Family Therapy

The joint treatment of two or more members of the same family in order to change unhealthy patterns of communication and interaction.

Family therapy is generally initiated because of psychological or emotional problems experienced by a single family member, often a child or adolescent. These problems are treated as symptomatic of dysfunction within the family system as a whole. The therapist focuses on the interaction between family members, analyzing the role played by each member in maintaining the system. Family therapy can be especially helpful for dealing with problems that develop in response to a particular event or situation, such as divorce or remarriage, or the birth of a new sibling. It can also be an effective means to draw individuals who feel threatened by individual therapy into a therapeutic setting.

Family therapy has a variety of origins. It is related to the long-standing emphasis of psychoanalysis and other psychodynamic approaches on the central role that early family relationships play in the formation of personality and the manifestation of psychological disorders. Family therapy also grew out of the realization that progress made by patients staying in treatment centers was often reversed when they returned to their families. As a result, a number of therapists became dissatisfied treating clients individually with no opportunity to actively address the harmful family relationships that were often the source of their clients' problems.

Family therapy, either alone or in conjunction with other types of treatment, has been effective in the treatment of children suffering from a variety of problems, including anxiety, enuresis (bed-wetting), and eating disorders, and also in working with victims of child abuse. In addition to alleviating the child's initial complaint and improving communication within the family unit, family therapy can also help reduce stress and conflict by helping families improve their coping skills.

There are a number of approaches to family therapy. Perhaps the best known is structural family therapy, founded by Salvador Minuchin. A short-term method that focuses on the present rather than the past, this school of therapy views a family's behavior patterns and rituals as central to the problems of its individual members. Poor communication skills play a key role in perpetuating destructive interactions within families, such as the formation of alliances among some family members against others. The goals of structural family therapy include strengthening parental leadership, clarifying boundaries, enhancing coping skills, and freeing family members from their entrenched positions within the family structure. Minuchin divided families' styles of interacting into two basic types—enmeshed and disengaged, considering behavior at either extreme as pathological, with most families falling somewhere on a continuum between the two. Minuchin believed that the functioning of family systems prevented individuals from becoming healthier emotionally, because the family system relied on its troubled member to play a particular role in order to function in its accustomed way. This stability is disrupted if an individual changes significantly.

Psychodynamically oriented family therapy emphasizes unconscious processes (such as the projection of unacceptable personality traits onto another family member) and unresolved conflicts in the parents' families of origin. The lasting effects of such traumatic experiences as parental divorce and child abuse are explored. This type of therapy focuses more on family history and less on symptoms, resulting in a lengthier therapeutic process. Therapists who employ an object relations approach emphasize the importance of having the parents in a family work out conflicts with their own parents. Some practitioners include grandparents in their work with families in order to better understand intergenerational dynamics and deeply rooted behavior patterns. Ivan Boszormenyi-Nagy, a well-known proponent of this orientation, would only treat families when members of three generations could participate in therapy sessions.

Behavioral family therapy views interactions within the family as a set of behaviors that are either rewarded or punished. The behavioral therapist educates family members to respond to each others' behavior with positive or negative reinforcement. A child might be discouraged from repeating a negative behavior, for example, by losing some privileges or receiving a " time-out." Positive behavior might be rewarded with the use of an incentive chart on which points or stickers are accrued and eventually exchanged for a reward. Behavioral approaches sometimes involve the drawing up of behavioral "contracts" by family members, as well as the establishment of rules and reinforcement procedures.

Several other family therapy approaches, including that of Virginia Satir, are primarily concerned with communication. Satir's system combines the teaching of family communication skills, the promotion of self-esteem, and the removal of obstacles to the emotional growth so that family members can have full access to their innate resources.