COUNSELLING THE FAMILY

1. COUNSELLING THE
FAMILY
RECENT DEVELOPMENT IN
FAMILY COUNSELLING

2. Introduction to Family Counselling.
 A family, by definition, is a group of people affiliated by a specific
relationship. Basically, the family is the most fundamental unit of social
organization that with which we most intimately identify.
 Family counselling, is a branch of psychotherapy that works with families
and couples in intimate relationships to nurture change and development.

3. The different schools of family therapy have in common a belief that,
involving families in solutions often benefits clients.
This involvement of families is commonly accomplished by their
direct participation in the therapy session.
Family counselling thus, is a type of therapy that involves the whole
family.
They work on their relationships with each other, try to improve
communication and get an understanding about what factors in the
family are causing problems for people.

4. RECENT DEVELOPMENTS
The Shape of Family Therapy Today from a radical new experiment in the
1960s, family therapy grew into an established force, complete with its own
literature, organizations, and legions of practitioners.
Family therapy movement has been shaken and transformed by a series of
challenges. Today, all of that has changed. The field is no longer neatly
divided into separate schools, and its practitioners no longer share a
universal adherence to systems theory.
Today, one-size-fits-all therapies are no longer seen as viable. Now
therapists approach families less as experts confident of fixing them than as
partners hoping to shore( to support) up their resources.

5. EROSION OF BOUNDARIES
The boundaries between schools of family therapy gradually blurred in
the 1990’s to the point where fewer and fewer therapists would
characterize themselves as purely Bowenian or Structural.
One reason for decline in sectarianism(excessive attachment) was
that it gained experience, practitioners found no reason not to borrow
from each other’s arsenal of techniques.
Another reason for the erosion of orthodoxy was the growing
recognition of the need for individualized techniques to deal with
specific problems and population

6. This modernist perspective influenced the way family therapy pioneers
approached their clients. The therapist was the expert. Structural and strategic
blueprints were used to search out flaws that needed repair, regardless of
whether families saw things that way themselves.
POSTMODERNISIM
Postmodernism was a reaction to this kind of hubris.(excessive pride)
Most of the conflicts that tore the now-ending modern era were between
different belief systems, each of which professed to have the truth: In family
therapy it was structural truth versus psychodynamics: Bowen versus Satir.

7. The feminist movement challenged assumptions about gender that
had been considered laws of nature. This mounting skepticism
became a major force in the 1980s and shook the pillars of every
human endeavor.
In literature, education, religion, political science, and psychology,
accepted practices were deconstructed-that is, shown to be social
conventions developed by people with their own agendas.
Michel Foucault interpreted the accepted principles in many fields as
stories perpetuated to protect power structures and silence alterative
voices.
The first and perhaps most influential of those voices to be raised in
family therapy was feminist critique.

8. The Feminist Critique
Feminism prompted family therapy's rudest reawakening. Feminist family
therapists not only exposed the gender bias inherent in existing models,
but they also advocated a style of therapy that called to question systems
theory itself.
Family therapists locate family dysfunction entirely within interpersonal
relationships in the family, ignore broader patterns of dysfunction
occurring across families, and fail to notice the relationship between
social context and family dysfunction.
Germane (relevant to) in crimes against women, such as battering, incest,
and rape, for which psychological theories have long, been used to imply
that women provoked their own abuse.

9. The family constellation most commonly cited as contributing to
problems was the peripheral father, over involved mother, and
symptomatic child. For years, psychoanalysts had blamed mothers
for their children's symptoms.
What feminists contended that therapists failed to see was that -
Mothers were overinvolved and insecure not because of some
personal flaw but because they were in emotionally isolated,
economically dependent, over responsible positions in families,
positions that were crazy-making.
Gender-sensitive therapists sought to help families reorganize so that
no one, male or female, remained stuck in such positions.

