If you’ve ever heard someone who’s really frustrated state “My family makes me so crazy!” there was likely a lot of truth to it. You see, family therapy – a type of therapy in which a therapist works with the entire family at the same time – developed from early studies of the families of schizophrenics. Pioneers in clinical psychology noticed particularly dysfunctional patterns in the families of schizophrenic individuals. As a result, many believed that treating the entire family was often more effective than treating an individual member. (It should be noted that schizophrenia is not “caused” by family dysfunction.)
Today, family therapy is widely used and recommended by many mental health professionals. It is often a key element of treatment in residential programs that focus on eating disorders, drug and alcohol addiction, and mental health issues. However, it’s used in a variety of different settings.
Basic Premise of Family Therapy
The basic premise of family therapy rests on the fact that no one grows up in a vacuum. We’re all deeply influenced by our family of origin, which is a unique system in and of itself. Every family has patterns of interacting, behaving, and communicating. These patterns range from quite healthy to highly dysfunctional. The more dysfunctional the family, the more negative impact there is on each individual member.
Family therapists recognize that when someone in the family is “sick” (e.g. struggling with a depression, anxiety, or an addiction) it’s often a symptom of problems within the family. By treating just the individual, they’re essentially treating the symptom but not addressing the illness itself.
If that person gets better, it’s not uncommon for someone else in the family to get sick or for the first person to get sick again (due to the family’s resistance to change). One way or another, the family unit strives to maintain the status quo – a state of homeostasis. If one person changes – e.g. starts to get well – then everyone else in the family must change in order to adapt.
This is why people who begin to improve their lives, overcome an addiction, or recover from a mental illness are often met with a lot of resistance from their own family. It’s very common for family members to sabotage one member’s progress – whether intentionally or subconsciously – even when they’re superficially expressing their support. This particular dynamic is why family therapy often plays a very important role in drug and alcohol treatment programs.
Family therapy helps get to the heart of these issues. By doing so, the family as a whole can make positive changes – changes that benefit each member individually as well. Rather than focusing on a single individual, family therapy treats the family as a unit. No single family member is regarded as “the problem”, although many families often use one member as a “scapegoat”, on which all or most of the problems are blamed. Family therapists recognize that this is a reflection of much deeper, and much bigger, issues within the family.
As a general rule, the primary goals of family therapy include improving communication among family members, creating healthier and more balanced relationships between members, and learning how to resolve conflicts in a healthy manner.
Although it’s very common for one individual within the family to have a formally diagnosed mental health condition (e.g. bipolar disorder or ADHD) – the “identified patient” – family therapy typically regards the family unit as the patient, rather than that individual. One family therapy approach that is somewhat of an exception to this is family-focused therapy (FFT). It focuses on improving family relationships, resolving conflicts, and educating other family members in order to help the individual successfully manage his or her disorder, rather than perpetuating it or making it worse.
A Brief History
To truly appreciate how family therapy works, as well as how it can benefit the issues that many families face, it’s helpful to understand the thinking of several family therapy pioneers. Following are five highly respected individuals who’ve had an especially strong influence on the development of family therapy:
Salvador Minuchin – Dr. Minuchin was a child psychiatrist who developed the concept of structural family therapy. He believed that the relationships amongst family members ranged from completely disengaged to highly enmeshed. Disengaged families feel very detached from each other. Enmeshed families lack healthy personal boundaries and become overinvolved in each other’s lives, unable to see themselves as separate, unique individuals. He also often observed “triangulation” in families, which occurs when two members align together against another member. Each of these patterns reflect problems in the family’s “structure” – hence the premise of Minuchin’s approach, in which a healthy restructuring of the family was the goal.
Virginia Satir – Virginia Satir’s approach to family therapy was based on the belief that family members had good intentions, but didn’t know how to interact with each other in a healthy way. She viewed the family as a “balanced system” in which various imbalances within the system (i.e. some members carrying too much “weight” or responsibility) caused problems. Her goals included helping families to embrace change and communicate their feelings openly with each other.
Carl Whitaker – Dr. Whitaker’s (author of “The Family Crucible”) symbolic-experiential approach to family therapy was quite unique. He tended to be quite confrontational, encouraging families to address taboo, uncomfortable issues. By “stirring the pot”, his seemingly irreverent methods disrupted the family’s usual unhealthy patterns and helped them learn to interact more openly, honestly, and genuinely with each other.
Murray Bowen – Dr. Bowen developed a multigenerational approach to family therapy. He believed that current unhealthy family dynamics developed across several generations. With the use of genograms (similar to a family tree), the families he worked with mapped out their history (focusing on relationships, alliances, and influences) to uncover and change dysfunctional family patterns. One of his primary therapy goals was to help members become less emotionally entangled with each other.
Jay Haley – Jay Haley, who co-founded the Family Therapy Institute of Washington DC with his second wife, played a key role in creating what’s known as “strategic family therapy”. His goal was to help each family develop a practical strategy or plan to resolve specific a problem. Over the course of treatment, the strategy is continually evaluated and revised as needed. The strategic approach is short-term and focused on solutions.What to Expect in Family Therapy
Like other types of therapy, family therapy isn’t a one-size-fits-all approach. As you can see from the different approaches used by Satir, Bowen, and others mentioned above, the approach a family therapist takes can vary greatly. That’s not to say, however, that one approach is better or more effective than any other.
In family therapy, as much of the nuclear family as possible is involved in the process. Many family therapists require that every family member is there for every session, or the session won’t happen. If extended family members play a significant role or live with the family (e.g. a grandparent), those individuals would likely be included.
One of the challenges of family therapy is that not everyone in the family is always on board. Sometimes a family member finds the idea very threatening or uncomfortable, or feels that it’s not appropriate to “air the family’s dirty laundry” to some outside person. If this person refuses to participate then the effectiveness of family therapy may be hindered. However, this doesn’t necessarily mean that other members can’t benefit. These issues can be discussed up front with the therapist to determine how to best proceed.
Although the length of family therapy can vary greatly depending on a variety of factors, anywhere from 2 to 6 months of weekly, 1-hour sessions is fairly typical. Granted, therapy may take much longer if the issues being addressed are particularly complex.
It’s not uncommon for family therapy sessions to be conducted by two therapists, rather than one. It’s difficult to catch all the subtle nuances (e.g. nonverbal interactions between family members) that occur with multiple people in the session. Two therapists working together are more likely to catch things that one working alone might not.
In many cases, one member of the family is already in some form of mental health or addiction treatment (e.g. individual therapy, residential treatment, or drug rehab) when family therapy is recommended.
During a family therapy session, the therapist will facilitate discussion, observe interactions, and help the family find ways to constructively deal with the primary issue.
What It’s Used to Treat
Family therapy can be used to help a variety of different problems. They include, but are not limited to:
- Resolving conflict within the family (e.g. between parents, between siblings, between parents and children, and extended family issues that are causing conflict such as a meddlesome relative or overbearing grandparent)
- Helping families prepare for and / or adapt to a challenging transition, such as moving on after the loss of one parent due to death or divorce, the remarriage of a parent (and subsequent blended family issues), or adjusting to life in a new and very different living situation or environment (e.g. moving to a large city from a small town, or a major change (good or bad) in socioeconomic status)
- Addressing specific problems, such as coming to terms with a recent serious mental or medical diagnosis of a family member (e.g. an adolescent’s recent diagnosis of schizophrenia or finding out a parent has cancer) or the acting out behavior of a family member
- Changing harmful patterns of verbal abuse and increasing harmony within the family
- Finding ways to talk openly and deal with painful issues without it escalating into a huge family bconflict
Benefits and Advantages of Family Therapy
There are several benefits of family therapy. They include:
- An increased awareness of the impact the family has on each individual, and also how the behaviors of individuals members impact the entire family
- The ability to address deeper issues that can’t be dealt with in individual treatment
- The ability to reduce or eliminate unhealthy patterns that have been passed down through generations, which in turn benefits future generations
- Decreasing or ending the scapegoating and blame that contributes to and maintains illness within the family
- Improvement in communication and problem solving skills, not just of the family as a unit, but also of each individual – skills that will also benefit them in their relationships outside the family
- Can increase the effectiveness of individual treatment (when contributing family issues are addressed)
- Each individual has a voice in the therapy session, which isn’t always the case at home
- Family members can practice new behaviors and ways of interacting with each other in the therapy session under the guidance of the therapist
While there are many benefits of family therapy, it’s not without potential disadvantages, including:
- A therapist who lacks the proper training, skills, and experience in family therapy can do more harm than good (which is true for all types of therapy)
- It can be difficult for busy families to get everyone to a weekly session, especially when schedules significantly conflict or a parent (or other family member) is traveling frequently
- Family therapy can, potentially, open a Pandora’s box of secrets and issues that may create more problems and conflict between family members (e.g. an older sibling lets it slip that she knew her mother had recently had an affair, and the father and siblings weren’t aware)
- Not all family members are willing to participate and may refuse to go to sessions
- If a family decides to stop going to therapy prematurely, it can result in things being worse than they were before therapy. This is often because emotional wounds have essentially been opened (in therapy sessions) and not yet properly dealt with during therapy
Where to Find a Qualified Family Therapist
Family therapy is usually provided by a clinical psychologist, marriage and family therapist, or a clinical social worker. If you’re already working with a therapist, he or she may be able to provide you with the names of one or more family therapists. A local mental health clinic may also be able to suggest some qualified therapists. You can also search online for family therapists in your area.
Be sure to check out any potential therapist’s credentials and inquire about his or her history and experience with family therapy. Work only with someone who has the proper training and experience in this type of therapy. Just because someone is a licensed mental health professional doesn’t mean he or she is qualified to offer family therapy. Working with an entire family unit comprised of several different unique but intertwined personalities is significantly different than working with an individual one-on-one. It’s also quite different than conducting group therapy because a therapy group lacks many of the challenging dynamics that are an inherent part of a family unit.
Family therapy can be very effective in helping your family overcome major obstacles, learn to resolve conflicts effectively, and improve communication skills. Working together as a family unit under the guidance of a skilled therapist can help each member of your family feel more connected, valued, and heard.