ignou

W 1lE PEDPl.E'S
UlLUUIT
Indira Gandhi
MCFT-004
Counselling and Family Therapy:
National Open University
National Centre of DisabiIiy Studies Applied Aspects

PROCESSES OF COUNSELLING AND

FAMILY THERAPY 4
/
l'fum +lACf CfiT ~ it ~ ~ ~ 3lh: aTf\if

~ pr ifm ~ (11Cfld'54I ctT meAT·CfiT ~ ~

~I \iR1 ~ ~ CflI(On ~ ~ ~ ~

~ fCll'pidFm CfiT· ~ ~ ~ ~ CfiT ~

~ ~ "OOffiT ~ I"

"Education is a liberating force, and in our

age it is also a democratising force, cutting
. \
across the barrzers of caste and class,
smoothing out inequalities imposed by birth
and other circumstances."
. - Indira Gandhi
 •
MCFT-004
l§)i::) ~lgnou
THE PEOPLE'S
UNIVERSITY
Counselling and
Indira Gandhi National Open University Family Therapy:
National Centre for Disability Studies
Applied Aspects

Block

4
PROCESSES OF COUNSELLING AND
FAMILY THERAPY
UNIT 15
Referral and Intake 5
UNIT 16
Initial Phase 20
UNIT 17
Middle Phase 31
UNIT 18
Termination Phase: End Processes 45
EXPERT COMMITTEE
Prof. V.N. Rajasekharan Pillai (Chairperson)
Vice Chancellor
IGNOU, New Delhi

Prof. Reeta Sonawat Prof. Mathew Verghese Prof. Girishwar Misra

Dean & Head, Department of Head, Family Psychiatry Centre Department of Psychology
Human Development, SNDT NIMHANS, Bangalore University of Delhi, New Delhi
Women's University, Mumbai

Prof. Shagufa Kapadia Prof. Manju Mehta Prof. Aha\ya Raghuram

Head, Department of Human Department of Psychiatry Department of Mental Health
Development and Family Studies AIIMS, New Delhi and Social Psychology,
The M.S. University of Baroda NIMHANS, Bangalore
Vadodara

Dr. Rajesh Sagar . Prof. Rajni Dhingra Prof. T.B. Singh

Associate Professor, Head, Department of Human Head, Department of Clinical
Deptt. of Psychiatry, AlIMS & Development Psychology, IHBAS, New Delhi
Secretary, Central Mental Health Jammu University, Jarnmu
Authority of India, Delhi

Prof. Anisha Shah Prof. Sudha Chikkara Prof. Aruna Broota

Department of Mental Health and Department of Human Department of Psychology
Social Psychology, NIMHANS, Development and Family Studies University of Delhi
Bangalore • CCS HAU, Hisar New Delhi

Prof. Minhotti Phukan Mrs. Vandana Thapar Dr. Indu Kaura

Head, Deptt. of HDFS Deputy Director (Child Secretary, Indian Association for
Assam Agricultural University Development), NIPCCD Family Therapy, New Delhi
Assam New Delhi

Dr. Jayanti Dutta Ms. Reena Nath Dr. Rekha Sharma Sen
Associate Professor of HDCS, Practising Family Therapist Associate Professor
Lady Irwin College, New Delhi New Delhi (Child Development), SOCE
IGNOU, New Delhi
Prof. Vibha Joshi Prof. c.R.K. Murthy Mr. Sangmeshwar Rao
Director, School of Education STRIDE Producer, EMPC, IGNOU
IGNOU, New Delhi IGNOU, New Delhi New Delhi

Prof. Neerja Chadha Dr. Amiteshwar Ratra

(Programme Coordinator) (Convenor & Programme
Professor of Child Development Coordinator)
School of Continuing Education Research Officer, NCDS
IGNOU, New Delhi IGNOU, New Delhi

Acknowledgment:
We acknowledge our thanks to Prof. Omprakash Mishra, Former PVC, IGNOU; Prof. e.G. Naidu, Former Director (I/c)
P&DD and Head, Nodal Unit; Dr. Hemlata, Former Director (l/c) NCDS; and Dr. Arun Banik, Director, NCDS, for facilitating
the development of the programme of study.

PROGRAMME COORDINATORS - M.Sc. (CFT) I PGDCFT

Dr. Amiteshwar Ratra Prof. Neerja Chadha
Research Officer Professor of Child Development
NCDS, IGNOU, New Delhi SOCE, IGNOU, New Delhi
COURSE COORDINATORS
Dr. Amiteshwar Ratra Prof. Neerja Chadha
Research Officer, Professor of Child Development
NCDS, IGNOU, New Delhi SOCE, IGNOU, New Delhi

COURSE WRITERS
Unit 15 Dr. Bino Thomas, Junior Consultant, Dept. of Psychiatric Social
Work, NIMHANS, Bangalore

Unit 16 Dr. C.P. Jyothsna, Part-time Lecturer, The Richmond Fellowship

Post Graduate College, Bangalore

Units 17 & 18 Dr. Shruti Kiura, Consultant, Clinical Psychologist, VIMHANS,

New Delhi

BLOCK EDITORS
Prof. Anisha Shah Prof. Neerja Chadha
Department of Mental Health and Professor of Child Development
Social Psychology, NIMHANS, SOCE, IGNOU, New Delhi
Bangalore
Dr. Amiteshwar Ratra
Research Officer,
NCDS, IGNOU, New Delhi

Acknowledgment:
We express our thanks to all those whose photo images have been used on the
cover page.

January.Ztrl l

© Indira Gandhi National Open University, 2011

ISBN: 978-81-266-5227-3
.All rights reserved. No pan of this work may be reproduced in any form, by mimeograph or
any other means, without permission in writing from the Indira Gandhi National Open University,
New Delhi.
Further information on Indira Gandhi National Open University courses may be obtained
from the University's office at Maidan Garhi, New Delhi- 110 068 or the official website of
IGNOU at www.ignou.ac.in.
Printed and published on behalf of Indira Gandhi National Open University by Registrar,
MPDD.
Laser Composed by: Rajshree Computers, V-166A, Bhagwati Vihar, (Near Sector-2, Dwarka),
Uttam Nagar, New Delhi-ll0059
Printed by: Kalyan Enterprises, D-20,Sec.B-3, Tronica City (lnde.Area) Loni,G.Z.B.(U.P.)
BLOCK 4 PROCESSES OF COUNSELLING
AND FAMILY THERAPY
Introduction
The Block 4 "Processes of Counselling and Family Therapy" will acquaint you
with the knowledge of various phases of counselling and family therapy. The Block
consists of four units.

The Unit 15 is entitled "Referral and Intake". As the name suggests the Unit describes
the referral and intake process in counselling and family therapy. The Unit is divided
into two parts. The first part of the Unit explains the referral process which includes
the meaning of referral, who refers and to whom. This part helps, you to understand
how referral helps in family therapy and also describes the various reasons of non- .
attendance of session. The later part of the Unit deals with the intake process. It
includes various resistance to the family concept, environmental settings, observations
and therapeutic planning and the contact. Further, the Unit also explains the important
things to remember while conducting intake. In the end of this Unit, the role of the
counsellor and family therapist in referral and intake process is described.

The Unit 16 is on "Initial Phase". The Unit begins with the main theme of initial phase
and important assumptions of initial phase. Further, the Unit acquaints you with the
knowledge of assessment process in initial phase, which includes, initial contact,
defining the goals for the initial phase and family history and genograms. In the end
of this Unit, structural family system rating scale is explained in detail. The main
aspects included in this scale are family structure, resonance, flexibility, developmental
stage of family, identified patienthood, conflict resolution, common techniques,
developing a family formulation, feedback and recommendations to the family and
arranging the next step.

Unit 17 is "Middle Phase". The Unit aquaints you with the knowledge of middle
phase of family therapy. It begins with the main goals of middle phase of counselling
and family therapy. The family therapy goals should have joint creation and agreement
on goals. Clarity of goals to family members as well as family therapist is very
important. There are two types of goals, that are, short-term and long-term goals.
Further, the Unit discusses the various challenges to establishing goals in family
therapy. The Unit illustrates the middle phase' processes with the help of a case, In
the end of the Unit, various challenges to family therapy are explained, with particular
focus on therapist neutrality and family resistance.

Unit 18 is entitled ''Termination Phase: End Processes". Termination phase is the last
phase of family therapy and this Unit acquaints you with the processes involved in
this phase. The Unit begins with the introduction of termination phase and its types.
Further, the Unit highlights the indicators for planned termination. The various steps
included in termination process like, information regarding planning of termination,
summarise hypothesis, goals and what happened in therapy, examine changes,
anticipate problems, reinforcement and hope biulding and plans for. follow-up are
explained. The two important issues - termination anxiety and resurgence of problem
are also discussed. While going through the Unit, you can understand various therapist
and client related factors that lead to unplanned termination. In the end of this Unit,
you will learn to deal with termination both planned and unplanned.
UNIT 15 REFERRAL AND INTAKE
Structure
15.1 Introduction

15.2 Meaning of Referral

15.3 Who Refers?

15.4 Referral to Other Centres

15.5 How Referral Helps?

15.6 Non-attendance

15.7 Meaning of Intake

15.8 Process of Intake

15.8.1 Resistances to the Family Concept
15.8.2 Environmental Setting
15.8.3 Observations
15.8.4 Therapeutic Planning and the Contract

15.9 Important Things to Remember while Conducting Intake

15.10 Aspects to be kept in Mind by the Family Therapist or Counsellor

15.11 Let Us Sum Up

15.12 Glossary
15.13 Answers to Check Your Progress Exercises

15.14 Unit End Questions

15.15 Further Readings and References

15.1 INTRODUCTION
The present Unit deals with the referral and intake processes in Counselling
and Family Therapy. The Unit begins with introduction of referral. Further, it
states the persons who normally -refer (send) the client or patient to the
counsellor or therapist. You will understand the reason of referring client or
patient to other related professionals and how this process takes place. The
second part of this Unit deals with intake process. It describes the meaning
and process of intake. There are some important points that a counsellor or
therapist should keep in mind with repard to the intake process. We will
discuss these points in detail in this Unit.
Objectives
After studying this Unit, you will be able to:
• Define referral and intake process;
• Understand importance and procedure of referral and intake process;
and
• Understand the role of therapist or counsellor in intake process.
5
Processes. of Counselling and
Family Therapy 15.2 MEANING OF REFERRAL
. Referral usually is the process in which a client is sent for seeking a higher
level intervention or opinion. In general, a lot of patients are sent from primary
care centres to tertiary care centres for availing services. In the same way,
couples or families who seek help in harmonising the relationship or bringing
change in their life are sent to specialists who are experts in handling relationship
issues.
The client's first contact with the counsellor will be either by sending a letter
or calling up through telephone to seek an appointment or by face to face
contact, if there is a drop-in service or crisis service. So, therapists need to
be appropriately prepared and monitor how the clients experience this first
cominunication. This may be a crisis intervention. Along with dealing with the
presenting problems, arrangements can be made for further counselling
appointments also.

Check Your Progress Exercise 1

Note: a) Read the following question carefully and answer in the space
provided below.
b) Check your answer with that provided at the end of this Unit.
1. Define referral.

15.3 WHO REFERS?

Usually, the families or couples will be referred by practising psychologists,
psychiatric social workers, teachers, doctors, friends or by self: It is important
to understand why they are referred to you and their expectation from you
as therapist. You may thank the person for referring and also report to her
or him about what happened later. You may also contact the person who
refers for further details in helping the couple or family. You need to be
discretionary about what and how much feedback you will give about the
family matter. You may discuss the interaction pattern or a few dynamics to
a therapist, but not to the friend. Taking the permission of the couple or the
family for the same is more important.

Sometimes referrals will be made to you by another counsellor or therapist.

It may be that the therapist has no vacancies, or that you have an expertise
in a certain. area or that the other therapist is moving to another part of the
country. Ideally the other therapist will contact you first in order to ask you
whether you are willing to accept this referral and possibly she or he will give
you some information about the client (with client's permission). If you receive
a referral from another counsellor or therapist it is important to spend as
much time as is needed on the client's feelings about the referral. While it may
6 appear a sensible option' to the practitioner involved to refer the client to
another counsellor but, it may appear differently to the client. The family or Referral and Intake
the client may feel rejected or may understand that her or his problem is so
bad that no one can deal with it or there may be anger on client's part. If
these feelings are not explored there may be resistance from the client in the
new counselling situation.

