Psychology Topics > Family Therapy
Family therapy is basically what the term implies. It is a form of therapy in which the counselor works with the entire primary family at once instead of individual members. Often, a family therapist will even refuse to begin a session if one or more members of the family aren't present. The essential theory behind family therapy is that a family is a system made up of parts and a problem with one of the parts (or members of the family) affects the entire system. Families try to maintain homeostasis. This means that families try to keep things stable or the same. If one member of the family does anything out of the "norm" for that particular family, the members of that family will fight against him or her to bring things back the way they used to be. This is problematic, especially if one member of the family is in therapy and learning new coping styles, yet the family is fighting their healthy changes.
One reason why families and systems try to maintain homeostasis is because a change in one family member forces the rest to adapt and change also. For example, if a battered wife goes to therapy and learns how to stand up to her husband and take care of herself, the husband will fight against her to maintain control. This makes it harder for her to change. Therefore, family therapists propose that treating the entire family as a whole is much more effective than one member individually.
Family therapists believe there are no isolated problems. Families often enter therapy with an "identified patient" or "scapegoat." They blame one or more individuals for all the problems. Family therapists, however, believe that a problem with one member of the family reflects deeper issues and problems in the entire family system. In other words, the family member with the problem behavior is bringing attention to the family in order to help the whole system.
The first family theorists started by studying schizophrenia in families. They discovered that families with an identified schizophrenic member also had pathological communication patterns (in other words, they had poor communication skills that resulted in a variety of problems.) This led theorists to believe that it was the pathological communication and behaviors in the family that caused the schizophrenia in the first place. The family literally "drove the person crazy." Theorists such as Gregory Bateson explained that this was accomplished by the use of double binds in the family. A double bind is a situation in which a person is given conflicting messages and punished no matter what they do- just like the expression "damned if you do and damned if you don't." Bateson documented the following situation in a paper about the double binds in schizophrenia,
"A young man who had fairly well recovered from an acute schizophrenic episode was visited in the hospital by his mother. He was glad to see her and impulsively put his arm around her shoulders, whereupon she stiffened. He withdrew his arm and she asked, "Don't you love me anymore?"He then blushed, and she said, "Dear, you must not be so easily embarrassed and afraid of your feelings."(p. 259)
In this situation the son gave his mother a hug. Interpreting his mother's stiffened reaction to mean she was upset with him, he drew back. After drawing back, his mother contradicted her body language by suggesting that her son didn't love her anymore. He was, in a sense, punished for showing affection and then punished for not showing affection. Consequently, after this encounter he experienced another schizophrenic episode and had to be taken back to the ward. Several interactions like this one over the space of many years is very detrimental to the development of a child. The child may grow up not being able to relate to people or trust that people mean what they say they mean. In the next section, we will take a look at the historical precursors of family therapy.
Cybernetics and General Systems Theory
Cybernetics is important to the development of family therapy because it marked the beginning of the exploration of many types of systems including families. In fact, Cybernetics is the study of systems whether they are electrical, social, physical, mechanical, biological, or even psychological. An important piece of cybernetics is the concept of feedback. Feedback is output that will affect the same action in the future to either change (positive feedback) or stay the same(negative feedback).
A common example of negative feedback (feedback that keeps things stable or the same) is the population control of foxes versus rabbits. When rabbits are plentiful, the fox population grows because there are plenty of rabbits for them to eat. If the fox population gets too high then the rabbit population starts to dwindle because the high number of foxes are eating all the rabbits. A decrease in the rabbit population causes a decrease in the fox population because there are not enough rabbits to sustain the high fox population. Once the fox population decreases, the rabbits begin to multiply and the cycle starts all over again. Therefore, this negative feedback loop keeps the fox and rabbit population in check.
