Clients may believe that a particular therapist is the best choice because he or she is already well versed in the couple’s or family’s therapy issues. It feels safe to stay with the same professional.

You may have noticed that previously we referred to the potential shift from individual to couple or family therapy as the “ubiquitous temptation.” From a therapist’s perspective, it is almost always tempting to continue counseling when there has been some success with a client, or when a client expresses a strong preference to continue counseling with you, or when there is potential ?nancial gain from continuing counseling. We also refer to this as a temptation because close inspection of the reasons for shifting from individual to couple or family therapy reveals many potential problems or counterarguments. As you read about and re?ect on our views regarding this issue in individual/family therapy, keep in mind that we are expressing our professional opinion and bias-there are many therapists and counselors who disagree with this position.

Con?icts of Loyalty Perhaps the greatest reason to avoid shifting from individual to couple or family therapy is that con?icts of loyalty inevitably ensue. Speci?cally, unless the therapist makes great efforts to build trust and rapport with the original client’s romantic partner or family, the new parties are likely to believe the therapist holds a deeper loyalty to his or her original client. Additionally, if the therapist, for whatever reason, sides with the new therapy client against the original client, the original client may feel betrayed and abandoned. Consequently, the therapist can become stuck in a no win therapy bind; both or all clients may quickly suspect the therapist has already “sided” with the original client, or has switched allegiances. Such dynamics can add unnecessarily to an already dif?cult therapy task.

Cultural, religious, and racial differences are expressed in families and couples more fully than in individual therapy. Therefore, these differences and how they are handled can play a pivotal role in the therapy success. This area is covered more thoroughly in Chapter 13, but its importance cannot be underestimated.

Shifting from Individual to Couple or Family Therapy As noted throughout this chapter, interviewers should treat all couple and family members equally. We also have emphasized the tendency of relationship partners and family members to triangulate interviewers in an effort to have greater power or control in the therapy and family settings. For these reasons, we usually avoid the ubiquitous temptation to shift from individual to couple or family therapy with people from the same family system. We also advise against simultaneous individual and couple or family work by the same counselor. Our rules for handling this issue are:

• Once an individual client, always an individual client. Generally, we will not do individual counseling with someone and then initiate couple or family work that involves that person. Instead, we refer those involved to a competent colleague.

• Following completion of couple or family counseling, on rare occasions, we might

consider working in individual therapy with one of the family members. However, when doing so, we always make it clear: Once we start individual therapy, we will not return to couple or family therapy.

For a number of reasons, many therapists do not abide by these suggestions; consider the following scenarios: An individual client says something to the therapist such as, “Because we’ve already been working together, I trust you. I don’t want to start all over and go see someone else for marriage therapy. And my husband says he doesn’t mind.” Interviewing Couples and Families 365A teenage boy and his therapist mutually conclude that family therapy is needed. The boy states, “I absolutely refuse to go to therapy with anyone else but you! There is no way I’m going to see a different shrink!” Therapists may want to prolong therapy with a person because they enjoy working with that client or because they need to maintain their caseload for ?nancial reasons.

Genograms

Most modes of family therapy and some modes of couple therapy use a schematic drawing of the family tree of both parents, including stepparents and half siblings.

There are slight variations in the construction guidelines, but knowing how to do a basic genogram is essential in working with families . The counselor may not actually do a genogram with the family present but may accumulate the data necessary to complete one. However, it is a common activity to do with families early in treatment. Numerous books are available for teaching interviewers how to complete genograms .

Gathering Family Therapy Goals

Many family therapists, when gathering information during the body of an interview, maintain balance by systematically orienting toward each family member. For example, Lankton, Lankton, and Matthews state: “We always ask each member what he or she would like to have changed in the family and how, and even if members contradict each other, each input becomes the basis of a goal” .

A key to gathering goals in family therapy is to emphasize inclusion and minimize 356 Interviewing Special Populationsscapegoating or constant references to the identi?ed patient. It is crucial to explore the range and quality of strengths and de?cits of all family members and to begin determining how they are in?uencing the identi?ed patient .

Willingness to Make Changes

A close corollary to the level of commitment in couple interviewing is each person’s willingness to do homework, try new things, experiment with change, and try out new perspectives. Besides asking directly, a good way to assess this area is to have each member try a new behavior or listening skill during the interview. This can be as simple as saying: “Barney, I wonder if you could take Betty’s hand for a minute and just let her cry.” “Mom, it seems like you and Karen are sitting closer together than anyone else. I wonder if you could have Karen sit by her brother for a few minutes while Dad moves over here and we talk a bit further.” If the couple or family agrees to homework or to setting aside talking time, interviewers should inquire as to exactly when such a new behavior might ?t into their schedules.

A family therapist working in the structural family theory model approaches the family as a living organism, which leads to an open de?nition of both family and normality . During an initial interview, the therapist absorbs all aspects of family functioning to begin to draw a family map. This map, or schema, allows for an analysis of structural strengths and weaknesses in the family.

