Judgment, Action, and Personal Development in Family

Counseling(Introduction to Part III)

Transition to Part III

We now put the pieces together and examine the current and future practice of family counseling

Joining, Struggling Together, and Saying Goodbye

(Chapter 9)

Objectives for this chapter

Conceptualize a couple or family case according to multiple perspectives.

Develop an intervention plan based on intake information. View a case in long-term perspective. Revise a family intervention plan based on new information. Assess a family’s readiness to end counseling.

Introduction

Working with couples and families can involve multiple issues and different approaches over time

Helping processes are interactions in which counselors and clients mutually influence what is done

This chapter follows a single case from first session through successful termination

Review of BONES themes

The Morgan-Thompsons: A Family in Crisis

Rick and Alice were not yet a couple—their early relationship was disrupted by addiction

Rick and Alice

Rick, 43, had just been released from the hospital following a cocaine binge; he was unemployed and living with his mother

His addiction history had included prior treatment and significant clean time before he returned to his old friends and life style

During his active recovery he became involved with Alice—she was now his strongest ally

Alice had a history of relationships with men whose lives were out of control

Concerned about her adolescent son, having recognized her tendency to sacrifice herself in prior relationships, she was setting clear limits this time

She was accompanying Rick to the first appointment to get him started, but was not committed beyond that point

Phase 1: Separation and rapprochement

The early phase of this work was shaped by dependency and insecure attachment

Engaging and assessing

The first session was designed to elicit multiple perspectives Rick opened with an apparent plea for sympathy and Alice

immediately countered with confrontation The story that emerged showed two people who both had

needs to rebuild their identities.– Rick portrayed himself as an addict, a manipulative and destructive

person– Alice portrayed herself as codependent—a chronic helper,

attracted to chaos

Making sense of the clients’ needs I

The 5 BONES themes and subthemes provided multiple ways of understanding this situation (see slides following)

The many possibilities had the potential to be overwhelming Decisions were shaped by a theory of Identity Renegotiation

Counseling (see slide)

BONES themes and subthemes (Behavior)

Skills: Decision making and basic communication skills are limited.

External knowledge: The partners need information on recovery processes and relationships.

Internal knowledge: The new couple are learning about self and other.

Cued responses: Environmental cues predictably lead to negative patterns.

Contingent responding: Reinforcements help to sustain negative patterns.

BONES themes and subthemes (Organization)

Function: Rick’s alcoholism and Alice’s rescuing are the basis of their relationship.

Conflict: Rick accepts the losing position in any negotiations. Development: Rick and Alice both want “post-parental” intimacy. Intergenerational patterns: It will eventually be discovered that Rick and

Alice are both children of alcoholic parents. Direct communication: Rick and Alice seem uncomfortable with

dependency; Rick’s relapse justifies these feelings. Indirect communication: Both partners express the same message: I want

to be closer but if you get too close I’ll hurt you. Structure: Their shared crisis helps to create a bond Systemic patterns: The complementary pattern (Bateson) describes a

system that could get continually worse over time. Evolution of system: Because relapse has already transformed the

system, counseling should focus on stability and healing.

BONES themes and subthemes (Narrative)

Identity: Both Alice and Rick are living with negative identity stories.

Cognitive complexity: Focusing on addictions is important, but this relationship also involved other issues that interfere with recovery.

Dominant discourse: Both the addict discourse and the codependent discourse emphasize a sense of hopelessness and powerlessness.

BONES themes and subthemes (Emotion)

Connection: Closeness may have become uncomfortable for one or both partners.

Internal experiencing: Shame issues on both sides intense make intense feelings a threat.

Emotional expression: Neither partner was identifying and expressing emotions in a clear, open, nonmanipulative manner.

Empathy: Alice’s stable relationship with her daughters helps her to maintain balance.

Emotion management: In an attempt to escape from strong emotions, Rick used pornography as an emotional buffer.

BONES themes and subthemes (Spirituality)

Ethnosensitivity: Both Rick and Alice were estranged from their religious backgrounds.

Beliefs and themes: AA and Al-Anon seemed to offer reasonable replacements.

Instrumental practices: Neither was practicing any spiritual or religious discipline or studying spiritual teachings.

Metaphysics: Both Alice and Rick had become isolated from larger forces beyond themselves.

