FAMILY THERAPY

Family therapy is a type of psychological counseling (psychotherapy) that helps family members
improve communication and resolve [Link] Therapy – or to give it its full title, Family
and Systemic Psychotherapy – helps people in a close relationship help each other.
Also known as couple therapy, relationship therapy, marital therapy,
COMMUNICATION THERAPY.
It enables family members, couples and others who care about each other to express and explore
difficult thoughts and emotions safely, to understand each other’s experiences and views,
appreciate each other’s needs, build on strengths and make useful changes in their relationships
and their lives. Individuals can find Family Therapy helpful, as an opportunity to reflect on
important relationships and find ways forward.
Some of the issues or situations a family could benefit from through family therapy are listed
below.
 Health problems, particularly chronic physical illnesses
 Psychosomatic problems
 Child and adolescent mental health
 Adult mental health
 Psychosexual difficulties
 Alcohol and other substance abuse
 Marital problems including separation and divorce issues
 Foster care, adoption and related issues
 Issues involving the Family’s life cycle and transitional stages of life
 Promoting parenting skills and family functioning
 School-related problems
 Work-related problems
 Traumatic experiences, loss and bereavement
 Disruption of family life due to social, political and religious conflicts
Background
Family therapy is a relatively recent development in psychotherapy. It began shortly after World
War II, when doctors, who were treating schizophrenic patients, noticed that the patients'
families communicated in disturbed ways. The doctors also found that the patients' symptoms
rose or fell according to the level of tension between their parents. These observations led to
considering a family as an organism or system with its own internal rules, patterns of
functioning, and tendency to resist change. The therapists started to treat the families of
schizophrenic patients as whole units rather than focusing on the hospitalized member. They
found that in many cases the family member with schizophrenia improved when the "patient"
was the family system. (This should not be misunderstood to mean that schizophrenia is caused
by family problems, although family problems may worsen the condition.) This approach of
involving the entire family in the treatment plan and therapy was then applied to families with
problems other than the presence of schizophrenia.

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History
The origins and development of the field of family therapy are to be found in the second half of
the twentieth century. Prior to the Second World War, psychotherapy was based on the Freudian
tradition centered on the dyadic relationship between patient and doctor. Pathology was thought
to be within the individual. It was not until around the 1950s that insights started to come out of
work done with families of schizophrenic patients. The change of perspective away from
Freudian theory and toward a systems approach has been unfolding since then.
The figures who seem to have had the most impact on the family field in its infancy were, oddly
enough, not so much psychotherapists but scientists such as information theorist Claude
Shannon, cyberneticist Norbert Wiener, and general systems theorist John von Neuman. One
must add to this list George Bateson, whose synthesizing genius showed how ideas from such
divergent sources could be useful to the understanding of communication processes, including
those associated with psychopathology.
Procedure of family therapy
Family therapy is often short term. It may include all family members or just those able or
willing to participate. Your specific treatment plan will depend on your family's situation. Family
therapy sessions can teach you skills to deepen family connections and get through stressful
times, even after you're done going to therapy sessions. Members or friends may give
recommendations based on their experiences.
Information given to clients
Education and experience. What is your educational and training background? Are you
licensed by the state? Are you accredited by the AAMFT or other professional organizations? Do
you have specialty training in family psychotherapy? What is your experience with my family's
type of problem?

 Location and availability. Where is your office? What are your office hours? Are you
available in case of emergency?
 Length and number of sessions. How long is each session? How often are sessions
scheduled? How many sessions should I expect to have?
 Fees and insurance. How much do you charge for each session? Are your services covered
by my health insurance plan? Will I need to pay the full fee upfront? What is your policy on
canceled sessions?
 Taking the interview
I like to keep the first interview very structured. Interview the whole family, if possible.
Focus on Communication: BUT NOT CONTENT LISTEN FOR PROCESS
Make a note as to who has the POWER.
USES OF FAMILY THERAPY

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Family therapy has been shown to be of use in a number of different conditions. There is
good evidence that family therapy is very useful in the following childhood and adolescent
conditions:

 Conduct disorders
 Substance abuse
 Eating disorders (such as anorexia)
 Behavioural disorders (including inattention and hyperactivity)
In adults, family therapy has been shown to be useful in:

 Psychotic disorders (including schizophrenia)

 Mood disorders (including depression and bipolar disorder)
 Drug abuse
 Eating disorders
 Marriage and couple counselling
 Chronic pain management
 Anxiety disorders
 Obsessive compulsive disorders

Schizophrenia
Patients with schizophrenia often come from family groups that have high levels of hostility or
criticism. Because of this, family therapy has for a long time been suggested as a possible
treatment for schizophrenia.

