Family Therapy

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 Introduction
• Family is a social institution
• Its functions cannot taken over by any other
institution
• Family exists from time immemorial
 Definition of Family
• Family is a group of individuals related by
blood
• Share same food, live under one roof, decision
making is common.
• It is usually comprised of one or more
generation.
• Family is now defined as system of
entitlements and obligations.
• Entitlements – conjugal rights, basic needs,
• Caring children, elderly, sick,
• Entitled unconditional love and affection
• Fulfilling emotional needs
• Family is the only place where complete love
is possible without complete understanding
 Definition of FT
• It is professionally organised attempt to bring
beneficial changes in a disturbed marital and
family unit by essentially interactional methods
• AIM
– More satisfied way of living for the entire family
– Not just for the single member
– The focus is on the family as whole
– The focus is on family systems, present patterns of
interactions
 Understanding the family
• From system perspective
• Family system is interaction with other social
system ; economic, political, social and
cultural and educational.
• Family life cycle stage: there are 8 stages
• Legal contract between two individuals
• Family tasks : basic necessities, recreation,
relaxing
• Development of the marital coalition
• complimentary roles is accepted
• Personality development
• Enculturation of offspring
• Values, beliefs
 Dysfunctional family :
• it does not function as system,
• members are unable to perform tasks
• Lack of sense of involvement
• Minimal contact
• Pseudo closeness
• Defective in problem solving
 Evaluating the family / Assessment

• Family life cycle stages

• Family goals and
• Family expectation
• What is the problem area
• History of past attempts to solve the problem
• Background of the problem
• Why family has come for treatment now – at
this phase.
• sources of conflicts
• Patterns of social control
• Generation gap
• Strains generated by transitions
• expectations from partner (in terms of equality).
• libidinal satisfaction and companionship:
• expectations from marriage (related to security),
• desire to grow, and embody the new women;
• expectations from family
orientations of the spouses in terms of non-
interference, autonomy and own family rules
expectations of the institution of marriage
related to growth of both the spouses,
• degree of togetherness, moral and ethical
aspects
• Leadership pattern
• Boundaries: Clear and Open/ Closed and rigid
• Role functioning
• Communication pattern
• Family cohesion, rituals, bonding
• Social support system
• Adaptive patterns – problem solving ability
 Family Subsystems
• Spousal subsystem: wife & husband
• Parental subsystem : mother & father
• Sibling subsystem : children
• Extended: grandparents, other relatives
• Family member play a different role in each of
the subsystems they belong
• Three interdependent
family subsystems are
considered:
• the marital subsystem,
• the parent-child
subsystem,
• and the sibling
subsystem
 Types of coalition in the family
• Disengaged family
• Pseudo democratic
family
• Schismatic family
• Skewed family
 Indicators
• There is no improvement with individual
therapy
• One member improves and other member
becomes sick,
• Patient improves in hospital, institution and
relapse occurs at home due to EE
• Patients symptoms disturbs family as a whole
• Problem lies in the family rather than an
individual
 Therapeutic approach
• Based on the coalition of family members
• Socio-cultural pattern of the family members
• Therapeutic approach need to be selected
• Goals of the family therapy must be clear to
the participants
• Goal of the therapy must be to bring about
communication of feelings and thoughts
 Contraindications
• Non-availability of family members
• Family is in the verge of divorce, break up
• Antisocial personality disorder
• Prejudice against therapy
• If the family treatment produces more problems
• If the family members problem does not show
any emotional or behavioral consequence in the
family
 Family Treatment
• Family Participation : husband , wife, grown up children.
• If needed extended family , joint family ,significant others.
• Our culture is hierarchical , authoritarian( based on age,
sex)
• To insist that all the family members must attend the
session is not possible in India.
• Asking the participants to pay for the session will make
them to attend the session regularly .
• Sessions are not conducted on a simultaneously.
• It has to be flexible & if they like they must be allowed to
space individually with all the members.
• Therapist must be receptive + neutral + optimistic.
• Educator + role model and indirect.
 Therapeutic combination
- Two therapist must be involved .
- Sometimes female& male therapists.
- Therapy here is conducted in medical settings for
psychosis.
- (space in the room , privacy, transportation are
some of the problems)
- Therapists can act together.
- Having therapists of both sexes will bring out the
interaction very effectively.
 FT Setting
• Office Setting:
– Therapist time is saved, two therapist can interact,
– Cost of travel for family, therapy will be formal
• Home Setting :
– Family dynamics can be seen
– All family members may be there
– Easy to divert the mind of the therapist
 Stages of Treatment
• Early stage
• Middle stage
• Late stage
 Early Stage
• Establishing the therapeutic relationship
• Details of the primary problem
• Clarifying the goals for treatment
• Focus must begin with one member
• Then shift to all other members
• Decrease the guilt and blame
• Point out each members view
• Each members empathise with each other
 Middle Stage
• Focus on attitude
• Interpersonal relationships
• Non-functional coalition
• New ways of interacting
• Handling the resistance – not saying anything
 Late Stage
• Reviewing goals
• Review the course of the therapy
• Decide when to stop the therapy
• Therapy is stopped when the goals are
achieved
 Techniques of Family therapy
• Family Sculpting
• Family tasks
• Role play
• Psycho-drama
• Multiple family group therapy
• One-way mirror
• Circular questioning
• Hypothesizing
• Problem formulation
• conceptualization family pathology
• Joining
• Alliance / Aligning
 Family Studies
• 'family' as an important unit both from the
point of understanding the etiology of a
mental illness as well as planning treatment.
• Through the study of the families of the most
severely disturbed patients (schizophrenics)
the family as a unit started getting included in
treatment plans.
• This was primarily due to the efforts of
Ackerman who is considered the father of
family psychiatry (Ackerman, 1958).
 Double-bind communication
• 'double bind communication in the families of
schizophrenics.
• Double bind communication convey two or
more messages which are mutually
contradictory and
• they occur in emotionally heightened
situations.
• Parents of individuals with schizophrenia were
found to suffer from profound logical
inconsistencies in their communication.
• marital 'schism' husband and wife stay
together despite overt scrapping because one
marital partner is dependent on the other.
• There is an intense discord and distrust in the
marital relations of the parents of
schizophrenics called marital skew
 Assumptions
• the index patient was seen as a symptom of
the family pathology. (For eg: Child)
• mental disturbances are causally related to
mental disease or psychopathology in parents.
 Conclusion
• All happy families are alike
• All unhappy families are unique