Orienting to a family and to the family’s distress systemically will substantially change interviewer client interactions and interviewer inquiry. For instance, in the body of a family interview, coming from an ecosystemic approach, Amatea and Brown recommend seeking answers to the following: What is the nature of the problem and what solutions have been tried to solve this problem? Who else has been involved in helping with this problem? If you were to bring in anyone to help with this problem, whom would you invite? Who would be the last person to bring in to help with this problem? If this problem were solved, how would things be different? The authors also advocate assessing the entire ecosystem that surrounds the problem and intervening at whatever junctions in the system seem most likely to positively effect change. Amatea and Brown draw heavily from the MRI approach, which stems from the early work of Gregory Bateson, Paul Watzlawick, Don Jackson, Jay Haley, Virginia Satir, and others .

Using a systems or ecological perspective to some extent, behavioral family therapy shares similarities with behavioral couples therapy. Behavioral family therapists believe that families develop behavioral patterns that may be counterproductive or maladaptive, but these behaviors represent the family’s best efforts to respond to their situation . Behavioral therapists’ intentions are to conduct a functional analysis of the problem and begin altering behaviors through traditional behavioral change strategies. Education and communication training are also important features of behavioral family therapy.

The preceding descriptions are by no means an exhaustive list of couples counseling modalities. Many other approaches exist . To give these diverse approaches appropriate consideration, you would need to read the original texts and obtain speci?c training and supervision. The Suggested Readings and Resources section includes introductory and/or advanced readings from various theoretical perspectives.

Theoretical Orientations with Families

The following quote from Lewis Thomas’s Lives of a Cell, included in Minuchin and Fishman’s article, Family Therapy Techniques, captures the ?avor of the orientation foundational to much of family therapy: “There is a tendency for living things to join up, establish linkages, live inside each other, return to earlier arrangements, get along whenever possible. This is the way of the world” .

Most family therapy theorists and modalities come from a systems or ecological perspective. Such perspectives, though quite similar to each other, are a radical departure from seeing counseling as a process that cures or eliminates the pathologies of an individual or even of a family. The context for the manifestation of the dysfunction is as important, and in some cases, more important, than the actual dysfunction itself. From Whitaker’s symbolic experiential family therapy to Bowenian theory and therapy with its concepts of Interviewing Couples and Families 353differentiation and multigenerational transmission, writers and therapists with a family orientation attend to a much broader domain than those focusing on individuals or even nuclear families .

When speaking about anything that has to do with the two of you, I want you to look at and talk to each other. It’s my job to interrupt and help you change your communication patterns, but I can do that best if I watch you communicate with each other.” Even after this instruction, couples often keep turning to the interviewer to make statements such as: “I just don’t know how to tell if he is interested in talking with me. I come home and he says hello, but he doesn’t initiate conversation and I just feel so alone.” In a communications model, the interviewer intervention often consists of: “I’d like you to turn to Barney and restate what you said, only this time, talk to him.” An underlying assumption of this model is that it is more important for Betty and Barney to learn to communicate effectively with each other than it is for them to learn to communicate effectively with the interviewer .

In contrast, psychoanalytic or object relations couple therapists formulate relationship problems in terms of individual psychopathology. Consequently, they may not even view conjoint couples therapy as an appropriate treatment modality for addressing con?ict. For example, Strean states, “In most instances, but far from all, the psychodynamically oriented therapist has favored individual long term therapy for the treatment of marital con?ict” . Therefore, strange as it may sound, some psychoanalytically oriented clinicians view couple therapy as of little use. Instead, they believe that psychologically healthy relationships are based on psychologically healthy individuals. Therefore, the treatment of choice is individual therapy.

I hope we can also talk about how family therapy might help.” Family therapy openings are wide ranging, depending on the interviewer’s theoretical orientation. Another guide is from Virginia Satir : In the ?rst interview, the therapist starts out by asking questions to establish what the family wants and expects from treatment.

a. He asks each person present, though not necessarily in these words: “How did you happen to come here?” “What do you expect will happen?” “What do you hope to accomplish here?”

Maintaining Balance with Families

A classic situation in family work is the “identi?ed patient” phenomenon , wherein the entire family system claims that one member is the cause of all family problems. Satir was among practitioners who have pointed out that, in a family, the disturbed person may be reacting to a family imbalance and, through his or her symptoms, is trying to absorb the family pain. Such situations illustrate why maintaining balance in family work goes beyond simply making sure everyone gets a chance to speak.

Even in the opening minutes of an initial interview, your job is to make sure one person is not attacked or scapegoated by the rest of the family. It is also your task to determine how and when you begin to alter the system. Again, theory, supervision, and experience are essential components of developing this important skill.

CASE EXAMPLE The Ragsdale Hagan family came in for therapy because their 14 year old, Theo, was extremely aggressive toward his 9 year old sister, Sira. The parents, Thomas and LaChelle, disagreed on how to handle it, but agreed that Theo was way out of line. After hearing the basic con?dentiality information and the counselor’s opening statement, Thomas took the ?oor and complained bitterly that his son seemed bent on killing his sister. “I ought to pound that boy once a day. Maybe more. But his mother won’t hear of it.” LaChelle put her hand on Thomas’s arm and said, “Now, Baby. You know he’ll be bigger than you before you know it. He’s not going to change ’cause you pound him, are you, Theo?” Theo said to the counselor, “He’s not my real dad. He’s been with my momma a long time, but he’s not my dad. He’s her dad, though.” The parents started into why the biology didn’t matter. Theo was clearly directing the interactions. Sira was completely silent. In this case, to achieve balance, the interviewer would need to intervene and redirect the conversation in a way to involve Sira.