There is now extensive evidence for the use of family therapy in schizophrenia. The first studies
to show that family therapy was useful in schizophrenia where published in the 1970s and from
this time there has been a lot of research into the use of family therapy for schizophrenia. The
different types of family therapy that have been used include the more traditional psycho-
education component and communication improvement as well as more novel approaches
including motivational interviewing, crisis handling therapy and even relaxation therapy. The
number and type of family therapy sessions required vary depending on the particular person and
family

The results of a mayor review of the research found that family therapy did reduce the symptoms
and may also reduce the number of times that a patient had to be placed into hospital. Family
therapy was also useful in reducing the isolation and the social withdrawal that many people who
suffer from schizophrenia experience. Another benefit of family therapy is that people who
receive family therapy often take their medications more regularly and as a result have fewer
symptoms and a better quality of life.

Depression

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Family therapy is often used in depression. Numerous different types of family therapy have
been investigated for the treatment of depression and while there is still some disagreement about
how useful family therapy is for depression. Family therapy has been shown to be very useful in
some patients the evidence is not as solid as for other forms of psychological therapy,
especially cognitive behavioural therapy.
An important topic to also consider is the use of family therapy in children and adolescences
with depression. A recent study looked at children with depression and offered these children a
family therapy program of 12 to 16 1 hour sessions over a 5 month period. The family therapy
focused on communication and problem solving skills and included education and role playing to
practice new skills. The results were that two thirds of the children and adolescents had
recovered from their depression when the program finished and that three quarters had recovered
9 months after the treatment. This demonstrated that although there may be doubt about the use
of family therapy in adults it is a very good treatment for children and adolescents with
depression.

Bipolar disorder
Family therapy for bipolar disorder has been used for many years as an addition to medications.
The main types of family therapy that are used include psycho education, family cognitive
behavioral therapy and communication therapy (such as the post-Milan type therapy). However,
despite its long term use there is not much evidence for the use of family therapy in bipolar
disorder. Research has shown only small improvements in symptoms in the short term and no
real improvements in the long term (in terms of months and years). More research is needed to
provide the answers about the use family therapy in bipolar disorder.

Anorexia nervosa
There is good research about the use of family therapy in anorexia nervosa. Originally, family
therapy was shown to be useful in people who had very bad anorexia and needed to be placed in
hospital to have their weight restored. In these people family therapy was shown to be useful in
helping keep a healthy weight after they left hospital. There has now been more work done that
shows that family therapy is also very useful in people with less severe anorexia. In these people
family therapy can result in quick weight gain and more importantly help keep the weight stable
in the long term (up to 5 years have been looked at and many people still had stable weight).
Unlike the very time consuming and restrictive treatments of anorexia that often need the person
to stay in hospital for a long period of time family therapy can be run (with the person at home)
as a series of about 20 sessions over the course of a year.

Family therapy is useful for both adolescences and adults with anorexia nervosa. For adolescents
family therapy encourages the parents to take control of the adolescent’s eating. An example is a
3 stage program. In Stage 1 the parents (and siblings) are tasked with restoring the adolescent’s
weight. In stage 2 the parents gradually give the adolescent control over eating. Stage 3 finishes
the program by addressing the broader concerns of the adolescent (such as body image issues).
Although such a program may seem very difficult research shows that such programs are
generally well received by the families and often have very good outcomes in maintaining
healthy body weight.

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 Marital problems
 Parent-child conflict
 Problems between siblings
 Teaches family members about how families function in general and, in particular, how their
own functions.
 Helps the family focus less on the member who has been identified as ill and focus more on the
family as a whole.
 Helps to identify conflicts and anxieties and helps the family develop strategies to resolve them.
 Strengthens all family members so they can work on their problems together.
 Teaches ways to handle conflicts and changes within the family differently. Sometimes the way
family members handle problems makes them more likely to develop symptoms.
During therapy sessions, the family's strengths are used to help them handle their problems. All
members take responsibility for problems. Some family members may need to change their
behavior more than others.
Family therapy is a very active type of therapy, and family members are often given
assignments. For example, parents may be asked to delegate more responsibilities to their
children.
The number of sessions required varies, depending on the severity of the problems and the
willingness of the members to participate in therapy. The family and the therapist set mutual
goals and discuss the length of time expected to achieve the goals. Not all members of the family
attend each session.
Approaches and Techniques in Family Therapy
Strategic Family Therapy

Key figure :Jay Haley and Cloe Madanes

Time focus : Present and future
Goals : Eliminate presenting problem; change dysfunctional patterns, interrupt sequence
Techniques : Reframing, directives and paradox; pretending, enactments

For strategic therapy is to describe what it is not: strategic therapy is not a person laying on a
couch describing what kind of inner turmoil or thoughts he or she is having or experiencing,
what past childhood experiences contributed to a sense of self, or how a particular psychological
issue could have arisen from past experiences.