Check Your Progress Exercise 2

Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this
Unit
1. State 'True' or 'False' for each of the following statements:
1. Referrals can not be made by another counsellor. _

n If the feelings of client are not explored there may be resistance

in new counselling situation .. _

m It is not important to understand the expectations of client from

a counsellor/therapist. _

15.4 REFERRAL TO OTHER CENTRES

It is important for a counsellor to refer the family in the case when he or she
is not able to meet the needs of the client. Not only during the first counselling
or therapy session, especially, but also throughout the whole conselling contract,
we need to be alert to the possibility of the advisability of referring to a
medical expert for mental health problems. Some forms of fatigue, emotional
problems, anxiety and depressive stages may result from a physiological or
hormonal imbalance that could be cured by investigations and treatment from
a medical practitioner. It is helpful to be aware of the complementary therapies
available that could be used in conjunction with counselling. As you practice,
it is exceedingly useful to have the name and phone number of the client's
doctor or psychiatrist, to explore the family's or couple's resources and terms
of available family members or friends. A referral in the middle phase of
therapy is advised if there is transference and counter transference and the
therapy is stuck.

15.4.1 Referral for Psychiatric Assessment

The bottom line is "Can counselling help this client?" Warning signs may be
where there is a history of suicidal or extreme aggressive impulses, serious
alcohol abuse, obsessive compulsive disorder, personality disorder, severe
depression or psychosis. It may be that you have a special training or ability
or experience in dealing with these kinds of problems, but it is always useful
to have a second opinion and back up. There are also some people who
need psychotropic drugs as psychiatric intervention alongwith you (that would
require involvement of a medical expert) in order to control their problematic
thoughts, feelings or behaviour.

The counsellor should be aware and be able to judge the point at which the
individual, family or couple needs to be sent for another opinion. Therapist
should have a list of professionals working in the locality to refer. Send the 7
Processes of Counselling and client to the exact place and concerned person. A referral note containing a
Family Therapy
brief introduction about the individual or couple or family and its problems
should be sent to the professional whom you are referring, along with request
to give you feedback.

15.5 HOW REFERRAL HELPS?

A call or a letter from a source helps therapist to form an initial hypothesis.
It also hell's to start probing as there is already some information available
about them. A referral also helps in finding out a therapist.

15.6 NON ATTENDANCE

If the client or the family doesn't attend the first appointment, it is usual to
offer another appointment either by telephone or through any messaging source.
Some clients may not wish to be phoned at home or work. It's essential for
the counsellor to get the contact details of the individual, family or couples
whom they are counselling and counsellor should give her or his contact, so
that they can contact if there is any change in the session. Make it open to
them that, informing you on certain changes in appointments will be appreciated.
Also, the counsellor should find out the reasons for missing the appointment.

Check Your Progress Exercise 3

Note: a) Read the following questions carefully and answer in the space
provided below.
b) C heck your answers with those provided at the end of this
Unit
1. Fill up the blanks:

(i) It is helpful to be aware of the therapies

available, that could be used in conjunction with counselling.

(ii) Some clients need drugs through psychiatric

intervention in order to control their problematic thoughts, feelings
or behaviours.

(iii) A call or a letter from a source helps therapist to form

(iv) It is essential for the counsellor to have the _

details of the family whom they are counselling.

15.7 MEANING OF INTAKE

A family systems interviewing format is particularly useful in mental health
consultation. It can serve effectively as a diagnostic tool and for planning and
initiating psychotherapy of any variety. Information is developed rapidly and in
appropriate multi-dimensional complexity; scapegoating of the identified patient
is reduced, family systems' resistances are made visible, and strategies for
coping with them are initiated from the outset. While it is not always practical
8 or psychologically feasible to arrange for such family consultations, substantial
benefits can accrue to the patient, family and the therapeutic enterprise when Referral and Intake
this standard structure is used.

The psychotherapist accustomed to one-to-one dyadic interviewing is apt to

feel bewildered by the rate and volume of information obtained. In this Unit,
an attempt is made to provide a simple guide to considering such consultation.
'Intake session' means initial family interviewing; it would be presumptuous to
suggest there is 'one' correct way to carry out such a consultation. Some
regularisation of interviewing techniques is possible and major training centres
tend to teach in fairly standard ways. There is obviously much difference in
these ways as welL The most obvious sources of it are the family itself and
the personal style, training and theoretical persuasion of the therapist.

An initial family systems consultation would certainly include all of those

evaluation that are conventionally associated with mental health; such as
assessment of an individual family member's psychic functioning, principle
conflictual areas, adaptive and coping capabilities, biologic endowment, skill
level and so on.

Goal

The main goal of intake process is mapping the aspects of systems of the
present complaint. This is limited to defining those aspects of the systems
which are relevant to the immediate presenting difficulty and to the immediate
family.

Check Your Progress Exercise 4

Note: a) Read the following question carefully and answer in the space
provided below.
b) Check your answer with that provided at the end of this Unit.

1. Write short note on intake.

15.8 PROCESS OF INTAKE

The initial interview is full of excitement, uncertainty, newness and difficulty of
understanding. In this, parties come together by previous arrangement, and
they meet for the first time in the knowledge that they will need to find a way
to work and live together.

During the intake process, the tentative establishment of an emotional contact

between the family therapist and the various members of the family takes
place. They appraise the family therapist and her or his skill, as well as her
or his capacity to understand them and to relate to the client's distress. In
turn the therapist appraises the client-family as well as its various members.
The therapist evaluates the pathology as well as the healthy aspects of their 9
Processes of Counselling and relationships. She or he listens to them and evaluates the issues. After a
Family Therapy
tentative hypothesis is established, the therapist identifies some of the outstanding
conflicts and shares her or his observations with the individual or family. This
leads to the beginning of the therapeutic contact. Tentative treatment goals and
prognosis need to be set by the end of the intake. Intake also determines if
counselling/family therapy is required or not and further referral to other helping
sources.

Intake is basically the first meeting, the individual, family or couple has with
therapist. It is very important in many ways in the therapy. The individual,
family or couple may come for therapy as referred by somebody or by self
or after getting an appointment with the therapist or just walk-in for the
meeting. In any case, therapist meets them. Intake is the initial session with
them to understand their concerns and reasons for the visit, in brief. You may
not see all significant persons during the intake. You may get a person who
seeks help for others too. In any case, it becomes the responsibility of therapist
to enquire abo~it their problems. \

15.8.1 Resistances to the Family Concept

Sometimes, the client refuses to involve one or more of the family members.
In such instances, it is often useful for the therapist to review her or his own
doubts 'and anxieties such as whether she or he is convinced that the whole
family needs to be present at the session. Therapists often have a fear of
dealing beginning with so many people or of exposing the children to the
affairs of their parents or of handling an explosive marital situation in front of
both the partners etc. If the therapist has such resistance, then it is most likely
that it will reinforce resistance in the family.
Initiation of family sessions with few members of the family is risky. Many
experienced therapists have come to regard the willingness of the entire family
to participate as an important prognostic sign. Should the therapist ally herself
or himself with that member of the family, it undoubtedly threatens the rest of
the members. Resistances can be seen in terms of other family members
objection to sessions. So, in the initial session itself, the therapist can enquire
whether the other family members are aware of the visit and how they feel
about it.

15.8.2 Environmental Setting

The therapy room should be large enough to hold the family group and allow
for free movement. There may be more chairs than the number of people
expected so as to permit the family to represent their structural relationship by
the seating arrangements. Allowing family members to arrange the seating in
the room is a valuable guide to family splits, and to the position the therapist
is intended to occupy. Therapist should be seated in the position which is
visible to every member and, therapist can also look at all of them easily.
15.8.3 Observations
Visual data collection about the family begins as soon as the therapist sets
eyes on them. The common observations are 'How are they dressed?', 'How
do they hold themselves?', 'Who is alone and who clings to whom?'. The
therapist should particularly notice differences in the family interaction in the
waiting room in contrast with their presentation of themselves (family) in the
10 consultation room, for example, 'Do they talk naturally to each other while
waiting for the session to begin or are they frightened, fragmented or subdued?'. Referral and Intake
The family's way of greeting the therapist can be quite important. Who stands
up first, speaks first, dresses, scolds or cuddles with the children, all can be
observed and added to the hypothesis.

15.8.4 Therapeutic Planning and the Contract

Most families come into the therapeutic situation with a knowledge of their
symptoms, but they have no idea of what the underlying causes of their
distress are. The therapist should be in a position to share her or his tentative
formulations with the family and plan about the interventions. It is inappropriate
attempt to review here the wide range of considerations entering into treatment
planning. However, it is desirable for the treatment contract to be clearly
spelled out and reviewed in sufficient detail, so that, family members and the
therapist understand what is being proposed and how this would grow out of
the experience they have had in the initial consultation with each other.

Check. Your Progress Exercise 5

Note: a) Read the following question carefully and answer in the space
provided below.
b) Check your answer with that provided at the end of this Unit.
1. Briefly describe the process of intake.

15.9 IMPORTANT THINGS TO REMEMBER

WHILE CONDUCTING INTAKE
The following are the important issues in intake session:

1. Establishing rapport: Greeting the couple or clients and to offer them

seats is foremost. Make them feel comfortable. Family therapist or counsellor
needs to introduce herself or himself. Make sure the information you
share with the clients is necessary in a therapeutic relationship. The clients
would show interest in knowing more about the therapist. Therapist or
counsellor can be discretionary about details to disclose. You also ask ..,
,. ,
.~.,
them to introduce themselves and get to know about each of the family
members. Developing a rapport is possible by asking their whereabouts,
the place they come from, what they do etc. instead of directly jumping
into their problems.

2. Understanding reason for the session: Ask them about the reason for
meeting family therapist or counsellor, which helps in understanding their
difficulties. As far as possible try to avoid using the words like 'problem'
and 'why'. Family therapist or counsellor needs to enquire about what
each member thinks, and what the problem is. It is essential to get
perception of each member. 11
Processes of Counselling and 3. Understanding the expectations: It is important to understand
Family Therapy
individual's/family's expectations from the therapy and reason for seeking
help at this point of time. This is in order to understand how serious they
are with their help seeking behaviour and also to understand what steps
they had taken in the past to handle those issues. The family should be
explained about the role of dialogues in family therapy. Sometimes, they
may also expect miracles to happen. Therapist needs to discuss with
them about their various unrealistic and realistic expectations.

4. Appointment: After understanding the preliminary concerns, its important

to give the family a time and date for the session. Make sure that you
are available for the therapy session on the given time and date. It is
important to inform them, if there is a change. It helps in building up of
trust and rapport with the client(s).

5. Duration of intake: The intake session should not go on for a long time
as this is intended to be brief, to understand their primary concerns. The
session should take maximum 20 to 30 minutes. During this time the
therapist needs to understand the presenting complaint in systemic
perspective.

6. Payment norms: Payment for the session depends on the agency with
which the familty therapist or counsellor is working. The agency will have
its policies on charging the session. Usually, in the intake session, family
therapist or counsellor is expected to explain to the family or couple
about the payment aspects, so that the family can be prepared for the
payment or they have the choice to opt out.

7. Members to be present: Sometimes family therapist or counsellor

cannot decide who are the members to be presented for the intake
session. It may be any family member or members that will be present
for the intake session. But once the intake is done, the therapist should
know who are the significant members to be present in the coming
sessions, and the individual or the family should be informed about the
same.

8. Motivating the family for therapy: The intake session is not only
deciding minutes to screen the family for assessment, but there may be
some other family members who are not fully willing for family therapy.
The family therapist or counsellor needs to motivate all the members for
family therapy; in particular to work on their relationship or presenting
problems.

9. Duration of therapy: Most of the clients or families will have their

doubts on how long the session will go on and how many sessions
they need to bring about change. This is a tough question for a new
family therapist or counsellor to answer. The family therapist or counsellor
needs to gain the confidence and can learn it through supervision and
expenence.
12
 Referral and Intake
Check Your Progress Exercise 6
Note: a) Read the following question carefully and answer in the space
provided below.
b) Check your answer with that provided at the end of this Unit.
1. List down the important points that should be kept in mind while
conducting intake.

15.10 ASPECTS TO BE KEPT IN MIND BY THE

FAMILY THERAPIST OR COUNSELLOR
Following are the key aspects that need to be borne in mind by any family
therapist or counsellor:

1. Confidentiality: Family therapist or counsellor has greater role and

responsibility in the first meeting with the family. First and foremost, it is
essential to communicate with the family about the confidential nature of
the information they share. Confidentiality is essential in all the helping
professions. Family therapist or counsellor must not reveal details of the
therapeutic relationship without the client's permission. Family therapists
are often seeing more than one persons in a session; in that case, the
release of any information must be agreed to by all parties. The stated
exception is when the family therapist or counsellor fears the client will
do any harm to herself or himself, or to another person. It is good
practice to discuss the diagnosis being given and the expected treatment,
such as number of sessions and type of approach, with the client(s) and
to ask them to sign an understanding of that information. This process,
of informed consent, allows the client to decide whether and how they
are willing to proceed and protects the family therapist or counsellor who
may otherwise be questioned or charged with breach of the client's
confidentiality. The family therapist or counsellor will have to make efforts
for ensuring confidentiality; for instance, ensuring that others do not get
access to therapist's therapy notes, privacy being maintained and so on.

