FAMILY THERAPY

INTRODUCTION

Family therapy is a relatively recent development in psychotherapy. It began shortly after World
War II, when doctors treating schizophrenic patients noticed that the patients' families
communicated in disturbed ways. The doctors also found that the patients' symptoms increased
or decreased according to the level of tension between their parents. These observations led to
the consideration of a family as a system with its own internal rules, patterns of functioning, and
tendency to resist change.

The therapists started to treat the families of schizophrenic patients as whole units rather than
focusing on the hospitalized member. They found that in many cases the family member with
schizophrenia improved when the "patient" was the family system. (This should not be
misunderstood to mean that schizophrenia is caused by family problems, although family
problems may worsen the condition.) This approach of involving the entire family in the
treatment plan and therapy was then applied to families with problems other than the presence of
schizophrenia.

Family therapy is becoming more common as changes in American society are reflected in
evolving family structures. The treatment philosophy has led to the development of couples
therapy, which treats relationship problems between partners; and to the treatment of groups that
resemble families (such as religious communities).

Family therapy tends to be brief (averaging only about 9 sessions)—requiring less time than the
average individual treatment of 13 sessions. Nearly 65.6%of the cases are completed within 20
sessions, 87.9% within 50 sessions. Research indicates that marriage and family therapy is more
effective than individual treatment for many mental health problems such as schizophrenia,
alcoholism and drug abuse, children's conduct disorders, adolescent drug abuse, anorexia in
young adult women, childhood autism, chronic physical illness in adults and children, and
marital distress and conflict.
DEFINITION OF FAMILY

 Family is a group of individual that interact, support, and influence each other in
performing basic functions.
 They are an integral part of the society, bound together by intense and long- lasting ties
of past experience, social roles, mutual support, and expectations.

DEFINITION OF FAMILY THERAPY

 Family therapy is a type of psychological counseling (psychotherapy) done to help family

members improve communication and resolve conflicts. Family therapy is usually
provided by a psychologist, clinical social worker or licensed therapist. These therapists
have graduate or postgraduate degrees and may be credentialed by the American
Association for Marriage and Family Therapy (AAMFT)
 Family therapy is a method of treatment in which family members gain insight into
problems, improve communication, and improve functioning of individual members as
well as the family as a whole.

 Family therapy is a form of psychotherapy that involves all the members of a nuclear or
extended family. It may be conducted by a pair or team of marriage and family therapists
who have come from a wide variety of educational backgrounds including psychology,
psychiatry, social work, nursing, pastoral counseling and education.

GOAL OF FAMILY THERAPY

 Major goal is to facilitate positive change in the family.

 Family therapy can help you improve troubled relationships with your spouse, children,
or other family members.
Other goals are :-

o Fostering open communication of thoughts and feeling

o Promoting optimal functioning interdependent roles

5 INTERPERSONAL REQUISITE FOR MAINTENANCE OF WELL BEING OR

HEALTH IN INDIVIDUALS AND FAMILIES
• Love
 • Support
• Impulse control
• Feel part of the group
• Personal achievement and recognition

CHARACTERISTICS OF HEALTHY FUNCTIONING FAMILIES

According to Goldenberg & Goldenberg, 1995
• No single member dominates or control another
• Family members participates in activites together
• Children are allowed to express opinions
• Family members adapt to the changes

APPROACHES TO FAMILY THERAPY

Jones (1980) describes seven orientations or approaches to family therapy

• Integrative Approach
• Psychoanalytic Approach
• Bowen Approach
• Structural Approach
• Interactional or Strategic Approach
• Social Network or Systematic Approach
• Behaviorist Approach

1. Integrative Approach
Overall goal: Remove pathogenic or intrapersonal conflict and promote more healthy
relationships within the family (Jones, 1980)
• Nathan Ackerman
• Grandfather of family therapy
• Focused on family values
• A problem arises when interpersonal conflict is internalized by the client and it becomes
an interpersonal conflict

2. Psychoanalytic Approach
Goal: Guide the family members who exhibit pathology into clarifying old misunderstandings
and misinterpretations between themselves and parent s and members of the family of origin and
establishing an adult to adult relationship (Jones, 1980)
• Family members are affected by each member’s psychological make-up
• Problem arises when there is an internalization or introjection of parental figures