10. Feminist family therapist might help the family re-examine the roles that
kept mothers down and fathers out.
Fathers might be encouraged to become more involved with parenting- not
because mothers are incompetent but because it’s a father’s
responsibility too.
Only when we become more gender sensitive will we –
• stop blaming mothers and looking to them to do all of the changing
• be able to fully counter the unconscious bias toward seeing women
as ultimately responsible for childrearing and housekeeping.
• as needing to support their husbands' careers by neglecting their
own
• as needing to be married or at least to have a man in their lives

11. Only then can we stop relying on –
• Traditional male traits, such as rationality, independence, and
competitiveness, as the standards of health and
• Stop denigrating or ignoring traits traditionally encouraged in women, like
emotionality, nurturance, and relationship focus.
CONCLUSION
The feminist critic wasn't exactly welcomed by the family therapy establishment.
The early to mid-1980s was a period of polarization, as feminists tried to exceed
the establishment's "threshold of deafness,".
By the 1990s that threshold had been exceeded. Today the major feminist
points are no longer debated, and the field is evolving toward a more
collaborative and socially enlightened form therapy.

12. FEMINIST FAMILY THERAPY
Feminist therapy is designed to help women and men re-examine gender
roles that keep them from realizing their full potentials .Feminists are
concerned not merely with what women and men do but who they are.
Feminist therapists have integrated feminism into their approach to therapy
and into their lives" (Corey, 2005, p. 353).
One may do feminist therapy within a behavioral tradition, or from a
psychoanalytic perspective; what is common to both of these is the
therapist's consideration of how clients' gender beliefs and gender roles
constrain them from solving their problems.

13. Feminism isn't just a matter of noticing gender differences, nor is it a set of
techniques for fixing families. Feminist therapy is more like a worldview, taking
into account the pervasive influence of gender and how it operates on our
lives.
• Feminist therapy should be considered a distinct school.
According to this distinction, many therapists are non-sexist, but only those
who make gender equality the central focus of their practice should be
considered feminist therapists.
• Feminist therapy is deliberately political.
Its aim is to replace patriarchy with a feminist consciousness. Developing a
feminist consciousness involves helping clients realize that how they define
themselves and re- late to others is often distorted by gender-role
expectations.

14. •Feminist therapists help women rethink their relationships with their
bodies.
By examining the effects of social expectations communicated by the media,
women can assign less importance to appearance and focus more on being
themselves than on conforming to a cultural standard.
• Feminists make a point of exploring the income and work potential of
husbands and wives and the implications for the balance of power in
their relationship. They help couples clarify the rules by which roles are
chosen and rewarded in the family.
• Feminist family therapy helps couples examine the consequences for
the relationship of a husband's continuing to place work first and his
wife second.

15. • One of the core elements of feminist therapy is empowerment.
Underlying the specific conflicts between men and women in families is the
cultural programming for men to seek success and the programming for women
to nurture and support them, even at the expense of their own development.
Thus, Feminist therapists aim to redress this imbalance by empowering
women to feel competent.

16. • Feminist Therapists would challenge men to become more involved with
their families
Feminist perspective is about helping men learn to increase their capacity for
intimacy, become more involved in the lives of their children, express their
emotions, balance their achievement and relationship needs, accept their
vulnerabilities, and create collaborative relationships in their work and with
significant others that are not based on a power.

17. Conclusion
• The political agenda in feminist therapy has evolved to include not
only greater equality in the institution of the family but also in the
world outside the home.
• Twenty years ago the gender debate centered on breaking the glass
ceiling that kept women out of top management and professional
jobs, gaining equal access to the workplace, and securing equal pay
for equal work.
• Today concerns often revolve around reshaping the climate of the
work world to keep women involved, including compensating
managers for achieving diversity goals and reaching out to women
employees with families.

18. Businesses and institutions are beginning to realize that women's
needs are often different from those of their male counterparts and
they are making efforts to accommodate the needs of women with
families.
Women are becoming more aggressive about demanding fulfilling
careers and family lives, and many are willing to walk away from
organizations that fail to meet those needs like flexible schedules,
affordable child care, and greater availability of part-time work.

19. FAMILY THERAPY AND FAMILY MEDICINE
Family therapy/counselling is a type of psychological counselling
(psychotherapy) that can help family members improve communication
and resolve conflicts.
Family therapy is usually provided by a psychologist, clinical social
worker or licensed therapist. Family therapy is meant to help initiate
change and nurture development in intimate relationships between
family members and couples.
The goal of the therapy is to help family members identify how
specific behaviors affect others, learn new ways of relating to each
other, resolve conflicts, and open lines of communication between
all family members.

20. Techniques
Family therapy uses a range of counselling and other techniques including:
• Structural therapy - Looks at the Identifies and Re-Orders the
organization of the family system
• Strategic therapy - Looks at patterns of interactions between family
members
• Systemic/Milan therapy - Focuses on belief systems
• Narrative Therapy - Restoring of dominant problem-saturated narrative,
emphasis on context, separation of the problem from the person.
• Trans generational Therapy - Trans generational transmission of unhelpful
patterns of belief and behavior.

