When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

* bring to a halt the family's tendency to focus on one person as a scapegoat, "the problem"

* act in understanding, calm, and emotionally supportive ways and help supply the emotional stability that the couple or family temporarily lacks

* try to exemplify or personify for clients what it is to be adult, mature, caring, and able to relate openly and without feeling threatened

MARRIAGE AND FAMILY THERAPY TECHNIQUES

Marriage and family therapists may use a variety of techniques to encourage their clients to change in constructive ways. For example, it is becoming more common to videotape sessions so that couples and families may become more aware of their automatic, self-destructive patterns of interaction—which makes it easier to change them.

Family therapists also sometimes make home visits: often, being in their own familiar surroundings will encourage family members to let down their defenses and more clearly define the problems that need to be resolved. Another innovation that is becoming more widespread is multifamily therapy. Two or three families participate together in an especially modified form of group therapy so that each family can see its own problems in clearer perspective and learn by seeing more or less troubled interactions among members of another family.

Techniques drawn from behavior modification are frequently used in family therapy, especially when family difficulties seem to be localized around the behavior of rebellious or delinquent children.

Paradoxical intention, discussed in Chapter 11, can also be very helpful in marriage and family therapy. Instead of trying to restore a state of balance between husband and wife or among family members—something that usually stimulates the couple or family to fight to hold on to its old habits—a therapist encourages a state of imbalance so that the unbalanced system falls of its own weight. The cure, paradoxically, may lie in intensifying the problem. For example, a wife has migraines that prevent her from doing her family chores. A child throws up when he is forced to go to school. Both claim that they "just can't help it." The therapist's response might be, "I realize you can't help it. What I want you to do, Alice, when you feel household chores are just too much, is to go to bed and permit yourself to have a migraine. Don't fight it. Go ahead and have a bad headache. It gives you some relief, so I want you to do this through your own choice. And you, Johnny, I want you to go into the bathroom before you leave for school and throw up. It is unpleasant, but it hasn't hurt you. If you need to, stick your finger down your throat. I want you to take control and make yourself throw up each morning before going to school. And you, Alice, you won't interfere or try to mother him; let him alone. But do remind him to go and throw up." In a very short time, the results of these paradoxical strategies can be surprisingly effective.

APPLICATIONS OF MARRIAGE AND
FAMILY THERAPY

As in all approaches to therapy, the effectiveness of marriage and family therapy depends on the strength of the clients' desire to overcome the difficulties that have motivated them to ask for help. Goodwill and commitment to change may or may not be there. Sometimes a therapist can help clients become aware of their deep-seated but habitually ignored feelings of warmth toward one another. At other times, marriage therapy may lead to separation and divorce, if a couple comes to realize that their goals really are not compatible and what each needs or wants from the relationship the other is not able or willing to give. Marriage therapy and family therapy are not magic wands that can be waved over trouble to make things better. Therapists can make specific recommendations, they can help a couple or family become explicitly aware of destructive patterns, they can point to and illustrate constructive ways of interacting, and they can sometimes use therapeutic strategies to break old habits and make room for care and sensitivity to the needs of wife, husband, and children. These interventions from a therapist can be very helpful, perhaps even crucial, but they are, at most, catalysts for change: real and lasting changes can only come from clients themselves. Marriage or family therapy is ideally an educational experience. What wife, husband, and children do with what they have learned is, in the end, up to them.