3. Bowen Approach
Goal: To gain the clarity and conviction to carry through one’s own positions, such as a parent,
spouse, or dependent child (Titleman, 1998)
• Consist of both emotional and relational systems.
• Individuals behavior is a response to the functioning of the family system as a whole
(Bowen, 1978)
• Differentiation of self-concept
• Focuses on guiding one or more family members to become a more solid, defined self in
the face of emotional forces created by marriage, children, or the family of origin

4. Structural Approach
Goal: Develop clear boundaries for individual members and changing the family’s structural
pattern
• Salvador Munuchin
• Family as a system of individuals
• problem arises if family boundaries become enmeshed or disengaged and can’t cope
with change
• The therapy is short term and action oriented with the focus on changing family
organization and social context

5. Interactional or Strategic Approach

Goal: Homeostasis among family members
• Virginia Satir & Jay Haley
• Communication theory
 • The therapist studies the interactions between and among family members, recognizing
that change in one family member occurs in relation to change in another family member.
• Deals with interpersonal relationships among all family members and focuses on why the
family is in therapy and what changes each member expects

6. Social Network or Systematic Approach

Emphasizes the natural healing powers of the family
• Healing comes from social relationship
• Problem arises when the family loses its ability to recover quickly from change
• This used but is not clearly defined
• Bringing several people together as a social network who have similar ideals and goals

7. Behaviorist Approach

Goal: Behavioural change by positive reinforcement

• Individual learns that she or he obtain satisfaction or rewards from certain responses of
other individuals.
• Problem arises when maladaptive behavior is learned and reinforced by the family
• TO GAIN ATTENTION!!
• This approach is direct and clearly stated in bringing change

INDICATION

Family therapy is often recommended in the following situations:

 During treatment of a patient with schizophrenia or multiple personality disorder(MPD)

to help other family members understand the disorder and adjust to the person's
psychological changes
 Families with trouble across generations, such as problems caused by parents sharing
housing with grandparents or children being raised by grandparents
 Families who deviate from social norms (common-law relationships, gay couples rearing
children) who may be troubled by outsiders' attitudes
  Families with members from different racial, cultural, or religious backgrounds
 Families who are "picking on" one member or undermining the treatment of a member in
individual therapy
 Families who seem inextricably tied to problems of an identified patient
 Blended families with adjustment problems
 Psychosis reactive depression
 Anxiety disorder
 Psychosomatic disorder
 Substance abuse
 Childhood psychiatric problems

CONTRAINDICATION

Some families are not considered suitable candidates for family therapy, including:

 Families in which one or both of the parents is psychotic, antisocial or paranoid

 Families whose cultural or religious values are opposed to, or suspicious of
psychotherapy
 Families with members who can't participate in treatment sessions because of physical
illness or similar limitations
 Families with members with very rigid personality structures who are at risk for an
emotional or psychological crisis
 Families whose members can't or won't be able to meet regularly for treatment
 Unstable families or those on the verge of breakup.

TYPES OF FAMILY THERAPY

1) Individual family therapy:

