masters of family theory and practice—Nathan Ack-erman, Gregory Bateson, Murray Bowen, Oscar Christensen, Rudolf Dreikurs, Richard Fisch, Jay Haley, Lynn Hoffman, Don Jackson, Cloe Madanes, Monica Mc-Goldrick, Salvador Minuchin, Virginia Satir, David and Jill Scharff, Mara Selvini Palazzoli, Paul Watzlawick, John Weakland, and Carl Whitaker—developed ideas and models that would serve as the foundation for the family practice professions. After some 60 years of substantial growth and development, the field began to in-corporate the postmodern, social constructionist positions of Tom Andersen, Har-lene Anderson, Insoo Kim Berg, Steve de Shazer, David Epston, Kenneth Gergen, Harold Goolishian, William O’Hanlon, Michele Weiner-Davis, and Michael White. Race, culture, gender, and family life cycle development are now central consider-ations and assessments in family counseling.

From the last decade of the 20th century to the present, couples counseling has emerged as a distinct discipline in its own right. Although each of the family mod-els has adapted its approach to working with couples, three new models currently dominate the field. These models, developed by John and Julie Gottman (the sound relationship house model), Susan M. Johnson (emotionally focused therapy with couples), and Harville Hendrix and Helen Hunt (imago therapy), are all based on the neuroscience that supports and confirms attachment theory (see Porges, 2017). The models fall in the realm of evidence-based practice, and given their promi-nence, they are addressed in separate chapters in this book.


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Couples and family practitioners come in many different forms and represent similar, if distinct, orientations. There are the marriage and family therapists who receive their training in programs that are now largely autonomous and accredited by the Commission on Accreditation for Marriage and Family Therapy Education, the accrediting body of the American Association for Marriage and Family Thera-py. There are couples, marriage, and family counselors who receive their training in counselor education programs, sometimes accredited by the Council for Ac-creditation of Counseling and Related Educational Programs, and who belong to the International Association of Marriage and Family Counselors, a division of the American Counseling Association. Clinical family practitioners are also trained in schools of social work. And both psychiatry and psychology now have divisions devoted to family practice.

In general, those who are associated with the American Association for Mar-riage and Family Therapy and family practice in psychiatry and psychology tend to focus on psychopathology—both how it is maintained and what effects it has on family systems. Those associated with the International Association of Marriage and Family Counselors and counseling programs in general tend to focus more on family growth and development, resource identification, and what is now consid-ered resiliency practice (J. B. Simon et al., 2005). Here the emphasis is on normal-izing family process, activating ignored or denied individual and family skills and abilities, and focusing on what works and avenues to desired solutions. To be sure, these are not dichotomous positions, and many family approaches are embraced by both orientations (see Carlson et al., 2005; Sperry et al., 2019).

The theory chapters in this book have a relatively consistent format to aid you in comparing and contrasting the various approaches. Each chapter begins with a short introduction that introduces the founders and major contribu-tors to the theory as well as its main emphasis. This introduction is followed by dialogue from an actual counseling session conducted by one of the main contributors to the model. Within the presentation of this counseling session, I ask you to consider certain questions that relate to understanding the model, its application, and how it relates to your own values and beliefs about help-ing others and family practice. A section that highlights key concepts of the model follows the counseling session; here the heart of the theory is presented for your consideration. Somewhat shorter sections on counseling goals and the practitioner’s role and function follow so that an emphasis is placed on the purpose and the person of the counselor. The section on process and interven-tions is designed to provide you with the process, skills, and interventions most associated with the theory. In this section, I address how to use the model with couples and/or families. This section is followed by an application of the model to the fictitious Quests as a couple or a family. A full description of the Quest family is presented at the beginning of Part 2. Again, the purpose of presenting the Quest family is to allow you to compare and contrast the dif-ferent theories in actual practice. Each theory chapter ends with a summary of the approach; gender and cultural contributions associated with practitioners of the model; and a list of suggested readings, DVDs, and references. Although the word “counselor” is used throughout this text, it is intended to include all family practitioners from the fields of counseling, marriage and family therapy, psychiatry, psychiatric nursing, psychology, and social work.