21. The average number of family therapy sessions is 5-20 but the number of
sessions truly depends on the situation the family or group is involved with.
Family and couples therapy is considered to be a very effective method of
treatment for several mental health concerns.
Ideas and methods from family therapy have been influential in psychotherapy
generally: a survey of over 2,500 US therapists in 2006 revealed that of the ten
most influential therapists of the previous quarter-century, three were
prominent family therapists, and the marital and family systems model
was the second most utilized model after cognitive behavioural therapy.

22. FAMILY MEDICINE
Historically, the specialty of family medicine grew out of the general
practitioner movement in the late 1960s in response to the growing level of
specialization in medicine that was seen as increasingly threatening to the
primacy of the doctor-patient relationship and continuity of care.
Family medicine is built around a social unit (the family) as opposed to either
a specific patient population (i.e. adults, children, or women), organ system or
nature of an intervention (i.e., surgery).

23. Family physicians are trained with the intent to be able to deal with the
entire spectrum of medical issues that might be encountered by the
members of a family unit.
Family medicine is the medical specialty which provides continuing,
comprehensive health care for the individual and family. It is a specialty in
breadth that integrates the biological, clinical and behavioral sciences.
The scope of family medicine encompasses all ages, all genders, each
organ system and every disease entity.

24. Family medicine training is typically based in dedicated outpatient training
centers in which residents work throughout the course of their training.
Trainees are required to provide acute, chronic, and wellness care for a panel
of continuity patients, with a minimum number of encounters being with
children and older adults.
Additional requirements include 2 months of obstetrics, a minimum number of
new-born encounters, 1 month of gynecology, 1 month of surgery, 1 month of
geriatric care, and 2 months of training in musculoskeletal medicine.

25. Family medicine trainees must also have experiences in behavioral health
issues, and there is a particular emphasis on wellness and disease prevention.
This breadth of education equips family physicians to deal with a wide range of
medical issues, and this broad skill set may be particularly valuable in
communities or geographical areas where certain specialists and subspecialists
may not be available.
Because of their broad skill set, family physicians typically adapt the nature of
their practices to meet the specific medical needs of their community.

26. Family physicians are trained to coordinate care among different specialists
and subspecialists when these services are needed by their patients.
Thus, Quality healthcare in family medicine is the achievement of optimal
physical and mental health through accessible, safe, cost-effective care that is
based on best evidence, responsive to the needs and preferences of
patients and populations, and respectful of patients’ families, personal
values, and beliefs.

27. Psycho-education
The Psycho Educational model is a humanistic approach to changing the
behavior patterns, values, interpretation of events, and life outlook of individuals
who are not adjusting well to their environment(s) (e.g. home, school, work
place).
The practice of educating those with mental health conditions and their families
to help empower and support them with their condition is referred to psycho-
education.
Psycho-education is a strong tool against the stigmatization of mental health
conditions and those who face those challenges on a day-to-day basis.

28. Psycho-education is defined with four broad goals in mind:
-transfer of information
-medication and treatment support
-training and support in self-help
-an available a safe place to vent.
Dr. Carol Anderson, the “mother” of psycho-education, and her
colleagues at the University of Pittsburgh developed an innovative
psycho-educational model in the late 1970s.
Their goal was to prevent or delay relapse and re-hospitalization by
teaching parents about the illness, about dealing with symptoms, and
about creating a healing environment.

29. Merely informing the patient and his/her family about the disorder and some
general information about treatment / prevention/ crisis management is not
psycho-education.
• It is education and training about a condition that causes stress to the
person.
• Better understanding of condition leads to a feeling of control and results
in reduced stress associated with the condition.
• A person will feel more relaxed and in control of their condition if they
have a greater level of understanding

30. The psycho-educational model can be divided in many ways.
1. According to the target population for psycho-education.
a. Individual b. Family c. Group d. Community
2. According to the focus of psycho-education.
a. Compliance / Adherence focused b. Illness focused
c. Treatment focused d. Rehabilitation focused etc
Individual Psycho-education
Individual psycho-education can be more specific and focused and can
cover information and content that is more relevant for an individual
situation.