In individual family therapy each family member has a single therapist. The whole family
may meet occasionally with one or two of the therapists to see how the members are
relating to one another and work out specific issues that have been defined by individual
members.
2) Conjoint family therapy:
 The most common type of family therapy is the single-family group, or conjoint family
therapy. The nuclear family is seen, and the issues and problems raised by the family are
the ones addressed by the therapist, the way in which the family interacts is observed and
becomes the focus of therapy. The therapist helps the family deal more effectively with
problems as they arise and are defined.
3) Couple therapy:
Couples are often seen by the therapist together. The couple may be experiencing
difficulties in their marriage, and in therapy they are helped to work together to seek a
resolution for their problems. Family patterns, interaction and communication styles and
each partner’s goals, hopes and expectations are examined in therapy. This examination
enables the couple to find a common ground for resolving conflicts by recognizing and
respecting each other’s similarities and differences.
4) Multiple family group therapy:
In multiple family group therapy, four or five families meet weekly to confront and deal
with problems or issues they have in common. Ability or inability to function well in the
home and community, fear of talking to or relating to others, abuse, anger, neglect, the
development of social skills, and responsibility for oneself are some of issues on which
these groups focus. The multiple family group becomes the support for all families. The
network also encourages each person to reach out and form new relationships outside the
group.
5) Multiple impact therapy:
In multiple impact therapy, several therapists come together with the families in a
community setting. They live together and deal with pertinent issues for each family
member within the context of the group. Multiple impact therapy is similar to multiple
family group therapy except that it is more intense and time limited. Like multiple family
group therapy, it focuses on developing skills of working together as a family and with
other families.
6) Network therapy:
Network therapy is conducted in people’s homes. All individuals interested or invested in
a problem or crises that a particular person or persons in a family are experiencing take
part. This gathering includes family, friends, neighbors, professional groups or persons,
and anyone in the community who has an investment in the outcome of the current crisis.
 People who form the network generally know each other and interact on a regular basis in
each other’s lives. Thus a network may include as many as 40 to 60 people.
The rewards are great when all the people involved mobilize energy for
management of the problem. The power is in the network itself. The answers to each
problem come from the network and how people in the network decide to manage each
issues as it arises. The therapist serve as a guide to clarify issues, reinforce the
importance of and need for the network towards its members collectively and
individually, and assists in the development and effective management in the evolution of
the problem resolution.

PREPARATION

 The family therapist will usually evaluate a family for treatment by scheduling a series of
interviews with the members of the immediate family, including young children, and
significant or symptomatic members of the extended family.
 This process allows the therapist to find out how each member of the family sees the
problem, as well as to form first impressions of the family's functioning.
 Family therapists typically look for the level and types of emotions, patterns of
dominance and submission, the roles played by family members, communication styles,
and the locations of emotional triangles. They will also note whether these patterns are
rigid or relatively flexible.

Genogram:

 Preparation also usually includes drawing a genogram, which is a diagram that

depicts significant persons and events in the family's history.
 Genograms also include annotations about the medical history and major personality
traits of each member.
 Genograms help in uncovering intergenerational patterns of behavior, marriage
choices, family alliances and conflicts, the existence of family secrets, and other
information that sheds light on the family's present situation.
 The chief risk in family therapy is the possible unsettling of rigid personality defenses in
individuals, or couple relationships that had been fragile before the beginning of therapy.
Intensive family therapy may also be difficult for psychotic family members.
 The federal government has designated marriage and family therapy as a core mental health
profession along with psychiatry, psychology, social work and psychiatric nursing. Currently,
42 states regulate the profession by licensing or certifying marriage and family therapists;
many other states considering licensing bills.

Therapist:

The only preparation needed for family therapy is to find a psychologist or another type of
licensed therapist. You can ask your primary care doctor for a referral to a therapist. Family
members or friends may give recommendations based on their experiences. Your Health
Insurance Company, employee assistance program, clergy, or state or local mental health
agencies also may offer recommendations.

Before scheduling sessions with a therapist, consider whether the therapist would be a good fit
for your family. Here are some things to consider and some questions to ask:

 Education and experience. What is your educational and training background? Are you
licensed by the state? Are you accredited by the AAMFT or other professional organizations?
What is your experience with my family's type of problem?
 Location and availability. Where is your office? What are your office hours? Are you
available in case of emergency?
 Length and number of sessions. How long is each session? How often are sessions
scheduled? How many sessions should I expect to have?
 Fees and insurance. How much do you charge for each session? Are your services covered by
my health insurance plan? Will I need to pay the full fee upfront? What is your policy on
canceled sessions?

