Approaches to Family Counseling

Counseling

Psychoanalytic Family Counseling

Psychoanalytic theory was the dominant psychological paradigm that influenced counseling and psychotherapy in the first part of the twentieth century (Hall, Lindzey, & Campbell, 1998); however, it was replaced first by behaviorism and later by cognitively-oriented paradigms. Nonetheless, psychoanalytic thought has persisted into the twenty-first century and is enjoying a bit of a comeback beginning in the last part of the 1990's (Hall et al., 1998).

Of course Sigmund Freud originated the psychodynamic approach, but his work centered mostly on the individual (Hall et al., 1998). An early basis for the psychoanalytic family approach was the Psycho-Analytic Study of the Family by Flugel (1921). These early propositions by Flugel adhered closely to classical psychoanalytic theory, but attempted to understand family influences on desires of the child. Later Henry Dicks published results of his work with married couples in the 1940s examining the parallel representation of internal and external objects and their influence on the functioning of the personality as proposed by object relations therapists (Dicks 1967). The Freudian notions of drive and conflict became replaced by object relations and maturation, but the notion of early influences leading to adult problems was retained. Ackerman (1958) noted that the concentration on the maladaptive behavior of a child or the parent (usually the mother) in family therapy was a mistake and influenced by the work of Bowlby broadened the practice by looking at the family as the unit of diagnosis and treatment. Bowen (1966) contributed to the psychodynamic school of family therapy by forming detailed examinations of the family interactions and formulating the notion of family projection process, where parents and children played active parts in the transmission of the parental problems to the child. Major approaches to psychodynamic family therapy include the work of the object relations school of psychoanalysis and ego psychology-oriented approaches. The self-psychology of Kohut has also been quite influential in family treatment. Other major contributors to psychodynamic family counseling include Mahler, Wynne, Winnicott, Nagy, Stierlin, Sager, Framo, and Shapiro (Hall et al., 1998).

Psychoanalytic theory attempts to explain both pathological and nonpathological behavior on the basis of human motivation and nearly all of the major early pioneers in family therapy were psychoanalysts. Psychodynamic theory viewed mental activity as the end product of a person's early interpersonal relationships, thus making it particularly attractive for family counseling. This system of counseling/therapy was based on understanding the transference as the externalization of internal elements operating in the interpersonal domain, but has evolved with the times. Contemporary psychodynamic family counseling holds the viewpoint that the family is a social unit with interpersonal rules. Family members are best evaluated when the family is observed as a unit (Scharff, 1995). A functional family will have achieved a high degree of freedom from restrictions inflicted by developmental failures from earlier phases of the members' and family development, whereas a dysfunctional family will be burdened to some extent by its developmental failures. Psychodynamically oriented counselors often operate on the assumption that partners in a marriage are chosen based on either similar or complementary developmental experiences or failures, especially earlier patterns of mother-child and father-child relationships as they associate to preoedipal and oedipal patterns (Scharff, 1995). These patterns of partner choice regulate early experiences of the couple. The developmental failures of the family life can come from many different phases that include: traumatic events in the intergenerational sphere, traumatic events occurring in the childhood of the partners, or traumatic events occurring in the early stages of the family life of the couple (Scharff, 1995).

Psychodynamic family counselors hold to the notion of a family as a "system" in a similar manner to other family counseling orientations. The approach is to uncover repetitive interactional patterns, the rules directing these interactions, members' roles, the hierarchy of power, and family affect. The outward interactional organization of the family system is considered the exterior of the family unit, whereas the focus is exploring the more subtle character of family members and their interactions or the interior mental workings of the system and its members. These unconscious factors of the system are made up of two subtypes: motivational forces that represent wishes and desires, and defensive influences that try to control how these motivational forces are expressed (Scharff, 1995).

Motivational forces in the different members of the family come together and form shared family fantasies based on shared family conflicts. The shared family conflicts are kept in check by shared family defenses. The defenses consist of the collective defenses of the members of the family. Shared family conflicts are organized in a hierarchy of fantasies moving from the conscious to deep unconscious levels. Conscious fantasies are closer to external reality, whereas unconscious fantasies are associated with traumatic experiences from early family life. The shared family defenses are responsible for the repetitive interactional patterns observed in the family and these defenses act to try and contain family conflicts and prevent traumatic or dangerous situations occurring (Ackerman, 1958).

Psychodynamic family counselors believe that these unconscious dynamics are best understood in the context of the conscious organization of experience, the patterns of personality integration, and most importantly within the context of the existing interpersonal reality (Ackerman, 1962). Counselors need to be attentive to the level of need satisfaction in the family as well as the functioning of the family members. The needs of the family members include such things as the need for relationships, dependency needs, identity needs, sexual gratification, and aggression release or discharge. The theoretical concepts of psychodynamic counseling include:

1. Transference. This concept as defined by Freud (1958) has been applied to family counseling regarding the transference reactions among family members and between the family members and towards the counselor. Transference is a regressive process where unconscious conflicts (mostly occurring early in life) are gradually re-experienced in all kinds of situations and is potentially formed with everyone. But its greatest intensity is achieved between family members and in counseling sessions where attitudes are re-experienced in current relationships. Transference provides important information on needs, perceptions, feelings, etc. Of the family members.

2. Countertransference refers to the process of unconscious feelings that the counselor develops in response to the clients' behavior in sessions. Countertransference can become an impediment to progress or can be used to understand the nature of the client's transference and projections onto the counselor (Scharff, 1995). Counselors need to understand their own issues in order to make a tool of countertransference in counseling. It is important not to take sides, distance oneself, and try to remain outside the transference in the sessions (Scharff, 1995).

