¶ … family counseling requires a broad and diverse set of tools and techniques. Those tools and techniques should be adaptable to suit the needs of each family, individuals within that family, and also the contextual or environmental variables that impact families. Using a wide range of exercises and interventions, therapists can provide effective and evidence-based practice, as well as offer ongoing assessments and maintenance. Techniques and exercises that may be particularly useful for families and couples include the Royal Flush exercise for families with young children, the family-based school interventions for children with behavioral or academic performance problems, and the "altering the abyss" exercise for couples. Each of these exercises is rooted in fundamental family practice theory, and each can also yield measurable outcomes that improve the efficacy of the treatment.

Royal Flush

The "royal flush" technique is named as such because it uses picture cards, similar to those used in card games. The exercise can be used regularly, and involves simply arranging the picture cards spatially. Because it is relatively straightforward, the exercise can be repeated throughout ongoing therapy to provide measurable assessments of change. Because it connotes game play, this exercise can be useful for families with young children. The goal of the Royal Flush technique is to assess family structure, and understand how individual members of the family might perceive that structure differently.

It is important to understand the family's structure because family structure is empirically linked to several tangible outcomes. For example, there is a proven association between family structure and the children's academic and social development, and between family structure and the child's overall well-being (Thompson & McLanahan, 2012). However, family structure is also connected with cultural norms. The therapist's role in the Royal Flush is not to make judgments about the family structure or recommend changing it, but to simply help the family understand their own structure, and recognize their roles within it. In fact, one of the core strengths of the Royal Flush method is that it can be especially useful for extended families and larger households, which are common among many ethnic groups. The awareness of structure may help illuminate dysfunctional relationship patterns in a culturally appropriate manner.

With a better understanding of family structure, the therapist can apply what has been learned from the Royal Flush towards specific recommendations for change. The information gleaned from the Royal Flush technique can reveal gender interactions and norms in the family, and can help each family member "locate" themselves in the family structure, and become more aware of their roles and how they might want to change those roles. Concrete and measurable outcomes linked to the Royal Flush would include shifts in the balance of power in the family over time, and changes in self-perception over time.

The Royal Flush technique is grounded in several theoretical viewpoints including symbolic interactionism and family structure theory. Rooted in John Dewey's social psychology and Blumer's research that followed, symbolic interactionism suggests that "human beings are best understood in a practical, interactive relation to their environment," ("Symbolic Interactionism," n.d.). The arrangement of the cards is not inherently meaningful; what is meaningful are the attributes, emotions, and thoughts ascribed to those relationships. In other words, individuals in the family co-create their own family structure. The roles and relationships formed in the family are meaningful insofar as the people continue to play out their roles and project their expectations on other people.

Family-Based School Interventions

Family-based school interventions are indispensible for families with children experiencing any type of trouble related to school. Based on systems theory, family-based school interventions "empower family to advocate for their child by being included as equal partners with professionals in planning and implementing services," (Williamson, n.d., p. 217-218). The main strength of family-based school interventions is that it empowers the parents and the child, thereby potentially reducing resistance to interventions that may be useful. Family-based school interventions can be used with any client with school age children, and the method entails ongoing and systematic collaboration with educators, school counselors, therapists, and the primary caregivers of the child. Problems at school are not considered in isolation from problems at home or with the child's psychological assessments. No part of the child's system is considered in isolation, as per the core tenets of systems theory (Friedman & Allen, n.d.). The advantages of family-based school interventions include their comprehensiveness and the creation of "student support teams" that bolster children's social, academic, and psychological performance using evidence-based methods...

The disadvantages to using family-based school interventions is communication between the different parties, and ensuring that parents, educators, therapists, and all other members of the student support team work together regularly. Disagreements need to be addressed immediately.
On the other hand, family-based school interventions have readily available measurable outcomes, many of which are quantifiable such as test scores. The technique may be especially helpful for families who are politically, economically, or socially isolated or disenfranchised because the way family-based school interventions encourage empowerment and advocacy. For example, a new immigrant family with parents who speak little English would be highly unlikely to challenge decisions made by the school regarding the perceived behavior or performance of the child. Even if the child's behavior was due to the stresses of being an English language learner or adapting to the new cultural environment, the parents might not feel able to challenge the authority of the school. In this way, family-based school interventions are critical components of strategies with families struggling with issues like language or cultural barriers.

Altering the Abyss

Not all families have children, and even when they do, the children may be grown or have little bearing on the more pressing issues facing the integrity of a couple. "Negative couple interactions" can be worked out with exercises like "Altering the Abyss," (Brimhall & Gardner, n.d.). The "Altering the Abyss" exercise help couples identify and articulate the negative communication patterns and cycles they have fallen into, recognize their role and responsibility in the negative patterns, recognize and express their perceptions of the other persons' role, and replace any negative or dysfunctional patterns with positive ones. The theoretical grounding for Altering the Abyss comes from emotionally focused therapy and externalization theory, all of which delve into the deeper emotional and cognitive patterns impacting external behaviors and communication styles. The advantage of Altering the Abyss is that through externalization, negative patterns like blame are minimized. Acute conflicts are also dissipated, allowing the couple to recognize the bigger picture and the patterns rather than focusing on minute details. Using specific exercises and techniques like the circular pattern diagram recommended by Brimjhall & Gardner, n.d.), the couple and the therapist work over a period of time to map out difficult emotions and resolve conflict.

One of the drawbacks or limitations with the Altering the Abyss technique is that it precludes the therapist from using it in any situation where abuse is suspected. It may also prove challenging for some participants and can take a long time to complete the therapy. Measurable outcomes are more subjective than quantitative in nature, but include the therapists' observations of the couples' interactions as well as subjective or self-reports from the individuals.

Creating Rituals for Couples Coping with Early Pregnancy Loss

Because of its high level of specificity, the Thomas (n.d.) recommendations for creating rituals for couples coping with early pregnancy loss may not be helpful for my practice. The exercise is used when couples have experienced miscarriage and the related trauma and stress the experience entails. Rituals involving symbolic items and ceremonies may be helpful because, as Thomas (n.d.) points out, most couples suffer silently. They do not enjoy public support in the form of a funeral or other ritual that might help the grieving process. Without the help of a ritual, the couple may have trouble expressing their emotions or receiving support from friends. Exacerbating the stress could be a sense of failure and shame at the loss. Therefore, this technique is worth mentioning as an adjunct for couples who have gone through the trauma of early pregnancy loss.

Miscarriage can lead to breakdowns in communication within the relationship and occasionally leads to the dissolution of relationships. Therefore, this technique has the advantage of providing targeted assistance for a specific type of crisis and encourages both members of the couple to face the difficult issues ranging from anger and blame to self-hatred and depression.

The technique is based on symbolic-experiential therapy, which permits a degree of externalization that can help deflect blame (Thomas, n.d.). The rituals can be tailored to suit the needs of couples from different ethnic backgrounds or same-sex couples, another advantage to this technique. Moreover, ritual offers the potential for ongoing reflection and the therapist can return for assessment and the acquisition of measurable outcomes such as scores on psychological testing, if those tests were being used.

Speak Softly and Carry a Big Stick

Named after the famous quote from President Theodore Roosevelt, the Speak Softly and Carry a Big Stick method may be useful for some family scenarios. One of the…