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Family Therapy

by João Borges Ferreira
Family therapists apply techniques from several areas and to do partnerships with other health professionals seeking the accumulated knowledge to adapt to many different contexts of the patients.
Family Therapy
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Published
Jul 07, 2019

Brief historic overview

For centuries, formal interventions to help families have been used. However, the roots of Family Therapy as a distinct professional practice as a branch of psychotherapy were established in the early 1900s with the emergence of the child guidance movement (1909) and marriage counselling (1920s). Psychoanalytic treatment was applied in parallel confidential sessions with spouses and provided the theoretical foundation for early family and marital investigations. The formal development of Family Therapy dates from 1940’s and early 1950s, with the foundation of the American Association of Marriage Counsellors in 1942 and with the contribution of groups and individual clinicians (Ackerman; Bowen; Bell; Bateson; Haley; Milan Group – Italy and others). In addition to these practitioners, a number of other important figures had improved the development of Family Therapy (Whitaker; Minuchin; Boszormenyi-Nagy; Watzlawick and others). Initially, there was a strong influence from psychoanalysis, social psychiatry, learning and behaviour therapy. There were many movements around the theoretical role that considered the family as a system and not only as an aggregation of individuals. These movements, such as the Palo Alto USA group through the work of the anthropologist Gregory Bateson and colleagues - Jay Haley, Donald Jackson, Paul Watslavick and others, introduced theories from cybernetics and general systems into psychotherapy, focusing on the role of communication. This group was also influenced by Erikson and his innovative use of strategies for change such as paradoxical directives.

By the mid 1960s several Family Therapy schools had emerged, such as MRI (Mental Research Institute, Palo Alto- USA), Brief Therapy, Strategic Therapy, Structural Family Therapy (Minuchin) and the Milan Systems Model. Independently, there emerged various Intergerational Therapies (Murray Bowen, James Framo and others), Psychodynamic Family Therapy and Multiple-family Group Therapy. The late 1960s-70s saw the development of Network Therapy and Behavioural Marital Therapy. By the late 1970s there were demarcations between schools like feminism and post-modernist approaches that reflected the political and cultural environment at that time, which derived into various “post-systems” constructivism and social constructionist theories (1980s-1990s). Multicultural, intercultural and integrative approaches are being nowadays developed.

These days, there is a tendency on the part of family therapists to apply eclectic techniques from several areas and to do partnerships with other health professionals seeking the accumulated knowledge to adapt to many different contexts of the patients. The Family Therapy Model is one of the most utilised models in the US and Europe.

Description

Family therapy, also referred to as couple and family therapy, marriage and family therapy, family and systemic psychotherapy and family counselling, is a branch of psychotherapy designed to identify family patterns that contribute to a behaviour disorder or mental illness and help family members to solve the identified problem. Family therapy involves discussion and problem-solving sessions with the family. Some of these sessions may be as a group, in couples, or one to one. In Family Therapy, the web of interpersonal relationships is examined and, ideally, communication is strengthened within the family. “Family” is defined by the modern family therapist as anyone who plays a long-term supportive role in one’s life, which may not mean blood relations or family members in the same household. Family relationships are viewed as important for good mental health, regardless of whether all family members are participating in the therapy (Laney Cline King in https://healthypsych.com).

What distinguishes Family Therapy from individual counseling is its perspective or framework, not how many people are present at the therapy session. This type of counselling views problems as patterns or systems that need adjusting, as opposed to viewing problems as residing in the person, which is why Family herapy is often referred to as a “strengths based treatment.”

Aims

Family Therapy aims to:

Be inclusive and considerate of the needs of each member of the family and/or other key relationships (systems) in people’s lives

Recognise and build on people’s strengths and relational resources

Work in partnership ‘with’ families and others, not ‘on’ them

Be sensitive to diverse family forms and relationships, beliefs and cultures

Enable people to talk, together or individually, often about difficult or distressing issues, in ways that respect their experiences, invite engagement and support recovery.

Adapted from http://www.aft.org.uk

Main uses (indications)

Family Therapy is indicated when there is a stressful conflict in a family, with or without symptomatic behaviours in one or more family members. More recently, the use of Family Therapy in the treatment of major psychiatric disorders, such as schizophrenia, depression, alcoholism, conduct disorders and somatoform disorders, is recognized – in these groups of disorders, the interventions are mostly psychoeducational and combined with other treatments. Psychodynamic Family Therapy is used for interventions for patients with narcissistic and borderline personality disorders.

Other common reasons for seeking Family Therapy include:

  • When a child is having a problem such as with school, substance abuse, or disordered eating.

  • Adjustment to a new family member in the home (i.e. birth of a sibling, adoption, disordered eating foster children, a grandparent entering the home)

  • A major trauma or change that impacts the entire family (i.e. relocation to a new house, natural disaster, incarceration of a family member)

  • Domestic violence

  • Divorce

  • Parent Conflict

  • Unexpected or traumatic loss of a family member.