2. Informed consent: Clients have the freedom to choose whether to enter

into or remain in a counselling relationship and need adequate information
about the counselling process and the family therapist or counsellor. Family
therapists or counsellors have an obligation to review in writing and verbally
with clients the rights and responsibilities of both the family therapist or
counsellor and the client. Informed consent is an ongoing part of, the
counselling process. The family therapist or counsellor should appropriately
document the discussions of informed consent throughout the counselling r

relationship. 13
 Processes of Counselling and 3. Being neutral: Family therapist or counsellor who tries to understand the
Family Therapy
family will have to take a neutral position. In simple words, she or he
should not be taking sides with any of the members. It is obvious to see
in family therapy that family therapists or counsellors gets attracted more
to the sufferer or the underdog. Or sometimes spend a little more time
with one family member than another. Family therapist or counsellor taking
such a stand in favour of a single family member, can cause differences
in the rapport of the family therapist or counsellor and the other family
member and Family therapist or counsellor should ask questions to each
family member, give equal time for each member and avoid meeting
single members unless and until she or he can give equal time for each
member.

4. . Understanding the emotional aspects: At any point of the session,

family therapist or counsellor is expected to have skills in handling the
emotional issues during the session. The clients can be found sad, angry,
happy or in any other emotion. Family therapist or counsellor needs to
express appropriately with the situation.

5. Gender issues: Family therapist or counsellor needs to be gender sensitive.

You may get a male or female client and sometimes a predominance of
family members may belong to one gender. It is better that the family is
comfortable with the gender of the family therapist or counsellor, and
family therapist or counsellor also can find herself or himself comfortable.
It is also apt to take a eo-therapist of other gender if there are issues
expected from a gender perspective in the therapy like in sex therapy.

6. Ethical issues: The American Association of Marital and Family Therapy

Code of Ethics, addresses the confidentiality, fmancial, research, advertising,
and other business and professional concerns that protect the legitimacy
of the therapeutic profession and shows consideration for clients. It is the
responsibility of therapists to know and to adhere to the code of ethics
of the professional organisation with which they affiliate. It is their
'. responsibility to know about and utilise social services and other resources
that could be helpful to client families. When therapists make referrals,
they need to make sure clients understand and agree that referral will be
helpful for them. In a nutshell, therapists have to act responsibly, be non-
exploitative, protect client confidentiality and in general be respectful and
do no harm.

7. Responding to life threatening behaviours: There are times when the

client is endangering herself or himself or others, that a family therapist
or counsellor must intervene to protect both the client and the potential
victim. The decision to react to those situations is always difficult, usually
as painful to the therapist as to the client. A family therapist or counsellor
should utilise her or his professional support system, supervisors, and
colleagues to help implement these reactions and for support after having
taken the necessary action. In general, calling on supportive professionals
helps to reduce stress and bum out.

8. Supervision and continuing education: It is not ethical to allow biases

to interfere with providing appropriate services to clients, but how open
should one be? These issues should be addressed in supervision. When
14 the family therapist or counsellor becomes aware of being uncomfortable
 with clients around bias issues or any others, she or he should process Referral and Intake
those concerns with a supervisor or colleague. It is in the therapist's as
well as the client's best interest for the therapist to participate in a
supervision group, or at least have a colleague available for support and
consultation. This is true as long as a family therapist or counsellor is in
practice. If the therapist fmds herself or himself unable to overcome those
feelings of discomfort regarding particular clients, she or he must find a
positive way to refer them to some one who will be able to work more
successfully with them. It is also better to participate in continuing
education programmes which includes, attending conferences offered by
professional associations, workshops, seminars, reading professional books
and journals, and holding case conferences with colleagues.

9. Record keeping: Good record keeping is an important part of '1

professional's task. Records should be in clear straight forward language.

They should be concise and accurate. Record keeping is a key element
of how a service is delivered, assisting practitioners in planning, assessment
and decision making processes and in monitoring the progress of plans.
They should clearly differentiate between facts, opinion, judgements and
hypothesis. Case recording can give a structure so that work is focused.
The case record ensures that staff can account for and evident the work
undertaken, and provides a wider source of information necessary to that
work, including user views, resource allocation and financial management.
The record can also place the work with users in the context of agency
policy, procedures and criteria for service provision.

The important points that should be kept in mind while keeping records are:

i) Therapist should know 'HOW AND WHAT TO RECORD'.

ii) Keep your record up to date, that is, entries should be made not later
than five working days from the contact, correspondence or meeting.
iii) Make your record easy to read and understand. Use plain jargon-free
English, avoiding slang or colloquialisms.
iv) Recording should be purposeful. State wherever possible the purpose of
visits, contact or meetings.
v) Recording must contain information that is essential to the purpose of
your contact.
vi) Recording must be accurate. Ensure that names are spelled correctly and
consistently throughout.
vii) The record must not be used to record or justify time spent, resource
or funding difficulties relating to the service, or personal feelings and
comments.
viii) Keep the recording as concise as possible and relevant to the current
intervention.
ix) Separate fact from opinion. Indicate in your recording what is fact and
what is a judgement or opinion. Always state whose opinion is it.
x) Case files must contain a chronology of significant events at the front.
xi) Every individual case must have its own case file.
xii) All recording must be dated and legibly signed. 15
Processes of Counselling and xiii) Spring clean periodically like, shift through the case file, discarding duplicate
Family Therapy
papers and checking that everything is in the correct place. Update front
sheets and key information regularly.

xiv) Family therapists or counsellors create records and to the extent the
records are under their control. They maintain, disseminate, store, retain,
and dispose of records and data relating to their professional and scientific
work. It is done in order to:
(1) facilitate provision of services later by them or by other professionals,
(2) allow for replication of research design and analyses,
(3) meet institutional requirements,
(4) ensure accuracy of billing and payments, and
(5) ensure compliance with law. Family therapists or counsellors, maintain
confidentiality in creating, storing, accessing, transferring and disposing
of records under their control, whether these are written, automated
or in any other medium. Documentation should protect clients' privacy
to the extent that is possible and appropriate, and should include
only information that is directly relevant to the delivery of services.
They store records following the termination of services to ensure
reasonable future access. Records should be maintained for the
number of years required by state statutes or relevant contracts.
Case illustration
Therapist: Good afternoon.
Rahul: Good afternoon.
Therapist: I am Mr. Chetan, could you introduce yourself?
Rahul: I am Rahul and she is my wife Priya. We are basically
working in sofiW;"e company in this city.
Therapist: Could you tell me what brings you here?
Rahul: Well, we have been married for the last five months and
we find if difficult to live together.

Therapist: Could you explain about it?

Rahul: Its very difficult to adjust with her. She has her complaints
about me that I don't come home early from office. And
I don't find her also coming early for home.
Therapist: Priya, what do you say about it?
Priya: He said right. We don't get to see each other very often.
Therapist: What makes you say so?
Priya: Well, I think we both are very much interested in our
work than family life. We should have married' somebody
in the office than each other. Nowadays we talk only when
we need to shout at each other. And hardly go out.

Therapist: What do you think Rahul is the reason of such happenings?

Rahul: Well, I think, we haven't realised the importance of spending
16
 Referral and Intake
time with each other: And above all, the job is too hectic
for both of us. I think if we take some time out to talk
to each other, we may solve most of our issues.
Therapist: Good, you could identify some reasons for your difficulties.
Well, Priya, what do you say about it?

Priya: Of course. I feel the same and rest of the reason we need
your help to find out and help ourselves.

Therapist: That's really nice. I think, I need to understand both of

you in detail to comment about what is happening to you
and how to intervene. So are you both willing to work on
your relationship?

Rahul: That's the reason I am here.

Theraist: What do you say Priya?

Priya: Yes, of course! .

Therapist: So, we will meet again tomorrow at 2:00 P.M. Is that ok

with you?

Rahul and Priya: Yes.

Therapist: The information you give me will be kept confidential. The

session is for 45 minutes to one hour, and each session
will be charged as per the rules of the agency about which
I think you are already aware.

Rahul: Yes. We are aware and we agree to it. We will meet you
tomorrow.

Therapist: See you.

Rahul: Thank you so much.

Priya: Thank you.

15.11 LET US SUM UP

In this Unit, we have learnt about referral and intake process. The Unit began
with the introduction of referral process. It also described who refers and
how referral helps the family. The later part of the Unit deal. with intake
process. The intake procedure is brief in terms of the time but the things to
be taken care of during the session are too many. Family therapist or counsellor,
as he or she progresses with learning and experience, will master the skills in
understanding and managing the client and family.

15.12 GLOSSARY
Intake Session Initial family interviewing; it would be presumptuous
to suggest there is 'one' correct way to carry out
such a consultation.

Referral A client is sent for seeking a higher level intervention

or opinion. 17
Processes of Counselling and
Family Therapy 15.13 ANSWERS TO CHECK YOUR PROGRESS
r EXERCISES
Check Your Progress Exercise 1
1. Referral can be defined as the process in which a client is sent for
seeking a higher level intervention or opinion.
Check Your Progress Exercise 2
.-
1. L False
n. True
IlL False
Check Your Progress Exercise 3
1. L complementary
ii psychotropic
IlL an initial hypothesis
IV. contact
Check Your Progress Exercise 4
1.. Intake session is an initial family interviewing. It would be presumptuous
to suggest there is 'one' correct way to carry out such a consultation.
The main goal of intake process is to map the aspects of systems of the
present complaint. This will be limited to defining those aspects of the
systems which are relevant to the immediate present difficulty and to the
immediate family.

Check Your Progress Exercise 5

1. Process of intake: The initial interview is full of excitement, uncertainty,
newness and difficulty of understanding. In process of intake, two parties
come together by previous arrangement and they meet for the first time
in the knowledge that the family will need to find a way to work and
live together. The tentative establishment of an emotional contact between
the family and therapist takes place. Intake process also determines if
family therapy is required or not and further referral to other helping
source.
Check Your Progress Exercise 6
1. Important things to remember while conducting intake:
,"
L Establishing rapport,
u Understanding reason for the session,
IlL . Understanding the exceptions,
IV. Appointment,
v. Duration of intake,
VI. Paym~nt norms,
vii Members to be present,
viii Motivating the family for family therapy, and
18 ix Duration of family therapy.
 Referral irio Intake
15.14 UNIT END QUESTIONS
\
1. What do you mean by referral? Explain with the help of an example ..

2. How can referral help the family and the family therapist?

3. Explain the proc~ss of intake.

4. What are the aspects that a family therapist or counsellor needs to bear
in mind?

15.15 FURTHER READINGS AND REFERENCES

,-
Franklin, P. & Prosky, P. (1973). A standard initial Interview. In Bloch, D.A.,
Seminar in Psychiatry: Techniques of family psychotherapy. New York:
Grune and Stratton Inc.

Becaver, RJ. & Becaver, D.S, (1982); Systems theory and family therapy:
A primer. Washington, DC: University Press of America.

Green, J.B. (2003). Introduction to family theory and therapy: Exploring

and evolving field. Australia: Thomson Brooks/Cole.

Barker, P. (1998). Basic family therapy. USA: Blackwell Publishing.

" .""

19
 UNIT 16 INITIAL PHASE
16.1 Introduction

16.2 Main Theme of Initial Phase

16.3 Assessment Process in Initial Phase

16.3.1 Initial Contact
16.3.2 Defining the Goals for the Initial Phase
16.3.3 Family History and Genograms

16.4 Structural Family Systems Rating Scale (SFSR)

16.5 . Common Techniques Used in the Initial Phase
16.6 Developing a Family Formulation

• 16.7 Let Us Sum Up

, 16.8 Glossary
16.9 Answers to Check Your Progress Exercises
16.10 Unit End Questions
16.11 Further Readings and References

16.1 INTRODUCTION
The family systems perspective holds that individuals are best understood in
the context of relationships and a "client's" problem might be an indication of
how the system functions and is not just a symptom of the individual's
maladjustment, history and psychosocial development. To focus on just the
individual dynamics without considering the interpersonal dynamics yields an
incomplete picture. Therefore, a treatment plan that addresses both the 'client'
and the larger context is necessary.
Most commonly families seeking family therapy are the following :
• Concerns about children or adolescents;
• Families reporting that members have problems in relating to each other;
• Families in which one of the family members has a chronic illness and the
family members want to understand how to cope with it better; and
• Families that appear to be having difficulty making the changes required
to pass from one developmental stage to the next - for example when
adolescents start to become more autonomous.
• Family therapy in such cases is an effective way of dealing with concerns
which are set in a troubled family system. It may often be suitably
combined with treatment of individual family members:

Objectives

After studying this Unit, you will be able to:

• Understand the assumptions of systems theory;
• Learn the process of assessment in family therapy; and
20
• Make family formulation,

/
 Initial Phase
16.2 MAIN THEME OF INITIAL PHASE
The initial stage is a very crucial stage in any form of therapy. It's the stage
where a working relationship is established with the family. It also involves
motivating the family to accept treatment and clarifying any misconceptions the
family might have about therapy. The therapist right from the initial meeting
tries to alter the individual/family's perspective of the problem. An effort is
made to weaken the idea that the presenting problem associated with the
index patient is encased within that person; instead the problem is perceived
to be a by-product of the situation that individual is in. In other words,
therapy involves understanding what the individual/family wants, how they see
the problem, and how well the therapist can help each family member take
up responsibility for it. Then, the initial phase also involves defining tentative
goals for therapy which can either be modified or more precisely defined
during the course of therapy.
16.2.1 Assumptions.
The family perspective is grounded on the assumptions that the presenting
concern of the family may:
1. Serve a function or purpose for the corrective maladaptive/deficient family
pattern,
2. Maintain homeostatis in the family,

3. Be a function of the family's inability to operate productively especially

during developmental transitions, and
4. Be a symptom of dysfunctional patterns handed down across generations.

