UNIVERSITY OF NAIROBI

FACULTY OF ARTS

DEPARTMENT OF PSYCHOLOGY (MASTER OF COUNSELLING PSYCHOLOGY)

COURSE TITLE: Marriage and Family Counseling

COURSE CODE: CPY 553

LECTURER: DR. JOSEPHINE MUTHAMI

NAME: MARGARET MUSUMBI REG NO: C50/23287/2019

TOPIC OF DISCUSSION: RATIONALE AND HISTORY OF FAMILY THERAPY

INTRODUCTION

Family therapy, also referred to as couple and family therapy, marriage and family

therapy, family systems therapy, and family counseling, is a branch of psychotherapy that

works with families and couples in intimate relationships to nurture change and development.

It tends to view change in terms of the systems of interaction between family members. It

emphasizes family relationships as an important factor in psychological health. The different

schools of family therapy have in common a belief that, regardless of the origin of the problem,

and regardless of whether the clients consider it an "individual" or "family" issue, involving

families in solutions often benefits clients. This involvement of families is commonly

accomplished by their direct participation in the therapy session. The skills of the family
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therapist thus include the ability to influence conversations in a way that catalyzes the

strengths, wisdom, and support of the wider system. (From Wikipedia, the free encyclopedia)

Family therapy can employ techniques and exercises from cognitive therapy, behavior therapy,

interpersonal therapy, or other types of individual therapy. Like with other types of treatment,

the techniques employed will depend on the specific problems the client or clients present

with. Family therapy seeks to reduce distress and conflict by improving the systems of

interactions between family members. While family therapists often seek to have all family

members (affected by the problem) in the room that is not always possible or necessary. What

distinguishes family therapy from individual counseling is its perspective or framework, not how

many people are present at the therapy session. This type of counseling views problems as

patterns or systems that need adjusting, as opposed to viewing problems as residing in the

person, which is why family therapy is often referred to as a “strengths based treatment.”

 “Family” is defined by the modern family therapist as anyone who plays a long-term

supportive role in one’s life, which may not mean blood relations or family members in the

same household. Family relationships are viewed as important for good mental health,

regardless of whether all family members are participating in the therapy. Family therapy

is an ideal counseling method for helping family members adjust to an immediate family

member struggling with an addiction, medical issue or mental health diagnosis. It is also

recommended for improving communication and reducing conflict. American Addiction

Centers. (2017). The benefits of family therapy. Forterus. Retrieved from

http://forterustreatment.com/therapy/family-therapy/

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 RATIONALE

In the following paragraphs, is a discussion on why family therapy.

Why family therapy… because it deals with family pain.” – Virginia Satir

As the quote from Virginia Satir suggests, family therapy is necessary to address family pain and

heal a family’s wounds.

“To put the world right in order, we must first put the nation in order; to put the nation in order,

we must first put the family in order; to put the family in order, we must first cultivate our

personal life; we must first set our hearts right.” – Confucius

We all start this life with a family, whether that family is composed of blood relatives, adopted

parents, or a foster family. This family that we acquire when we are born influences every

aspect of our lives, from our first moments to our last.

Our family affects who we are and who we become, both for the better and for worse. We

learn our vocabulary, our habits, our customs and rituals, and how to view and observe the

world around us.

 We also learn how to love, and how to interact with others from these first important

relationships. If we are born into a healthy family with healthy relationships, we are likely

to learn how to maintain healthy relationships. If we are born into a dysfunctional family

that struggles to connect, we may also struggle to connect with others. (“Family Therapy”.

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 (2014, January 14). Good Therapy. Retrieved from http://www.goodtherapy.org/learn-

about-therapy/modes/family-therapy)

While it is certainly unlucky to be born into the second kind of family, that is a dysfunctional

one, it’s not an unchangeable situation. Nearly all families deal with some sort of dysfunction at

one time or another, yet most families retain or regain a sense of wholeness and happiness.