Adapted from https://healthypsych.com/family-therapy/

Efficacy

The efficacy and effectiveness research related to Family Therapy has demonstrated good experimental outcomes. In addition, reductions in health care use have been documented, especially for heavy users of health care, after participating in Family Therapy. In most cases, Family Therapy has produced results better than no-treatment in control groups and results as good as, if not better than, other forms of psychotherapy. Given that Family Therapy has been shown to be effective in numerous research reviews and that including it in health care systems does not seem to increase health care costs, it may now be the time to begin to educate policy makers and offer this form of care to families who desire to receive it (Crane, R., Morgan, T. - The efficacy and effectiveness of family therapy, January 2007).

Reasons to ensure and expand provision of Family Therapy include:

(Stratton, P (2005). Report On The Evidence Base Of Systemic Family Therapy. Association for Family Therapy)

  • There is very substantial supportive evidence for its effectiveness from diverse research and clinical experience.

  • Trained family therapists draw on a good range of approaches with clear theoretical rationales.

  • Current models of Family Therapy pay explicit attention to issues of culture, ethnicity, gender, discrimination and wider physical and societal contexts.

  • Properly trained family therapists have transferable skills in relation to team working, consultation, organisation etc.

  • Family therapists can support other professionals in their work with families.

Most Important Models of Family Therapy Summary

Theoretical Model

Theorists

Summary

Technics

Bowenian

Family Systems

Therapy

Murray Bowen,

Betty Carter,

Michael Kerr,

Thomas Fogarty,

Edwin Friedman,

James Framo

Also known as "Intergenerational Family Therapy", may be considered a main bridge from psychodynamically oriented views to systems perspectives. The concept of multigenerational transmission and each generation moves toward a lower level of differentiation. Family members are led to achieve a balance of internal and external differentiation causing anxiety, triangulation, and emotional cutoff.

Detriangulation, emotional cutoff, differentiation of self, genogram.

Strategic

Therapy

Jay Haley, Cloe

Madanes

The symptoms of dysfunction are aimed to maintain homeostasis in the family hierarchy, as it transitions through several stages of the family's life cycle. They are primarily committed to changing behavior rather than insight, and are famous for creative interventions.

Directives, paradoxical injunctions, reframing, metaphoric tasks, restraining.

Milan Systemic Family Therapy

Luigi Boscolo, Gianfranco

Cecchin, Mara

Selvini Palazzoli, Giuliana Prata

This group shifted the focus of treatment away from observing interactive sequences and patterns, and toward questioning family belief systems.

Therapeutically, they moved away from creating strategies to help families change their behaviour.

Based on Gregory Bateson's cybernetics, they challenge erroneous family beliefs and reworks the family’s linguistic assumptions.

Hypothesising, circular questioning, neutrality, counterparadox.

Collaborative

Language

Systems

Therapy

Harry

Goolishian,

Harlene

Anderson, Tom

Andersen, Lynn

Hoffman, Peggy

Penn

Collaborative therapists help families re-organise their perceived problems through a transparent dialogue about inner thoughts with a "not-knowing" stance.

The therapist and the family work together, using their own knowledge and understanding the issues, to conceptualise and illuminate the client’s problems.

Dialogical conversation, not knowing, curiosity, reflecting teams.

Narrative

Therapy

Michael White,

David Epston

Separates the person from the problem and encourages people to rely on their own skill sets to minimise the problems that exist in their lives.

Personal experiences are transformed into stories to establish their identity as social and political constructs based on individual knowledge.

Deconstruction, externalising problems, mapping, asking permission.

Solution

Focused

Therapy

Kim Insoo Berg,

Steve de Shazer,

William

O'Hanlon,

Michelle

Weiner-Davis,

Paul Watzlawick

The focus is on future using a goal-directed approach centered on solutions, rather than on the problems.

The conversation is directed toward developing and achieving the client’s vision of solutions.

Future focus, beginner's mind, miracle question, goal setting, scaling.

Structural

Family Therapy

Salvador

Minuchin, Harry

Aponte, Charles

Fishman, Jorge

Colapinto

The therapist join the family to win their confidence and circumvent resistance.

Family problems arise from maladaptive boundaries and subsystems that are created within the overall family system of rules and rituals that led their interactions.

Joining, family mapping, hypothesising, reenactments, reframing, unbalancing

Experiential

Family Therapy

Carl Whitaker,

Virginia Satir,

David Kieth,

Thomas Malone,

August Napier

From Gestalt foundations, Experiential therapy is rooted in the notion that the cause of family problems is the emotional suppression that create problems within the family system.

The therapist is encouraged to be authentic and spontaneous worried less about the problem and more about the process of the experience.