Check Your Progress Exercise 1

Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this
Unit.
1. List the common contexts in which a family therapist sees clients.

2. Name the important things to be covered during the initial phase of

therapy.

3. List the basic assumptions of systems theory regarding presenting

concerns of families.

21
Processes of Counselling and
Family Therapy 16.3 ASSESSMENT PROCESS IN INITIAL PHASE
Assessment reflects the theoretical basis of the therapists. But, regardless of
the theoretical background, a careful and thorough assessment is very important
for successful therapy. A psychoanalytic therapist emphasises interactional themes
including presenting complaints. Systems theorists centre assessments around
certain core themes or dimensions for all the family members. Behaviourists
focus on the stimulus-response contingencies in interactions. The presenting
complaints may be taken at face value in systems perspective or behavioural
perspective but not in psychoanalytic perspective. However, the aim of the
assessment process is to understand the current functioning of the family.
There are two ways of achieving this; these are given below:

1. Observe the family members' interaction, and

2. Ask relevant questions and study carefully the responses of the family
members, that is, both verbal and non verbal.

16.3.1 Initial Contact

This is where the stage for the formal assessment of the family is set. During
this phase, the emphasis is upon 'joining' the family and establishing a rapport
with the entire family. The therapist should demonstrate control over the session
while being relaxed, confident, conversational, indicating warmth through eye
contact, body language, and allowing all the members of the family to talk.

The therapist should explain to the family that the sessions would be once or
twice a week, and each session for about an hour.

The therapist should stress on the need for the entire family to attend the
sessions and elaborate on the same: To help the family members understand
the importance of this, the therapist may point out that:

• The problems of the individual may be best understood in the context of

that person's family,

• The 'behaviour of one person is always affected by the behavior of the

other family members,

• The other members of the family might be a part of the solution and may
be able to help in the improvement of the problem behaviour.

Even when the family members are reluctant to attend, the therapist will be
able to gather information regarding the system's functioning and resistances.

The therapist begins the process by obtaining details about various .family
events arid observing the interaction between the members of the family and
uses this to gradually understand the past and the present of the family life
and the family history gradually emerges over the course of therapy.

The therapist at this stage has to deal with the expectations that the family has
regarding therapy. They have to be helped to understand that the change will
happen gradually in the family and cannot be brought about at the end of
every seSSIOn.
22
 Most family therapy is conducted by a s010 therapist "though therapist pairs Initial Phase
and multiple observer- consultant teams are common in some training centres.

16.3.2 Defining the Goals. for the Initial Phase

Both the therapist and the members of the family are involved in defining the
goals for the initial phase. These goals can initially be tentative but can be
modified as the therapy progresses.

Most family, and couple-oriented therapists endorse many. or most of the

following goals, regardless of the particular nature of the presenting problem:

1. Reduction of presenting problem behaviour or experience

2. Improving the family or couple relationship, for example, enhanced

communication, problem-solving and conflict resolution skill and better
coping skills

3. Helping the family members improve autonomy and individuation

4. Improving the ability of the family to interact effectively with important

larger social systems, and

5. Increasing the awareness and understanding of how couples' and families'

patterns of interaction influence the everyday effectiveness in living.

.• There are goals which are short term and help the family in the process of \l,
.achieving their own or the therapist's objectives. These are sometimes referred
to as process goals. Common forms of such mediating or process goals are
achievement of insight, the teaching of various interpersonal skills, for example,
communication and problem-solving, and the disruption of problem-maintaining
patterns of behaviour to allow family members to learn more adaptive responses.
Mediating goals may also be more abstract and are not necessarily discussed
with the families by the therapist.

16.3.3 Family History and Genograms

A genogram, also referred to as 'family map', is a useful tool both in the
assessment phase as well as the intervention phase of therapy. Information
about the family can be gathered from the family using the genogram and the
duration or timeline as an aid. A useful point to start would be to gather
information regarding the dates of life events like marriage, birth of a child,
and death of a parent. This provides a reference point and the other information
can be gathered around it. It provides information regarding the relationship of
individual family members, their age, gender, health issues, strengths, weaknesses
and other relevant details. It is useful to construct the genogram in the family
.members' presence during the sessions since this makes it easier for them to
remember the relevant details.

It is important to include all the members of the family in the construction of

the genogram unless they are very young to participate. This further continues
rapport building and also helps therapist understand their perspectives about
family functioning.
Processes of Counselling and Check Your Progress Exercise 2
Family Therapy
Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this
Unit
1. What are the common goals of family therapy?

2. What are process goals?

16.4 STRUCTURAL FAMILY SYSTEMS RATING

SCALE (SFSR)
This scale, developed by Szapocznik et aL, helps the therapist understand the
family along the following six dimensions of family functioning. The therapist
should be able to make observations regarding most of these by the end of
the first session itself. Information on these aspects can help the therapist
draw hypotheses regarding the family functioning.
1. Structure: Structure can be defined as the invisible set of functional
,~::- _""'"demands that organises the way the family interacts, or the consistent and
.•.
repetitive modes of behaviour of the family members. The observation of
patterns of interaction gives clues about how the family is organised.
2. Resonance: Resonance is the extent to which the family members are
enmeshed or disengaged with each other.
3. Flexibility: Flexibility can be defined as the capacity of the members of
the family to tolerate change.
4. Developmental stage: Many families' presenting concerns would be
related to the difficulties in making the transition from one developmental
stage to the next. It then becomes important for the therapist to understand
the developmental stage and the successful or difficult transitions the family
has made. This would also guide the process of goal setting in the
therapy.
The developmental stages according to the Duvall are :
1. Married couples without children,
2. Child bearing families (oldest child 0 to 30 months),
3. Families with pre-school children (oldest child 2Y2 to 6 years),
4. Families with school going children (oldest child 6 years to 13 years),

24 5. Families with teenagers (oldest child 13 years to 20 years),

 6. Families launching young adults (from first child to last child leaving Initial Phase
home),
7. Middle aged parents (empty nest to retirement), and
8. Aging family members (retirement to death of both parents).
5. Identified patienthood: There is usually one person who would be seen
as the focus of the concern in the family. The relationships that the
identified patient (IP) has with others may reflect other relationships in the
family, even the relationships that do not involve the IP directly.
6. Conflict resolution: This gives information regarding the communication
within the family, the family's approach to solving a problem, it's strengths
and weaknesses. Families who are able to handle conflicts constructively
move from focusing on people to focusing on issues. They attempt to
meet everybody's needs instead of demanding their own.

16.5 COMMON ~ECHNIQUES USED IN THE

INITIAL PHASE
The following are some of the techniques to be practised by the therapist
during the initial phase itself and these techniques would be useful throughout
the process of therapy.
• Neutrality
When asking questions to each family member, the therapist may seem allied
with the person being questioned while the question is occurring, but the
alliance shifts when the therapist questions the next family member. The end
result is that the therapist has successive alliances with, every member and is
allied to everyone and no one at the same time. The therapist also has to be
careful to declare no judgement about any family member whether implicitly
or explicitly since this would lead to ruptures in the alliance.
• Circularity
This is the ability of the therapist to ask questions based on the feedback
given by the family members in response to her or his own questions about
the family. This is done to help the family to understand the systemic view and
also to provide new information about their own concerns. This also helps the
therapist confirm or negate her or his own hypotheses about the functioning
of the family. This method also helps the therapist raise the neglected issues
in the family indirectly. For example, expressing appreciation for each other or
modeling a desired behaviour for the child.
When asking circular questions, it is important to:
• Ask about specific ,behaviours, family events or interaction,
• Attempt to discover the full sequence of the members' behaviours which
may occur repeatedly with the problem behaviour thereby maintaining it,
• Ask only in terms of relationships between family members,
• Engage each member of the family, never spending more than 5 to 7
minutes with each person, and
• Ask those questions which are relevant to the hypotheses, not questions
which are random and without purpose. 25
 Processes of Counselling and Some examples of circular questions are given below:
Family Therapy
1. What does he do to show you that he is angry?
2. When does he show this behaviour?
3. How does your sister respond?
4. How is it different from what was happening when papa was alive?
5. What would be the problem in the family if the things continued to be
as they are?
6. What do you think your brother will do if mummy starts working full
time?

• Reframing
Reframing refers to changing the perspective of the family members about an
issue such that, the meanings of the behaviours associated with that issue are
_viewed in a different way so that modifying the behaviour becomes easier for
the person or family.
The member's intent behind the actions can be positively viewed, not necessarily
the actions themselves. The parents, for instance, may be using inappropriate
methods to discipline the child, may be using physical or verbal abuse. But,
the intent of disciplining the child is commendable if not the 'means'. This
feedback might help the parents think of other 'means' to achieve the same
goal namely, disciplining the child.

16.6 DEVELOPING A FAMILY FORMULATION

This involves considering how the family functions and if the presenting problems
are related to how the family functions, if so, how so and to what extent?
The formulation should summarise the therapist's understanding of the family.
It should involve:

• A brief description of the presenting concern that has led the family to
seek help, and of the expectations they have from therapy,
• Family members' ages, relationships, occupations, and the family's
developmental stage (genogram),

• The therapist's understanding of the family, it's current functioning and

how the problem behaviours are being maintained, using any theoretical
model that the therapist finds helpful,

• The family's strengths, assets and motivation to change, and

• Information about the family's relationship with the supra-systems and
how this is affecting the family.

The formulation also should logically -lead to the treatment plan and the
prognosis - with and without treatment.

Feedback and Recommendations to the Family: The feedback depends

on the theoretical orientation of the therapist as well as the nature of the
family's concerns. The feedback should always include any recommendations
the therapist has regarding the further investigation or assessment of the family
'. 26 and it should state whether further treatment is recommended and if so, what
type. At this stage, the family members are given more choices, alternatives, Initial Phase
and more effective options.

Arranging the Next Step: Following are the signs of successful completion
of initial phase and preparation for middie phase:

• Increased dependency on therapist, for example, family may ask therapist,

"Tell us what we can do?",

• Weakening of rigid family patterns,

• Spontaneous recognition of dysfunctional aspects of interactional styles,

• One or more than one member spontaneously identifies that she or he

needs to change in specific behoviours, and
• Family members are helped to remain hopeful.

It is important that the family knows what is to happen next when they leave
the initial interview.

11. Feedback to Referring Professional and Others: Feedback to the

referral source should include the referrers' involvement in the ongoing
treatment process for the family. Sometimes more active participation
might be necessary like joint treatment planning with teachers, special
educators, physicians or social workers.

Check Your Progress Exercise 3

Note: a) Read the following questions carefully and answer in the space
provided below.

b) Check your answers with those provided at the end of this

Unit

1. Name the six dimensions assessed in the Structural Family Systems

Rating Scale .
..................................................................................................................

..................................................................................................................
..................................................................................................................
2. What is circularity?
..................................................................................................................
..................................................................................................................
..................................................................................................................
3. What is neutrality?

..................................................................................................................
..................................................................................................................

..................................................................................................................

4. What is refrarning?

..................................................................................................................
..................................................................................................................
..................................................................................................................
-------------------------- 27
, ,
Processes of Counselling and
Family Therapy 5. What are the main aspects of a family formulation?

16.7 LET US SUM UP

• Family therapy involves understanding the presenting problems of the
individual in the context of his/ her relationships.

• During the initial phase itself, the therapist helps the family understand that
the presenting problem associated with one person is not only due to that
person; instead it is seen in the context of the interpersonal relationships
in the family.

• The assessment phase begins with the therapist joining the family and
establishing a relationship based on trust and respect with all the members
of the family.

• The family and the therapist are jointly responsible for discussing the
goals of therapy.

• The therapist tries to understand the functioning of the family by observing

the interaction of the family to understand about the past and it's relevance
to the present.

• Some of the techniques that would be useful to keep in mind through out
the process of therapy are neutrality, refrarning and the method of circular
questioning. This would help in building and strengthening alliance with the
members and also enhance their motivation to change.

• This would lead to a family formulation which explains if the presenting

problems are related to how the family functions, if so, how so and to
what extent?