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An Overview of the Theory ChaptersThe Early PioneersThe first modern psychologist to adopt a systemic orientation and actually con-duct family therapy sessions was Alfred Adler. The American pioneers included Murray Bowen; Virginia Satir; Carl Whitaker; Salvador Minuchin; and the stra-tegic therapists, especially Jay Haley. Later, David and Jill Scharff would apply object relations to couples and family work. Each of these models adopted a mod-ernist perspective in which there was a search for the essence of what made up a functional family. Some found that essence in communication, some found it in structure and hierarchy, and some focused on the development of the person within the system. Each of these founding models is unique in its perspectives and interventions, but all of them are systemic in nature.

Object Relations Family Counseling

Key figures: David and Jill Scharff, Nathan Ackerman, Ivan Boszormenyi-Nagy, Mary-Joan Gerson, Peggy Papp, Samuel Slipp

The theory chapters start with the systemic approach of object relations therapists. Beginning with Sigmund Freud’s original drive/structure psychology, multiple scientist-practitioners began in the late 1920s and 1930s to investigate actual children and the nature of their relationships with significant caregivers. Many of these investigations were initiated in England, and the theorists came to be known as object relations practi-tioners. David and Jill Scharff developed object relations family therapy more fully using emotional tracking and an analysis of transference and countertransference to uncover unconscious processes within the family.

Adlerian Family Counseling

Key figures: Alfred Adler, Rudolf Dreikurs, Oscar Christensen, Len Sperry, Jon Carlson, Paul Peluso, Bill Nicoll, Jim Bitter

Adler was the first practitioner-theorist to speak of social embeddedness, family atmosphere, family interactions, the family constellation, and birth order, and he was the first psychologist to engage in family practice and interventions. His initial work with families and communities was system-atized and expanded by Rudolf Dreikurs, who was, during his lifetime, the most prominent of Adlerian practitioners in the United States. Adler’s focus represented a huge paradigm shift in the development of psychodynamic theories, just as the general field of family counseling and practice would be another paradigm shift away from a focus on private, individual work.

Bowen and Multigenerational Family Counseling

Key figures: Murray Bowen, Betty Carter, Thomas Fogarty, Phillip Guerin, Michael Kerr, Monica McGoldrick

Sixty years ago, the models that would become the foundation for the field of marriage and family therapy began to emerge. These models


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included the multigenerational approach taken by Murray Bowen with his emphasis on differentiation of self, the problems of triangulation, and the passing of problems from one generation to the next. Murray Bowen also emphasized that the personal development and the profes-sional development of the therapist were linked and were essential to the practice of family therapy.

Satir and the Human Validation Process Model

Key figures: Virginia Satir, John Banmen, Jean McLendon, Maria Gomori, Jane Gerber, Sharon Loeschen

Perhaps no family practitioner emphasized the use of self in therapy more than Virginia Satir. A pioneer in the field of family therapy, Satir brought her background as a clinical social worker to her understand-ing of family process. She emphasized self-esteem and communication as avenues for understanding and intervening in family dynamics, and she provided us with a process for change that included human contact, touch, caring, and nurturance.

Whitaker and Symbolic-Experiential Family Counseling

Key figures: Carl Whitaker, David Keith, Thomas Malone, Gus Napier

Although Satir was highly experiential in her approach, it was really Carl Whitaker who introduced the symbolic (with all of its existential mean-ing) to experiential counseling with families. Whitaker gave a whole new meaning to the process of coaching in family counseling. He stretched the boundaries of creativity and innovation when he danced with families. Whitaker often provoked anxiety in an effort to promote change. He also demonstrated the value of working with cotherapists in family sessions. A chapter on this method is available at www.jamesrobertbitter.com.

Minuchin and Structural Family Counseling

Key figures: Salvador Minuchin, Harry Aponte, Jorge Colapinto, Charles Fishman, Patricia Minuchin

One of the family practitioners who both influenced and was influenced by Carl Whitaker was the great master of structural family therapy Salva-dor Minuchin. Minuchin helped the field of family counseling understand the organization of families through the sequences of interactions and the boundaries (or lack of them) that existed between subsystems. Using join-ing, reframing, and enactment, Minuchin and his followers provided the early foundation for systemic work with families, especially poor families.

Strategic Family Counseling

Key figures: Jay Haley, Cloe Madanes, Mara Selvini Palazzoli, Paul Watzlawick, John Weakland

By the 1980s, Minuchin’s work was often integrated with the problem-solution focus of the strategic therapists. Strategic therapists focused on

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