31. Group psychotherapy
Group psychotherapy is a form of therapy in which people share
therapeutic experiences under the guidance of a therapist. Group
therapy helps people learn to improve their inter-personal
relationships .The group therapy session is a collaborative effort.
Family psycho-education
It is a therapeutic method of training families to take part
collaboratively with the mental health professionals in the
management plan of their family member with psychiatric disorder .

32. Different models within family psycho-education are:-
(a) Single family psycho-education group,
(b) Multiple family psycho-education group,
(c) Mixed family psycho-education group (includes family
members as well as the patient).
In studies, it was found that at least 10 family psycho-education sessions
are required to be effective in reducing the family burden .
Mixed group family psycho-education is more effective than single
family psycho-education group.

33. Community psycho-education
In community psycho-education, the information is imparted to a larger mass
of population which may be non-homogeneous, irrespective of illness or
illness related risk status.
Media have a greater role in facilitating the psycho-education process. Video
conferencing, debate, teleshows may help in this process.

34. PSYCHO-EDUCATIONAL MODELS
The various psycho-educational models can be categorized into
four approaches:-
• Information model: The emphasis of this model is to provide families
the knowledge about psychiatric illness and its management. The aim of
this approach is to improve the families’ awareness about the illness and
contribution to the management of the patient.
• The skill training model: This model is directed at systematically
developing specific behaviors so that family members can enhance their
capability to assist the ill relatives and manage the illness more
effectively.

35. • The supportive model: It is an approach which generally utilizes
support groups designed to engage the families of patient in sharing
their feelings and experiences .Here the main goal is to enhance and
improve the emotional capacities of the families to cope with the
burden of caring for their ill relatives.
• Comprehensive model: It is also called combination approach
because it consists of information, skill training and supportive model.
In the initial phase of this approach members are given lectures about
the illness. They are to take part in multi-family support group. In the
final phase they have to participate particularly as a member of
individual sessions with a mental health professional.

36. The Multiple Family Group Therapy Model (The MGFT Model):
This model of psycho-education was developed by William McFarlane with
the aims of engaging families in the rehabilitation and after care programmes
of severe psychiatric illness like schizophrenia.
This model acknowledges the essentially chronic nature of this disease and
seeks to engage families in the rehabilitation process by creating a long-term
working partnership with them and providing them with the information
needed to understand schizophrenia.
This model seeks to assist the patient and family in accommodating the
disease while developing social support systems for the reduction of
confusing, anxiety, and exhaustion in the patient’s family, while they learn
adaptive strategies.

37. The Behavioral Family Management Model:
This model of family intervention gives maximum importance to family and
views family as the most effective and efficient resource for community
rehabilitation of severely ill mental patients.
As per this model healthy functioning of the mentally ill individual can be
achieved through instilling positive coping mechanisms that may buffer
the vulnerable family member from the negative effects of environmental
stresses.
Family members can be provided knowledge about how to plan and
implement of various tasks essential for rehabilitation and aftercare of patient
and attempts to enhance coping skills of family members through
increasing the efficiency of family problem solving .

38. • Family Focused Treatment (FFT):
This approach of family based psycho-education developed by David J.
Miklowitz and MJ Goldstein. This approach of psycho-education is primarily
developed for the treatment of bipolar patients.
This model has three modules; in first FFT module, psycho-education is
included and it is generally given in seven or more sessions. During these
sessions patients and relatives are to be told about the symptoms, nature,
causes, and treatment of bipolar disorder. Participants are to be educated to
know the prodromal (early signs) signs of illness and relapsing episodes.

39. The second module (seven to 10 sessions), aims to help patients and
caregivers to learn communication skills for dealing with intra familial
stress (active listening, requesting changes in each other’s’ behaviour,
giving positive and negative feedback).
Techniques like role-playing/behaviour-rehearsal format are generally
used to teach these people about communication related skills.
Finally, in the third module (four to five sessions), participants are given a
framework for defining problems and how to develop as well as
implement effective solutions to those problems. This approach also
aims to instil problem-solving and coping skills of the caregivers of
these patients.

40. Peer-to-Peer Psycho-education Approach:
This approach was successfully applied in clinical setting by Rummel et al.
The rationale of this approach is persons who underwent same kind of
experience earlier can understand the problem of the people who have that
problem now.
In peer-to-peer psycho-education programme mentally ill persons are given
the access to mix with the people who had the same problem earlier but they
recuperated from that problem. These people can motivate the patients up to
considerable extent and provide them a new ray of hope.