The fox and rabbit population constitute a system. A change in population of one species influences the population of the other. An example of a positive feedback loop could be a wife and husband disagreeing over a particular issue. Imagine in the past, they had argued and refused to compromise to the point that they were angry for an entire week afterwards. If however, the husband or wife decides to change their behavior in a beneficial way (e.g. -such as compromising) there would most likely be a different outcome. Their amount of conflict and fighting may decrease and perhaps the other partner would also compromise in the future. In this example, the husband or wife made a change that in turn changed the outcome. This idea that one aspect of a system influences the other parts of the system to adapt/change/or stay the same, is the essence of general systems theory. In the next section, we will identify some key theorists and family therapists.
Murray Bowen was influential in the development of family therapy because his theory (Bowenian family therapy) acted as scaffolding for many of the family theorists after him. Bowen believed that families were complex social systems that could only be understood though their relationships across many generations. In order to analyze these dynamics, he had the families he treated construct a genogram. A genogram is a mapping technique much like a family tree or pedigree chart except it also shows relationships between family members.
These relationships are illustrated by using different types and colors of lines such as zigzag lines for conflict between members or solid lines for close relationships. Then Bowen used their genogram to help the family understand the alliances and entanglements of family members. Bowen believed in order to solve family problems, the family members needed to differentiate from each other. This meant they needed to be able to tell the difference between their thoughts and emotions, needed to be able to plan, to think clearly and to act according to their personal values without being entrapped or reacting to someone else. He said families needed to learn how to balance being together as a family with being apart as individuals. Therefore, family therapists with a Bowenian philosophy attempt to treat families by lessening anxiety and increasing differentiation between individual family members.
Bowen also stressed the need for therapists to be differentiated from their own families of origin. He stated that if therapists were not differentiated, they were at risk for enmeshment with their client families' problems. Remember, differentiation does not mean emotionally cutting oneself off from family relationships. A differentiated individual is able to identify his or her own feelings and thoughts as separate from that of other family members and to make decisions without reacting to the family.
Carl Whitaker started his career by studying schizophrenics and their families. Like other theorists who began by studying schizophrenia, he found that the families of clients with schizophrenia were correlated with unhealthy communication and other behavioral patterns. It was the realization of this correlation that led psychologists such as Carl Whitaker to endorse family treatment as opposed to individual treatment.
Whitaker devised a new idea that every patient in therapy is a therapist to another member of the family and vice-versa. For example, a wife is a therapist to her husband and her husband is a therapist to her. In this relationship, each person grows. Likewise, Whitaker did not focus on stability in therapy, but in growth and development as a family.
His theory is also called the symbolic-experiential approach. The experiential piece focused on the here-and-now in family therapy instead of searching for past causes. The symbolic piece referred to the symbolic reenactments of relationships and meanings in the family. He believed one of his jobs as a therapist was to help the family become aware of their symbols and what they meant to them.
Whitaker also believed in co-therapy (conducting therapy with more than one therapist.) He believed co-therapy was important in order to prevent the therapist from becoming entangled in the family's problems. Co-therapists could help each other remain objective and notice non-verbal behaviors and patterns that the other therapist might miss.
At first glance, Whitaker's techniques appeared confrontational and offensive. For example, in one therapy session Whitaker asked the wife what made her choose to marry a cripple (her husband had a handicap with one arm being abnormally shorter than the other). Carl believed that bluntness gave families permission to talk about taboo topics, unspoken truths, and to be genuine and honest with one another. "The Family Crucible" is a book that thoroughly described how he treated a particular family from start to finish.
Virginia Satir was an experiential family therapist who was an important influence in family therapy theories and treatment. She believed that all families had healthy intentions that got lost in unhealthy encounters. In other words, family members want healthy relationships and have good intentions but just don't know how to convey or communicate their needs and desires in appropriate ways.
She explained all families were balanced systems, but some members of the family were weighted unevenly and that caused stress and conflict. For example, if a mother and father do not get along, they often recruit a child to be the "go-between" for them. They fight through their child. Parental conflict is an example of additional stress on a family which can cause a "weight imbalance." When children are used as equals to parents either by taking on adult responsibilities or roles, they also take on additional weight in the family.
