Introduction and Rationale

“There’s always help in the family system.”1

 David Treadway, Ph.D.

While such phrases as “no person is an island” and “it takes a village to raise a child” have become
truisms in our culture, the implications of such statements have not yet deeply penetrated the culture of
the helping professions. Whether the issue is physical health, mental health or some other behavioral
or emotional problem, the treatment is still too often focused wholly, or mostly, on the individual
client/patient/consumer. What about this individual’s family?

An even cursory review of knowledge gained from such disciplines as history, archeology, paleontology
and anthropology reveals the wisdom and truth behind the “island” and “village” statements. And
sociology, of course, is dedicated specifically to the study of the collective behavior of organized groups
of human beings. These disciplines have been telling us for a long time – in some cases for centuries –
how people have collectively built societies and civilizations, thereby shaping the very nature of human
existence. On top of all this, evolutionary biology, genetics and neuroscience are now telling us that the
human brain developed in the way that it has specifically for the purpose of enabling survival within a
group of fellow human beings. The smallest viable unit of human survival and socialization is the family
(Perry; van der Kolk).

Family engagement recognizes the importance of family in the helping professions and seeks to utilize
the family as an agent of healing. It posits that individuals are tied together by powerful attachment
bonds that are rooted in both human biology and the life cycle. Ellen Berman and colleagues at the
University of Pennsylvania note that this need for connection to others is so powerful that in adult
relationships there is “a strong biological component of soothing and stress reduction when the partner
is present, and anxiety and depression when the partner cannot be found physically or emotionally.”
And when “an attachment relationship devolves into chronic conflict or high expressed emotion,” it
affects the person’s pulmonary, cardiac and immune systems and increases vulnerability to depression.
“In psychiatrically vulnerable individuals this leads to relapse and often rehospitalization” (Berman et al.,
p. 23).

In other words, for psychologically vulnerable and emotionally distressed persons, relationships have
both prophylactic power and healing potential. Nevertheless, barriers to family engagement in
treatment settings continue to loom large. Despite widespread evidence of the effects of relationships
on physical and mental health, Western culture – especially in the United States – continues to privilege
individual needs over the family and larger group needs. Psychiatry, psychology and the fields of therapy

1
David Treadway, personal communication, Oct. 14, 2017.

Engaging Families in Service: Core Philosophy, Principles and Methods, introduction

and counseling too often continue to function as if illness and disorders, sadness and dissatisfaction,
only affect the symptomatic individual or a collection of individuals (such as those situations where
multiple members of a family are seeing their own individual therapist but are never seen together); and
our insurance system often continues to deny coverage for family therapy and family support.

And yet, the individuals who our organizations serve stubbornly continue to exist as members of
families! The purpose of this curriculum, then, is to help direct-care workers in the helping professions –
education and the human and social services – to increase the effectiveness of their work, whether their
client is an individual or the family as a whole.

TRAINING GOALS

We see family engagement as the very bedrock of providing effective behavioral and mental health
services. When working with an “index person,” helpers must be curious about the people who are
important in this person’s life. They have to be open to constructive contact with family members and
other significant persons in order to help the individuals they are working with make difficult changes in
their lives. People do better in all forms of treatment when they feel comfortable that they will have the
support they need – and there is no better support than that which comes from one’s loved ones: family
and close friends.

As with any endeavor, family engagement and family work require certain skills that are easy and not-
so-easy to acquire. However, more important than the acquisition of formal skills is the development of
the proper attitude and frame of mind. One must actually like families and care about the family unit as
much as one likes or cares about an individual client. One must be respectful of the family and its
members, and curious about its potential (often hidden) to help the individual client, and amazed at its
beauty and complexity. One has to believe, along with structural family therapy guru Salvador Minuchin,
that families and family members are more resourceful than they know, but they have been “trapped”
into taking the well-traveled road to which they’ve become accustomed (Minuchin et al., p.7). And, one
has to learn to think systemically, to understand how family (and other) systems work, and how to use
the system for the benefit and good of all persons involved (Imber-Black).

We believe that when a helper stops thinking linearly (he did this, so she did that), which often involves
blaming or identifying who is right and who is wrong, and begins to think in terms of complementary
behavior and feedback loops, then that helper is on the path to helping people make significant changes
in their lives. We believe that the rewards of this change in thinking will be as great for the helper as for
the helped; after all, what feels better than knowing that one is doing one’s work well?

The ideas and techniques of family engagement and family work that will be presented here are rooted
in the “classic” family systems models – structural family therapy, strategic therapy, Bowen and Bowen-
indebted therapy – but are also indebted to insights from motivational interviewing and the some of the
“post-modern” family therapies. Our understanding is bolstered by the exciting knowledge we are
gaining from attachment and development theory, as well as traumatology and neuroscience.

Engaging Families in Service: Core Philosophy, Principles and Methods, introduction

Ours is not the first word, the last word, or the word on family engagement and family work. Family
work is a rich field, and we are constantly discovering new practitioners and researchers to learn from.
This entire package is not for everyone: for the most part, we took an ambitiously broad approach,
hoping to appeal to those whose work with families is fairly intensive and involved. However,
proficiency in family counseling and therapy comes only with supervised clinical experience and more in-
depth study of this way of thinking about, and addressing, problems in living. Just as no person or family
is an island, so too no clinician doing family work can become proficient on his or her own.

But even if you see your work with families as being somewhat less intensive, we encourage you to pick
and choose those modules which most fit your work. While we realize that not everyone is a therapist
(hence module XI), we believe that the work of every professional helper can be therapeutic. We
therefore hope that a variety of professionals will gain something from this curriculum and that he or
she will, like us, never stop learning about families and family work.

REFERENCES

Berman, E., et al. (2017) Family-Oriented Care in Adult Psychiatric Residency Training. Center for
Couples and Adult Families, Perelman School of Medicine, University of Pennsylvania. Retrieved on
9/22/2017 at
http://www.med.upenn.edu/ccaf/assets/usercontent/documents/family_oriented_care_in_adult_psych
iatric_residency_training.pdf>

Imber-Black, E. (1988) Families and Larger Systems: A Family Therapist’s Guide Through the Labyrinth.
New York: Guilford.

Minuchin, S., Reiter, M.D., and Borda, C. (2014) The Craft of Family Therapy. New York: Routledge.

Perry, B. D. (1997) “Incubated in Terror: Neurodevelopmental Factors in the ‘Cycle of Violence,’” in

Children, Youth and Violence: The Search for Solutions, pp. 124-148. J. Osofsky, ed. New York.

Van der Kolk, B. (2015) The Body Keeps the Score. New York: Penguin Books.

Engaging Families in Service: Core Philosophy, Principles and Methods, introduction