Changing Practice for Changing Families

1. Changing Practice for Changing Families Thomas W. Blume, Ph.D., LMFT, LPC GCSA/Chi Sigma Iota Conference 2007

2. I Matching our practices to client and community needs Premise: The field of marriage and family counseling has developed in response to particular social trends and family circumstances

3. Client and community needs… • Social climate prior to 1950 • Rural populations moved into the cities beginning in the 19th Century, and the resulting physical and social dislocation led to crime and delinquency • Individuals in “modern” society struggled against tradition, but they also suffered from loss of extended family and community support

4. Client and community needs… • Mental Health/Psychiatry Before 1950 • Contrasting positions (focusing on the individual): • Liberate the individual from constraints (psychotherapy, including the humanistic movement) • Control the behavior of deviant, “mentally ill” individuals (hospitalization)

5. Our practices … • Family counseling before 1950 (not a mental health specialty) • Social workers visited homes, provided support for family life • Home economists taught classes on nutrition, parenting • Religious leaders provided guidance • Medical experts addressed sexual problems

6. Client and community needs… • Social climate 1950-1970 • The urban middle class moved from cities into suburbs • Middle class, educated, nuclear family norms gained dominance

7. Client and community needs… • Mental Health/Psychiatry 1950-1970 • The “Orthopsychiatric” movement focused on optimizing mental health • Family ideas caught on quickly: • The person who is “sick” is showing that the whole family has a problem • If the family “illness” gets fixed, everyone will benefit

8. Our practices … • Family counseling in its formative years (1950s through 1970s) • Multiple perspectives coexisted in a search for ways to be helpful • In the marketplace of competing ideas, the liberation ideology generally lost out to the ideology of control

9. Our practices … • The “Major Models”—What they were, what they were not… • Multidisciplinary sharing • Mixtures of ideas • Systems reflected the founder’s image, e.g. Bowen • Not always theories in a strict sense, but “institutionalization of ideas”—Berger and Luckmann

10. Our practices … • Practices based on assumptions about nuclear family needs (submarine metaphor) • Preservation of hierarchy and order • Life cycle norms • Communication—speaking and listening, few letters • Emotion management • Discipline styles • Sexual functioning espec female low SD, male premature ejaculation

11. Our practices … • Criticisms of “first order” approaches • Mechanistic, manipulative stance • Gender bias, stabilizing inequalities • Heteronormative bias • Ethnic and cultural insensitivity • Insensitivity to alternative family forms

12. II What’s changed since the 1970s Premise: Families today are different from the ones that came to the training clinics of Satir, Minuchin, Haley, and Madanes in the 1970s.

13. What’s changed… • Postmodern family – Judith Stacey and others. Families are different AND we are more aware of differences. • Family forms • Family functions • Conditions • Resources

14. What’s changed… • Family politics • Sexual revolution US • Youth rebellion, drugs and activism • Gender revolution • Recognition of LGBTQ relationships • Declining numbers of children • Declining early marriage • Declining marriage

15. What’s changed… • Family economics • Decline of single-employer careers • Decline of single-income families • Increased educational demands • Increased service industry, low pay jobs • Delayed entry of youth into full workforce participation • Global mobility, migration with family

16. What’s changed… • Family technology • Problems: Less sharing of • entertainment activities (megaplexes, game consoles) • culture/information sources • transportation • Problem: Weakened family “boundary” (Springer Break example) • Improvements: More access • tracking/access by mobile phone, IM • long distance communication options (telegram example)

17. What’s changed… • Family health • Deinstitutionalization of health & MH care • Increased survival with care needs eg alzheimers • Longer life spans • Declining fertility • Increased fertility options

18. What’s changed… • Family structures • Increased divorce • Increased stepfamily formation • More intergenerational and single parent households • More multinational households • More same-gender households • More unmarried couples • Egalitarian couple relationships

19. III Counseling needs of contemporary families Premise: These new families have special counseling needs that are not effectively met using models and techniques developed for a prior era.

20. Needs and issues: How do we make sense of the options? • BONES taxonomy as a structure for needs assessment • Behavioral assumptions • Organizational assumptions • Emotional assumptions • Narrative assumptions • Spiritual assumptions

21. Changing issues and needs? • Not everything has changed, e.g. we still need help with communication • Talking and listening skills (B, N, E) • Mobile phone rules and expectations (O, S) • Text skills—writing and reading/interpreting (B, N, E) • Text rules and expectations (O, S)

22. Changing issues • Family politics • Sexual expectations and performance, including male ED and women’s body image • Sexual identity announcements and responses • Gender expectations • Intergenerational conflicts • Decisions abut having children • Decisions about commitment and/or marriage

23. Changing issues • Family economics • Career choice, loss, re-choice in family context • Pressures of multiple jobs, conflicting schedules • Time and money for education • Lack of job satisfaction • Extended dependency of early adulthood • Relocation, financial and other responsibilities for relatives

24. Changing issues • Family technology • Separation of family members’ entertainment, transportation, and information create isolation • Family boundaries require constant attention • Access by mobile phone, IM (Disney lets us track kids) • Long distance communication continues to improve, including video • Text may once again become peripheral in families?

