Family Counseling Approach, Research Paper Example

Abstract

This paper examines the cognitive behavioural therapy approach to family counselling within the context of psychology.  The paper provides a brief introduction to family counselling methods and approaches and particular focus on cognitive behavioural therapy. The paper is structured into two main parts: Part 1 deals with the method, technique and application of cognitive behavioural therapy whereas Part 2 deals with the more holistic approach of integrating this with personal belief and Christian values.  The conclusion provides a summary of the key points.

Introduction

There are varied approaches to Family Counselling and these include such items as structural, psychoanalytic, Bowenian, experiential etc.  This paper focuses upon the aspect of cognitive behavioural family therapy.  Early in the family therapy movement, this approach was treated with a degree of scepticism by the more traditionalist family counsellors.  They saw the technique as having insufficient depth to deal with the complexities and dynamics of family dysfunction.  In the early days, this approach was only considered useful in the counselling of children with family disorders but it has since evolved into much wider applications. It is only in the last 10 years that Cognitive Behavioural therapy as emerged in its own right as a major approach to family counselling. (Leahy, R. 2004).

The different approaches to family counselling are extensively discussed in the work of Goldenberg.  (Goldenberg, H, 2008).  Cognitive behavioural approaches have been particularly successful in treating adolscents and youths with behavioural problems. The theoretical approach has the capability of adapting to different behavioural circumstances and environments. It deals with both emotioal and social domains and as such ius extremely persuasive in its applied application. The theory deals directly with those cognitive forces that stimulate emotional reactions and behavioural responses. As such it provides a problem solving orientation in order to determine the best or most suitable forms of psychological treatment.  In order to deal successfully with cognitive problems it is important to gain a precise understanding of the emotions being displayed and understand the causation factorsa behind these.  Mental health professionals have outlined the importance of family and social relationships as an important contributory part of the therrapeutic process in treating problems. As such favourable outcomes in treatment is highly influenced by a positive approach and supportive stance being adopted from the parents. (Kendall, P.C.2006)

Part 1 | cognitive behavioural family therapy

In the early days, the behavioural therapist saw only those individuals who were involved in problematic marriages. The others are children within problem families. The concept of strategic behavioural therapy developed the need to build on individual cognitive frameworks. Two of the major contributors were Aaron Beck and Albert Ellis. Both of these were influenced by Freud (instinct), Jung (mysticism) and Adler (common sense). Hence, from the perspective of the behavioural counsellor – thoughts resulted in feelings and these in turn led to behavioural responses.  (Friedberg, R.D. 2010)

The problem areas that most readily identified with cognitive behavioural approach were that ofposttraumatic stress disorder (PTSD), substance abuse, Obsessive-compulsivedisorder (OCD), Anxiety, mood disorder, marriage and family therapy and eating disorders. The goal of CBT is consideredthreefold:  (i) To enable the patient to become more aware that help is available and remedial action can be applied (ii) To assist the client in greater awareness of the problem and thereby invoke both confidence and belief (iii) to inspire the counsellor towards a more positive therapeutic approach. It is important that the counsellor develops a rapport with the patient and helps in the development of new cognition.

The important aspect of CBT is that it is a relative short form of treatment and only requires about 4-7 months of therapy in order to treat most form of problems. It is essentially a combination of psychotherapy and behavioural therapy and combines a joint approach between patient and counsellor in order to determine a set of principles that can be applied to their daily lives. CBT uses the assumption that it is not the events that disturb us but the interpretation and meaning we give them. Hence if we provide too much of a negative emphasis we are blocked from doing action that we do not believe in. In this concept we only hang on to old thoughts and are prevented from learning new things. (Martin, B, 2007)

Dialectical Behaviour Therapy (DBT) may be described a treatment modality that combines a number of techniques i.e. relaxation and soothing skills, cognitive behavioural techniques and improvement of self-awareness skills. In this context, modality may be defined as an application approach using a therapeutic agent.  The approach to treatment is by that of problem solving, cognitive modification, exposure skills and contingency management. Patients with borderline personality disorders or those showing suicidal tendencies are difficult to treat. DBT is an innovative therapeutic approach aimed at addressing these needs. (Swales, B.K. 2011).