Strategic therapists are problem-solvers and solution-finders. They are the referees and coaches,
not the spectators passively observing the action played out before them. They aren’t concerned
with where or how the problem started, only how to address it and solve it at this point in time.

strategic therapy pioneer Jay Haley, “strategic therapy is any type of therapy where the therapist
initiates what happens during therapy and designs a particular approach for each problem.”

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The strategic therapist becomes actively involved and responsible in helping clients turn their
lives around, in helping them strategically plan, execute, and measure “game winning”
outcomes.

Haley outlined five integral stages that all strategic therapists implement:

 Identify solvable problems

 Set goals

 Design interventions to achieve those goals

 Examine the responses

 Examine the outcome of the therapy.

Systemic Therapy/Structural Family Therapy

Key figure: Salvador Minuchin

Time focus: Present and past
Goals : Restructures family organization; change dysfunctional transactional patterns
Techniques: Joining and accommodating, unbalancing, boundary making

Systemic therapy is rooted in family therapy, a therapeutic adaptation of a larger interdisciplinary

field known as systems theory.

Systems theory is a study of the complex systems present in nature, science and society, and its
framework investigates and describes any group of objects that work together to produce a result.
This could be a single organism such as a plant or a single human, or it could apply to a large
organisation or indeed a family.

While the systems theory and systemic therapy can be applied to individuals, couples and in a
variety of other settings, it is most commonly practiced in a family setting, as it doesn't seek to
address people on an individual level and instead focuses on understanding problems in a
contextual framework.

Human Validation Process Therapy

Key Figure: Virginia Satir

Time Focus: Here and now
Goals : Promote growth, self-esteem, help family reach congruent communication
Techniques: Empathy; touch, communication, sculpting, role playing
Her approach emphasizes:
 Communication

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  Emotional Experiencing
 And, stresses the involvement of the therapist with a family
Goals:
1) Open Communication
 Individuals are allowed to honestly report their perceptions
2) Enhancement of Self-Esteem
 Family decisions are based on individual needs
3) Encouragement of Growth
 Differences are acknowledged
4) Transforming extreme rules into useful and functional rules
 Families have many spoken and unspoken rules

Transgenerational Therapy/ Multigenerational Family Therapy

Key Figure: Murray Bowen

Time focus: Present and past (3 generations)
Goals : Change individual in the context of family system; decrease anxiety
Techniques: Genograms, family of origin issues, detriangulating relationships

Transgenerational approaches to family therapy have grown out of the work of such pioneers as
Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, Norman Paul, and Donald Williamson.
These theorists share the belief that; present day problems are related to issue in a person’s
family of origin Although their theories and practice may differ, all agree that the royal road to
problem resolution involves working with more than one generation in therapy. A common
misconception is that these models espouse a linear approach, in which people’s problems are
“caused by their families of origin”. In fact, all of these are larger systems models that view
problems as being maintained in ongoing patterns that span generations.
 Genogram is a family diagram, which can be thought of as an elaboration of the family
tree. Genograms provide a way of mapping family patterns and relationships across at
least three generations. Genograms report information on family structures like family
trees do.
 Family of Origin : Certain kinds of events or family dynamics contribute to some of us
being more "stuck" than others and this creates problem in our lives. But we are all on
that continuum somewhere, no one escapes it completely.

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 Even so called "good families" may only be that way because everyone is "towing the
line" for fear of what would happen if they expressed an idea that was different or
followed a life course that was other than "the family way." Underneath, there might be a
tension growing that may lead to a health issue, a personal issue, family secrets or
potential conflict in the future.

That said, there are people and families who do function well. Each is able to maintain
their sense of self in relation to other family members without feeling like they risk
rejection or being in conflict. Those families are generally adaptable and aren't threatened
by differences. They begin to reflect what living and loving optimally is all about.
 Triangulation (psychology) Triangulation is a situation in which one family member
will not communicate directly with another family member, but will communicate with a
third family member, which can lead to the third family member becoming part of the
triangle.
It is argued that a conflict between two people will resolve itself in the presence of a third
person who can avoid emotional participation with either while relating actively to both
(Bowen 1978). Typically, it is the therapist who takes on the non-anxious role and forms a
triangle with a couple. While remaining emotionally un-reactive, the therapist is able to
induce change in the relationship that would not have occurred had the same things been said
in the absence of the therapist (Friedman 1991).
Key Concepts
1) Differentiation of self: One’s emotional and intellectual systems are
distinguishable.
2) Differentiation of Self Scale: One’s degree of undifferentiating (no self) is
directly correlated with one’s degree of emotional fusion into a common self with others.
3) Emotional cut off: In the process of separation, isolation, withdrawal, running
away, or denying the importance of one’s parental family, dealing with unresolved
attachment may be problematic.
4) Emotional System: Kerr and Bowen believe that all natural systems respond in a
patterned, reactive manner.
5) Entitlement: This is the amount of merit a person accrues for behaving in an
ethical manner with others.
6) Family Projection Process: According to Bowen, this process in which parents
may project part of their immaturity onto one or more of their children.
i. The child who is the object of the projection develops the lowest level of differentiation
of self and is more likely to be symptomatic in the future
7) Ladger: An accumulation of the accounts of what has been given and what is
owed.