• Feedback is given to thefamily and the recommendations regarding further

investigations and treatment are given.

• The referral sources are also involved in the treatment process if and
when necessary.

16.8 GLOSSARY
Circularity Ability -of the therapist to ask questions based
on the feedback of the family members on
therapist's earlier asked questions about the
family.

Flexibility The capacity of the members of the family to

tolerate change.

Genogram A pictorial display of a person's family

28 relationships and medical history.
Process goals Short term goals that help the family in the Initial Phase
process of achieving their own or therapist's
objectives.
Reframing Changing the perspective of the family
members about an issue such that, the
meaning of the behaviours associated with that
issue are viewed in a different way so
modifying the behaviour becomes easier for
the person or family.

Resonance The extent to which the family members are

enmeshed or disengaged with each other.
Structure Tile invisible set of functional demands that
organises the way the family interacts, or the
consistent and repetitive modes of behaviour
of the family members.

16.9 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
Check Your Progress Exercise 1

1. The common contexts in which a family therapist sees clients are families
with concerns about children or adolescents, families reporting that members
have problems in relating to each other, one of the family members has
a chronic illness and the family members want to understand how to
cope with it better, and families with difficulty in transition from one stage
to the next.

2. The important things to be covered during the initial phase of therapy are
establishing rapport, alteration of problem perception, motivating the family
for change and setting of tentative goals.

3. The basic assumptions of systems theory regarding presenting concerns of

families are to serve a function or purpose for the corrective maladaptive/
deficient family pattern; maintain homeostasis in the family, be a function
of the family's inability to operate productively especially during
developmental transitions and be a symptom of dysfunctional patterns
handed down across generations.

Check Your Progress Exercise 2

1. The common goals of family therapy are: reduction of presenting problem

behaviour, improving the family or couple relationship, helping the family
members improve autonomy and individuation, improving the ability of the
family to interact effectively with important larger social systems, increasing
the awareness and understanding of how couples' and families' patterns
of interaction influence the everyday effectiveness in living.

2. Process goals can be defined as short term goals that help the family in
the process of achieving their own or the therapist's objectives.

29
Processes of Counselling and Check Your Progress Exercise 3
Family Therapy
1. The six dimensions assessed in the Structural Family Systems Rating
Scale are structure, resonance, flexibility, developmental stage, identified
patienthood and conflict resolution.

2. Circularity is the ability of the therapist to ask questions based on the

feedback given by the family members in response to her or his own
questions about the family.

3. Neutrality can be defined as the technique where the therapist has

successive alliances with every member of the family and is allied to
everyone and no one at the same time.

4. Reframing is changing the family's perspective of a problem such that the

meanings of behaviours associated with the problem are viewed in a way
that modifying the behaviours becomes easier for the family.

5. The main aspects of a family fonnulaiton are brief description of presenting

concern and expectations from therapy; genogram; therapist's understanding
of current family functioning; family's strengths and weaknesses and family's
relationship with the supra-system.

16.10 UNIT END QUESTIONS

1. What is the main theme and assumptions of Initial stage of family therapy.

2. Describe the various processes used in assessment in your words.

3. What do you mean by SFRS? Explain the common techniques used in

this.

4. Discuss the main signs of successful completion of initial phase. r

••

16.11 FURTHER READINGS AND REFERENCES

Ables, B. S. (1997). Therapy for Couples. San Francisco: Jossey Bass.

Barker, P. (1992). Basic Family Therapy. Third Edition: Blackwell Scientific

Publications

Carter, E. Ar. & McGoldrick, M. (1980). The Family Life Cycle: A

Framework for Family Therapy. New York: Gardner Press, Inc.

Green, J. B. Introduction to Family Theory and Therapy: Exploring an

Evolving Field. USA: Thomson, Brooks/Cole.

Sholevar, G. P. (1981). The Handbook of Marriage and Marital Therapy.

New York: Spectrum Publications Inc.

Szapocznik, J.; Hervis, 0.; Rio, Arturo T.; Mitrani, & Victoria B. (1991).
Assessing change in family functioning as a result of treatment: ~~ "tro!~tural
Family Systems Rating scale (SFSR). Journal of Marital & Family Therapy,
17(3), 295-310.

30
UNIT 17 MIDDLE PHASE
Structure
17.1 Introduction

17.2 Goals of Therapy

17.2.1 What are Goals?
17.2.2 Joint Creation and Agreement on Goals
17.2.3 Clarity of Goals
17.2.4 Short and Long-Term Goals
17.2.5 Challenges to Establishing Goals in Family Therapy

17.3 Case illustration

17.3.1 Reason for Seeking Family Therapy and Background Information
17.3.2 Family Life Cycle Assessment
17.3.3 Family Hypothesis
17.3.4 Creating Treatment Goals
17.:5.5 Intervention
17.3.6 General Principles in Family Therapy

17.4 Challenges in Family Therapy

17.4.1 Therapist Neutrality
17.4.2 Resistance to Change

17.5 Let Us Sum Up

17.6 Glossary

17.7 Answers to Check Your Progress Exercises

17.8 Unit End Questions

17.9 Further Readings and References

17.1 INTRODUCTION
The middle phase of therapy marks the beginning of the intervention phase.
Through the assessment, the therapist obtains information on the problem areas,
the structure and functioning of the family and its strengths. Most importantly,
assessment contributes to the development of the family hypothesis. An
important, initial task of the middle phase is the formulation of therapy goals.
The second task of the middle phase is to address the therapy goals by
employing various family therapy techniques. Some techniques employed are
common across the different schools of family therapy, while others are more
specific to a particular school. Usually, techniques are integrated from different
schools to best achieve the goals of therapy. The middle phase of therapy
usually incorporates an average of fifteen sessions. The number of sessions
may vary across families. Some individuals/families that present with more
complex issues require more number of sessions. The usual frequency of
sessions is once or twice a week. In this Unit, we will study about the middle
phase of counselling/family therapy.

31
Processes of Counselling and Objectives
Family Therapy
After studying the Unit, you will be able to:

• Understand the middle phase of family therapy;

• Explain the goals for middle phase of therapy; and
• Discuss the challenges in family therapy.

17.2 GOALS OF THERAPY

Let us now get familiarised with the goals of family therapy.

17.2.1 What are Goals?

Family therapy goals refer to the objectives of therapy. Everything the therapist
does help the family to achieve these goals. Goals are the answer to the
questions, like "what do I want to achieve at the end of this therapy?"; and
"what are the changes that need to be brought about in the family to improve
its functioning?". Goals often represent the 'desired state' at which families
coming for therapy wish to reach (Barker, 1992).. Many families and couples
come to family therapy with negative goals. Parents want their children to stop
fighting with each other, a spouse may want her or his partner to stop arguing;
a couple may want their child to stop spending so much time with friends.
Though these are valid reasons for seeking therapy, it is helpful if the family
therapist can help the family reframe their objectives in positive terms. For
example, it is useful to ask if the children are not to fight, how they should
deal with disagreements. This gives some direction to the goals. The family
may then defme the goal as children should learn how to talk peacefully and
solve disagreements.

17.2.2 Joint Creation and Agreement on Goals

In family therapy goals are always created jointly by the family and the family
therapist. When a family comes for therapy, the family members have their
own agenda of what they would like to see changing. At times, what the
family wants may not be in their best interest. At other times, the family
therapist may identify some areas that are important to be addressed for
healthier functioning of the family, but the family may no! identify that as a
goal of therapy. For example, the family may identify change in the behaviour
of the children (fighting) as a goal of therapy. However, as a family therapist
one may identify that for the behaviour of the children to improve the parents
need to function better as a unit and their communication and disciplining
styles need to improve. The therapist then puts this across as the goal of
therapy and helps the couple see the importance of achieving this goal for
themselves and/or their family. The therapist does not force her or his own
agenda, rather, helps the family accept it as valid. Consensus between the
therapist and the family on what the goal of therapy is important. Absence of
this consensus often becomes a reason of poor outcome and drop-out from
therapy.

17.2.3 Clarity. of Goals

Many a times even when goals are stated in positive terms, they are often
32 vague and ill-defined (Barker, 1992). A family may define the goal of therapy
as 'to be a happy family'; to 'get along with each other better' or 'be closer Middle Phase
as a couple'. These are desirable goals for a family and for family therapy;
however, these are still vague. The therapist does not have an idea of what
will make a family closer or help them get along better. It is helpful to ask
the family to elaborate or describe in detail what will make them happy. Some
questions that can be used to gain clarity can be "what would make you
happy as a family; what needs to change to make things happier; how should
things be in the family now; what does each member need to do differently
to make it a happy family?" Answer to these questions will help both, the
therapist and the family to gain clarity on what they expect out of therapy and
their family members.

17.2.4 Short and Long-Term Goals

As the name suggests goals can be either short-term or long-term. Short
term goals refer to the goals that are more immediate and need to be
achieved in order to address the larger goals. These, at times, are not even
explicit to the family but are a step towards achieving the desired goals. Some
of the short-term goals include: (a) ensuring that both partners participate
equally in the session; (b) help discussions on their emotional experiences (for
example, hurt or shame); (c) altering communication between members to
reduce conflicts and increase positive communication; (d) increasing their problem
solving capacity; (e) ensuring the well-being of the family members and reducing
the stress experienced; and (f) avoid blaming and decrease escalation of fights
in the family.

Long-term goals reflect the domains of the family functioning that need to be
improved. These may include: (a) increasing intimacy between couple; (b)
increasing cohesiveness; (c) making the hierarchies more age appropriate; (d)
encouraging forgiveness in the relationship; (e) building trust between family
members; (f) creating healthier subsystem boundaries; and (g) creating healthier
external boundaries to make families self-reliant for negotiating future events.

17.2.5 Challenges to Establishing Goals in Family

Therapy
There exist numerous challenges to establishing goals in family therapy. These
challenges can present in different ways. For example, while obtaining clarity
on goals, one member's criteria for happiness can be quite different from the
opinion of the other family member. One partner may define happiness in form
of greater closeness between the couple while the other may defme it in terms
of partners sharing a better relationship with her or his family of origin. Parents
may want that the family can become cohesive if the children (adolescents)
spend more time with them, while the adolescents may demand their own
space and privacy. At other times, the goals may be completely opposite
where one partner may want to stay in the marriage while the other may want
to separate. Thus, in these situations though the members have clarity on
goals, there exists a disparity and disagreement on the goals of therapy. It is
at these times that one of the primary task of the family therapist is to help
in arriving at a common agenda in therapy, where all the family members are
willing to work towards achieving it. Reaching a consensus on goals then
becomes an important short-term goal of therapy. This arriving at a consensus
on goals itself may require a few sessions. It is often achieved through use
of present and future 'Oriented circular questions. 33
Processes of Counselling and At times, though diverse, agendas of all family members can be adopted. For
Family Therapy example, the quality of time that the adolescents and parents share can be
enhanced to increase closeness; simultaneously the importance of individuation
can be explained and encouraged in the parents, where they respect their
child's right to privacy. On the other hand, there are times when the goals ar:e
opposite and a middle path needs to be found. For example, a couple may
decide that they are going to give their marriage one more try, and then
decide if they can not be in a relationship together and separate. Establishment
of a common agenda is essential for the therapy to have a direction, achieve
its goals and be successful.

Check Your Progress Exercise 1

Note: . a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this
Unit
1. What are short-term goals? Give examples.

2. State a few long-term goals of family therapy.

17.3 CASE ILLUSTRATION

17.3.1 Reason for seeking therapy and background
information
Mr. B and Mrs. P had been married for nine years and had a daughter M
aged seven years. Mr. B was aged 36 years, a postgraduate and a manager
in a private firm. Mrs. P was aged 32, a postgraduate and a homemaker for
last five years. The family presented for consultation as they wanted to know
how to deal with their daughter. M's teacher had found her beginning to get
angry with her classmates and occasionally hitting them, and thought it best to
inform parents about this emerging problem. Both parents felt that something
was not fine with M as she had become clingy and demanding at home also>-
P also consulted as she felt helpless at not being able to do anything for M
and felt sad most of the time.
~.
17.3.2 Family Life Cycle Assessment
To understand the problem, we have to first assess the family information.

1. Family of origin of Mr. B

B was youngest of three siblings and described his family as being a distant
34
family. His father was a strict disciplinarian and frequently used punitive
measures. He was often afraid of his father and switchboard communication Middle Phase
was present through the mother. Father was the nominal and functional head
and his leadership was accepted by the family. Decision making style was
autocratic. Roles were gender specific. B admired his mother for her patient,
selfless way of looking after the family, but resented her for not being able
to stand up for him in front of the father. Over time he accepted this behaviour
of mother. His style of coping was to avoid fights; he would often agree with
his father on the face, but did what he pleased to do. His family would only
collie to know about it later and if they got angry, he would tune himself out
or just bear with what they said. Communication was more instrumental.
Family rituals were present. The noise level in the family was high.