Identity Renegotiation Counseling

The handling of this case was informed by a theory in which four clusters of understandings, goals, and counseling techniques, are organized into a recurring series of learnings and practices

Addressing the clients’ needs

The treatment plan would– Begin with behavioral theme, internal and external

knowledge (IRC Clusters 1 and 2) What is addiction? Codependency? What are the needs of an addict? Information and opinion sources have conflicted,

creating confusion– Work toward a clear definition of recovery and clear

expectations for Rick’s treatment and Alice’s keeping distance until he could show her stable “clean time”

Intervention

Rick created and implemented a relapse prevention plan He showed reluctance to be involved in NA (fear of influence) Alice was expected to keep her distance as Rick worked on

clarifying his own issues

Crisis #1

Rick began using cocaine again, taking money from Alice It was time to reassess Once he developed a realistic plan he started to stabilize and

the couple started to talk about getting more involved Looking back, the decision to take the case on family terms

was risky but it appeared that it would be appropriate

Phase 2: Building a stepfamily

The next phase was dominated by the challenges of merging two families

Bill and Teresa

At age 15, Bill was accustomed to receiving all of his mother’s attention

Like many adolescents, he recognized that this intense relationship could not last forever

From Bill’s perspective, Rick was both a threat to his current lifestyle and a solution to a future problem

Living out of state, 16-year-old Teresa had not seen much of her father in recent years

She had been in frequent trouble, and her scheduled summer visit—if it happened—would call for close supervision

Making sense of the clients’ needs II

Recovery issues were not yet stabilized Everyone was somehow at risk, and relationship skills seemed

to offer the greatest likelihood of making a difference Relationship loyalties and power dynamics could be

conceptualized as a web of interlocking triangles Time and other resources would be in short supply, and

competition was likely Trust was limited--all parties had limited basis for assuming that

they would be treated fairly and the others would be reliable Rick was under scrutiny and Bill seemed to be his overseer The couple relationship needed strengthening

Intervention

Couple sessions became the primary focus Recovery issues alternated with IRC issues of influence,

intentionality, and acceptance

Crisis #2

Rick’s seasonal work ended and he attempted to set up an internet business—but he developed an addictive relationship with pornography

Challenged, Rick countered with criticisms of Alice and Bill Control issues—control of self and control of others-were

becoming central in the lives of Rick and Alice, as predicted by Bateson’s (1972) and other authors’ theories of addiction and shame in families

Looking back, emotional conflicts at this stage might have been reduced if emotion had been given a more prominent place in the earlier work

Phase 3: Enlarging the family

With recovery and relationships stabilized, Rick and Alice tried to have a “normal” life

Marriage and economic partnership

Having lived together for some time, Alice and Rick decided that marriage was an important part of having a respectable life

The hastily-planned wedding included Bill and Teresa as well as other relatives

Making sense of the clients’ needs III

Commitment required paying much more attention to identity issues for both Alice and Rick

Intervention

Marriage provided an opportunity to examine the strengths and challenges in Rick and Alice’s relationship

Both partners were involved in examining their differences and their interactional patterns

Crisis #3

With Teresa in crisis at her mother’s home, Alice and Rick offered her a home, and family rules were clear

Rick’s new job, working evenings, placed major parenting demands on Alice

Triangles proliferated:– Teresa created havoc immediately– At home, she tried to get Bill to resist rules– She also began attending Bill’s school and joined a negative peer

group– Within 3 months she had run away with a new friend

Looking back, The intensive relational focus had been timely New skills and understandings helped the new parental team to

work together through this series of challenges

Phase 4: Pulling together

United by the experience with Teresa, the household focused on Bill’s senior year

Making sense of the clients’ needs IV

Bill had less than a year before he intended to leave home and go away to college.