25. Changing issues and needs? • Family health • HIV/AIDS affects survivors and those infected—and creates prevention needs • Home/community health & MH care options continue to grow • Aging family members increase in number, along with care needs • Fertility problems and treatments are increasingly common

26. Changing issues and needs? • Family structure • Divorce (common but no longer growing) • Stepfamilies (now the dominant family form) • Intergenerational and single-parent households • Same-gender parent households • Multiple-worker households with no full-time caregivers • Unmarried couples with children • Grandparents caring for children

27. Changing needs—the Postmodern World • Intimacy • Mediated world, real vs. virtual connections • Information flood, getting lost in the noise • Skepticism vs. commitment--guardedness • Rapid change, loss of empathic connection • Consumerist values—“I can offer you a better deal”

28. Changing needs—the Postmodern World • Identity • Mediated world, “Saturated self” – Gergen • Information flood, intersecting and conflicting discourses • Skepticism vs. commitment—rejection of influence • Rapid change, danger of stagnation and irrelevance • Consumerist values—“How would you like that prepared?”

29. Changing needs—the Postmodern World • Diversity • Mediated world, increasing visibility of marginalized realities • Information flood, pathologizing discourses • Skepticism vs. commitment—distrust of consensus • Rapid change, difficulty understanding symbols & meanings • Consumerist values—“You can leave your unfortunate family history behind you”

30. IV Structures and systems for delivering services Premise: Serving contemporary families may require working in new ways—in different places, with professionals who are not conducting “medical consultations” or “psychotherapy”

31. Structures and systems… • In-home and integrated teams • In school and/or after school • Offices in health facilities • Walk-in, single session • Adventure/activity centers • Structured visitation centers • Online text chat, email, video chat, multifamily chat

32. Structures and systems… • Creativity needed— • Couple counseling cruises? • Couple crisis centers at resorts? • Family counseling summer camps? • Relationship World Theme Parks? • Offices in Meijer Stores? • Mobile family counseling offices? • Cell phone video sessions?

33. V Theories and models for contemporary issues Premise: We may need new theories and models that address contemporary issues.

34. Theories and models…. • EFT (Susan Johnson et al) • People need each other • Relational behavior is driven by emotional needs and reactions • People who feel weak and dependent often compensate by acting tough and aggressive • Emotional skills and responses can be modified

35. Theories and models…. • Feminist approaches (Bird, Hare-Mustin, Jordan, Knudson-Martin) • Power is a major factor in relationships • Unspoken power differences may be interpreted in emotional, personality, and relational quality terms • Human relationships are personal and unique

36. Theories and models…. • Narrative (Zimmerman & Dickerson, etc.) • Personalities, family structures, and mental disorders are all “stories”—different ways of describing events • Changing people’s stories changes their lives • It is hard to change stories all by one’s self, and loved ones can help with the “re-telling”

37. Theories and models…. • Social constructionist (Weingarten, Winslade, et al) • The words we use have power to help us connect or to complicate our connections • Careful listening—”witnessing”—is something people can learn to do for each other

38. Theories and models…. • Multicultural (Hardy, et al) • Unique “cultural locations” have their own realities • People with different realities often have trouble sharing their experiences • Before people can connect with others, it is helpful to spend time on exploring their own biases and expecations

39. Theories and models…. • IRC (Blume, et al) • Identities are not inside our heads, they are in interpersonal “space” • People seek positive validation from others • When identities become negative, they can be altered by working with others to change relationship stories

40. Identity Renegotiation Counseling T.W. Blume

41. The Process • There are many ways to conduct counseling that fit with the general idea of Identity Renegotiation. I summarize those options into four clusters of related understandings, goals, and counseling techniques. • These clusters of conversations and activities have a circular, sequential quality. A counselor may step into a client's life at any point in the process.

42. Observing Selves in Relationship (Identities) An IRC process begins with relational identity: learning to see and hear identity demonstrations and statements. • With an individual client, this awareness comes from • observing interactions with the counselor, and • reviewing stories about interactions with others. (This violates the “We’re here to talk about YOU” rule). • With couples, groups, and families, the IRC counselor attends to the verbal and nonverbal communications of identities.

43. Observing Coalitions, Discourses, and Negotiations As people become more aware of identities in interaction, an IRC process moves to a focus on interpersonal influence. • The counselor helps to identify coalitions and discourses in which interacting identities are shaped by expectations, labels, and selective approval. • The counselor also helps to identify more direct identity negotiations, as in the following common messages: • “Why can’t you get better grades? Your sisters were A students” • “I want you to be more loving”

44. Teaching and Practicing New Negotiation Strategies The actual process of Identity Renegotiation requires effective, collaborative negotiation strategies. • The IRC Counselor teaches collaborative problem-solving approaches that are broadly applicable in relationships. • With couples, families, and groups, clients can begin to practice these higher-level negotiation strategies in the counseling office.

45. Renegotiating Identities Identities are renegotiated through identity bargaining (verbal and nonverbal “bids”) and working toward consensus. • The IRC counselor acts a coach, helping to strategize about the changes people want in their lives and how (with whom) they will negotiate those changes. • As appropriate, the IRC counselor may act as facilitator for these negotiations or refers couples and families to trusted colleagues for this support.