Family Therapy

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Family Therapy

THC Editorial Team December 29, 2020
Image of gamily upset over broken item
Broken Eggs, 1756, Jean-Baptiste Greuze, The Metropolitan Museum of Art

Contents

What Is Family Therapy?

Family therapy is an evidence-based form of psychotherapy that works to help people overcome individual and group issues in the context of a family. Family dynamics often play a large role in shaping who we are and who we will become. They provide early examples of how to love and interact with others, and they model rituals, customs, and habits that often influence our relationships later in life. A healthy family dynamic promotes healthy habits, but dysfunctional ones may promote the opposite. Family therapy offers the space and tools necessary to address familial problems effectively. Within a family therapy framework, the therapist’s understanding of the group dynamic is crucial.

Families may seek family therapy for many different reasons. This type of therapy may be extremely helpful during periods of transition, in times of intense emotional difficulty or conflict, or if one or more family members have mental health issues. For instance, families may seek this form of therapy if an adolescent or a parent suffers from a substance use disorder, an eating disorder, depression, or schizophrenia. In other instances, family therapy may help address situations in which a particular trauma has influenced the entire family (e.g., a natural disaster, incarceration, or death). Family therapy is also particularly helpful in situations when a new family member enters the home and requires significant adjustment, such as in the case of adoption, divorce or remarriage, and child fostering.

What Is the History of Family Therapy?

Various elements of family therapy can be identified in family-centered social work in the 19th and 20th centuries. However, family therapy was formally developed and founded in the early 1950s. This began around the time when the American Association of Marriage Counselors was established and various independent clinicians, such as Nathan Ackerman, Theodore Lidz, Carl Whitaker, and Ivan Boszormenyi-Nagy, started treating family members together.1

In the 1950s, a group of psychoanalysts including Carl Whitaker, Murray Bowen, and Ivan Boszormenyi-Nagy had a particular interest in the psychosocial causes and treatments of schizophrenia; they noted that changes in the emotional functioning of one family member were compensated for by changes in the emotional functioning of other family members.1 The fundamental premise that a family is an emotional unit was established. As a result, many therapists shifted their point of intervention toward a “family system” perspective that specifically addressed interpersonal family dynamics. The new approach allowed more flexibility in therapeutic practices and enabled greater progress;2 even if the family member who experienced schizophrenic symptoms did not want therapy—or was forced to go to therapy—the approach supported improvement in the other family members, which eventually influenced the family’s overall dynamic.3 That improvement includes greater emotional stability, greater communication skills, stronger emotional ties, and more.

How Does Family Therapy Work?

Family therapy can be administered by a psychologist, a clinical social worker, or a licensed marriage and family therapist.

Family therapy sessions usually take place once a week, and research has shown that positive outcomes often occur within 20 sessions.4 However, the number of sessions necessary to yield results varies from family to family. Sessions in this form of therapy do not follow a set sequence, but therapists often follow key steps.

Initially, a family enters therapy together to define the focus of their sessions. If the family includes both adolescents and parents, the therapist may ask to meet with the family members separately. This allows the therapist to gain a better understanding of each individual’s perspective, habits, interests, and concerns within the family. It may also enable the therapist to redefine the identified issues more specifically. For example, if a family enters therapy to support a child who has depression, the therapist may try to ascertain whether the depression is caused by what the family attributes it to or by something else.5 Sometimes, parents attribute their child’s depression to a personality trait, which places the responsibility on the child. However, a therapist may recognize that root problems in the entire family’s communication dynamics may contribute to the child’s depression. In response, the therapist may try to involve the entire family in the process of creating sustainable, productive change.

In this form of intervention, therapists seek to repair relationships and to strengthen familial support systems. They focus on facilitating effective communication and on decreasing criticism, anger, and unproductive conversations. By attending to the quality of family interactions, therapists encourage respectful and understanding engagement. The overall goals are to create positive experiences and resolve conflicts in order to teach families that immediate, open communication about any issues that arise is crucial for healthy family dynamics.

Effectiveness of Family Therapy

Family therapy is most effective when everyone within the family—that is, anyone who plays an essential, long-term, and supportive role—participates in the sessions.

Research has shown that family therapy leads to the following productive outcomes:6,7,8,9,10

  • improved communication
  • greater empathy
  • reduced conflict and tension
  • increased honesty
  • environments that are more supportive
  • increased family integration and decreased individual isolation
  • reduced instances of internalizing and externalizing problems
  • higher cohesion, satisfaction, and sense of competence (as reported by parents)
  • decreased parenting stress
  • improved symptoms in children and adolescents who have depression

Family therapy may help improve the following mental health disorders:11,12,13,14,15

  • anxiety
  • depression
  • eating disorders
  • schizophrenia
  • substance use disorders

In one study, researchers evaluated the effectiveness of a structural-strategic family therapy for adolescents and their families. They interviewed 41 parents with their adolescents and obtained detailed information on the adolescents’ behavior, the sense of competence the parents felt, and their family dynamics. The researchers found that regardless of the adolescents’ gender, adolescents had fewer internalizing (anxiety, social withdrawal, hypersensitivity, and depression) and externalizing (physical aggression and defiance) behavior problems after undergoing family therapy. Additionally, parents reported higher family cohesion, higher satisfaction in their relationship with their adolescent, and healthier parental practices (less authoritative behavior). This study displays the efficacy of structural-strategic family therapy and how it can improve the family dynamic and individual behavioral traits in both parents and adolescents.9

In another influential case study, researchers examined the effectiveness of family-based interventions for an adolescent with co-occurring schizophrenia and substance use disorders. They applied a family intervention for dual diagnosis (FIDD) program, which primarily focused on educating the adolescent’s family about his disorders, setting goals, building communication, and facilitating effective problem solving within the family dynamic. The study showed that the FIDD intervention helped the adolescent lessen his substance use problems and build skills for healthier relationships. The FIDD intervention also increased the adolescent’s ability to empathize and reduced his interpersonal stress.14

Potential Benefits of Family Therapy

Family therapy may benefit individuals who live in any type of family dynamic. However, it may be particularly beneficial for families that include parents and children.

Some studies have found correlations between family dynamics and children’s psychopathologies; such dynamics may contribute to mental health difficulties among children. Additionally, some mental health conditions have a genetic component and may run in the family.16 In such situations, family therapy offers a pathway to identify those disorders in children and to treat them effectively. Issues such as anxiety that present in childhood are often predictors of and risk factors for problems in the future. Therefore, alleviating mental health struggles at an early age within the family setting may improve the long-term quality of life for individuals and for their support systems.

References

  1. The Center of Family Systems Theory of Western New York. (n.d.). History of family systems theory. Retrieved November 19, 2020, from
    http://www.familysystemstheory.org/history/
  2. Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: Challenges and solutions. Neuropsychiatric Disease and Treatment, 11, 145–151.
    https://doi.org/10.2147/NDT.S51331
  3. The Center for Family Systems Theory of Western New York. (n.d.). Retrieved September 9, 2020, from
    http://www.familysystemstheory.org/
  4. Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian Journal of Psychiatry, 62(Suppl. 2), S192–S200.
    https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19
  5. Fauber, R. L., & Long, N. (1991). Children in context: The role of the family in child psychotherapy. Journal of Consulting and Clinical Psychology, 59(6), 813–820.
    https://doi.org/10.1037//0022-006x.59.6.813
  6. Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. International Journal of Environmental Research and Public Health, 16(7), 1255.
    https://doi.org/10.3390/ijerph16071255
  7. Cottrell, D. (2003). Outcome studies of family therapy in child and adolescent depression. Journal of Family Therapy, 25, 406–416.
    https://doi.org/10.1111/1467-6427.00258
  8. Couturier, J., Kimber, M.,&Szatmari, P. (2013). Efficacy of family‐based treatment for adolescents with eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders, 46, 3–11.
    https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.22042
  9. Jongerden, L.,& Bögels, S.M. (2015). Parenting, family functioning and anxiety-disordered children: Comparisons to controls, changes after family versus child CBT. Journal of Child and Family Studies,24, 2046–2059.
    https://doi.org/10.1007/s10826-014-0005-6
  10. Fauber, R. L., & Long, N. (1991). Children in context: The role of the family in child psychotherapy. Journal of Consulting and Clinical Psychology, 59(6), 813–820.
    https://doi.org/10.1037//0022-006x.59.6.813
  11. Austin, A. M., Macgowan, M. J., & Wagner, E. F. (2005). Effective family-based interventions for adolescents withsubstance use problems: A systematic review. Research on Social Work Practice,15(2), 67–83.
    https://doi.org/10.1177/1049731504271606
  12. Berglund, N., Vahlne, J. O., & Edman, Å. (2003). Family intervention in schizophrenia. Social Psychiatry and Psychiatric Epidemiology,38(3), 116–121.
    https://doi.org/10.1007/s00127-003-0615-6
  13. Diamond, G., & Siqueland, L. (1995). Family therapy for the treatment of depressed adolescents. Psychotherapy: Theory, Research, Practice, Training,32(1), 77–90.
    https://doi.org/10.1037/0033-3204.32.1.77
  14. Gottlieb, J.D., Mueser, K.T.,&Glynn, S.M. (2012). Family therapy for schizophrenia: Co‐occurring psychotic and substance use disorders. Journal of Clinical Psychology, 68, 490–501.
    https://doi.org/10.1002/jclp.21852
  15. Scholz, M., Rix, M., Scholz, K., Gantchev, K.,&Thömke, V. (2005). Multiple family therapy for anorexia nervosa: Concepts, experiences and results. Journal of Family Therapy, 27,132–141.
    https://doi.org/10.1111/j.1467-6427.2005.00304.x
  16. Steinsbekk, S., Berg-Nielsen, T.S., Belsky, J., Helland, E. B., Hågenrud, M., Raballo, A., & Wichstrøm, L. (2019). Parents’ personality-disorder symptoms predict children’s symptoms of anxiety and depressive disorders—Aprospective cohort study. Journal of Abnormal Child Psychology,47, 1931–1943.
    https://doi.org/10.1007/s10802-019-00568-9

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