Family therapy offers families a way to do this – a way to develop or maintain a healthy,

functional family. We are all aware of the many issues, that families may be going through, a

few examples are:

 When a child is having a problem such as with school, substance abuse, or disordered

eating

 A major trauma or change that impacts the entire family (i.e. relocation to a new house,

natural disaster, incarceration of a family member)

 Unexpected or traumatic loss of a family member

 Adjustment to a new family member in the home (i.e. birth of a sibling, adoption, foster

children, a grandparent entering the home)

 Domestic violence

 Divorce

 Parent Conflict

 A family member with special needs/disability

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 Family finances etc

When the above mentioned issues present themselves in a family, family therapy will help to:

 Develop and maintain healthy boundaries

 Foster cohesion and communication among family members

 Promote problem solving through understanding of family patterns and dynamics

 Build empathy and understanding.

 Reduce family conflict

 In addition, family therapy helps family members improve communication, solve family

problems, understand and handle special family situations (for example, death, serious

physical or mental illness, or child and adolescent issues), and create a better functioning

home environment. For families with one member who has a serious physical or mental

illness, family therapy can educate families about the illness and work out problems

associated with care of the family member. For children and adolescents, family therapy

most often is used when the child or adolescent has a personality, anxiety, or mood

disorder that impairs their family and social functioning, and when a stepfamily is formed

or begins having difficulties adjusting to the new family life. Families with members from a

mixture of racial, cultural, and religious backgrounds, as well as families made up of same-

sex couples who are raising children, may also benefit from family therapy. (Howes, R.

(2010, January 17). The ten coolest therapy interventions: Introduction. Psychology

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 Today. Retrieved from https://www.psychologytoday.com/blog/in-therapy/201001/the-

ten-coolest-therapy-interventions-introduction)

Another observation why family therapy is essential is that the number of children from ages 0

to 3 in need of early intervention services has increased over the past decades. A family-

centered approach to early intervention services is essential. The family-centered approach

emerged from early intervention philosophy developed by professionals in response to the

needs of children and families. Over the past two decades, professionals providing intervention

to families with children with disabilities have witnessed a philosophical shift from individually

oriented care to family-centered care. Although the relevance of family therapy to these

families has been formally acknowledged through the Individuals with Disabilities Education Act

(IDEA), the integration of the fields of family therapy and developmental disabilities has not yet

occurred to any significant degree. Awareness of critical issues associated with developmental

disabilities and the potential impact on the family system is vital to the process of family-

centered intervention. Becvar, D. S., & Becvar, R. J. (2000). Family therapy: A systemic

integration. Needham Heights, MA: Pearson Education

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 THE HISTORY OF FAMILY THERAPY

Family therapy as a distinct method of psychotherapy practice did not actually emerge until the

early 1960s. However, the conceptual and clinical influences that informed the development of

family therapy can be traced to a much earlier period. Whereas the seeds of contemporary

family therapy were planted by those engaged in family-centered research on the etiology of

schizophrenia in the 1950s, the tillers of this soil were from a much earlier historical period.

Beginning with the development of professional social work in the Progressive Era of the late

19th and early 20th centuries, along with the early group work, marriage counseling, and child

guidance movements in the early 20th century, the soil from which family therapy was to spring

forth was duly cultivated (Becvar & Becvar, 2000; Nichols & Schwartz, 2008; Sayger, Homrich, &

Horne, 2000).

This soil was to be enriched in the late 1940s and early 1950s by the development of

cybernetics, systems, and communication theory. These theories, informed by concepts from

multiple disciplines including sociology, anthropology, and biology, provided powerful

theoretical frameworks for a more in-depth understanding of the complexities of family

interaction. These theories provided the conceptual framework for much of the early family-

centered research on schizophrenia. These research initiatives challenged the dominant

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psychoanalytic understanding that emotional disorders were of intrapsychic origin by

postulating the rather innovative and then novel hypothesis that these disorders were

symptomatic of troubled family relationships. It was then up to a group of innovative clinicians

in the 1960s who applied this research to psychotherapeutic work with families. Based on their

creative and groundbreaking work with families, family therapy truly emerged in the 1970s as a

clinical method to address issues of emotional suffering in families.

