Family Therapy Health Article

Definition

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 therapists. In many cases the team consists of a man and a woman in order to treat gender-related issues or serve as role models for family members. Although some forms of family therapy are based on behavioral or psychodynamic principles, the most widespread form is based on family systems theory. This approach regards the family, as a whole, as the unit of treatment, and emphasizes such factors as relationships and communication patterns rather than traits or symptoms in individual members.

Family therapy is a relatively recent development in psychotherapy. It began shortly after World War II, when doctors, who were treating schizophrenic patients, noticed that the patients' families communicated in disturbed ways. The doctors also found that the patients' symptoms rose or fell according to the level of tension between their parents. These observations led to considering a family as an organism or 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 an increasingly common form of treatment as changes in American society are reflected in family structures. It has led to two further developments: couples therapy, which treats relationship problems between marriage partners or gay couples; and the extension of family therapy to religious communities or other groups that resemble families.

Purpose

Family therapy is often recommended in the following situations:

• Treatment of a family member with schizophrenia or multiple personality disorder (MPD). Family therapy helps other family members understand their relative's disorder and adjust to the psychological changes that may be occurring in the relative.
• Families with problems across generational boundaries. These would include problems caused by parents sharing housing with grandparents, or children being reared by grandparents.
• Families that deviate from social norms (common-law relationships, gay couples rearing children, etc.). These families may not have internal problems but may be troubled by outsiders' judgmental attitudes.
• Families with members from a mixture of racial, cultural, or religious backgrounds.
• Families who are scapegoating a member or undermining the treatment of a member in individual therapy.
• Families where the identified patient's problems seem inextricably tied to problems with other family members.
• Blended families with adjustment difficulties.

Most family therapists presuppose an average level of intelligence and education on the part of adult members of the family.

Precautions

Some families are not considered suitable candidates for family therapy. They include:

• families in which one, or both, of the parents is psychotic or has been diagnosed with antisocial or paranoid personality disorder,
• families whose cultural or religious values are opposed to, or suspicious of, psychotherapy,
• families with members who cannot participate in treatment sessions because of physical illness or similar limitations,
• families with members with very rigid personality structures, (here, members might be at risk for an emotional or psychological crisis),
• families whose members cannot or will not be able to meet regularly for treatment,
• families that are unstable or on the verge of breakup.