Battling, redefining symptoms, affective confrontation, co-therapy,

Social Network

Therapy

Ross Speck,

Carlos Sluzki,

Mony Elkaim,

Jaakko Seikkula

"Social networks affect positively or negatively a person’s health, and a person’s health affects, in turn, the network’s availability" (Sluzki, 2010).

Explores the patterns and characteristics of social networks that maintain health and help prevent illness.

Ecomap, Retribalisation, Network Assembly, Open dialogue.

Comment from an expert and or quote from a famous psychotherapist

“I describe family values as responsibility towards others, increase of tolerance, compromise, support, flexibility. And essentially the things I call the silent song of life - the continuous process of mutual accommodation without which life is impossible”.

Salvador Minuchin

Comment from a trainee with some kind of experience

"All psychiatry residents would improve their clinical practice by learning about Systemic and Family Therapy, especially serving children and adults across the lifecycle. Clinicians learn how to apply comprehensive assessment and treatment for individuals, couples and families representing the needs of our diverse community. It leads us to help families discover their strengths and resources to solve problems including depression, anxiety, adolescence behaviour problems, family conflict, grief and loss, or to cope with health concerns. More than a therapy, it’s a way to deal with and prevent mental disorders."

Rita Almeida Leite, Psychiatry Trainee from Psychiatric and Mental Health Department – Baixo Vouga Medical Center – Aveiro, Portugal

Books, manual, videos, application, published online courses or international association

It is not possible to name all the important authors since there are so many great works in this area. To mention some of them:

  • Bateson, Gregory (1972) Steps to an Ecology of Mind

  • Watzlawick (1967) Pragmatics of Human Communication

  • Minuchin, S., & Fishman, H.C. (1981) Family Therapy Techniques

  • Haley, J. (1987) Problem-Solving Therapy

  • Selvini-Palazzoli, M., Boscolo L., Cecchin, G. & Prata, G. (1988) Paradox and Counterparadox: A New Model in the Therapy of the Family in Schizophrenic Transaction

  • de Shazer, S. (1991) Putting difference to work. New York: Norton.

  • Ackerman, N. (1966)Treating the Troubled Family.

  • Sluzki, C. (1976) Double-Bind: The Foundation of the Communication Approach to the Family

  • Whitaker, C. & Bumberry, W.M. (1988) Dancing with the Family.

Research possibilities and Courses

There are many possibilities for training and research around the world. All information is provided on local and international Family Therapy Associations whose websites are listed below in the annex. A summary of current evidence, research and training is available via the UK's Association of Family Therapy on http://www.aft.org.uk/training/view/academic-and-research-training.html.

Bibliography

Sholevar, G., Scwoeri, L. (2003) Textbook of family and couples therapy: Clinical Applications. American Psychiatric Publishing, 1st Edition

Guttman, H.A. (1991). Systems Theory, Cybernetics, and Epistemology. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel

Crane, R., Morgan, T. - The efficacy and effectiveness of Family Therapy, January 2007

https://healthypsych.com/family-therapy/

http://www.aft.org.uk

Europe: http://www.europeanfamilytherapy.eu

International: http://www.ifta-familytherapy.org

Family Therapy Associations outside Europe:

American Association for Marriage and Family Therapy - http://www.aamft.org/iMIS15/AAMFT/

American Family Therapy Academy - http://www.afta.org

Australian Association of Family Therapy - https://www.aaft.asn.au

FAMSA-Family and Marriage Association of South Africa - http://mzansiitsolutions.co.za/famsaorg/?q=node/48

Asian Academy of Family Therapy - http://acafamilytherapy.org/wordpress/

Journal

American Journal of Family Therapy

Journal of Feminist Family Therapy

Cahiers critiques de Thérapie Familiale et de pratique de réseaux

Journal of Marital and Family Therapy 

Ecologia Della Mente

Kontext

European Research Journal for Qualitative Research in Psychotherapy

Mediazione Familiare Sistemica

Family Systems Medicine

Psychotherapist im Dialog

Familiendynamik

Metalogos: Systemic Approaches and Psychotherapy

Family Learning

Mosaic

Family Process

Perheterapia

Family Relations

Psicobiettivo

Human Systems: the Journal of Therapy, Consultation and Management

Revues de psychologies et de travail social

Consultation and Management

Rivista di psicoterapia relationale

Hungarian Journal of Psychotherapy

Systeemtherapie

Interazioni

Systeme

International Journal of Group Psychotherapy

Systemic Thinking & Psychotherapy

Journal of Family Psychotherapy

Thérapie Familiale

Journal of Family Therapy

Zeitschrift für Systemische Therapie und Beratung

Affiliations

João Borges Ferreira: Psychiatry Trainee from Psychiatric and Mental Health Department – Baixo Vouga Medical Center – Aveiro, Portugal.

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