Partial Attendance in Family and Couples Therapy

      According to Wilcoxon (1986), “No single member may successfully alter relationship characteristics in a marital or familial unit without some reaction from the other(s) within that system” (p. 323).  This statement paints a grim aura around the concept of marital and family counseling as it often seems as though one or more members of a unit are resistant to the idea of attending therapy.  If Wilcoxon’s (1986) statement holds true, family counseling will not be effective if all members of the unit are not engaged and open to change.  While I would like to believe that counseling a partial unit could still be effective, empirical evidence cited by Wilcoxon (1986) suggests the opposite:

• ·         When therapy is not provided to all members of the family or marital unit, problems may be exacerbated rather than resolved.

• ·         Conjoint therapy of married couples is twice as effective as individual therapy.

• ·         A successful outcome from family therapy is more likely when both parents attend.

• ·         Family therapy leads to greater durability of changes (p. 323).

With the above evidence in mind, Wilcoxon (1986) presents the ethical considerations when not all family members are engaged in therapy.  While several considerations are listed, the most ethically obvious root of each is whether therapy will be harmful without all unit members engaged.  An ethically-questionable solution that Wilcoxon (1986) cites, but does not advise, is withholding services until all members are engaged in therapy.  Wilcoxon (1986) proceeds to cite Teishmann’s (1980) suggestions of either holding a brief session with attending members to counsel them on the proper way to engage those who are not willing to attend, or to request a private session with the non-attending member(s) in exchange for a group session with attending member(s).  In regards to marital counseling, Wilcoxon (1986) cites Wilcoxon and Fenell’s (1983) suggestion of providing a letter to clients that outlines the benefits of conjoint sessions as opposed to individual sessions.  The letter includes an invitation to the non-attending spouse to join the counseling sessions, as well as a request for both spouses’ signatures stating that they understand the risks of one-spouse therapy.

Even though I am an undergraduate student with no experience in this field, I feel compelled to give my reaction on this subject.  If I were a therapist with a client requesting marital or family counseling, and other members of the unit wished to remain disengaged, I would provide counseling service to those who were willing to attend, and invite the disengaged member to private sessions until they felt comfortable joining the other member(s) of the unit.  My assumption is that the main reason for refusal to attend therapy is due to the misconception that the therapy sessions involve certain family members blaming others while the therapist chooses which side to validate.  Therefore, my first goal would be to educate all members of the unit as to what therapy entails, what can be expected in terms how therapy is conducted, and the projected outcome of the therapy.  This education would either take place in person during the first session or via Wilcoxon and Fenell’s (1983) suggestion of a letter to the disengaged member(s) (as cited in Wilcoxon, 1986).

References

Wilcoxon, S. A. (1986). Engaging Non-Attending Family Members in Marital and Family Counseling: Ethical Issues. Journal Of Counseling & Development, 64(5), 323.