COUPLES AND FAMILY THERAPY

SPECIAL AREAS IN COUNSELLING

DR. KETOKI MAZUMDAR
 WHY IS PREMARITAL COUNSELING VERY IMPORTANT IN TODAY’S SCENARIO?

https://www.youtube.com/watch?v=bQ6VT7jVi_Q
https://www.youtube.com/watch?v=aajmvTe7Npo
 Premarital counseling allows one to get to know your significant other on a deeper level and address conflict in a
productive way.

 Family is defined in many different ways and our perception of family is based on our own past experiences which differ
from what our partners have experienced.

 Couples may make assumptions about what marriage will look like or not look like based on what was modeled to them
by their own parents.
 The more conversation you can have around what you and your partner expect and find a compromise where your
beliefs aren’t completely aligned the easier it will be to move forward knowing that you are on the same page.
 Research shows that people who share the same values, communicate effectively, and have a good
friendship are more likely to enjoy their romantic relationship and build a marriage that lasts.
 A couple might already know that they want a family and children however, a counselor can help you discuss
your vision of family and what one expects from each other as partners and parents.

 Another couple may wonder how to best manage a big career while still making their marriage a
priority. Some clients are coming into the relationship with children and need to discuss effective strategies
for blended families.

 Other big questions such as how you define fidelity and commitment, how will you engage with
your own parents, your expectations around job and career.

 How you spend money and manage finances

 Finances: Money can be a stressful and contentious issue for married couples, so deciding how to manage your
finances in advance can help prevent problems down the road.

 Beliefs, values, and religion: Sharing your beliefs, values, and religious sentiments with your partner can help
foster better understanding and respect.You can also discuss the implications of these aspects on your daily life.

 Roles in the marriage: It’s important to discuss the roles you expect yourself and your partner to play in your
marriage to prevent conflicts later on.

 Activities and time spent together:You and your partner can discuss how you plan to spend time together and
what activities you enjoy doing together.
 Children: Couples sometimes realize after getting married that they are not on the same page about whether or
not they want to have children. Deciding in advance whether or not you want to have kids and how you want to
raise them is important.

 Family relationships: Premarital counseling can offer you a chance to be honest about your relationships with
your own family as well as any concerns you have about your partner’s family.

 Premarital counseling helps identify core beliefs, set realistic expectations for
marriage, plan for the future, and decide how your lives will be merged.
BENEFITS OF PREMARITAL COUNSELLING

 Understanding your partner: Premarital counseling can help you develop a better understanding of your
partner. In particular, it can help you understand your partner’s beliefs, values, expectations, motivations, priorities,
and routine.

 Setting realistic expectations: This form of counseling allows you to discuss all the important aspects of
married life with your partner so that you both know what to expect. It also helps identify your strengths and
weaknesses as individuals and as a couple.

 Planning for the future: Much like you and your partner would meet with a wedding planner to plan your big
day, seeing a premarital counselor can help you plan your marriage and your life together.
 Learn constructive communication: A core aspect of premarital counseling is communication, as partners learn to
convey their positions clearly without attacking or harming the other.

 Develop conflict resolution skills: Premarital counseling also teaches you and your partner problem-solving and
conflict-resolution skills. Initially, communication often leads to conflict, but with time, couples can have more
constructive discussions.

 Focus on the positive aspects: Premarital counseling can help you and your partner focus on the positive aspects of
your relationship rather than the negative.

 Eliminate dysfunctional behavior: Premarital counseling can identify unhealthy behaviors and patterns in a
relationship and help you correct them.
 Build decision-making processes: Premarital counseling can help you and your partner develop healthy and
equitable decision-making processes.

 Alleviate fears related to marriage: If you or your partner are anxious about what married life will entail,
premarital counseling can help you discuss important issues and give you some clarity.
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 WHAT IS COUPLES AND MARRIAGE THERAPY?

 Intervention on the couples’ relationship

 Broad range of treatment modalities
 Modify the couple relationship - the way two people relate with
each other, the way they interact with each other.
 Goal of enhancing couple relationship, satisfaction or correcting
relationship dissatisfaction
• Draws on systemic theories that locate the individual as part of a broader system.
• This broader system includes family, community, race, culture, religion, demographics, education, and
sexuality.

• This is the context into which the individual is born and it embeds relational patterns such as ways of
reading and making sense of interpersonal cues, ways of responding, and ways of connecting relationally.

• The individual is seen as one part of this larger system and each part of that system affects the others. This
creates a type of cohesive unit of roles, functions and interconnectedness; a type of equilibrium of all its
parts.
 Systemic therapy guides individual awareness of relational patterns and dynamics, recognizes
the ways that no longer serve or have become maladaptive, and explores alternate ways of
being relational.

