Family Therapy

Graphics courtesy of Welldoing.orgOpens in new window Family therapy (also called family counselling) is a branch of psychologyOpens in new window and clinical social work that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members (WikipediaOpens in new window).

Early forms of psychotherapy, such as Freud’s psychoanalysisOpens in new window and Carl Rogers’s client-centered therapyOpens in new window, were based on the idea that psychological problems arise from unhealthy interactions with others. Freud maintained that neurotic conflictsOpens in new window were spawned in the family, and the best way to undo these influences was to treat the patient in private, away from the family’s influence.

Likewise, Carl Rogers believed that problems stemmed from early family interactions and cravings for parental approval. Rogers practiced individual therapy in private, where the therapist could provide unconditional acceptance to help guide the client on the road to self-actualizationOpens in new window (Nichols, 2008).

MarriageOpens in new window and family counselingOpens in new window in the United States originated in the 1940s and 1950s, with major expansion in the late 1970s and early 1980s. the popularity of marriage and family counseling increased because of several factors.

After World War IIOpens in new window, there was a sharp increase in the divorce rate, occurring simultaneously with the beginning of the baby boom in 1946. It was also related to the changing role of women. After World War II, more women sought employment outside the home.

The role of women continued to change with the rise of the women’s rights movement in the 1960s. The increase in the life span meant that couples found themselves living with their partners longer than at any previous time in history. All these factors set the stage for researchers and practitioners to find new ways to work with couples and families (Gladding, 2004).

In 1958, New York psychoanalyst Nathan AckermanOpens in new window treated families using psychoanalytic technique. Ackerman’s work led to newfound respect for family therapy in the field of psychiatryOpens in new window (Gladding, 2004).

American psychologist Jay HaleyOpens in new window, a domiant figure among early family therapists, blended his ideas with those of American psychiatrist Milton EricksonOpens in new window, who practiced hypnotherapyOpens in new window. Haley played a major role in the development of strategic family therapy, and his work influenced structural family therapy.

In the late 1950s, groups of researchers led by Gregory BatesonOpens in new window (Palo Alto, California) and Murray BowenOpens in new window and Lyman WynneOpens in new window (at the National Institute of Mental Health) explored how couples and families functioned when a family member was diagnosed with schizophreniaOpens in new window.

The Bateson group came up with concepts such as the double bind, described below:

When a person receives two contradictory messages and is unable to follow both, she develops psychological and physical symptoms as a way to escape the situation and reduce tension.(Gladding, 2004.)

Bowen developed a systemic treatment approach and a clinical tool known as the genogram. The genogramOpens in new window, still popular today, is a multigenerational visual representation of one’s family used to examine family patterns and roles. In the late 1970s, Bowen introduced ideas such as enmeshment and triangulation.

• Enmeshment refers to environments in which family members are overly dependent or involved with one another.
• Triangulation describes situations in which a person is pulled in two different directions by other family members.

In the 1970s, Argentinean therapist Salvador MinuchinOpens in new window originated structural family therapy, and Italian psychiatrist Mara Selvini PalazzoliOpens in new window created a form of strategic family therapy known as the Milan ApproachOpens in new window. In the 1970s and 1980s, American psychotherapists Steve deShazerOpens in new window and Bill O’HanlonOpens in new window developed brief solution-focused approaches to family therapyOpens in new window.

In the 1990s, Australian social worker Michael WhiteOpens in new window and David EpstonOpens in new window, a therapist from New Zealand, founded narrative family therapyOpens in new window (Nichols, 2008). In 1996, American social worker Monica McGoldrickOpens in new window emphasized the importance of multicultural factors and cultural background in treating families (Gladding, 2004).

The group therapy movementOpens in new window of the 1960s influenced the ongoing development of family therapy. There are similar theoretical underpinnings in group and family therapy.

Both groups and families focus on problem behaviors, influences between people and the environmentOpens in new window, and the influences of family on individual behavior. However, because a family has a shared historyOpens in new window and multigenerational influencers, family work calls for different techniques than working with a group of unrelated individuals.

Families are also different because of family roles, multiple complex relationships within families, and differences in status and power within a family. Two concepts of group dynamics that are important to family therapy have to do with communication and role theory.

Family members fulfill roles that influence each other. For example, if one child plays the role of the rebel, another child may fill the role of the hero, the good child, or the peacemaker. Family roles influence each other to maintain a balanced system (homeostasis), making behaviors more resistant to change.

Families often present for therapy with one one member identified as having or causing the problems (the identified patient). However, most family therapists work with the entire family system, focusing on the family structure, dynamics, and relationships.

Research shows that family counseling interventions are as effective as individual interventions for most client complaints and may lead to more enduring changes. Some forms of family therapy (e.g., structural-strategic family therapyOpens in new window with substance abusers) are more effective in treating problems than other approaches. The presence of all family members in therapy may improve the chances of successful outcomes. Overall, there is high client satisfaction from those who receive marital and family counseling services (Gladding, 2004).

Individual therapyOpens in new window and family therapy both have their place. To determine which treatment modality (e.g., individual or family therapy) is most appropriate, it is important to assess each case and situation on its own terms. Factors to be considered include the developmental stage of the family, cultural and gender issues, other mental health problems of family members (including substance abuse or dependence), and potential for abuse or domestic violence.

Professional organizations such as the American Association for Marriage and Family TherapyOpens in new window, founded in 1942, have developed professional standards and guidelines for training and credentialing marriage and family therapists.