In the above situation, the parents caused a "weight discrepancy" to the family system so the child was either recruited or unconsciously took the role to re-balance the system, i.e. the child took on additional weight or responsibility for his or her parents to counteract the imbalance. In order to fix this problem, Satir believed the parents needed to become more balanced so their child could step back and would no longer be needed to take on the additional weight.
Jay Haley, referred to as a strategic family theorist, was a central force in the development of strategic family therapy. Haley believed that all families were unique and thus needed individualized treatment. Haley explained that strategic therapy was not a theory but a process that was unique to each particular family. Strategic therapists work with the families they treat to create a strategy for solving the family's problems. They create a plan, follow through with assigned tasks, and re-evaluate afterwards. If there are still problems and issues after executing their plan, the therapist helps the family revise their plan and then they go through the process again. His theory of therapy was problem focused and short-term.
Ivan Boszormenyi-Nagy was a Hungarian-American psychologist who was noted for developing contextual family therapy. Contextual family therapy consists of an integration of various psychological frameworks such as systems theory, psychoanalysis, existential psychology, and ethics. Nagy's approach to family therapy was very unique because he believed relationships in the primary and extended family caused the problems the family was experiencing. He explained that problems in the family were caused by relational ethics, e.g. debts, entitlements, hidden loyalties and obligations. For example, if a husband always stays out late and doesn't come home, the wife might expect him to make up for it by doing additional chores or nice things for her. In other words, the husband had an emotional debt to his wife and she expected him to repay that debt. If debts of this kind are not repaid, resentment grows and family members become angry and want justice and fairness restored.
Some debts or entitlements are passed down from previous generations. If one family believes that their daughter should live in the same city as they do but their daughter's husband wants to move away, there will be conflict in the marriage. The daughter might believe if she moves away from her parents she would be in debt to them or disloyal to the family. Her guilt at leaving could cause her to believe she has to do extra things for her parents in order to repay the debt. According to Nagy, she would need to understand why she thought she had a debt to repay, and would need permission or support in accepting rules and obligations that she wanted to keep and to let go of the rest.
Nathan Ackerman was noted for using psychodynamic approaches to family therapy. Psychodynamic theory focuses a great deal on past unconscious conflicts and therefore, the goal of treatment was to make the unconscious conscious. Ackerman was a child psychiatrist who began assessing and treating families in order to help their preschool age children. After several years, he became an exclusive family therapist. He studied how families impacted the development of psychological disorders in their children.
One of his theories was that family members were complimentary to each other and problems were caused by a "failure of complimentarity." In other words, the family members became so rigid and entrenched in their roles that they were no longer fit together well. Ackerman professed that healthy families were flexible and adapted to fluctuating roles as children grew to maturity.
Minuchin was a structural family therapist. One of his contributions to family therapy concerned boundaries. He stated that family relationships existed on a continuum from enmeshment to disengagement. Enmeshment describes relationships such as the overinvolved parent. It is a relationship in which members of the family cannot determine where they end as an individual and where the other person begins. Disengagement is the opposite of enmeshment. In disengagement, family members' boundaries are so closed that they avoid each other, feel unable to ask for help, and have no sense of family loyalty.
Minuchin also described the concept of triangulation. An example of triangulation is the situation in which a parent allies with one of their children against the other parent. If the child sides with either parent, they are seen as being disloyal to the other. Therefore, they are in a no-win situation. The child is used as an external barrier between the fighting parents. Enmeshment, disengagement and triangulation are all issues of family structure. Minuchin's process of family therapy was to examine the family structure, monitor their dysfunctional patterns, and restructure the family in more healthy ways.
Walter Kemplar was a family therapist that used Gestalt theory as a basis for his treatment style. Similar to Gestalt process, Kemplar stressed that members of the family unit be genuine and honest with each other. Like Whitaker, he also stressed growth and development as individuals and as a family. He challenged family members to be aware of themselves, their thoughts, feelings, and physical sensations at any given moment. If clients were not aware, he said they were avoiding themselves and were thus depriving themselves and their families of the growth that could occur from their being genuine.