Family Therapy Basics by Mark Worden

This book offered good instructions for conducting family therapy, but it was not written for Christian counselors. This was strictly a “techniques” manual. Although the book was theologically limited because of its focus on secular counseling methods, helpful concepts were found. The strategic questions Dr. Worden asked were very insightful. However, an inexperienced therapist would have difficulty recalling questions during specific points of the session. One would have to compile these questions into notes and then refer to it during family counseling, which may inadvertently hamper the therapeutic process since the counselor is distracted with asking the “right” questions instead of understanding the family’s presenting problem.The number and length of sessions was left up to the discretion of individual therapists. Considering that Dr. Worden wrote the book for “a beginning therapist,” he failed to answer his initial question, “What do I do next?” in regards to this important aspect of counseling. Granted there are various factors involved with different families, Dr. Worden still should have recommended his own standard number and duration of sessions as a “rule of thumb.” He did mention that HMOs found five to 10 sessions the “acceptable standard” for treatment (34), but it was stated as an expected fact when one counsels HMO clients.

Dr. Worden included ways of confronting family members during a therapy session, even though he said it “may harm as much as it helps” (67). These questions seemed harsh and unproductive. For example, he asked, “Mrs. Martin, your complaints fall on deaf ears. I wonder why you persistently bring them up?” Then he said, “Cindy, you have a one-note act. All you can do is interrupt in a hostile fashion” (68). This line of questioning and remark might actually erode the therapeutic alliance instead of helping the overall counseling process.

In redirecting the session from “the emotional to the cognitive,” Dr. Worden used some closed-ended questions, such as “Is this what happens at home?” or “Do the same issues start the same fights?” (76). These questions were meant to allow family members to “interact in problem-solving mode with the therapist,” but instead of allowing for a comprehensive cognitive reflection, it would probably yield only simple “yes or no” answers (76).

Dr. Worden believed that “continually” asking someone, “How did that make you feel?” was counterproductive for feelings to “emerge” and exhibited in counseling (86), but if the therapist never asked the client to label their feelings, an outburst of emotions may be misinterpreted and thus mislabeled. Also, Dr. Worden never quantified what he meant by “continually.”

According to Dr. Worden, play and drawing therapy can be useful tools for seeing the family from a child’s perspective; however, asking a child to “draw a picture of everyone in your family, including yourself, doing something,” may be taken literally and the result will be pictures of each family member doing some sort of activity unique to that individual (88). This could be misread to imply that the “family is absorbed in personal interests” because family interaction is not taking place in the child’s drawing (89). If the purpose for the drawing therapy was to find “family interactional patterns” (89), then perhaps asking the child to draw a picture of the family doing something together is a better approach. If the family never does anything together, the child will have nothing to draw.

There were several positive aspects of the book. For instance, asking family members certain questions like, “After an argument, can you predict what will happen next?” was a good way to make people realize their influence in family interactions (87). The basic premise is if a behavior can be predicted, then it could be “controlled” and “modified” (87).

Dr. Worden included a section on “avoiding an emotional trap” (77). He discussed how a family’s “dynamics” could influence a therapist’s discernment into “agreeing that the scapegoat is the family problem” or “believing that someone needs to be rescued” (77). He suggested that the therapist “take a step back” and ask him or herself questions such as, “Why do I feel like rescuing this person?” He said the answer would give the therapist a “clearer perspective” of the counseling situation (77).

Despite the fact this book was void of Christian principles, it ought to be read by pastors and family ministers who would benefit in understanding basic techniques of family counseling. Dr. Worden’s step-by-step treatment of a realistic dysfunctional family was instructional for preparing students in what to expect from an actual therapeutic setting. “Family Therapy Basics” is a book all counselors should read.

Copyright © 2007 M. Teresa Trascritti

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