LPC Couples and Family Counseling 1 — Questions and Answers
Question 1: Murray Bowen's concept of the 'triangle' in family systems theory refers to:
- A three-generation genogram depicting family patterns
- The stabilizing mechanism of introducing a third person into a two-person relationship under stress (Correct answer)
- Three-way communication patterns common in blended families
- Three distinct roles: hero, scapegoat, and lost child
Correct answer: The stabilizing mechanism of introducing a third person into a two-person relationship under stress
Bowen's triangle is the basic unit of the emotional system — when two-person anxiety escalates, a third person is drawn in to stabilize the system by spreading tension.
Bowen observed that two-person (dyadic) relationships are inherently unstable under stress and tend to 'triangle in' a third person to dilute the anxiety. For example, a conflicted couple may focus anxious attention on a child, who then becomes the identified patient. Bowen used the concept of detriangulation — where the therapist or a family member disengages from the emotional triangle — as a key therapeutic intervention.
Question 2: John Gottman's research on couples identified four communication patterns predictive of divorce, known as:
- Enmeshment, disengagement, triangulation, and escalation
- Criticism, contempt, defensiveness, and stonewalling (Correct answer)
- Avoidance, aggression, passivity, and withdrawal
- Negative sentiment override, flooding, harsh start-up, and emotional dysregulation
Correct answer: Criticism, contempt, defensiveness, and stonewalling
Gottman's 'Four Horsemen of the Apocalypse' — Criticism, Contempt, Defensiveness, and Stonewalling — are highly predictive of relationship dissolution.
Through the Love Lab, Gottman observed thousands of couples and identified that these four communication patterns were the strongest predictors of divorce: Criticism (attacking partner's character), Contempt (treating partner with disrespect, disgust, superiority — the most corrosive), Defensiveness (making excuses, counter-attacking), and Stonewalling (withdrawing from interaction). Gottman Couples Therapy aims to replace these patterns with their antidotes: gentle startup, responsibility, validation, and self-soothing.
Question 3: Structural family therapy, developed by Minuchin, focuses on changing which aspect of the family system?
- The cognitive belief systems of each family member
- Family structure — boundaries, subsystems, and hierarchies — to improve functioning (Correct answer)
- The narrative stories family members tell about the presenting problem
- The intergenerational transmission of attachment patterns
Correct answer: Family structure — boundaries, subsystems, and hierarchies — to improve functioning
Structural family therapy focuses on reorganizing the family's structure — the patterns of interaction, boundaries, and hierarchies — to create clearer, more functional organization.
Salvador Minuchin's Structural Family Therapy identifies family structures in terms of subsystems (spousal, parental, sibling), boundaries (clear, diffuse/enmeshed, rigid/disengaged), and hierarchies (appropriate parental authority vs. role reversal). Dysfunctional structures maintain symptoms. Techniques include joining, enactment (having the family demonstrate the problem in session), boundary making, and unbalancing. The therapist actively challenges and restructures family patterns rather than exploring history.
Question 4: In Emotionally Focused Therapy (EFT) for couples, the primary therapeutic focus is on:
- Teaching communication and problem-solving skills
- Accessing and restructuring the underlying emotional experiences and attachment needs that drive negative interaction cycles (Correct answer)
- Challenging cognitive distortions about the partner
- Behavioral contracts and reciprocal exchange agreements
Correct answer: Accessing and restructuring the underlying emotional experiences and attachment needs that drive negative interaction cycles
EFT (Sue Johnson) focuses on accessing and restructuring the emotional and attachment experiences underlying negative cycles, helping partners move from defensive reactivity to safe bonding.
Developed by Susan Johnson and Les Greenberg, EFT is grounded in attachment theory. EFT works through three stages: (1) De-escalating negative cycles (Stage 1), (2) Restructuring the attachment bond — accessing vulnerability and creating new interactional events of safe bonding (Stage 2), (3) Consolidation and integration (Stage 3). EFT has among the strongest evidence base of any couples therapy, with 70-75% of couples recovered and 90% showing significant improvement in RCTs.
Question 5: The technique of 'reframing' in family therapy involves:
- Asking family members to literally rearrange their seating to change perspective
- Offering an alternative interpretation of a behavior or situation to change its meaning (Correct answer)
- Confronting a family member's distorted beliefs about other family members
- Reviewing and rewriting the family's documented history of conflicts
Correct answer: Offering an alternative interpretation of a behavior or situation to change its meaning
Reframing offers a new interpretive frame for behavior — for example, reframing a teenager's defiance as a bid for autonomy — to shift the emotional context and open new possibilities.
Reframing is a technique used across multiple family therapy approaches (structural, strategic, narrative, brief). By offering an alternative, more benign or systemic interpretation of behavior, the therapist shifts the family's perception and emotional response to that behavior. For example, reframing a withdrawn spouse as 'protecting the relationship from escalating conflict' rather than 'not caring' can reduce blame and open new interactional possibilities.
Question 6: The concept of 'identified patient' (IP) in family therapy refers to:
- The family member who first initiates contact with the counselor
- The family member whose symptoms are understood as carrying or expressing the family system's dysfunction (Correct answer)
- The family member most willing to engage in therapy
- The family member with the most severe psychiatric diagnosis
Correct answer: The family member whose symptoms are understood as carrying or expressing the family system's dysfunction
The identified patient is the family member whose symptoms are seen by the family (and often society) as the problem, while systemic therapists understand these symptoms as expressions of broader family dysfunction.
Family therapists reframe the presenting 'problem person' as the identified patient whose symptoms serve a function in the family system. For example, a child's school refusal may stabilize parents' marital conflict by uniting them around the child's problem. Treating only the IP without addressing the systemic function of the symptom often results in symptom substitution. Family therapists engage the whole family as the unit of treatment.
LPC Couples and Family Counseling 1
Murray Bowen's concept of the 'triangle' in family systems theory refers to: