Introduction to Family Therapy
Family Therapy is a specific kind of psychotherapy that addresses different issues and crises of a family, placing various struggles of individuals in a broader context, of a family as a whole. That perspective helps clients to work towards achieving a common goal – improving their functioning as a team.
Every family, sooner or later, goes through a challenging period, struggles with significant life transitions or faces adverse situations such as health issues or grieving a loss of a loved one. The treatment helps to smoothen these difficult experiences. It is aimed at enhancing the communication skills of family members and strengthening their relationships by creating a safe zone of mutual respect and understanding.
Family therapy is designed to deal with complex issues such as behavioural problems of children and adolescents, domestic violence, substance abuse, mental health problems, facing a divorce or unexpected death or illness. Depending on those situations, the therapeutic process is tailored to the specific context of the family and matches the goals of the treatment with their particular needs.
To be considered a family member, one does not need to be a blood relative, living under the same roof as others. Family can be generally defined as a close circle of individuals who deeply care for each other and provide mutual support in the long term.
Even though the research says that the treatment works best when applied to all family members, that’s not always possible or necessary. Sometimes it can also happen that the therapist may wish to see a family member individually.
The duration of the therapeutic process can differ depending on the current issues of clients. Nevertheless, the treatment is relatively short-term, usually lasting for 12 1-hour sessions.
Common Types of Family Therapy
Family Therapy stems from systems theory introduced in the late 1960s by a psychiatrist, Dr Murray Bowen. He claimed that analysing the specific struggles of an individual in a systemic context of their family of origin can be beneficial in understanding and treating them. The basic premise of this theory states that every person has faced specific issues within their family of origin, which further influence their behavioural and emotional patterns. Bowen suggests that a shift in the functioning of one family member does impact the state of the whole system of a family in the long term. In this way, even if we feel disconnected from our family, we are inseparable from them.
Bowenian Therapy
Bowenian approach can work best for clients who seek an individual setting of the treatment and do not feel comfortable working therapeutically in the presence of other family members. This kind of therapy emphasises helping clients find a sense of balance between their independence from a family of origin and the ability to connect to them healthily. These are the two main concepts of Bowen Therapy that serve as a foundation to the treatment:
Differentiation Of Self
The level of the individual’s ability to think, feel, act, deal with pressure or anxiety in separation from their family varies from one person to another. Partially, we are already born with some level of it. Nevertheless, it is the dynamic of the relationships within a family during childhood and adolescence that determines how inclined each person is to fuse with or separate from the influence of other people in their adulthood.
Those with a poorly differentiated ‘self’ tend to emotionally merge with the current feelings of the group due to unhealthy boundaries within a family. They seek validation from others and depend on their approval.
On the other side of the spectrum are people with a well-differentiated ‘self’ who can stay emotionally connected to the family while maintaining their individuality even in crisis or conflict. Their actions are a consequence of their own decisions, not external pressure.
The lower the level of differentiation within a family, the more significant the vulnerability and susceptibility to distressing situations that result in an inability to adapt to challenging events correctly.
Triangulation
The other core concept focuses on the dynamic of “the smallest stable relationship system”. Bowen claims that even the most healthy couples tend to involve a third party in a time of crisis.
Theoretically, involving a third person provides an opportunity to stabilise the group, managing the resources to manage conflict and decrease distress levels. Nevertheless, the practice shows that triangles create problematic situations by uniting two individuals and leaving the third person out.
In times of conflict, the dynamics of the triangle change as the anxiety levels rise and the usual insider anticipates being rejected or threatened by the third party. The children in the family often become entangled in the parents’ marital issues, creating a dysfunctional triangle. The research even proves that triangulation can trigger mental health problems such as depression or anxiety.
Structural Therapy
This treatment emphasises the importance of reorganising the roles and distribution of power in a family as a practical way to solve specific issues. The core belief of this method says that the problems with which a child struggles can often have a root cause in unresolved conflicts of the whole family. The most common challenges that families face is the uneven distribution of power, where one parent makes all the decisions while belittling or excluding the other parent.
Throughout the duration of the therapeutic process, families can work together with the therapist to identify the dysfunctional behavioural patterns and improve them through the application of various techniques such as role-play and examination of different subsystems.
Strategic Therapy
Strategic therapy can be a good fit for families interested in a short-term, direct approach to solving their issues. The main objective of the therapeutic process is to enable change to take place as soon as possible. Instead of focusing on the family’s past, the emphasis is put on evaluating their behavioural patterns outside of the therapeutic setting in the present moment and coming up with a specific plan on how to deal with the particular issues of the clients. This therapy stresses the importance of tailoring the treatment to the family’s particular needs and solving their problems in a very efficient way.
Systemic Therapy
Systemic therapy takes a deep dive into the subconscious sphere of the family’s functioning and addresses the underlying issues of each conflict. The treatment is a good fit for those who, until now, could not find a therapeutic practice that would help them effectively cope with issues within a family. Systemic therapy’s core belief states that each family member takes part in the unconscious ‘game’, creating a vicious cycle of continuous issues without being aware of it. Throughout the therapeutic process, clients can expect to gain an understanding of these dysfunctional patterns and recognise them in the future. This knowledge gives a new opportunity to stop perpetuating the harmful patterns and choose to act differently.
The Role of a Family Therapist
The therapist’s role is to promote strength-based relationships within a family throughout the therapeutic process and replace dysfunctional behavioural patterns with healthy ones. Before engaging further in the treatment, therapists need to clarify that every topic mentioned during the sessions will stay confidential. Once that is settled, the duration and length of sessions are discussed along with a common shared goal.
However, before any of that can happen, therapists undergo formal training that educates and prepares them to deal with couple’s and family’s relationship issues after receiving a bachelor’s degree in psychology, social work, counselling or sociology. They also need to gain substantial clinical experience in coping with a wide variety of issues from infidelity, addiction, living with a person diagnosed with a mood disorder to facing an unexpected illness or death.
The practitioner should make clients feel safe, comfortable and hopeful by focusing on the positive memories rather than blaming someone or dwelling on the family’s troubling past. It is usual for a family therapist to play the objective role of a facilitator who pays attention to each member of the family, creating a safe space that enables everyone to engage in the conversation without fear or resistance. The practitioner aims to gently guide a conversation by making remarks, asking many questions or suggesting more topics.
Therapists tend to use various techniques like genograms to gain insight into a family’s intricate issues. It is also common for therapists to give the in-between sessions homework to the clients.
Functional Family Therapy (FFT)
FFT is a family-based short intervention program designed for high-risk adolescents aged between 11 and 18 who display behavioural issues such as violence, addiction, substance use, delinquency or crime.
In the short-term perspective, FFT focuses on improving the communication between family members. In the long-term, the treatment aims to stop the harmful behaviour by eradicating risk factors as well as ensure an adaptive development by strengthening protective aspects in and outside of the youth’s family.
FFT usually consists of 10 – 14 sessions over three months, each lasting for about 50 minutes to 1 hour. The meetings can occur in both clinical and home-based settings. That depends on the specific situation of the adolescents and their families. The treatment is proven effective when applied to various ethnic and cultural contexts as well.
Functional Family Therapy program follows these five phases:
Engagement
Building and supporting a stable relationship between the therapist and the clients is the priority of the initial phase of the treatment. Practitioners focus on being responsive to the family’s needs, actively listening and being highly available. The main objective here is to show the adolescent and their family the validity of the therapeutic process.
Motivation
Once the therapeutic relationship is established, it is crucial to elicit clients’ motivation to continue the treatment. That is achieved by shifting the focus from negativity, hostility or blame to strengthening the hopeful and positive vision of maintaining a lasting positive change in the family. The therapist should remain non-judgemental at all times while enabling healthy communication between family members through interventions such as stopping any hostile interactions, reframing the negative thinking patterns into positive ones.
Relational Assessment
In this phase, each issue is perceived from a relational rather than individual perspective. The therapist’s work here focuses on identifying, analysing, and assessing interaction patterns between family members and their consequences. Through asking questions, considering the bigger picture and observing the exchanges within the family, the therapist gains insight into the family’s core values, resources and limitations. That knowledge is essential when moving on to the next phase.
Behaviour Change
Once the relational assessment is finished, the action towards behaviour change can be taken. This phase primarily aims to diminish the dysfunctional or problematic relational patterns within the family and develop interpersonal skills to enable a lasting positive change in the family’s life. The behavioural interventions applied in the therapeutic process depend on the specific issues that clients are struggling with. The families receive skills training in the realm of communication, problem-solving or conflict management.
Generalisation
The program’s final phase emphasises solidifying the improvement made throughout the therapeutic process and applying it in various areas of the family’s life. The therapists also pay attention to addressing relapse prevention. A big significance is stressed on creating a sense of family’s independence by initiating and maintaining contacts with an outside community.
Benefits of Family Therapy
A substantial body of research conducted in the UK supports the effectiveness of family therapy and marriage interventions in coping with mood disorders, alcohol abuse, domestic violence or relationship distress (Shadish & Baldwin, 2003) as well as treating problems among children and adolescents such as delinquency, child abuse, eating disorders or drug abuse (Carr, 2009).
Other benefits of family therapy are receiving help to acknowledge the dysfunctional beliefs and patterns of interacting within a family and reorganise them into healthy ones. Throughout the process, family members gain essential communication, problem-solving, anger and conflict management skills that foster overcoming issues together and an enhanced compassionate understanding of one another.
If you feel like you and your family could benefit from this kind of therapy, ask your doctor for a referral to a therapist. Family Therapy, as a form of counselling, is refunded by the NHS.