The history of family therapy also reveals profound paradigm shifts in understanding the

causative factors that contribute to emotional disorders.

Murray Bowen, the progenitor of BOWENIAN SYSTEMS THEORY, presented a seminal

professional paper in 1967 on his own process of differentiation from his family of origin. This

laid the groundwork for his focus on the awareness of, and disengagement from, toxic triangles

in one’s family of origin (also applied to his supervision with trainees). He believed that

therapists in training who undertook personal family of origin work became more effective

psychotherapists and had more satisfying personal relationships than those who did not

(Roberto, 1992). Guerin and Fogarty (1972) elaborated Bowen’s intriguing work on genograms,

dimensions of self (Fogarty, 1976), and the multigenerational model of family therapy (Guerin

& Guerin, 1976). McGoldrick and Gerson (1985), later joined by Shellenberger (McGoldrick,

Gerson, & Shellenberger, 1999), further illuminated the language and technique of genograms

Several other concepts contributed to family systems theory by members of this group merit

inclusion here. Jackson (1957) developed the construct of family homeostasis, referring to

attempts of the family unit to maintain its status quo and resist internal and external threats to
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its equilibrium. The historical development of family therapy reveals initially a challenge to the

notion of the autonomous self with the systems-based concepts of the relational self. Some

contemporary family therapy models are now grounded in the notion of the narrative self. It is

without saying that one of the earliest and enduring paradigms for understanding the human

self is based on the notion of individualism, self-reliance, or what can be labeled as the

autonomous self. Even though the family unit has always been valued as a basic social

institution in society, the family was seen as a collection of individuals or an institution that

could either support or impede the development of the autonomous self. (Gergen, 1999;

Polkinghorne, 1988).

There were two significant sociological theories, symbolic interactionism and later structural

functional theories that challenged the notion of the autonomous self with the understanding

that the human self was embedded in a system of human relationships. With the emergence of

systems and communication theories, those theorists and researchers who were giving

attention to understanding mental disorders such as schizophrenia confirmed that the human

self was indeed a relational and communicating being. And this self is embedded in a system of

relational networks, the primary one being the family. This concept of the human self as

embedded or as the relational self was to be the guiding paradigm for early family therapy. For

early family therapists, the source of human emotional suffering was seen as symptomatic of

disordered family relationships and/or disordered family communication patterns.

The third paradigm, which reflects a more contemporary and postmodern perspective of the

self, is the narrative self. This postmodern understanding of the self provides a unique insight
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into understanding families by giving attention to how family members construct their

intrafamilial experiences through language. Language is the means of organizing and structuring

life experiences. It is the narrative that individuals construct about their lives that provides

them with a sense of personal identity. Narratives further reveal the significance of individuals’

lived experience within the context of their social worlds (Gergen, 1999; Polkinghorne,

1988). Here the focus shifts from examining relational interactions and communication patterns

to examining the meaning embedded in narrative forms of expression. Human actions and

relationships as expressed through narratives or stories are seen as efforts to create meaning

out of personal experiences. These efforts at meaning construction are reflected in narratives

or stories that give organization and structure to a person or family (Kilpatrick & Holland, 2009).

 Thus family problems are located within narrative constructions of meaning. The narrative

emphasis on “meaning” is further supplemented by a focus on ways in which broader

sociopolitical influences impact family and individual narratives. As the history of family

therapy unfolds it will be apparent that the following account will be both chronological

and thematic. Yet, there were research efforts, social movements, and clinical initiatives

that occurred at the same point in time and were independent of each other. These

efforts, movements, and initiatives are joined together by a thematic connection as they

were addressing the same clinical, research, or conceptual issues often without mutual

awareness. It is the confluence of these events and themes that forms the historical

narrative of family therapy. Family therapy. (2017B). In Encyclopedia of Mental

Disorders. Retrieved from http://www.minddisorders.com/Del-Fi/Family-therapy.html

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 THE PROGRESSIVE ERA AND EMERGING CONCERNS ABOUT THE FAMILY

The opening chapters of the history of family therapy were written in the late 19 th century.