3. Resistance describes processes that occur in sessions that threaten to hinder progress (Scharff, 1995). Counselors can often view resistance as a sign that some emotionally charged issue is being touched upon. In family counseling resistance surfaces by the collusive behavior of the family such as avoiding certain topics, scapegoating, becoming depressed to avoid expression of anger, refusing to consider one's own role in dysfunctional interactions, seeking individual sessions, keeping secrets, threatening to leave or change counselors, etc. Such tactics allow clients to avoid pain or anxiety about remembering painful experiences. Resistance is overcome by using reflection, questioning, helping clients gain insight, and empathy with clients (Scharff, 1995).

4. Socially shared psychopathology is the result of a several interpersonal psychological processes like delineation and projective identification. It is through such processes that an individual will impart their own psychopathological tendencies to a member of their family and that person claims ownership of this projected tendency (Scharff, 1995).

5. Projective identification is a defense mechanism shared by two or more people where the parts of the self and internal objects (values, images, etc.) are split off and projected onto an external object (another person). The object is then identified with part that was the split-off and is and controlled by it (Scharff, 1995). So in family counseling the counselor can be pulled toward one person's side and acts out against the other person which can disrupt the treatment. This also occurs extensively and frequently between spouses and between parents and children such as telling a child something like "You are just like your father" or the child views one parent's perceptions as being more in line with reality than the other (Scharff, 1995).

6. The concepts of true self and false self Winnicott (1975) are rooted in early development. The "true self" comes from a child's experience of nurturing by a mother or caregiver. The false self may signal the absence of this experience so the infant had a caretaker who was unable to meet their instinctual needs and deprived the infant through their own self-involvement. This led to the child withdrawing from spontaneity and authenticity. Intellectualization is a defense mechanism associated with the false self which decreases the couple's ability to satisfy one another in their relationship.

7. The separation-individuation theory proposes that the infant enters into a symbiotic relationship with their caregiver after being preoccupied with maintaining internal homeostasis. For the first three the child experiences a succession of phases by which they attempt differentiate themselves from the mother (object). At age three the child should be at a minimum level of individuation and separation from the caregiver (Mahler, 1975). This is the state of object constancy: the formation of an internalized relatively stable sense of self and object, so that the child can bear the anxiety of separation. A decisive period here is the rapprochement phase where the infant is pulled between the need to stay close to the caretaker while being pushed to function autonomously. The failure to deal with the crises able can lead to an inability to establish a satisfactory distance in relationships.

The primary goal of psychodynamic family counseling is to move towards a more functional family unit relatively free from conflicts and inhibitions. The use of the therapeutic alliance, transference issues, empathy, reflection, and interpretation are all important in psychoanalytic counseling. Psychoanalytic family counselors are committed to the resolution of presenting issues, enhancing the self-esteem of the members, tolerance for differences in family members, helping to establish flexibility and adaptability of roles, and a balanced sharing of power with clear boundaries with an accent on individuation and maturity in the family members. The last aspect decreases the chance of projection on other members or responding to projections of others in a shared pathological manner (Scharff, 1995).

The goals of psychodynamic family counseling are very similar to those of Bowen family systems therapy (Bowen, 1966):

1. Members develop a differentiated and internally integrated sense of self (Meissner 1978).

2. Members resolve conflicts by positive means (Ackerman 1958).

3. Transference projections among family members are resolved.

For this writer the main surprise was the conclusion that different counseling paradigms psychotherapies are more similar than one believes. Waldron et al. (2004) developed an interesting instrument for measuring psychodynamic features applied in all psychotherapies, the Analytic Process Scales (APS), which has been used to measure the similarities between different schools of psychotherapy. There are five indentified therapist variables that are shared by psychotherapies that we can relate to three major paradigms of client centered therapy (CCT), cognitive behavioral therapy (CBT), and psychodynamic therapy (PDT):

1) Clarification is the extent to which attention is directed by the therapist to insufficiently noted surface features of client behavior and how these are psychologically linked within the individual. CCT, PDT, and CBT share this core feature; however, their theoretical differences place a different emphasis on how these are interpreted (cognition, conditions of worth, or conflict).

2) Interpretation refers to how the therapeutic intervention aims at transforming meaning by bringing events that are outside of one's awareness into full awareness. All of these techniques utilize this principle; however, the approach to change differs depending on the paradigm.

3) Addressing defenses refers to the defenses that are active during the session and the degree to which the client attempts to avoid objectionable impulses, emotions, or thoughts. Again, these schools will address defenses as they arise but in a different manner.

4) Addressing transference refers to the therapist's pointing out the client's reaction to the therapist in the therapeutic setting. All schools do this, but in a manner consistent with their paradigm.

5) Addressing inner conflicts refers to the degree to which the therapist focuses on the patient's conflicts in the session and in life. Again, all techniques do this, but the manner of approach to conflict is different depending on the paradigm.

Thus, different paradigms are alike in their general approach, but different in the specific technique/focus.

Integrating Faith and Counseling

As a Christian studying psychological principles I was confronted by scientific claims that conflicted with many of the Christian doctrines I had been taught. In the face of this confrontation I had several options: I could simply abandon my faith and accept premises of secular science and psychology, I could just ignore the contradictions, or I could have rejected psychology. However, none of these are very satisfying for a Christian wishing to be a counselor. The other option was that of integrating aspects of psychology that are harmonious with biblical truths and reject those which are not. Integration is not an unusual process for psychologists practicing therapy, in fact there is a whole literature on integrated psychotherapy that combines tenets of different psychological paradigms into a cohesive theory-driven approach (Arkowitz, 1992). This process is not an eclectic process where techniques are haphazardly combined from different paradigms, but where the psychologist uses theory to guide the integration.