PATIENT SELECTION

 Families may be referred for treatment by, private physicians, and agencies such as the
school system, welfare board, parole officers and judges.
 Some families are referred for therapy from emergency room psychiatric services after a
visit caused by a crisis in the family, such as a drug overdose.
  On discharge from a psychiatric hospital, a patient and his family may be referred for
family therapy, as part of follow up services.
 Family therapy is the treatment of choice when there is a marital problem or sibling
conflict; family therapy may also be indicated when problems are caused by using one
child as the scapegoat.
 Situational crises such as the sudden death of a family member and maturational crises
such as birth of the first child, may cause sufficient stress to warrant family therapy

STAGES OF FAMILY THERAPY

1) The Initial Interview
2) The intervention or working phase
3) Termination phase

1) The Initial Interview

• Engagement stage-The family is met and put at ease

• Assessment stage-Problems that concern the family are identified

• Exploration stage- The therapist and family explore additional problems that may have a
sbearing on present family members

• Good setting stage- The therapist synthesizes all the information and family members
state what they would like to see changed

• Termination stage-The initial interview ends appointment is set for the next session, it is
determines which family members need to attend

Family Assessment Guide

1. Construct of a family genogram
2. Description of the family in relation to the community, focusing on ethnicity,
socioeconomic class, educational level and religion
3. Description of presenting problems, focusing on each family member’s perception
of the identified problem
4. Identification of communication patterns focusing on who speaks to whom, tone of
voice, emotional climate and manner by which emotions are expressed
 5. Identification of roles of family members as supportive, antagonistic, critical
scapegoat, rescuer, or victim. Are there family coalitions, pairings, triangles,
splits?
6. Developmental history of the family in general and of presenting problems
7. Family’s expectations of therapy

2) The Intervention or Working Phase

• The goal of the intervention phase is to help the family accept and adjust to change
• Occurs once a week
• The therapist role is to clarify and interpret communication as well as to offer suggestion
and guidance
12 family strengths by Otto (1963)
1. Provide for the physical, emotional and spiritual needs of each family members
2. Be sensitive to the needs of family members
3. Communicate feelings, emotions, beliefs and value effectively
4. Provide support, security and encouragement to enhance creativity and
independence
5. Initiate and maintain growth-producing relationships within and without family
system
6. Maintain and create constructive and responsible community relationships in the
neighborhood, school, town, and local and state governments.
7. Grow with and through children
8. Help one’s self and accept help when appropriate
9. Perform family roles flexible
10. Show mutual respect for the individuation and independence of each family
member
11. Uses crisis as a means of growth
12. Have aconcern for family unity and loyalty and for cooperation among family
members

3) The Termination Phase

• If the family has achieved the goals and identified specific problems have been resolved
then its time to initiate the termination phase

WHAT YOU CAN EXPECT

 Family therapy typically brings several family members together for therapy sessions.
However, a family member may also see a family therapist individually.
  Sessions typically take about 50 minutes to an hour. Family therapy is often short term —
generally less than six months. However, how often you meet and the number of sessions
you'll need will depend on your family's particular situation and the therapist's
recommendation.
 During family therapy, you'll examine your family's ability to solve problems and express
thoughts and emotions. You may explore family roles, rules and behavior patterns in
order to identify issues that contribute to conflict — as well as ways to work through
these issues. Family therapy may help you identify your family's strengths, such as caring
for one another, and weaknesses, such as difficulty confiding in one another.

For example,

Say that your adult son has depression. Your family doesn't understand his depression or how
best to offer support. Although you're worried about your son's health, conversations with your
son or other family members erupt into arguments and you're left feeling frustrated and angry.
Communication diminishes, decisions go unmade, and the rift grows wider.

In such a situation, family therapy can help you pinpoint your specific challenges and how your
family is handling them. Guided by your therapist, you'll learn new ways to interact and
overcome unhealthy patterns of relating to each other. You may set individual and family goals
and work on ways to achieve them. In the end, your son may be better equipped to cope with his
depression, and the entire family may achieve a sense of understanding and togetherness.

RESULTS

Family therapy doesn't automatically solve family conflicts or make an unpleasant situation go
away. But it can help you and your family members understand one another better, and can
provide you with skills to cope with challenging situations in a more effective way.

CONCLUSION

Family therapy is that branch of psychiatry which sees an individual’s psychiatric symptoms as
inseparably related to the family in which he lives. Thus the focus of treatment is not the
individual, but the family. It represents a form of intervention in which members of a family are
assisted to identify and change problematic, maladaptive, self-defeating, repetitive relationship
patterns. The goal of family therapy is to bring about positive change in relationships, thus the
therapist ideally conducts the initial assessment with the entire family.
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Publisher(2007) Pp:320-324

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