The main aspect of DBT is that of accepting the condition of the patient whilst trying to teach them to change. This is achieved by building and maintaining a positive relationship with the client. The therapy looks towards getting the client to understand the reasons for the suicidal or dysfunctional behaviour. There are essentially four modes of treatment: (i) Individual Therapy – the main body of work (ii) Group Skills – teaching a number of techniques that include emotion moderation skills, inter-personal effectiveness, distress, tolerance etc. (iii) Telephone contact – provision of help line sessions by telephone, outside of the main therapy sessions (iv) Therapist consultation – group sessions in the DBT mode; the therapists work collectively to remain dialectical in the interaction with one another.

There is a large literature base covering this area “Dialectical behaviour therapy is the brainchild of Marsha Linehan, a clinical psychologist from Seattle with an impressive academic track record. She is the author of a book describing the treatment and of an accompanying skills training manual” (Palmer, 2002). The concept of dialectical thinking has been defined as “The ‘dialectical’ in DBT refers to the way in which it uses a broad way of thinking that emphasises the limitations of linear ideas about causation. It substitutes ‘both/and’ for ‘either/or’ and sees truth as an evolving product of the opposition of different views” (Palmer, R.L. 2002).

Counselling and Marriage Problems

Modern society poses numerous challenges upon a successful marriage.  One of the most demanding is that of financial hardship.  That might be brought on by a job loss or physical illness, leaving one’s spouse to cope with the problem.  This is often the situation where marital communications breakdown, when in fact it is the most important time for working as a team and communicating with one another.  Another important issue is the loss of self-image, where either weight gain or loss occurs.  [The concept of obesity or anorexic] this can lead to bouts of depression and subsequent illness.  Another factor is dealing with family relationships, and this is particularly trying in new marriages.  The concept of dealing with intervention and demands by in-laws, and having to deal with expectations that posed a strain on the marriage.  The concept of long-term illness, disability or major illness can impose a tremendous strain on the spouse who is working and equally having to look after their partner. (Long, H. 2007)

Examples of cognitive therapy include the following:

Arbitrary inference – This relates to where you leap to a conclusion without having any evidence to support it.  For example, where a businesswoman and (wife) arrives home late from work and the assumption is that she is having an affair with someone else.

Selective Abstraction – This is where one piece of information is taken out of context with another important piece of information.  A husband failing to say goodbye to his wife before departing for the office is interpreted as he is ignoring me and no longer cares for me.

Overgeneralization – The drawing together of a conclusion based upon non-related facts or circumstances. For example:  The feeling of rejection, when a woman does not want a date with a man he suddenly feels that all women are the same and will reject him.

Personalization – Where an individual relates external events as applying to himself even when there is no logical basis for that conclusion. For example, a husband moves a wife’s dress to another closet and the assumption is he hates the way I dress.

Dichotomous thought – The placing of experiences in different or opposite categories. i.e. loved, unloved, good and evil.  Example: A husband asks a wife’s opinion and she provides an unfavourable response, the conclusion being I cannot do anything right. (Dattilio, F.M. 2011)

In the last 20 years we have seen a dramatic rise in divorce rates, particularly in the US and Western Europe.  Studies have indicated that this decline in marriage is largely due to the general breakdown and weakening of the traditional family structure.  It is the maintenance of the family structure that really necessitates the importance of marriage.  The children produced from the marriage are the future in terms of perpetuating human society.  Strong family values teach the children the ethics and the social responsibilities of adulthood.  The love of the parents to the children translates to the personality of the adult.  The displacement of this leads to a more random outcome and potentially more uncaring society. Research carried out in the UK indicated that a large majority of those surveyed feel marriage is no longer necessary today.  (Papadopoulos, L. 2009)

Counselling & cognition in mental illness

During the 19th Century, it was considered that there was a strong link between serious mental disorder and violent behaviour. The violence is considered to be in the minority grouping of those patients with mental disorders and there has been strong links associated with behavioural dysfunctions through substance abuse or noncompliance with medical applications. Research conducted by Dr.E.F. Torrey in the United States looked at a cross-section of mental illness patients with violent or aggressive tendencies. In 1990, the National Association for the Mentally Ill in the USA studied some 1400 Families with Mental illness and violence. From this research, they discovered a link that the majority of cases resulted from three distinct types of psychological conditioning i.e. Schizophrenia, Bipolar Disorder and Acute Depression. (Torrey E. 1997).

