Family Therapy

Family therapy is a form of psychotherapy that involves all the members of a nuclear or extended family. It may be conducted by a pair of therapists—often a man and a woman—to treat gender-related issues or serve as role models for family members. Although some types of family therapy are based on behavioral or psychodynamic principles, the most widespread form is based on family systems theory, an approach that regards the entire family as the unit of treatment, and emphasizes such factors as relationships and communication patterns rather than traits or symptoms in individual members.

Purpose The purpose of family therapy is to identify and treat family problems that cause dysfunction. Therapy focuses on improvement in specific areas of functioning for each member, including communication and problem-solving skills.

Family therapy is often recommended when:

  • A family member has schizophrenia or suffers from another severe psychosis: the goal in these cases is to help other family members understand the disorder and adjust to the psychological changes that may be occurring in the patient.
  • Problems cross generational boundaries, such as when parents share a home with grandparents, or children are being raised by grandparents.
  • Families deviate from social norms (unmarried parents, gay couples rearing children, etc.). These families may or may not have internal problems, but could be troubled by societal attitudes.
  • Members come from mixed racial, cultural, or religious backgrounds.
  • One member is being scapegoated, or their treatment in individual therapy is being undermined.
  • The identified patient’s problems seem inextricably tied to problems with other family members.
  • A blended (i.e. step-) family is having adjustment difficulties.

Description 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 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. When the therapists began to treat the families as whole units instead of focusing solely on the hospitalized member, they found that in many cases the schizophrenic family member improved. (This does not mean that schizophrenia is caused by family problems, although they may aggravate its symptoms.) This approach was then applied to families with problems other than schizophrenia. Family therapy is becoming an increasingly common form of treatment as changes in American society are reflected in family structures; it is also helpful when a child or other family member develops a serious physical illness.

Family therapy tends to be short term, usually several months in length, aimed at resolving specific problems such as eating disorders, difficulties with school, or adjustments to bereavement or geographical relocation. It is not normally used for long-term or intensive restructuring of severely dysfunctional families.

In therapy sessions, all members of the family and both therapists (if there is more than one) are present. The therapists try to analyze communication and interaction between all members of the family; they do not side with specific members, although they may make occasional comments to help members become more conscious of patterns previously taken for granted. Therapists who work as a team also model new behaviors through their interactions with each other.

Family therapy is based on systems theory, which sees the family as a living organism that is more than the sum of its individual members and evaluates family members in terms of their position or role within the system. Problems are treated by changing the way the system works rather than trying to “fix” a specific member.

Family systems theory is based on several major concepts:

The Identified Patient The identified patient (IP) is the family member with the symptom that has brought the family into treatment. The concept of the IP is used to keep the family from scapegoating the IP or using him or her as a way of avoiding problems in the rest of the system.

Homeostasis This concept presumes that the family system seeks to maintain its customary organization and functioning over time. It tends to resist change. The family therapist can use homeostasis to explain why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and what is likely to happen when the family begins to change.

The Extended Family Field The extended family field is the nuclear family plus the network of grandparents and other members of the extended family. This concept is used to explain the intergenerational transmission of attitudes, problems, behaviors, and other issues.

Differentiation Differentiation refers to each family member’s ability to maintain his or her own sense of self while remaining emotionally connected to the family; this is the mark of a healthy family.

Triangular Relationships Family systems theory maintains that emotional difficulties in families are usually triangular—whenever any two persons have problems with each other, they will “triangle in” a third member to stabilize their own relationship. These triangles usually interlock in a way that maintains homeostasis. Common family triangles include a child and its parents; two children and one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law.

Source: Encyclopedia for Mental Disorders

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