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Changing Practice for Changing Families. Thomas W. Blume, Ph.D., LMFT, LPC GCSA/Chi Sigma Iota Conference 2007. I Matching our practices to client and community needs.

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Changing Practice for Changing Families

Thomas W. Blume, Ph.D., LMFT, LPC

GCSA/Chi Sigma Iota Conference 2007

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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)

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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

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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

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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.

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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

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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)

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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

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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

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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?

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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

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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

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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”

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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?”

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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”

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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”

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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

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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?

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V Theories and models for contemporary issues

Premise: We may need new theories and models that address contemporary issues.

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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

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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

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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”

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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

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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

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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

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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.

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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.

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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”

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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.

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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.