41. The elements critical for effective family psycho-education consist of the
following:
• Mental illness education—this consists of providing the family with
information about the probable etiology, course, and treatment of the
mental illness in question. Additional information about medications,
medication side effects, treatment options, and psychiatric rehabilitation
services is also provided.
• Problem solving—families are taught problem-solving strategies that
they role-play and practice on a regular basis.
• Stress reduction—family members and the consumer are taught stress
reduction techniques. In combination with problem solving, this helps to
improve morale, reinforce caregiving, and sometimes forestall crisis.

42. Long-term duration—supports are provided as long as they are
needed. The family psycho-education services are tailored to the
needs of the individual family.
Family and consumer involvement—family psycho-education
training is conducted with the consumer present as an integrated
member of the family.

43. Outcomes of Family Psycho-education
High-fidelity FPE produces the following results:
1. Reduced relapse rates
2. Reduced hospitalizations and hospital utilization (i.e., length of
stay)
3. Improved family knowledge of mental illness, symptoms,
medications, therapeutic effects, and side effects
4. May improve family problem solving
5. May reduce family stress
6. May assist family recovery

44. Working with families with mental illness and disability
The main goals in working with the family of a person who has a mental illness
or disability are
• to achieve the best possible outcome for the patient through collaborative
treatment and management .
• to alleviate the suffering of the family members by supporting them in their
efforts to aid the recovery of their loved one.
Treatment models that have been supported by evidence of effectiveness
have required clinicians to adhere to 15 principles in working with families of
persons who have mental illness:

45. ♦ Coordinate all elements of treatment and rehabilitation to ensure that
everyone is working toward the same goals in a collaborative, supportive
relationship.
♦ Pay attention to both the social and the clinical needs of the consumer.
♦ Provide optimum medication management.
♦ Listen to families’ concerns and involve them as equal partners in the
planning and delivery of treatment.
♦ Explore family members’ expectations of the treatment program and
expectations for the consumer.

46. ♦ Assess the strengths and limitations of the family’s ability to support the
consumer.
♦ Help resolve family conflict by responding sensitively to emotional distress.
♦ Address feelings of loss.
♦ Provide relevant information for the consumer and his or her family appropriate
times.
♦ Provide an explicit crisis plan and professional response.
♦ Help improve communication among family members.

47. ♦ Provide training for the family in structured problem-solving techniques.
♦ Encourage family members to expand their social support networks—for
example, to participate in family support organizations such as NAMI.
♦ Be flexible in meeting the needs of the family.
♦ Provide the family with easy access to another professional in the event if the
current one working with the family ceases.

48. SYMPTOM FOCUSED DYNAMIC PSYCHO-THERAPY
Symptom targeted intervention/Therapy (STI) is a clinical program being used
in medical settings to help patients who struggle with symptoms of depression
or anxiety or adherence to treatment plans but who are not interested in
receiving outpatient mental health treatment.
STI is an individualized therapeutic model and clinical program that teaches
patients brief, effective ways to cope with difficult thoughts, feelings, and
behaviors using evidence-based interventions.
Its individualized engagement process employs techniques from solution-
focused therapy, using a Rogerian patient-centred philosophy.

49. Social workers and other mental health practitioners and medical
professionals use STI to assist patients with a number of specific concerns,
from sleep and stress to pain management, relationships and mood
management.
STI's coping tools are cognitive behavioral therapy and mindfulness
interventions that have been condensed and modified to make them user
friendly and effective in brief sessions.
After meeting with the clinician, the patient takes charge, performing
interventions at home through assignments that extend and reinforce
learning.

50. Using STI, the clinician helps the patient identify the most problematic symptom
of the depression (such as depressed mood, insomnia, anxiety, rumination,
irritability, negative thinking, social isolation).
Then together the clinician and patient address that symptom using STI's
evidence-based selection of brief cognitive, behavioral, and mindfulness
techniques.
The emphasis is on keeping interactions brief as it is time limited.
With STI training, clinicians learn a nuanced approach to all patients, even those
who resist help, since often those are the individuals who need help most.

51. CONCLUSION
Thus, the different schools of family therapy have in common a belief that,
regardless of the origin of the problem, and regardless of whether the
clients consider it an individual or family issue, involving families in
solutions often benefits clients.