 This space includes couple and family conflicts,

 stress and tension;
 corresponding issues that can include anxiety, depression, panic attacks, mood swings,
 resentment, disconnection, isolation, aloneness,
 issues of low self-esteem, eating issues, substance dependency, affairs, parenting difficulties,
 emotional and behavioral struggles in children, adolescents, and adults.
 The Systemic model focuses on the unconscious communications and meanings behind family
members’ behaviors.
 The therapist in this form of treatment is neutral and distant, allowing the family members to dive deeper
into their issues and problems as a family.
SYSTEMIC PRACTICE

Systemic family therapy is NOT about the people in the room –

It is about :
• How you view the presenting problem
• How you think about change and how problems resolvee
• What types of questions you ask
• Where you choose to focus your enquiry
• What is targeted in treatment/intervention
FAMILY DEVELOPMENTAL TRAJECTORY
FAMILY LIFE CYCLES AND FAMILY FUNCTIONING

 Family dysfunction often is a result of unmet family developmental tasks.

 Family life cycle changes are a major source of stress and disequilibrium for families.

 As families grow, there are developmental tasks that are required; when a family negotiates these
tasks successfully, family roles and structures change.
 When the family does not or can not accommodate these changes, stress and symptomatology will
occur.
 It is not the normal difficulties that create the problem but rather the chronic mishandling of
problems over time.
THE NATURE OF CHANGE

 Change/healing occurs when family members

1. Gain insight into their dynamics
2. Change repetitive patterns that hinder the family
 Learn more effective ways of communicating
 Change family roles
 Develop more healthy boundaries
 GOALS OF COUPLES AND FAMILY THERAPY
 Provide a confidential dialogue normalizing feelings
 Enable each partner to be heard and to hear themselves
 Set boundaries so each person feels safe and empowered to express their views in a way the other can
hear and understand even though there may be disagreements
 Teach active listening – using I statements and objective terms from the beginning

 Reflect on the relationship’s difficulties and the potential for change

 Inform couples that it is not a matter of one person being right or wrong, since both partners make sense
from their perspectives. They will be learning how to better understand each other and improve
communication to restore harmony and intimacy
 Identify times in the past that were good and what was different.
 GOALS CONTD.

 Help each partner begin to understand how he/she is contributing to the conflicts and can
contribute to solutions
 Move from the ‘blame game’ to looking at what happens to them as a process
 Look for exceptions
 Help both partners see the relationship in a more objective manner
 Identify repetitive, negative cycles as a pattern
 Sex/intimacy
 Resentments explosions
 Change the view of the relationship via a functional perspective taking
 How is this behavior helpful to him/her/you.?
COMMON PRINCIPLES OF COUPLE THERAPY
 Altering the couple’s view of the presenting problem, to be more objective, contextualized, and dyadic

 Decreasing the emotion-driven dysfunctional behavior (dysregulated behavior shouting, screaming hostility, or
emotional disengagement. And a lot of them are driven by certain emotions. So we need to tell them that these are the

maladaptive behaviors and maladaptive patterns that are causing more harm to the relationship.)

 Eliciting emotion-based behavior (what is the underlying reason, if I'm upset, and I'm angry, and I'm shouting
and screaming at somebody, I may feel I may be hurt about something and then feel rejected by somebody,
and they feel that I'm not cared for or whatever, what is the reason behind this feeling?)

 Increasing constructive, communication patterns (constructive communication in the face of

destructive communication.)

 Emphasising the strengths and reinforcing gains

 Couple counseling focuses on the problems existing in the relationship between two people.
These relationship problems might involve individual symptoms or psychological problems in one or both
partners, as well as relationship conflicts.
 Relationship is the focus of attention, instead of one individual diagnosed with a specific
psychological problem.
 All psychological problems, and all psychological changes, involve both individual symptoms (behaviour,
emotions, conflicts, thought processes) and changes in interpersonal relationships.

For example, if one is constantly arguing with one’s spouse, one will probably be chronically
anxious, angry or depressed (or all three). Or, if one has difficulty controlling one’s temper,
one will have more arguments with one’s partner
COUPLE AND FAMILY SYSTEMS THEORIES
COMMON COMPLAINTS

1) Increased frequency of arguments between partners due to poor communication patterns; Emotional
Disengagement

2) Emerging differences in opinions or value systems; Power Struggles

3) Strained relationship between couple due to certain emerging familial issues; Family of origin issues

4) Dissatisfaction in sexual relationship/ intimacy issues

 5) Feeling of being trapped in stale relationship due to lack of common interests and shared activities;

 6) Constant dispute between the couple leading to excessive distress or Couple Counselling
psychopathology such as depression or alcohol abuse in one or both the partners;

 7) Extramarital affair; Jealousy

 8) Few or frequent instances of intimate partner violence.

 9) Problem solving or communication difficulties

 10) Value or Role conflicts

 Respect the family/ background/ relationships ▪ Remain curious inner experiences

• Note facts
 Drop the causality approach • Note spontaneous disclosures
• Give equal air time to each partner
 Search for string of maintaining factors
• Ask for examples of recent interactions that
 Weaken symptom / disease model involving the illustrate their difficulty
client • Reset goal of session
 Keep symptom
• Organise knowledge of the couple in the 1st 20
/disease/psychopathology/personality models
mins of session
away from non-diagnosed members till later.

Circular questioning
https://www.youtube.com/watch?v=tHfUHaZA
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FACTORS THAT CONTRIBUTE TO MARITAL DISTRESS

1) Faulty patterns of communication: Distressed couples have few pleasant and

rewarding interactions with each other but many angry, blaming, or punishing ones.