When someone calls to request help with a situation that might best be handled by family therapy, it is advisable to arrange a time when all family members can be present for an initial interview. You may not continue to have all members attend, but meeting everyone who lives in the family home is standard when initiating family therapy.

Many family therapists or clinicians with a family systems orientation are insistent about having every family member living in the home come to the ?rst session . Further, some family therapists welcome or even encourage initial participation by extended family members. An example of a telephone conversation follows: Interviewer: “Ms. Wilber? This is Tina Jones. I’m a counseling trainee at the University Counseling Center, returning your call.” Ms. W: “Yes, I’d like to make an appointment to talk with someone about my husband and my daughter. Well, actually, Bill said he might be willing to come too, but I just wasn’t sure what would be best. Do you have any openings? Dr.

Green said your center would be good because we don’t have insurance right now and you do a sliding fee.” Interviewer: “Yes, we have openings. I have several late afternoon openings right now. It sounds like you want some help with relationships in your family. Is that right?” Ms. W: “Well, I don’t know. My husband, Bill, is just so upset these days with our daughter, Kim. She’s 15, and she’s got a mouth on her, if you know what I mean. And she’s been pushing him. He’s a quiet guy most of the time. Our son, Wally, is just kind of lost in the ?ghting. And maybe I should just bring Kim in, but she says it isn’t her fault. She says she won’t come if her dad doesn’t come too.” Interviewer: “Kids growing up can be hard on everyone. One of the ways I’ve been trained to help people is through family therapy. It’s best if all of you Interviewing Couples and Families 343could come in for at least the ?rst few times. Do you have others living at home besides your husband, son, and daughter?” Ms. W: “No. That’s it. Sometimes, that feels like a few too many.” Interviewer: “So, do you think everyone could come in for an hour and a half next Thursday at 4?” There are an in?nite number of variations on the themes in this phone call. Parents who call for counseling may not be aware that family therapy is available and are often confused as to what might help with some of the struggles they face. Initial phone calls require at least minimal amounts of clinical judgment and education to set up for a family therapy intake interview.

Meeting and Greeting Couples

Interviewers should be careful to greet couples with relatively equal warmth and mild enthusiasm. Couples may be watching for subtle signs that the interviewer favors one client over the other. Whenever possible, avoid even the appearance of being triangulated by one member of the couple; equal treatment is the order of the day.

342 Interviewing Special PopulationsNot surprisingly, potential triangulation makes chitchatting with couples in the waiting room a task requiring thought and observation. If you talk about the weather, the woman may take offense because she is already angry with her husband, who she believes talks about the weather too often . If you talk about how it was to locate the of?ce, they may plunge quickly into a con?ict regarding who “took the wrong turn” or who really “knew the best way” to navigate to your of?ce. When meeting and greeting seriously con?icted couples, virtually anything you say can and will be used against you.

Despite prospective dangers, try to make a few comments and engage in small talk when greeting couples in the waiting room. Stick with relatively neutral trivia, shake hands with both people, and generally avoid comments that might be interpreted as too personal or as evidence that you like or identify more with one client than the other.

Telephone Contact or Scheduling with Families

Much of the previous advice can be applied to initial family therapy telephone contacts.

The primary difference is that it is unusual for a family member to call with a clear request for family counseling. The request for help usually centers on a description of certain troubling patterns of behavior in the family, or in one or more members of the family. Both theoretical orientation and clinical judgment must be involved in determining whether family therapy or individual therapy with or without family member consultation is the treatment of choice.

The family oriented mental health professional must ?nd both a comfortable working de?nition of family and a theoretical basis for determining appropriate treatment modalities. Learning to effectively interview a family and then proceed with family therapy requires serious study and close supervision. At this point, theoretical approaches to interviewing families and conducting family therapy are diverse and sometimes contentious. This theoretical and practical diversity, along with the complexities noted previously, requires that beginning interviewers not conduct family interviews or family therapy unless they have close supervision. Our preference is for beginning interviewers to obtain training experiences by conducting family interviews in conjunction with their immediate supervisors or with a team of fellow therapists . This apprenticeship model is especially important when learning family interview, assessment, and therapy techniques.

The Generic Interview

In this chapter, important aspects of interviewing couples and families are described.

We also identify problems and possible solutions associated with these interview pop340 Interviewing Special Populationsulations. However, when it comes to interviewing either couples or families, practitioners from various theoretical approaches strongly disagree with each other regarding appropriate and effective interviewing strategies. In fact, some practitioners might argue that there is no such thing as a generic or atheoretical approach to interviewing families or couples because the initial interview is based on the professional’s theoretical and treatment orientation. We believe, however, that there are basic elements in family interviews common to most accepted family treatment theories. These elements, therefore, are important considerations for beginning interviewers who work with couples and families.