Family Therapy

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

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

Links to Societies

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.