Economic stresses, Bill’s dating relationship, and ambivalence about separation created tensions between Bill and Alice

With Rick trying to become more actively involved in parenting, conflicts were likely to occur

Crisis #4

Rick’s attempts to enforce family rules quickly led to a scene in which Bill hit Rick, Alice called the police, and Bill spent the night in jail

Alice had further demonstrated her commitment to Rick, moving Bill to a weaker position in the major family triangle

Bill was court ordered to get treatment for anger management issues

Intervention

Sessions were set up with with Bill, mixing generic anger management issues (cognitive and behavioral skills) with explorations of his personal struggles

Emotional issues with his mother became clear, going back to their post-divorce years as a single-parent household

Mother-son sessions were set up to address the conflicted relationship

Rebuilding

Relationships improved as Bill became less reactive, Alice focused on being a more active and connected parent, and Rick accepted a less active role in parenting

Rick and Alice began a search for spiritual connections

Looking back

A focus on emotional issues, rather than on power issues, made this period a time of healing and reconnection

Bill faced his own control issues related to his mother—his inability to get the kind of parenting he had wanted

Alice was able to participate in this reconnection process, having worked on her own emotional availability with Rick

Phase 5: Moving on

Bill’s transition to college was intertwined with Alice and Rick’s couple issues

Making sense of the clients’ needs V

Facing life in a household without children, Rick and Alice knew that their relationship would be tested

Intervention

Sessions were varied during this period, with small groups intermixed with individual sessions

IRC issues in all four clusters were addressed as needed Changes were occurring rapidly

Launching

As Bill admitted some of his own fears, his mother was able to provide parental support during his decision-making about colleges

Alice and Bill visited campuses and planned transitions Alice and Rick discussed their future as a “post-parental”

couple Once Bill was away at school (and Teresa came back for a

brief visit), the couple relationship moved into new levels of intimacy

Reviewing the case

This fictionalized case shows many choices being made in work with a single family

Choices, alternatives, and strategies

The most consistent choice demonstrated in this case is that of seeing problems in the context of the family

Sequencing was intentional, but at the same time shifts of priority had to be made when circumstances changed

All 5 of the BONES themes came into play at one time or another (see slides)

The case illustrates an attitude of empowerment, working collaboratively with clients to clarify and support their goals

BONES themes and subthemes (Behavior)

Skills: Skill deficits included self-disclosure, assertiveness, and contingency contracting.

External knowledge: Learning about their parallel needs helped Rick and Alice to bond, even though old patterns continued to present challenges.

Internal knowledge: As Alice and Rick learned to be honest, they became more committed and more able to provide appropriate support.

Cued responses: Rick and Alice learned to avoid conditions that made relapses more likely and they developed alternative responses.

Contingent responding: Family members learned to accept realistic limits on enjoyment and satisfaction.

BONES themes and subthemes (Organization)

Function: As Alice and Rick achieved intimacy, there was less manipulation Conflict: Family members began to handle conflicts in a productive way Development: Developmental needs of adolescents became central Intergenerational: Rick and Alice broke patterns, freeing their children Direct communication: Alice, Rick, and Bill became more direct about their

desires and their discomforts Indirect communication: Family members learned to examine behavior for

its underlying messages, then neutralize them or express them directly Structure: Teresa remained in an ambiguous status, but Bill received

appropriate support for moving into adulthood Systemic patterns: Alice and Rick’s complementarity was reduced Evolution of system: Crises and transformations left the family in a healthier

position

BONES themes and subthemes (Narrative)

Identity: Caught between a familiar story and a new reality, each family member took some risks

Complexity: A complete and healing story of this family integrated the parents’ intimacy problems and their search for approval and security

Dominant discourse: Rick and Alice resisted recovery discourse but found a discourse of small business owners to help organize forward movement

BONES themes and subthemes (Emotion)

Connection: Closeness and distance became less problematic because the potential of rejection was reduced

Internal experiencing: Shame led to frequent misunderstanding. Progress included facing fears instead of hiding from them

Emotional expression: Direct expression of feelings and thoughts allowed the couple and family members to know “where they stood” with each other

Empathy: All members of the family made progress toward understanding each other’s feelings and feeling understood

Emotion management: Rick’s withdrawal into drugs and Alice’s withdrawal into control each became less necessary

BONES themes and subthemes (Spirituality)

Ethnosensitivity: Rick and Alice recalled young adult values and beliefs that had come from religious involvement.

Beliefs and themes: Alice and Rick learned to fit the beliefs of NA, Nar-Anon, and their church into an integrated whole.

Instrumental practices: Returning to regular participation in religious services felt comforting to both Alice and Rick.

Metaphysics: Having tried to control their life together, each eventually found ways to fit into a larger system of meaning and purpose

Personal challenges of family counseling

This case illustrates both intellectual and emotional investment in clients’ lives