Beginning in 1890 and ending at the start of the Great Depression, this era in American history

known as the Progressive Era was a time marked by the appearance of a wide range of social

and political reform movements. It was during this period that the United States witnessed a

dramatic shift from an agrarian based society to an industrialized urban society. Because of this

transition many urban families found themselves coping with an array of issues stemming from

rapid social change resulting from the impact of the industrial revolution and rapid

urbanization. Social problems such as poverty, increasing social dislocation, immigration,

illiteracy, disease, exploited labor, and slum housing adversely impacted the lives of increasing

numbers of individuals and families. Many of these families often found themselves living in

crowded tenements with more than one family living in small and rodent-infested quarters.

Many individuals, including children, also found themselves working in the highly dangerous,

unsafe, and exploitative conditions in the emerging factory system. Living in such marginally

economic and otherwise vulnerable conditions these individuals were without the benefit of

health protection and coverage for themselves and their families. (Becvar, D. S., & Becvar, R. J.

(2000). Family therapy: A systemic integration. Needham Heights, MA: Pearson Education.

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 SETTLEMENT HOUSE MOVEMENT

Settlement House Movement gave attention to the family within the broader environment.

The Hull House founded by Jane Addams and Ellen Gates Starr in 1889 viewed family problems

as resulting from debilitating environmental conditions. Contrary to the “moral treatment”

orientation of the friendly visitors, those within the Settlement House Movement sought to

change those societal, city, and neighborhood conditions that had a deleterious impact on

family life. As such, this movement shifted the intervention orientation from a sense of “moral

responsibility” to one of “social responsibility” (Hull & Mather, 2006). In other words, the

concern of the Settlement House workers emphasized increased social and public

responsiveness to family and human need rather than addressing defective individual moral

character. Settlement Houses were often set up in immigrant neighborhoods. These

community-based settings provided a venue for both individuals and families to learn those life

skills that would enable the participants to support their families. These life skills were taught

through educational programs, recreation activities, and other forms of social and community

involvement. In these various activities the Settlement Houses provided the opportunity for

individuals and families to come together for mutual support and assistance. It is important to

note that the focus of these activities was more on providing the participants with those life

skills that would enable them to better assimilate into a dominant culture that reflected White

middle-class values and cultural habits (Hull & Mather, 2006).

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 THE EARLY RESEARCH ON GROUP DYNAMICS

The activities within the Settlement Houses were often conducted within small informal groups.

As such, the use of groups in the Settlement House Movement was a major impetus for the

later development of group work as a major modality of helping within professional social

work. Concurrent with the use of groups in the early years of professional social work there

were a number of social scientists who began to turn their attention to studying group

dynamics. For example, in the late 19th century there were studies on the impact of groups on

individual behavior (Triplett, 1898). Additional studies on the impact of groups on individual

task performance were conducted in the early 1900s (Allport, 1924; Moede, 1920).

In addition to the above studies, there were other social scientists in the 1930s who further

examined the influence of groups on individuals. One example is the seminal research

conducted by Lewin, Lippett, and White (1939). therapists turned to group therapy and group

dynamics as a model for conducting therapy with families.

THE MARRIAGE COUNSELING MOVEMENT

Another precursor to the family therapy movement was the marriage counseling movement in

the 1920s. During this period, greater social attention was being given to providing troubled

couples with information, support, counseling, and guidance. Though there were no individuals

specifically trained as marriage counselors, such counseling was provided by a number of

professionals who interfaced with couples as a part of their professional work (Broderick &

Schrader, 1981). This diverse group of marriage counselors composed of clergy, lawyers,

gynecologists, social workers, and college professors often presented itself to the public as a
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group of family life specialists. It was not unlikely that these professionals were perceived as

specialists in family life, for it was often these professions that couples turned to at significant

times in the life of a family—times that included birth, marriage, illness, and death. (Broderick

& Schrader, 1981)

THE CHILD GUIDANCE MOVEMENT

Many of the founders of family therapy believed it was critical to involve children in family

treatment; however, family therapists tend to limit the inclusion of young children for a variety

of reasons. In the 1960’s several important therapy approaches emerged and contemporary

models include the following: Strategic, Experiential, Transgenertional, Structural, Post-Modern

(including Solution-Focused and Narrative Therapies), and several attachment-based family

therapies such as Emotion-Focused Family Therapy, and the Gottman Method. The two latter

approaches are evidence-based and are widely touted as effective and desirable family therapy

and couple’s therapy approaches. Ackerman, N.W. (1958). The psychodynamics of family life.