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 8) Legacy: Legacy is a specific configuration of expectations that originate, not from
the merit of the parents, but simply from the universal implication of being born of parents.
There is a chain of destiny anchored in every parent-child relationship.
9) Loyality: Internalized expectations, injunctions, and obligations in relation to
one’s family of origin have powerful interpersonal influences.
i. “What to an outsider may seem like irrational or pathological behavior may, in fact,
conform to a basic family loyalty.”
10) Multigenerational Transmission Process: This is a pattern that develops over
several generations, in which children grow up and marry partners with similar levels of
differentiation to themselves.
11) Nuclear Family Emotional System: Parental undifferentiation may produce; (1)
marital conflict, (2) dysfunction in a spouse, (3) projection to one or more children.
12) Personal Authority in the Family System: When an individual has personal authority, he
or she is in charge of his or her own thoughts and opinions, acts freely and responsibly,
and maintains appropriate social connection with others.
13) Relational Ethics: Life is a chain of interlocking consequences between the generation.
The behavior of an individual is both rooted in the past and has the ability to affect future
generations. Because of this, individuals are ethically responsible for the consequences of
their behaviors.
14) Sibling Position: Sibling position is useful in understanding how a particular child is
chosen as the object of the family projection process.
15) Societal Regression: What is needed is better differentiation between emotion and
intellect, allowing more constructive societal decision to be made.
16) Triangle: A three-person system, the smallest stable relationship system.

Key Clinical Skills

1) Coaching: Role in supervising patients and trainees in the process of differentiation of
self. The actual work is done by the patient, and the learning comes as the patient works
toward his or her goal outside the therapy session.
2) Cross-Confrontation and Self-Confrontation: Clients reactions to the stressor stimuli are
aduio or videotaped and are later played back to them as a type of self-confrontation.
3) Detriangling: An individual keeps him or herself outside the emotional field of two
others.
4) Exoneration: A process by which the therapist attempts to help the client see the positive
intent and intergenerational loyalty issues behind the behavior of members of previous
generations.
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 5) Genogram: A written symbolic diagram of the family system, the genogram is not unlike
a “family tree”.
6) Multidirected Partiality: Therapists keep channels open among all family members and
that all solutions serve the best interests of everyone.
7) Operational mourning: Norman Paul states that “ there is a direct relationship between
the maladaptive response to the death of a loved one and the fixity of symbolic
relationships within the family.
8) Person-to-person Relationships: Two family members relate personally to each other
about each other; they do not talk about others (triangling) and do not talk about
impersonal issues.

ADVANTAGE OF FAMILY THERAPY

 Focus on the expectation of change within the family (which may involve multiple
adjustments)
 Test new patterns of behavior
 Teach how a family system works, and how the family supports symptoms and maintains
needed roles
 Elicit the strengths of every family member
 Explore the meaning of substance abuse within the family
 Adolescent Domain:
o Address identity formation, improve self awareness, and enhance self-worth and
confidence
o Develop meaningful short-term and long-term life goals
o Improve emotional regulation, coping, and problem solving skills
o Improve expressive and communication skills
o Promote success in school/work
o Promote pro-social peer relations and activities
o Reduce drug use and problem behaviors
o Improve and stabilize mental health problems
 Parent Domain:
o Strengthen parental teamwork
o Improve parenting skills & practices
o Rebuild emotional bonds with teen

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 o Enhance parents individual functioning
 Family Domain:
o Improve family communication and problem solving skills
o Strengthen emotional attachments and feelings of love and connection among
family members
o Improve everyday functioning of the family unit
 Community Domain:
o Improve family member’s working relationships with social systems such as
school, court, legal system, child welfare workplace, and neighborhood
o Build family member capacity to actively reach out to access and actualize
needed resources necessary for stress reduction or daily life needs

DISADVANTAGE OF FAMILY THERAPY

 Family therapy can make some problems worse if it is not guided appropriately by a
well-trained counselor.
 Therapy may not sufficiently resolve issues if it is stopped too soon.
 Family therapy may be less effective if one family member refuses to participate.

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References
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