Like other aspects of the Counseling profession, family counseling practice continues to evolve in response to societal changes, research, and other developments. Learning to work with families can be an effective way for Counselors to strengthen their community support.

Family counseling does require particular skills and techniques, but it can be one of the most rewarding practices in Counseling, says Bita Rivas, EdD, NCC, ACS, LPC, LAC, LMFT, LPCC. Dr. Rivas is Associate Professor of Marriage, Couple, and Family Counseling at California State University, Sacramento.

“It’s a different challenge, a different intervention,” says Dr. Rivas. “And I think it’s really neat to be able to pivot from individuals to couples to family.”

Fundamental to meeting this challenge of family counseling is viewing the distinct subsystems within the family system, explains Dr. Rivas.

“One of the things Counselors should look for is how are you looking at the system,” says Dr. Rivas. “You are assessing the functioning of the system through the lens of development and the family lifecycle, so the family is coming in and looking at it as a system with subsystems within it: looking at roles, rules, and hierarchy and how that’s playing out when you have an entire system there, to tailor your intervention—not only the system, but the subsystems within it. . . . It is important to be familiar with at least a few family systems theories.”

Of course, the same therapeutic principles apply to family counseling as to individual therapy. Family counseling may also sometimes involve working with individual family members or the parental unit.

“What you're doing with individuals, it’s all kind of encompassed with a family,” says Dr. Rivas. “There are times you're working with one of the individuals or perhaps a subunit within it because you have to consider the system and the subsystems and its interaction. I think sometimes people may fear working with the family, like you always have to have everyone there, and you don’t.”

Family counseling may seem intimidating initially due to the differences from individual counseling, but the similarities are more significant. The same counseling process fundamentally applies.

“It’s just a conversation—just with a lot of people—and it’s OK to watch a family be themselves,” advises Dr. Rivas. “All information you have helps inform how you think that system needs an intervention. The first time you have a family, it may feel like a rush of information, but then after using that time to case conceptualize and put a treatment plan together, it doesn't feel that messy once you get into that intervention phase.”

This is not to say that family counseling doesn’t present unique challenges; however, Counselors have the training and skills to overcome these.

“Any time you have more than one person in the room, especially with the neophyte Counselor, it feels very overwhelming,” says Dr. Rivas. “And so I think that one of the unique challenges is not feeling overwhelmed. And I think the other challenge is countertransference, as we all have family stuff and just being mindful to be objective with it. And I think the third thing is having a good idea of roles, rules, and hierarchy and not being timid to intervene. Structuring your sessions is important in a way that you don't have with an individual.”

Some of the most challenging moments may yield powerful insights, explains Dr. Rivas. Assisting a family through intense feelings requires a delicate balance. Some of the same skills and techniques used in group therapy can be well suited to family counseling. These include managing a conversation between multiple people and understanding the Counselor’s role in the system and how they take space.

“Every now and again it gets very close to the heart,” says Dr. Rivas. “You may see your family have a real argument like they would at home. And so now you're observing, maybe, something you have to conflict-manage and de-escalate or bring back to the purpose of your time together. And if you're hesitant to intervene, you may easily lose control. On the one hand, that’s really good data. It’s good to observe how they’re actually interacting. But then the other part is, now how do you intervene therapeutically?”

Family counseling calls for many unique, or at least particularly suitable, interventions and tools. These approaches should be tailored based on the ages of children in the family.

“A lot of the interventions we're doing with a family are modeling and playing and inviting parents to share the things that they don't always share when they're together in the family system,” says Dr. Rivas. “There’s a lot of things out there that you can bring into session that are therapeutic games that would be helpful to get everyone engaging. Because you do have to meet the kids where they’re at, and if it’s young, you’re doing play and you’re talking with everyone through play. If they’re a bit older, inviting the family to share or even something like a sculpting activity. But I think the key piece that we have some power over is giving everyone some space to share how they're experiencing each other, changing communication patterns and inviting vulnerability.”

Telehealth has grown immensely in popularity and availability in recent years. For family counseling, telehealth delivery offers advantages and challenges.

“On the one hand, you see their interactions even more naturally than you would if they were coming in,” says Dr. Rivas. “So that’s a unique vantage point. At the same time, there’s distractions at home that could impact sessions.”

The accessibility of telehealth can also make it easier to schedule sessions that focus on family subsystems. A Counselor might see parents one day of the week and the entire family on a different day.

When younger children are included, family counseling by telehealth calls for play, just as it does in person. Incorporating this physical element into remote counseling may call for a different approach.

“The beautiful thing is you can see them engaged together if you’re asking them to play or you're using play in that time together,” says Dr. Rivas. “The other side, though, is that you're not able to really use your body as a therapist. So, you’re leaning on asking the family to engage together. There’s a structure to it and a directedness to it.”

One approach is to incorporate different types of play from those used for an office visit. Video games and virtual activities can offer additional options for family counseling with children.

Dr. Rivas points to the building game Minecraft as a promising example: “It’s a really interesting medium to use with kids because it's essentially a sand tray of sorts.”

The clinic at California State University, Sacramento, has had success using Minecraft in therapy for children, but Dr. Rivas sees a need for more research and guidance on incorporating such virtual activities into counseling.

“If you know how to do sand play, that makes sense. It’s traditional, being taught sand play, but that means you’re in person. Now how do we simulate that virtually? Minecraft is one of the ways to meet kids where they're at using something familiar when we have to meet with them virtually. But there's no textbook for it. There's no protocol. It's not been researched yet. It’s very new and we need more research on it. Use of Dungeons & Dragons, Minecraft, and other gaming options are likely to continue to grow as therapeutic options.”

Whether it’s in person or by telehealth, the impact a Counselor can have through family counseling is profound and rewarding, says Dr. Rivas.

“I think it’s an honor to be able to work with the entire family system,” she says. “It’s challenging for a system to change, but if the system is able to change, you’re seeing the greatest growth with everyone within it. To influence a system means our influence is more than just an individual. It’s lasting because whatever happens with that system is now going to be intergenerational and the tools that they use, the kids are going to see that shift and then they’re going to use that tool set.”

Dr. Rivas has been a Counselor Educator since 2013. Prior to joining CSUS, Dr. Rivas held faculty positions at Western Connecticut State University and University of Colorado, Colorado Springs. Having worked in mental health since 2008, she has experience with inpatient residential treatment working with adolescents providing individual, family, and group counseling, as well as community mental health providing group counseling for court-mandated clients. She has been in private practice working with individuals, couples, and families in addition to providing supervision for individuals seeking licensure. She holds three licenses in Colorado: Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), and Licensed Addiction Counselor (LAC). In California she holds her Licensed Professional Clinical Counselor (LPCC) and Licensed Marriage and Family Therapist (LMFT) licenses. She also holds her credentials as a National Certified Counselor (NCC) and Approved Clinical Supervisor (ACS).