Family of origin of Ms. P

P was second of four siblings and reported her family to be conflictual. There
were frequent fights between parents about how things needed to be done at
home. Father was the nominal and functional head, though his leadership was
challenged by her mother: Decision making was chaotic, though most of the
time mother had to do what the father said. P felt that the parents were often
so involved in their fights that she felt left out. She learnt the habit of asserting
herself as she wanted her needs met. Comparatively close relationship was
present between the siblings. P was often the person who was good at things
but at times felt that her family favoured her brothers. She often took
responsibility for her siblings and advised them, but felt unappreciated.
Communication was instrumental and emotional. Roles were gender specific.
Family rituals were present.

Courtship

The couple had an arranged marriage with the courtship lasting four months.
Both families liked the proposal on account of the family background, partners
being well educated and financially independent. Communication was minimal
during the courtship and at times initiated on wife's insistence. Husband wanted
a wife who could be his companion and who would be able to get along with
his family such that there would not be any fights. Wife wanted a partner who
would be able to appreciate her for who she was; who loved, supported and
cared for her.

Married Couple Without Children

The couple lived as a joint family after marriage. Fights usually revolved
around wife feeling unsupported' by the husband. P experienced role strain on
account of continuing with her job and looking after -the family. She felt family
was unappreciative and un-cooperative as she put in her level best to fulfill
her responsibilities. She often felt B was unable to take a stand or a decision;
often she had to push him to do something. Husband felt that P was often
dominating; telling him what to do. He felt incompetent and began to feel less -
confident about his ability to handle his family. During fights B would often
withdraw, angering P more. P thought that B kept quiet as he did not understand
what she meant and would often continue to explain things to him for a long
time. B at that point would tune himself out, superficially agree with P and
then not do it. This angered P more and she felt that B did not listen to her
or respect her.

35
Processes of Counselling and Married Couple .with Child 0-3 Years
Family Therapy
Couple planned a child within a year of marriage. Over a period of time the
above mentioned pattern of interaction was further established. P experienced
a greater role strain with the birth of M. Though she had some help from B's
parents in bringing up the child, she felt his parents where indulging M. This
increased fights at home and increased the occasions where P expected B to
take a stand.' make a decision or support her in front of his parents. B felt
that P was always angry with him and kept demanding more from him. B felt
that P's behaviour of confronting his parents was leading to a tense atmosphere
at home.

Married Couple with Child 3-6 Years

Couple decided to separate from B's parents when M was three years.
P decided to quit her job and become a homemaker. B felt that separation
was a way of decreasing fights at home. Though role strain felt by P was
marginally reduced and B was supportive in childcare, the other pattern of
interaction continued. P felt that every thing at home was her responsibility. B
had to be continuously reminded of things like bills, or maintenance work at
home. B gradually felt less and less need to remind himself of it as he felt
that anyway P would tell him about it. P felt she was the only one thinking
about their family and their relationship and felt tired of being the responsible
one. Parenting roles were shared by the couple and M shared a close
relationship with both parents. M also shared a good relationship with her
grandparents; however, P felt that times when M was with her paternal
grandparents they indulged her and often put P down in front of M or
challenged her disciplining style. She found B unsupportive in trying to establish
a boundary with his parents.

Married Couple with Child 6-12 Years

With the same pattern of interaction fights continued to increase with B beginning
to avoid time spent with P. P felt increasingly unloved, unsupported and sad.
B often came back late from work as he felt uncomfortable in the tensed
atmosphere at home. Fights increased with M often witnessing these. For the
last few weeks parents reported that M would start crying or getting angry
if the couple had any fights. This ended the fights as the couple paid attention
to M. At times M became more clingy and demanding and parents would
have a difficulty disciplining her or understanding her behaviour. Both felt
alarmed when the teacher also noticed changes in M's behaviour.

By the end of assessment, information was obtained about the life cycle
stages, maladaptive interaction cycles, and behaviour of each of the family
members and their feelings about the situation and each other.

Therapists need to gather information across all three areas: behaviour, thoughts
and feelings. Even across the family therapy, continuous intormation is obtained
across these areas. For this family, more information was available about
behaviour; thoughts and feelings about each other need to be explored more.

At the end of assessment some of the areas of intervention thac can be

visualised include, addressing M's insecurities, parenting skills, communication,
conflict resolution styles, decreasing role stain in wife, creation of positive
interactions, addressing external boundaries and identifying and meeting emotional
needs.
36
17.3.3 Family Hypothesis Middle Phase

In his family of origin, B learnt the conflict resolution style that the best way
to deal with conflict is to avoid it. He avoided conflict with dominating people
(father) and became passive aggressive. He saw mother agreeing to everything
father had to say and appreciated her being selfless. In her family of origin,
P was always the responsible one, but felt unappreciated for her strengths.
She saw that mother could oppose the father but, there was no point as he
did what he wanted. She learnt that asserting herself was important.
After marriage B's expectation of having a companion and no fights in the
family was not fulfilled. P found herself again being the one taking responsibility
of the relationships and not being supported or appreciated by B. B began
to view P as dominating and reacted to her in the same way as he would
to his father. P became more adamant about asserting herself as B often
would not do what she asked and neither would he independently take
responsibility for things. Both felt disappointed in each other and their
relationship. The more P as-serted herself or made B sit down and listen to
her the more he tuned out and did what he pleased and lost confidence in
himself. He felt that P was constantly undermining him. B was unable to get
a feeling of companionship and P felt uncared for. The disappointment and
fights increased over the years. The couple started to drift apart. Further, their
style of conflict resolution (B withdrawing P becoming aggressive) continues to
feed relationship anxiety. Thus, a mutually dissatisfying cycle of interactions is
perpetuated. M's getting aggressive, clingy or demanding was a reaction to
fights at home. M was feeling emotionally insecure. Often her crying and
aggression made the parents stop the fights and this reinforced her behaviour.
Further, disagreements over how to discipline M between P and B' s parents
was increasing the disciplining problems they faced with M.

17.3.4 Creating Treatment Goals

The assessment was completed and the couple was given a feedback of
hypothesis. Both accepted that their behaviour was having a negative impact
on the child and that they needed to make the child feel more secure. Here
we can see that the child's behaviour was bringing the parents closer together
so as to work on their problems. This is the role played by the symptom.
Both accepted the hypothesis partially; they accepted that their style of resolving
conflicts was making them distant from each other. Both agreed to make this
a goal of family therapy.

Though both accepted the hypothesis, they had difficulty understanding the
systemic view. They blamed each other for their fights. P felt that B deliberately
did not want to listen to her and took pleasure in making her angry. B felt
that P was dominating, thought he was incompetent and incapable of anything
and he felt tensed with her. Each felt the other should change. These negative
attributions that they had about each other were reframed - couple was
helped to see them not as inherent faults in each other but as the outcome
of their interaction pattern where each was arousing these feelings and thoughts
in the other. This helped the couple shift their stance from individual to systemic,
decrease blame and made them willing to explore it further as a goal of
family therapy.

Not all issues identified during assessment are addressed in family therapy ..
37
Family therapists need to identify those areas, where change will lead to
Processes of Counselling and maximum positive impact on the relationship. The couple was helped identify
Family Therapy the following goals:

Short- Term Goals

• Helping deal with M's feelings of insecurity,

• Improving patenting skills,

• Improving communication skills,

• Identifying a different way of handling conflicts,

• Addressing wife's anger and feeling that the family was only her
responsibility,. and

• Increasing participation from husband (family therapist objective - not

visible to couple).

Long-term goals
• Clarity on expectations from relationship

• Fulfillment of emotional needs

17.3.5 Intervention
Intervention began simultaneously across the different goals set in therapy.
Primarily the interventions described here can be understood as: doing systemic
work, changing dysfunctional thoughts and feelings; and skill building
(communication, conflict resolution and problem solving). It is discussed here
in the order of intervention techniques and not in the order in which it occurred
across sessions.

Right at the beginning of therapy one rule was set for the couple, that is,
there would be no fighting in front of M. Consent and cooperation was
elicited from both spouses. They were helped to understand the negative
psychological impact of M being a witness to their fights. Both agreed to
make efforts to do the same.

The interaction pattern identified was repeated in the session, with P automatically
assuming responsibility for the discussion and B not participating much. Efforts
made by P to elicit an opinion from B were met by silence; this increased her
. giving explanations to him about what they should be doing as parents. B
response to this was saying yes to P that he would do what she asked him
to do. P interpreted this as a again putting responsibility on her, which led to
increased anger in P. At this point the family therapist needs to create space
and support the partner who usually speaks less in order to encourage them.
Setting up communication rules of the session like each partner will get their
own time to talk; respecting each other's time to talk; emphasising on the
importance of listening to each other; importance of respecting diverse views
'of the p~rtner even if they are different from your own; and making them
understand that both are likely to have different perspective on things and this
does not make either person a 'liar', are often helpful in making the partners
slow down and listen to each other.

Interactions can be broken down and the couple can be helped to reflect on
38 their feelings a'nd verbalise' them. Asking both partners about 'how the
 interaction went, how would they like it to be different and what made P Middle Phase
angry and B withdraw' helps elicit both feelings and thoughts about their
interaction. This lays the foundation of systemic intervention with the family.
Often the therapist can assist this process by breaking down the sequence of
the interaction and encouraging reflections from partners on each aspect. Family
therapists can also add their own reflections in order to prompt reflections
from clients. This process helped B identify that he was not just tensed when
with P, but felt scared of her. His fear of her prevented him from voicing any
ideas and he put the responsibility of the decision on P (connecting feeling
with behaviour). B realised that his assumption that 'P will take care of
everything anyway' had kept him from paying attention to P's needs (connecting
thoughts with emotions and behaviour). B made negative attributions that
P was aggressive and critical of him. This made his behaviour towards P
passive aggressive and dismissive 'of her feelings. P's aggressiveness was
reframed as her clarity of thought and desire to do the best for her family.

P identified that it was important for her to do the right thing for her family.
This implicit expectation ofherself became stronger when she felt that she
could not rely on B to think for their family. She was able to reflect that
it was this expectation that increased the pressure she put on herself and on
B. Further, P was encouraged to reflect on B's disclosure of his feelings (he
felt scared of her). P initially felt angry at how could B think of her like that.
Questions like; "What did you feel when he shared this with you? Is he
usually withdrawn with all people? How are his interactions different with
other people? What could be the reason for this difference?" helped P reflect
s
on her behaviour. Here the positive aspect of B feeling was emphasized;
it was important for B what P thought of him. P was able to state that her
anger was not because of B's inability to take responsibility, rather because
he could not be open with her about his thoughts and feelings. This made her
feel insecure. Encouraging B to reflect on this helped him understand P's
fears. This identification of underlying feelings, fears, insecurities and needs in
I.

a relationship is an important technique of emotion focused school of therapy.

This school assumes that expressing underlying emotions encourages bonding
between partners.

These insights into what caused and maintained their dysfunctional patterns
., weJe translated into goals for change. Couple was helped to discuss about
what-they would like their relationship to be like in the future. This solution
focused technique was used to help the couple identify what they would like
to see changing in their relationship to make it better. This also helped clarify
expectations from the relationship. B identified increased participation in family
decision making, and spending more time with wife and increased comfort in
being himself in the relationship as his therapy goals. P identified working on
her anger, directly asking for B's involvement and being open to B's ideas as
goals for herself. Family therapist also interpreted P's actively pursuing any
decision and. trying to gain control as a way of achieving security in the
mamage.

While it was encouraged that B become more open about his thoughts and
feelings, P's style of communication often prevented an open discussion from
taking place. P's frequent and uncontrolled expressions of anger came in the
way of B feeling safe with her. B's lack of assertive skills prevented him from
opening up with P. For instance, while discussing how they would make M. 39
Processes of Counselling and feel more secure and how they can address her behavioural problems, P
Family Therapy made statements like 'You are ridiculous, you don't know how to handle
her'. B withdrew initially and then hesitantly said that 'She always thought that
she knew what was the best, if that was so then things would not have gone
wrong'.

These negative interactions are characterised by blame and often have a

tendency to escalate such that they then lead to fights. It is the task of the
therapist to change dysfunctional communication styles. Spouses here were
taught communication skills. Communication skills work is not done
independently in therapy. It is usually contextualised in discussions about issues
in therapy. In communication skills training both verbal and nonverbal aspects
of communication were addressed.

While communicating it was found that P's tone of voice was sarcastic; she
would get loud and start raising her voice when angry - these were related
to B withdrawing from the interaction. B's silence and using a blaming or
dismissive stance caused P to get angry. Often B would not pay attention to
P as a result when P asked him something he would not respond appropriately.
Communication skills taught to them included active listening skills like:
maintaining eye contact; not interrupting a partner, rather waiting for them to
finish; listening to partner, asking a question, clarifying or confirming if they
have understood it correct and then giving a response; listening to what the
partner is saying now, and not responding on the assumption that she or he
is going to always say the same thing, and; understanding partner's point of
view were taught. P was also encouraged to modulate her tone of voice,
especially when angry.