 Dysfunctional patterns – Destructive patterns of neglect, criticism, arguments, negative

experiences, and beliefs.

 A typical pattern that can be identified in this regard is reciprocated negative behaviour which
implies if one spouse behaves negatively, the partner is likely to respond in kind and thus starts
a chain of escalating negative interaction (Gottman, 1979).
 E.g.: Chain of negative behaviors in a couple having marital problems start with one spouse
expecting to be criticized for not completing some household task that he or she normally
performs. When the other spouse begins to ask about the task, however neutrally, then the
first spouse, in anticipation of further criticism, starts responding to the query in a defensive
manner and responds with a criticism of something the other did or did not do.

 The questioning spouse senses the critical tone and feels attacked so attacks back, and so
forth. Thus, the components of this argument are a negative expectation of one spouse from
the other, and reciprocated negative behaviors (escalating criticism).
2. Faulty patterns of emotional reaction

 Distressed couples can be seen to have more impulsive, strong and negative reactions.
High reactivity in distressed couples may increase the likelihood of misunderstanding
and poor communication.

 Since spouses are so used to of feeling attacked, they may cease to listen carefully to
one another and instead be prepared for a counter attack to the initial criticism.
Are you seeing that this system is escalating into
conflict (such as heading towards an argument)?
3) Poor coping skills and inability to resolve conflicts:
◦Distressed relationships are further characterised by an inability to resolve conflicts.

◦Lack of conflict resolution skills leave couples with a backlog of unresolved fights and
conflicts that have built up over the history of their relationship.

◦A history of such unresolved conflicts may also contribute to negative expectations

about future conflicts and make engagement in constructive problem-solving even likely
to occur in their relationship.
4. Reinforcement erosion:
 This occurs when partners lose the satisfaction that was once present in the
relationship.
 This might be attributed to habituation: behaviours that were pleasing at one time are
not as important any more.
 They may fail to appreciate each other’s efforts, take each other for granted, or have new and
different needs that their partners have not yet learned to meet. One or both spouses may
have stopped doing some of the nice things that formerly helped to provide many warm
feelings between them.
4. THINKING IN
CIRCLES
The goal is to get everyone in the family thinking about how they're contributing to the situation, not just
blaming someone else. By seeing how their own actions trigger others, families can start to break
unhealthy patterns and find new ways to communicate and resolve conflict.

Imagine a family caught in a constant loop of arguing, a non-systemic therapist might ask, "Who started
the fight?" But a systemic therapist, using circular questioning, "When things get tense, what usually
happens first? How do each other's words and actions change? What happens next? Who
does what then?"
THE INITIAL INTERVIEW

 Pre-session Planning: The therapist determines in advance who will attend the
session.
 The Joining Stage: The therapist joins with the family, taking on their affective
tone, tempo, language, and structure.
 The Problem Statement Stage: Who gets to initially frame the “problem”?
Sometimes the person who has the least involvement with the problem is addressed
first.
 The Interaction Stage: The therapist focuses on determining the patterns of
interaction sustaining the problem.
 In-session analysis: The therapist takes a moment alone to think about what has
been said and how that relates to the therapist's hypothesis regarding the problem.
 Goal Setting Stage: The therapist reaches an agreement with the family on a
solvable problem, stated in a behavioral term so that all involved will know when the
problem has been solved.
 Ending Stage: The therapist sets the next appointment and indicates which family
members will be present.
 Post-session: Debriefing and processing
FAMILY THERAPY ASSESSMENT TECHNIQUES

 Family Interview
 Circular Questioning: The same question is asked of each family member.
 Family Sculpting: Assessment tool that examines power and closeness in a family by
asking each family member to physically arrange all other family members in order of
relationships.
 Reenactment: Asking the family to act out a situation rather than describe it verbally.
 Genogram: Gives a picture of three or more generations (like a family tree) and
notes important family dynamics, rules, patterns, mental health issues, etc.
• Mom married Dad (after he stopped drinking
and went to AA) but they had a contentious life

• Mom’s Dad drank (and went to AA)

• Mom’s Mom drank (but denied the problem)

• Matt, Stan’s sister’s husband drinks as does Stan

• Karl the younger brother is close to Stan

• Stan is distant or disengaged from Dad & older

brother
FAMILY THERAPY INTERVENTION TECHNIQUES

 Reframing: The problem must be put into solvable, behavioral terms, be referenced as
a family problem and not just the problem of one family member, and be put into
positive terms.

 Giving Directives: Creating or selecting an intervention that will impact the

presenting problem.

 Modifying the structure Switching roles

 COMMUNICATION SKILLS TRAINING
 Talking and learning to listen, taking turns
 Avoiding solution response turnoff, lecturing
 Stating needs and expectations in non-judgemental stance
 Expression of feelings; ongoing communication of dissatisfaction
 Avoiding abstractions :You just don’t love me
 Avoiding ‘Why’ questions with statements of needs and feelings
 Identifying red flags
 Avoiding mind reading
 https://www.youtube.com/watch?v=1o30Ps-_8is&t=33s
Thank you!