Neuroscience and Schizophrenia.  Neuropsychology can provide important information about the behavioural conditions and symptoms of brain-damaged patients. It is often possible to detect conditions of brain abnormalities that provide clues to certain behavioural conditions. Schizophrenia is a relatively common ailment and statistics indicate the potential for 1:100 people to be impacted in their lifetime. It can appear at any time and take on a number of different forms.  Many of those afflicted hallucinate and hear voices talking to them.  They feel as if their actions are being controlled by an external force. (Frith 1992)

Bipolar Disorder  Medication is now available as a maintenance treatment for those with bipolar disorder. Research has shown that a high proportion of patients do not comply with the treatment. Clinicians believe that there is a need for ‘psychoeducation’ in order to explain the importance of maintaining medication. Many patients find it difficult to accept that they have a mental or psychological illness. This causes them to rebel against the treatment program. (Fang-Yen, C. 2005).

Impulse controls have been accepted as a psychiatric disorder that results from illnesses like bipolar disorder. This often leads to acts of violent behaviour.  This is a psychiatric condition that results in a disorder from criminal behaviour  (HuckerS.J.2005) .

Part 2 | personal integration

Family counselling can be provided from a Christian perspective and there are many voluntary services that offer this service. I believe that you don’t necessarily have to be a Christian in order to help others in distress or need but the overarching philosophy of Christianity supports this.  The objective of the Christian approach is to bring the sincerity of love and care into the power of healing and a theoretical orientation into listening, understanding and relating to people’s problems. As such faith based counselling is not applied based on winning converts to Christianity but is part of an overall philosophy of the religion that is devoted to the care, well-being and help of mankind. There are for example biblical teachings that help in provision of guidance for dealing with people that have mental issues and family troubles.  This is not achieved by the imposition of views on others but understanding client needs and providing a service of focused intervention in order to help them navigate towards a successful outcome.

One of the fundamental approaches to that of Christian counselling is the provision of holistic strategies that equip the families with a basis to understand their relationships, the ability to re-connect and rediscover the love for one another and getting to grips with the root cause analysis of problems in order that they are better equipped to deal with them. Using the strengths-based approach it is helped that such counselling services helps to make a difference and by a joint participatory approach it is possible to heal people from past hurts and retributions in order to expose the family to a renewed and better relationship through the preservation of family relationships.

A break down in family communications are often attributed to many of the marital problems that require intervention and counselling. There are numerous challenges in the integration of Christian principles into family therapy and counselling services. It was Berger and Luckman (1967) that managed to distinguish between two core competencies in family counselling i.e. primary socialisation where the process involves the identification as a member of a social group i.e. where a child still has abstract views of the social world and that of secondary socialisation where a child has already internalized a specific view of the world.  In a marital break-down, the children are often the most vulnerable in terms of conceptualising what is taking place in terms of a communications breakdown. The loving and caring background often turns to anger, rage, open hostility and deception. (Frederick, T. 2011).

In becoming a Christian Marriage and Family therapy counsellor, it is important that a number of core competencies and skills be obtained. These are defined by the American Associate for Marriage and Family (AAMFT).  They combine the core cognitive and social skills required with the more holistic Christian world-views. As such, it is important to develop Christian morals and incorporate these doctrines into the family therapy process.  Social work also embraces aspects of sociology and psychology and these should be encapsulated into both undergraduate and postgraduate training.  Another important aspect considers the inclusion of Doherty’s soul searching, this within the context of MFT theories, considers the moral and ethical responsibilities of the role. In particular, to assist the parents in making relationship enhancing decisions and incorporates the important characteristics of caring, courage and prudence. (Frederick, T. 2011)

Conflicting purposes can arise between Social Workers, Nurses and Doctors. This is often caused through lack of communication, service integration and not working with a common set of patient records. Social Workers who are professionally trained do not need supervision apart from in special cases i.e. dealing with mental illness, terminal cases or other special illness where medical and psychiatric supervision might prove appropriate. (Esther Coren, W.I. 2010).   Because of the complex nature of this work, it has linkages to other professions that include the medical profession (specifically nursing), psychology, local government administration (social services).  Social Workers have been described as occupying the role of safety net for society. Social workers often act as barometers to society and the determination of people’s relationships with one another. In Britain the Association of Social workers has campaigned against such items as the demonization of the younger generation, the image that society is portraying of people with mental illness and how asylum seekers are being portrayed as people who are devious and socially undesirable. Finally, how the elderly people have been branded as undesirable and a cost burden to society.  Stereotyping is a dangerous consequence in society and history has taught us lessons about the ramifications of this if it goes unchecked.