Couple was encouraged to use "I" statements instead of "You" statements. P

was then able to articulate that "I will sit down and talk to M about how she
is feeling. I don't know if she is feeling scared. I know that you worry about
her also, so I would like us both to talk to her together". B responded by
saying "I agree with you. I think we both should talk to her. I think my
spending more time with her, and you, will also help her see that we are
together". Here the couple was not only able to find a solution to how they
would address the goal of M's feelings of insecurity, they were also able to
talk about what they think, express their own ideas about how they can solve
the situation and affirm each other's point of view. It is important that couples
learn these skills. Teaching couples to express ideas of resolving a situation
instead of blaming each other, making requests instead of demands and each
assuming responsibility for the well-being of their family is vital. Parenting skills
were addressed in the same context.

Couple was explained regarding not using derogatory labels for each other. P
often had a habit of telling B, "How can you be so stupid". This was
discouraged and more respectful communication style of making requests, giving
positive feedback and not using any threats or ultimatums was taught. They
were helped to understand that when communication breaks, both people are
responsible for its failure and blaming the other does not help.

Importance of having a common and consistent style of parenting was

emphasized. The couple was explained that it was important that M received
the same message from both parents. It was vital that P and B share a
40 common view of what is acceptable form of behaviour. P was encouraged not
to put down B's efforts in front of M. P was helped to understand that even Middle Phase
if she did not agree with how B was handling a situation, it was important
they do not challenge
•.~,
'
or disagree with each other in front of M. Having a
discussion in: private to sort out and reach an agreement on how to discipline
M was encouraged.

Boundary issues with B's parents were addressed in the end. This was done
so as the family of origin is a sensitive subject and more importantly the
martial subsystem needs to be strong enough to negotiate with it. Both were
asked to discuss what did M being close to her paternal grandparents mean.
P was able to clarify that she wanted M to be close to both sets of
grandparents but felt hurt when the paternal grandparents put P down; she felt
hurt and felt that they did not consider her a part of the family. P wanted to
share a positive relationship with them but did not know how to begin.
Clarification of this helped soften B's stand regarding the issue. Both were
encouraged to problem solve regarding how would they like to communicate
the same, who will do it, how would they like to encourage a more positive
relationship, and what behaviours could make it happen.

Solutions to any problem need to emerge from the couple and are not provided
ready made by the therapist. The therapist can guide the partners in reaching
a solution by facilitating the process. It is only when the family members come.
up with a solution will they be motivated to work towards it.

17.3.6 General Principles in Family Therapy

One of the important initial tasks of the family therapist is to help build hope
in the family. Often asking the family members to identify their strengths,
positive moments or aspects of their relationship helps build hope. Therapists
should however refrain from making blanket statements like "everything will be
fine". Therapist may often have to act as the role model and help family
members identify positive changes. Positive reinforcement from the family
therapist validates the efforts put by the family and builds hope. Therapist
helps the family members learn the importance of positive feedback as an
important motivator of change. Additionally, if the therapist finds that only one
aspect is being discussed predominantly in the sessions (behaviour, thoughts
and attitudes or feelings), it is the task of the family therapist to find out more
about the neglected areas. Usually couples find it easier to talk about behaviours
and these are first to change in therapy. Finally, it is vital that family members
understand that responsibility for change lies with all members of the family.

17.4 CHALLENGES IN FAMILY THERAPY

17.4.1 Therapist Neutrality
In family therapy, neutrality is one of the biggest challenges in therapy. Since
both partners are likely to feel that they are right, family therapists are often
put in the uncomfortable role of 'judging who is right' by the family. Family
therapists need to be aware of it such that they do not get pulled into the
position of taking sides. They need to encourage the family members to clarify
their positions with each other and come up with answers. Therapists can step
in with a solution only when they find that the solutions that the family members
have come up with are unacceptable, unrealistic or damaging to the well-being .
41
of the family.
Processes of Counselling and 17.4.2 Resistance to Change
Family Therapy
Resistance in therapy can be visible in different forms. It may present as one
family member disrupting the sessions process, a member not being able to
move ahead in family therapy (for example, remaining stuck with a belief), and
at other times it may be the inability of the family to carry out the tasks
discussed in therapy. In either case, it is important that the family therapists
do not lose patience with the family or feel disappointed and angry at them.
It is crucial that the reason for resistance be identified and addressed. For
instance, at times the task set may be difficult for the family such that they
are either not ready for it or do not have the necessary skills to execute it.

Check Your Progress Exercise 2

Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this
Unit
1. State 'True' or 'False' :

i) Therapist neutrality is one of the biggest challenges to family therapy.

ii) Resistance to family therapy does not affect the family therapy process.

iii) The identification of underlying fears, emotions, feelings, insecurities and

needs in a relationship is an important technique of emotion focused
school of therapy. _

17.5 LET US SUM UP

In this Unit, you have studied that;
• Middle phase marks the beginning of the intervention stage,
• Tasks of the middle phase include : setting of therapy goals and employing
various therapy techniques to~dress them,
• Goals refer to the objectives of therapy,
• Goals are created jointly by the family and the family therapist - consensus
between the family members and the therapist is important, .
• Clarity is essential in formulation of goals,
• Goals can be short term or long term,
• Goals link the family assessment with the therapy plan,
• Middle phase involves feedback of hypotheses to family. This helps them
understand the problem better,
• Techniques from various schools are integrated to address the goals of
therapy,
• Change needs to be brought about in three areas there are, positive
42 behaviour, feelings and thoughts,
• Responsibility of change lies with both partners, and Middle Phase

• Therapist neutrality and resistance to change pose challenges to the therapy.

17.6 GLOSSARY
Short-term goals The goals that are more immediate and need to be
achieved in order to address the larger goals.

Resistance The factors that restrict the family members from

participating in family therapy.

Neutrality Therapeutic quality to be observed towards the

various participants in a family group equally.

17.7 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
Check Your Progress Exercise 1

1. Short term goals refer to the goals that are more immediate and need to
be achieved in order to address the larger goals. Some of the short-term
goals include:

i) Ensuring that both partners participate equally in the session,

ii) Help discussions on their emotional experiences,

iii) Altering communication between members to reduce conflicts and

increase positive communication,

iv) Increasing their problem solving capacity,

v) Ensuring the well-being of the family members and reducing the

stress experienced, and
vi) Avoid blaming and decrease excalation of fights in the family.

2. Long-term goals of family therapy may include :

i) Increasing intimacy between couple,

ii) Increasing cohensiveness,

iii) Making the hierarchies more age appropriate,

iv) Encouraging forgiveness in the relationship,

v) Building trust between family members,

vi) Creating healthier subsystem boundaries, and

vii) Creating healthier external boundaries, making families self reliant for
negotiating future events.

Check Your Progress Exercise 2

1. i) True

ii) False

iii) True 43
Processes of' Counselhng and
Family Therapy 17.8 UNIT END QUESTIONS
1. What are the tasks of the middle phase?

2. What are the types of goals for middle phase?

3. What are the principles of communication skills training?

4. List some of the techniques that can be used to bring about a change
in maladaptive emotions.

17.9 FURTHER READINGS AND REFERENCES

Ables, B.S. (1977). Therapy for couples. San Francisco: Josey-Bass.

Barker, P. (1992). Basic family therapy. Oxford: Blackwell Scientific

Publications.

Green, lB. (2003). Introduction to family theory and therapy: Exploring

an evolving field. Canada: Thompson Learning.

'f·

44
UNIT 18 TERMINATION PHASE: END
PROCESSES
Structure
18.1 Introduction

18.2 Types of Termination

18.3 Indicators for Planned Termination

18.4 Steps of Termination

18.5 Issues in Termination

18.5.1 Termination Anxiety
18.5.2 Resurgence of Problems

18.6 What can Cause Unplanned Termination?

18.6.1 Client Related Factors
18.6.2 Therapist Related Factors

18.7 Dealing with Unplanned Termination

18.8 Let Us Sum Up

18.9 Glossary

18.10 Answers to Check Your Progress Exercises

18.11 Unit End Questions

18.12 Further Readings and References

18.1 INTRODUCTION
Termination is often a topic that although important, is comparatively less
emphasised in literature. Much of the literature focus on how to initiate and
continue the therapy rather than how to end it (Barker, 1992). Nevertheless,
the way the therapist handles the therapy termination is important. Termination
of a therapy session and the therapeutic relationship are significant for the
client. Termination is a process and usually not carried out in a single session.
The termination phase may last up to three sessions. Sessions are gradually
tapered with longer gaps such that both the therapist and the family feel
confident of their ability to handle things on their own.

Family therapists usually begin by sharing with the families in the initial session
that the family therapy process is a time-limited relationship established for
achieving certain goals in family therapy. Even if the duration of family therapy
is not specified, clients know that it is a time-bound arid session-bound
relationship. This helps prepare the families for the termination right from the
beginning. We will learn about the termination phase of family therapy in this
Unit

45
Processes of Counselling and Objectives
Family Therapy
After studying this Unit, you will be able to:

• Understand termination and its types;

• Explain indicators and steps in planned termination process;

• Discuss the issues in termination process; and

• Identify the causes of unplanned termination.

18.2 TYPES OF TERMINATION

Therapy. terminations are of two types: (a) planned termination and (b)
unplanned termination. Planned terminations, as the name suggests, are designed
and considered. These are initiated by the therapist and on some occasions
by the family. For example, when the family therapist feels that the family has
been able to achieve the goals of.family therapy. Unplanned terminations are
usually sudden and leave the family therapy tasks and goals unfinished. These .
are initiated by the families themselves. For example, when the family has a
session appointment and does not turn up for the session and does not make
any efforts to continue with the family therapy.

18.3 INDICATORS FOR PLANNED

TERMINATIONS
Termination by the family therapist may be indicated in any of the following
circumstances:

• When objectives of the treatment are met. A review by both the therapist
and the family regarding whether the desired changes have taken place
helps clarify if the family is ready for termination. Asking the family to
examine what has changed is helpful. Termination is better accomplished
when the family members are able to see the extent of the changes that
have occurred, and when they realize their problem solving skills have
improved.

• At times the family therapist may decide to terminate the therapy if the
family's functioning has changed positively such that now they have the
resources needed to deal with any of the remaining problems. Here, even
though all the goals set are not met, if the family has the resources to
achieve them on their own, termination is planned. There may be structural
and functional changes in the family which enables the family members to
cope with problems that they could not have been able to solve earlier.

• Confidence of the family members in the changes they have been able to
bring about is another essential condition. Their confidence that they can
maintain these changes achieved in therapy indicates to the family therapist
that a termination can be planned. Also, certain techniques can be used
in termination to help them develop this confidence for immediate future
interactions and events the family will encounter after termination.

• The family therapist may decide to terminate therapy if it has been

46 .
r
ineffective despite giving it a good trial. At times a family may not respond
 to a particular style of therapy. The therapist explains to the family the Termination Phase: End
Processess
reasons for termination. If the family is willing for therapy, a referral is
arranged for them with another professional such that the therapy process
can continue. It is important to do this in a manner such that the family
does not lose hope for change. At times, explaining that a different therapist
or a style of therapy may benefit them more is useful in maintaining the
hope and motivation for change.

• At times a family therapist may plan termination as individual therapy may

be more indicated than family therapy. For example, in cases of domestic
violence, where one family member is scared that the other family member
is not going to take responsibility and stop the aggression; where a
member talking about the aggressor's behaviour is likely to make her or
him more aggressive, is where participation in the family therapy is
discouraged. Here individual therapy may be indicated and encouraged.

• Evidence of generalisation of skills learnt to many similar family problems.

18.4 STEPS OF TERMINATION

The termination phase of therapy incorporates the following steps:
1. Inform regarding planning of termination: Though the tapering of the
sessions is an indicator of termination, the family therapist explains to the
family that they can consider termination. The reasons for why the family
therapist thinks so are shared with the family. Family therapist can inform
the family either that their goals are more or less complete or that there
has been little or no progress, and that is why termination is being
planned.
2. Summarize hypothesis, goals and what happened in therapy: The
entire therapy process is summarised, right from the problems that the
family presented with, the goals established, what occurred, was addressed
or was learnt in therapy is recapitulated and gains consolidated. Each
member's understanding of their family relationships is focused on.
3. Examine changes: What has changed for each member and for their
family relationships is reviewed. Changes in beliefs, behaviours, feelings
and family structure and functioning are examined by asking all members
in therapy to reflect on them. Each family member's confidence in those
changes and their ability to maintain those changes is explored as well as
corrected from therapist's point of view. This is a good way for the
family to identify changes made, such that they feel motivated and hopeful.

