Family Therapy is a type of group psychotherapy that helps family members support one another, understand each other, and work through challenging situations. It is most appropriate for when psychopathology for any one individual is exacerbated by the interpersonal interactions in the family.
Family therapy is typically the mainstay treatment for children with disruptive behaviours.[1] However, there is strong evidence for the use of family therapy in schizophrenia and it is recommended in most clinical guidelines.[2] Family therapy is also a mainstay of treatment in anorexia nervosa.[3]
Definition and Questions to Think About | Examples | |
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Family | A family is an open system composed of individuals that are connected in a specific way that mutually affects one another | A family of a father, mother, son, and daughter. |
Family Structure | The family structure are the rules that govern a family’s behaviour.
| Family structure is that father is always in charge but never shows emotion. Mother will always be emotive and cry. |
Subsystems | Subsystems are the way in which families differentiate between each other and carries out its functions (e.g. — there is a “parent’s subsystem,” a “siblings subsystem”). Each individual is part of multiple subsystems in which they have different levels of power.
| Mother and father form the parent subsystem. Son and daughter form the sibling subsystem. Mother and daughter also form a subsystem of their own being the caretakers in the family. |
Boundaries | Boundaries are the rules that determine who participates in what subsystems, when, and how much. There are two types of boundaries: interpersonal and subsystems. Boundaries become problematic when they are unclear, or are in either extreme of being enmeshed or disengaged. The goal is for the family to develop clear boundaries. However, appreciate that the families are doing the best that they can under their circumstances.
| Father is disengaged from son and daughter's social life and shows no interest. Mother is overly enmeshed with daughter's friends and relationships to the point of being overbearing. |
Power and Hierarchy | The relative influence of each family member on an outcome.
| Father speaks on behalf of the family most of the time and assigns tasks for the family. Mother will look to father for approval. |
Alignment | When two or more people share reciprocal benefits and bond in a positive way | Son and daughter are aligned and bond positively. They support each other when needed. |
Coalition | An alliance of family members against another, that can lead to scapegoating | Father, mother, and son have an alliance against daughter when she starts a new relationship. |
Triangulation | When one member of a two-member subsystem tries to distract by bringing in a third person | Father and mother have an argument, but mother brings up the son in as a third party. |
Evidence-based family therapies typically include psychoeducation, stress reduction, emotional processing, cognitive reappraisal, and structured problem solving. Family therapy can be thought of as occurring in 5 different stages.
The therapist joins with the family through:
The therapist now identifies the problems, structures, and goals of the family by:
The therapist begins doing or observing the following, and identifying major conflicts in the family by:
The therapist is maintaining the gains, supporting, and encouraging the changes in the family. Therapist is also keeping in mind that positives that the family notices can also be experienced as stressors.
When finishing therapy, therapist allows the family to start regulating themselves, and encourages reliance on the family members themselves. The therapist should check:
The McMaster approach has several principles including:
Narrative family therapy is another modality of family therapy that attempts to separate a person from the problematic behaviour. For example, a family might be concerned about an “angry child,” in narrative therapy, the following approach is taken:
Model | Key point | Features | Therapist Role |
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Psychodynamic-Experiential | • Focus is on individual maturation in context of family system | • Clarity of communication and honesty are priorities | • Establish intimate bond with each family member, use metaphors and body language • Uncover unconscious pattern of family relationships |
Family Systems (Bowen Model) | • The individual differentiates themselves from their family of origin • Focus on increasing levels of differentiation (making changes for the self rather than trying to change others) • Uses the genogram (a historical survey of the family) | • “Hot triangle” | • Shift/stabilize the hot triangle that is producing symptoms • Therapist is neutral and limits emotional contact with family members |
Structural (Minuchin) | • Family as single, interrelated systems, characterized by alliances and splits, hierarchy of power. | • Emphasizes on clarity and firmness of boundaries between generations | • Family mapping • Giving set of instructions to enhance communication • Goal is to obtain clarity |
General Systems | • Families are systems • Every action produces a reaction in others • Overlaps with Bowen and Minuchin models | • Families have external boundaries and internal rules • Every family member plays a “role” (e.g. - spokesperson, persecutory, victim, etc…) • Family members may scapegoat another member by blaming them for the families problems | • Insight and improved communication |