Social work is best defined as being an activity performed by dedicated individuals, groups or communities to assist those people in society who are vulnerable or in need of assistance. The work comprises professional people who are skilled and trained in the application of counselling, social psychology and basic nursing skills.  The work may be carried out with individuals, groups or communities of people. The work is involved with dealing with the interactions of people and those institutions of society that have a direct relationship with how people conduct their lives. Social work may therefore be said to contain three specific purposes:

• to enhance the problem-solving, coping and developmental capacities of people;
• to promote the effective and humane operation of the systems that provide people
• with resources and services;
• to link people with systems that provide them with resources, services, and opportunities. (Wright State University, 2010).

In the last 20 years we have seen a dramatic rise in divorce rates, particularly in the US and Western Europe.  Studies have indicated that this decline in marriage is largely due to the general breakdown and weakening of the traditional family structure.  It is the maintenance of the family structure that really necessitates the importance of marriage.  The children produced from the marriage are the future in terms of perpetuating human society.  Strong family values teach the children the ethics and the social responsibilities of adulthood.  The love of the parents to the children translates to the personality of the adult.  The displacement of this leads to a more random outcome and potentially more uncaring society. Parenting styles as such become of paramount importance in the outcome of the child’s upbringing.

It is important to understand the two main parenting styles and how this can influence advice to the parents. For example in an Authoritarian style, this is most associated with the Victorian Era in England.  The Children were ‘to be seen but not heard’. It focused on a discipline background with specific rules and regulations. To breach them was to risk being scolded or punished. The style was most associated with Baumrind and was seen to show competence in children and emphasised child development is aspects of autonomy, discipline and respect.  (Cooke, B. 1991).  Thinking and Knowledge are what really defines those parents that have the best parenting styles.  This style also created detachment from the children and often involved a more hands-off approach by the parents relying on the use of Nannies and support people to assist in the raising of the children whilst the parents pursued careers. The children were often despatched to strict boarding schools, which further the disciplinary, and punishment aspect of their upbringing. Unruly children were fashioned into a respectable model of behaviour. (Hammer, T. 2001).

The more modern approach is that of permissive parenting.  These types of parents often adopt an indulgent style as such they have very few demands to make of their children because they have low expectations from them in terms of discipline and maturity. The parents become more responsive than demanding. Such approaches are very lenient, flexible and do not require mature behaviour. The style is very much geared towards nurturing the children and becoming more of a trusted friend than that of a parent. In the US this has been termed the ‘buddy approach’.  It is seen as being far more effective from a communications viewpoint as the child is more likely to confide in you and seek advice as a friend as opposed to a figure of authority that scares or intimidates.  It provides for a healthier more deeply affectionate relationship as the parent is viewed more of a coach / mentor figure that someone who is rule bound and inflexible.  This style can make for much happier parenting relationships and provides much better management of the puberty and teenage years.

The downside is that you may not always be taken seriously and in the teenage years the children may become manipulative.  This is the question of balance and ensuring that whilst you are a friend you are also the parent and as such have the final decision in terms of the more important decisions that need to be made.  This particularly where teenage relationships and wise counselling are concerned e.g. substance abuse, external influences, behavioural considerations etc.

Works Cited

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Dattilio, F. M. (2011). Cognitive Therapy for Relationship Distress. Retrieved 7 7, 2011, from Academy of Cognitive Therapy: http://www.academyofct.org/Library/InfoManage/Guide.asp?FolderID=1170

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Papadopoulos, L. (2009, 10). Marriage is no Longer Relevant in Today’s Society. Retrieved 2 9, 2010, from PR Newswire Europe: http://www.prnewswire.co.uk/cgi/news/release?id=182222

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