4. Identify Issues left out: Allow members to reflect on issues left out of
the sessions that they would like to address on their own. These can
either be goals that were established which the therapist feels the family
is capable of addressing, or these can be areas that have not been
explicitly addressed. Even asking the family what is it that they would like
to work on can identify left out issues.
5. Anticipatedproblems:Helping the family identify challenges it may face
in the future and how they can use their strengths and resources to meet
these challenges is useful. This prepares the family for what is likely to
happen. It helps build their confidence in their skills and also gives the 47
family therapist an idea of whether the family is ready for termination.
Processes of Counselling and 6. Reinforcement and hope building: The family therapist can also provide
Family Therapy
a recap of what changes she or .he has seen the family members make
during the course of therapy. Recognition of strengths of the family and
. individual members is useful. Positive reinforcement of the family members'
efforts builds hope and belief in their own ability to solve problems. This
also motivates them to maintain their efforts to improve as a family.

7. Plans for follow-up: The family therapist also makes plans for follow-up.
When the follow-up session can be scheduled and the purpose of the
follow-up session is explained to the family. Family is informed of the
availability of the family therapist if required; termination of sessions does
not imply that they cannot consult the family therapist ever again. Contact
numbers of the family therapist are made available. Family is informed
"regardingcoming for more sessions (booster sessions) if new issues emerge.

Case illustration
The termination phase of the couple discussed in Unit 17 on 'middle
phase' is discussed here. The middle phase of therapy with Band P
lasted for 14 sessions. Initially the sessions were held weekly. After session
six the sessions were made bi-monthly and then gradually tapered.
The termination phase with the family comprised of two sessions. Couple
was explained that the therapist felt that the family was ready to terminate
therapy. Both spouses felt that they too were ready to think of termination.
This phase focused on each partner's understanding of their relationship
and their family since the start of therapy. The presenting problems were
reviewed. Each partner was encouraged to verbalize their new understanding
of what had been happening in their family; each was able to reflect on
their own behaviour that was dysfunctional. The family therapist reviewed
the goals of the therapy with the couple. Both felt that they were able to
achieve most of the goals set at the beginning of therapy. They were able
to make M feel more secure and were able to discipline her better. M
was better adjusted at home and at school. Each felt the other was
supportive as a parent.
They were able to review the new understanding they had gained about
their own behaviour, needs and expectations from each other and the
relationship. Each member's confidence in the changes made was explored.
Both felt more confident about their style of interacting. B felt he was
more comfortable with P and was gaining confidence in his ability to make
decisions. P reported a better control over her anger and an increased
ability to involve B in discussions with her. Both were able to jointly take
decisions; though B felt that he himself would like to increase his
participation in the process by giving more ideas by himself rather than P
prompting him. New ideas about themselves and the relationship were
reviewed and where appropriate were readjusted by the family therapist.
Both also reported an increased emotional fulfillment as B was able to
respect P and be supportive of her. P felt more secure in the relationship.
B felt that he was able to build a sense of companionship in the relationship.
Quality time spent with the family had increased. Commitment of each
partner to the changes made was ensured. Both were hopeful and were
motivated to maintain the changes made.
Couple was also given space to freely reflect on issues left out of sessions
48 and what they would like to do about it on their own. P identified further
 Termination Phase: End
increasing their intimacy as a goal. B was also able to acknowledge that. Processess
Both discussed ideas to enhance it further. P felt a more direct expression
of her needs would perhaps make it easier for B to recognize them. B
felt that whenever he was aware of P's needs, he would try and address
them. Here the family therapist made the expectations realistic that B may
not always be able to do so; this was not a sign of failure. Rather, both
spouses can acknowledge when they will not be able to address each
other's needs immediately.
Any problems that they could anticipate were also discussed. Changes
made by the couple like improved parenting, softening their stance towards
each other, greater understanding of each one's motivation, commitment to
new forms of communication and behaviours etc. were highlighted both as
hope building and as a review of gains achieved. This helped address the
anxieties regarding termination.
Couple was explained regarding a follow-up after 4 to 6 months. Contact
numbers were given and the couple was assured of family therapist's
availability if need arose. the idea and availability of booster sessions was
explained.

Check Your Progress Exercise 1

Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this
Unit
1. State 'True' or 'False' :
i) Planned terminations are designed, considered and usually initiated
by the family therapist. _
ii) Termination cannot be planned even when the goals of the therapy
has been met. _
iii) Confidence of family regarding handling the problems can be one
of the indicators of termination. _
2. What are steps of termination process?

18.5 ISSUES IN TERMINATION

18.5.1 Termination Anxiety
It has been observed that at times when the termination sessions are being
conducted the family may express anxiety about their ability to handle things
on their own. They may doubt their ability to retain the changes made and
their confidence in their ability to employ the skills learnt may decrease. Space
is given to the couple or family to voice what problems they can anticipate
49
so 'that these can also be addressed. Often helping the family reflect on
Processes of Counselling and changes made, their strengths and the family therapist's confidence in their
Family Therapy
abilities helps the family overcome this anxiety. At other times, addressing
anticipated problems helps the family gain a sense of control.

18.5.2 Resurgence of Problems

Occasionally, the termination anxiety may present itself in the form of resurgence .
of problems. The therapist can then adopt some of the techniques discussed
above to address it. If the problems that emerge at this stage are new it
means that there are still issues that need to be addressed and that individual
or family is not ready for termination. The duration of sessions is extended to
address the newly emerged problem areas.

18.6· WHAT CAN CAUSE UNPLANNED

TERMINATION?
'There are numerous reasons for unplanned terminations. Some of the reasons
are client based while at other times some therapist related variables may
result in unplanned terminations.

18.6.1 Client Related Factors

Individuals come from different view points and this affects whether they
continue with family therapy or not. Some families may discontinue or dropout
from therapy after the single session itself. Others may terminate after two or
three sessions.

Some client related factors, that are related to unplanned terminations are:

• Some families may decide to terminate if they are not really interested in
improving their family functioning.

• At times, families may get referred to the family therapist and when they
come for therapy they may not have any idea of what family therapy is
all about. They corfie just because they have been referred. At times like
these, when the therapist explains to them what family therapy involves,
they may not feel the necessity to work on their family.

• At times when the family therapist is unable to help the family understand
the systemic view despite all efforts, and the family continues to see only
one individual in the family as problem, then the family is likely to drop
out of family therapy.

• Some families that have lived with their problems or dysfunctional patterns
for a long time may not engage in therapy.

• Lack of patience with the therapy process and lack of energy that is
required to be invested to bring about a change may also lead to abrupt
terminations.

• At times, families may expect that a single session will solve their problems.
The fact that there are no magical solutions may disillusion them.

50 • Some individual factors have been identified, that are related to individuals I

or families dropping out of treatment. Some of these are: individuals with

 poor coping skills, with minimal frustration tolerance, poor ego strength, Termination Phase; End
Processess
and those whose relations with other significant people in their infancy
and childhood were so bad that they expect only bad things from the
family therapist (Ables, 1977).

• At times, family therapy may be discontinued when one core family member
who is needed for the therapy decides not to come for therapy.

• Lack of motivation for change.

• Conflictual goals that affect therapy outcome and unwillingness to arrive

at common goals.

• Unwillingness to take responsibility for change and family despite efforts

made by the therapist to encourage the same may lead to terminations.

18.6.2 Family Therapist Related Factors

Some of the family therapist related factors that are related to terminations are
as follows:

• Failure to establish rapport with the family.

• Family therapists pushing their own agenda in family therapy and dismissing
family's agenda entirely.

• Times where the family therapist is unable to control the session process
such that it allows all the family members to feel safe in the session may
lead to drop-out of a family member and thus the family.

• If one family member feels guarded or threatened in the therapy and/or

by the therapist, it is important that therapists identify and address this.
At times, despite all efforts whatever interventions the family therapist
may try, she or he may fail to engage the clients in family therapy.

• Aligning only with one family member alienates the others leading to
termination.

• Sometimes a spouse may refuse to come for family therapy as they feel
that the therapist had already seen their partner earlier. It is helpful that
when the couple is seen together, therapists maintain neutrality and not
align only with the partner who sought therapy. Address the agenda of
the relationship and not the partner who came first for consultation.

• Difficulties in helping the family make some constructive use of the session,
especially, if they are not ready to work, or when little is accomplished
in therapy sessions may lead to terminations.

• Inadequate assessment of the problem.

• Setting unrealistic goals.

• Family therapist losing patience with the family and holding them responsible
for not changing.

51
Processes of Counselling and
Family Therapy 18.7 DEALING WITH UNPLANNED
TERl\1INATIONS
At times when unplanned terminations occur and where other family members
are left who still want to come for therapy, then the therapy is usually continued
with willing family members. The systemic view is retained and the members
are helped to achieve their goals for their family as best as they can. Efforts
to get the absent family member can still be made. Family therapists also need
to reflect if there was anything in the therapy process itself that may have led
to a family member dropping out of therapy. At times, family may approach
the family therapist after some time and want to resume therapy. This is
encouraged and their abrupt termination is not held against them.

Check Your Progress Exercise 2

Note: a) Read the following questions carefully and answer in the space
provided below.
b) Check your answers with those provided at the end of this
Unit

1. Fill up the blanks:

i) Some families may decide to terminate if they are _

in improving their _

ii) Lack of _ to change may lead to unplanned

termination.

iii) Family therapist's to establish rapport with family

can become the cause of unplanned termination.

iv) Setting goals is one of the therapist related factors

for unplanned termination.

18.8 LET US SUM UP

In this Unit, we have studied that:
• There are two types of terminations - planned and unplanned.
• Unplanned terminations can occur for both client and therapist related
reasons.
• The family therapists need to learn to deal with unplanned terminations.

• Achievement of goals of therapy, confidence in the changes made and

generalisation of these changes are indicators of readiness for therapy
termination.

• Informing the family of termination, summarising, examining changes and

issues left out, addressing anticipated problems, hope building and making
plans for follow-up are the steps of therapy termination.
• Termination anxiety and resurgence of problems can complicate termination.
• At times a family may not be ready for termination and family therapy
52
needs to be continued for more sessions.
 Termination Phase: End
18.9 GLOSSARY Processess

Planned Termination Termination that is designed, considered and

initiated by the family therapist.
Unplanned Termination Sudden termination in which tasks and goals
of family therapy are left unfinished.

18.10 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
Check Your Progress Exercise 1
1. D True

ii) False

iii) True
2. Following are the steps of termination process:
i) Inform regarding planning of termination

ii) Summarise hypothesis, goals and what happened in therapy,

iii) Examine changes,

iv) Identify issues left out,

v) Anticipate problems,
vi) Reinforcement and hope building, and
vii) Plans for follow-up.

Check Your Progress Exercise 2

1. i) not interested, family functioning
ii) motivation
iii) failure

iv) unrealistic

18.11 UNIT END QUESTIONS

1) What are the types of terminations?
2) What are the therapist related factors in unplanned terminations?
3) What are the indicators of a planned termination?

4) What are the steps of termination?

18.12 FURTHER READINGS AND REFERENCES

AbIes, B.S. (1977). Therapy for couples. San Francisco: Josey-Bass.
Barker, P. (1992). Basic family therapy. Oxford: Blackwell Scientific
Publications.
53
 ,-

Notes

' ..
 MCFT-004
COUNSELLIN G AND FAMILY THERAPY: APPLIED ASPECTS

BLOCKl PROFESSIONAL ISSUES IN COUNSELLINGAND ~FAMlbYTHERAPY

Unit 1 Essentials for a Counsellor and Family Therapist

Unit 2 Selfofthe Counsellor/Therapist
Unit 3 Therapist/Counsellor and Client Relationship
Unit 4 . Professional Approach and Ethical Issues

BLOCK2 PRACTICAL ASPECTS OF COUNSELLING & FAMILY THERAPY-I

UnitS Creating a Therapeutic Climate
Ul).it6 Developing Communication Skills tor Counselling
Unit 7 Mediation in Counselling and Family Therapy
UnitS Mediation in Family Disputes
. Unit 9 Life Skills Education

.BLOCK3 PHACTICA.LASPI{CTS OFCOliNS~LLING & FA1VIILYTHERAPY-[l

Unit 10 Re 11ecti vc Rflatiol1shir1' Icchniqucs
Unit l l Relationship
! t Buildina Str<.\tl'uil..'s
I...... \,.,.

Unit 12 Suategics forFacilitating and I '\·;tiumillS Change

Unit 13 Barriers to Actualizing Therapeutic Relationships
Unit 14 Copill!:! with Dilficul l Si tuation-. i11 Counselling und Family therapy

BLOCK 4 PROCESSES OF COIJNSELLINC AND FAMILY THERAPY

Unit 15 Referraland Intake
Unit 16 Initial Phase
Unit 17 Middle Phase
Unit 18 Termination Phase: End Processes

MANUAL FOR SUPERVISED PRACTICUM (MCFTL-004)

MPDDIIGNOUIP.O.2TlFeb.2011

, i

ISBN : 978·81·266·5227·3