New York, NY: Basic Books).

 Social workers' awareness of and formal involvement in family-centered early intervention

for infants and toddlers who are at risk of or who have developmental disabilities has

increased considerably during the past 15 years. The functional role that social workers can

play on early intervention teams and as coordinators of early intervention services is

underscored by the formal recognition of the discipline in the Individuals with Disabilities

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 Education Act. Despite the relevance of social work to early intervention, personnel often

enter early intervention practice without the benefit of formal preparation related to very

young children with developmental disabilities. Teen Treatment Center. (2014, March 20).

The benefits of family therapy. (Teen Treatment Center. Retrieved from

https://www.teentreatmentcenter.com/blog/the-benefits-of-family-therapy/

HISTORY OF COUNSELING AND PSYCHOTHERAPY IN KENYA

Historically, traditional medicine men and healers practiced caring interventions in local

communities. They focused on psychosocial and spiritual matters, in addition to physical

ailments. Given this cultural tradition, the introduction of applied psychology into the

community was received with skepticism or denial. This attitude is rapidly changing due to the

intensification of problems caused by corruption, HIV/AIDS, poverty, and the general

inefficiency of the social service system. Beginning in the late 1970s, the Catholic Church in

Kenya embarked on a massive campaign to educate people on natural family planning methods

(African Forum for Catholic Social Teachings, 1979). During this period, the practice of

counseling was closely linked to the population debate; counselors were perceived as

professionals who provided guidance on natural methods of family planning (Oketch &

Kimemia, 2012). In 1979, the establishment of Amani Counseling Center and Training Institute

(ACCTI) also contributed to the early development of counseling in Kenya. The center was

established as a voluntary organization to provide counseling services for people with

emotional and psychological problems, as well as training counselors (ACCTI, 2014). For about

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ten years the center served as the sole training institution for counselors in Kenya, offering

various certificate courses. Additionally, ACCTI offered a range of clinical services, from

individual, group and family counseling to crisis interventions. As one of the oldest counseling

agencies in the country, ACCTI set a precedent in its operations that has been emulated by

several other counseling agencies and professional counseling organization (Oketch & Kimemia,

2012). Another event that contributed to the development of counseling in Kenya was the first

diagnosis of HIV/AIDS and the Kenyan government declaring HIV/AIDS as a national disaster in

1999. This was because after the first diagnosis was made; much of the country was unaware of

the gravity of HIV and its potential impact socially and economically, leading to high death rates

due to AIDS... In 2003, the US-led Presidents Emergency Plan for AIDS relief (PEPFAR) that

provided funding to Kenya and many other African countries led to the mushrooming of

Voluntary Counseling and Testing Centers (VCT) around the country. Individuals conducting

these sessions were often health or social workers who had very limited training in counseling

interventions. Even for the trained workers, the training would likely have consisted of brief

workshops and seminars with an end goal of educating individuals on the implications of the

HIV test result (Oketch & Kimemia, 2012). Since 1999, many “counseling” centers have opened

their doors with little regard for specialized training requirements for counselors. This trend

causes confusion in the public about what counseling really entails because it can take as many

forms as there are people offering the services (Oketch & Kimemia, 2012). Faith Mueni

Masambia (2014) Embracing Counseling and Psychotherapy in Kenya.

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SUMMARY

As we describe family therapy we can say that the framework for family therapy is directed by

thinking of “family as context” informed by the belief systems wherein the family is a special

social environment conceptualized as consisting of multiple systems. A family is more than the

sum of its individual parts; it is a unique system with particular responsibilities and functions,

and changes within the family system affect all family members. (White, 2007; White & Epston,

1990).

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