family therapy

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Family Therapy

 

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 (commonlaw 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 candi- dates 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.

Description

Family therapy tends to be short-term treatment, usually several months in length, with a focus on resolving specific problems such as eating disorders, difficulties with school, or adjustments to bereavement or geographical relocation. It is not normally used for long-term or intensive restructuring of severely dysfunctional families.
In family therapy sessions, all members of the family and both therapists (if there is more than one) are present at most sessions. The therapists seek to analyze the process of family interaction and communication as a whole; they do not take sides with specific members. They may make occasional comments or remarks intended to help family members become more conscious of patterns or structures that had been previously taken for granted. Family therapists, who work as a team, also model new behaviors for the family through their interactions with each other during sessions.
Family therapy is based on family systems theory, which understands the family to be a living organism that is more than the sum of its individual members. Family therapy uses "systems" theory to evaluate family members in terms of their position or role within the system as a whole. Problems are treated by changing the way the system works rather than trying to "fix" a specific member. Family systems theory is based on several major concepts:

The identified patient

The identified patient (IP) is the family member with the symptom that has brought the family into treatment. The concept of the IP is used by family therapists to keep the family from scapegoating the IP or using him or her as a way of avoiding problems in the rest of the system.

Homeostasis (balance)

The concept of homeostasis means that the family system seeks to maintain its customary organization and functioning over time. It tends to resist change. The family therapist can use the concept of homeostasis to explain why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and what is likely to happen when the family begins to change.

The extended family field

The extended family field refers to the nuclear family, plus the network of grandparents and other members of the extended family. This concept is used to explain the intergenerational transmission of attitudes, problems, behaviors, and other issues.

Differentiation

Differentiation refers to the ability of each family member to maintain his or her own sense of self, while remaining emotionally connected to the family. One mark of a healthy family is its capacity to allow members to differentiate, while family members still feel that they are "members in good standing" of the family.

Triangular relationships

Family systems theory maintains that emotional relationships in families are usually triangular. Whenever any two persons in the family system have problems with each other, they will "triangle in" a third member as a way of stabilizing their own relationship. The triangles in a family system usually interlock in a way that maintains family homeostasis. Common family triangles include a child and its parents; two children and one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law.

Preparation

In some instances the family may have been referred to a specialist in family therapy by their pediatrician or other primary care provider. It is estimated that as many as 50% of office visits to pediatricians have to do with developmental problems in children that are affecting their families. Some family doctors use symptom checklists or psychological screeners to assess a family's need for therapy.
Family therapists may be either psychiatrists, clinical psychologists, or other professionals certified by a specialty board in marriage and family therapy. They will usually evaluate a family for treatment by scheduling a series of interviews with the members of the immediate family, including young children, and significant or symptomatic members of the extended family. This process allows the therapist(s) to find out how each member of the family sees the problem, as well as to form first impressions of the family's functioning. Family therapists typically look for the level and types of emotions expressed, patterns of dominance and submission, the roles played by family members, communication styles, and the locations of emotional triangles. They will also note whether these patterns are rigid or relatively flexible.
Preparation also usually includes drawing a genogram, which is a diagram that depicts significant persons and events in the family's history. Genograms also include annotations about the medical history and major personality traits of each member. Genograms help in uncovering intergenerational patterns of behavior, marriage choices, family alliances and conflicts, the existence of family secrets, and other information that sheds light on the family's present situation.

Key terms

Blended family — A family formed by the remarriage of a divorced or widowed parent. It includes the new husband and wife, plus some or all of their children from previous marriages.
Differentiation — The ability to retain one's identity within a family system while maintaining emotional connections with the other members.
Extended family field — A person's family of origin plus grandparents, in-laws, and other relatives.
Family systems theory — An approach to treatment that emphasizes the interdependency of family members rather than focusing on individuals in isolation from the family. This theory underlies the most influential forms of contemporary family therapy.
Genogram — A family tree diagram that represents the names, birth order, sex, and relationships of the members of a family. Therapists use genograms to detect recurrent patterns in the family history and to help the members understand their problem(s).
Homeostasis — The tendency of a family system to maintain internal stability and resist change.
Identified patient (IP) — The family member in whom the family's symptom has emerged or is most obvious.
Nuclear family — The basic family unit, consisting of father, mother, and their biological children.
Triangling — A process in which two family members lower the tension level between them by drawing in a third member.

Risks

The chief risk in family therapy is the possible unsettling of rigid personality defenses in individuals, or couple relationships that had been fragile before the beginning of therapy. Intensive family therapy may also be difficult for psychotic family members.

Normal results

Normal results vary, but in good circumstances, they include greater insight, increased differentiation of individual family members, improved communication within the family, loosening of previously automatic behavior patterns, and resolution of the problem that led the family to seek treatment.

Resources

Books

Clark, R. Barkley. "Psychosocial Aspects of Pediatrics & Psychiatric Disorders: Psychosocial Assessment of Children & Families." In Current Pediatric Diagnosis & Treatment, edited by William W. Hay Jr., et al. Stamford: Appleton & Lange, 1997.

therapy

 [ther´ah-pe]
activity therapy in the nursing interventions classification, a nursing intervention defined as the prescription of and assistance with specific physical, cognitive, social, and spiritual activities to increase the range, frequency, or duration of an individual's (or group's) activity.
aerosol therapy see aerosol therapy.
animal-assisted therapy in the nursing interventions classification, a nursing intervention defined as the purposeful use of animals to provide affection, attention, diversion, and relaxation.
anticoagulant therapy see anticoagulant therapy.
antineoplastic therapy see antineoplastic therapy.
antiplatelet therapy the use of platelet inhibitors such as aspirin, dipyridamole, or sulfinpyrazone, to inhibit platelet adhesion or aggregation and so prevent thrombosis, alter the course of atherosclerosis, or prolong vascular graft patency.
art therapy in the nursing interventions classification, a nursing intervention defined as facilitation of communication through drawings or other art forms.
aversion therapy (aversive therapy) a form of behavior therapy that uses aversive conditioning, pairing undesirable behavior or symptoms with unpleasant stimulation in order to reduce or eliminate the behavior of symptoms. The term is sometimes used synonymously with aversive conditioning.
behavior therapy see behavior therapy.
carbon dioxide–oxygen therapy see carbon dioxide–oxygen therapy.
chest physical therapy see under physical therapy.
client-centered therapy a form of psychotherapy in which the emphasis is on the patient's self-discovery, interpretation, conflict resolution, and reorganization of values and life approach, which are enabled by the warm, nondirective, unconditionally accepting support of the therapist, who reflects and clarifies the patient's discoveries.
cognitive therapy (cognitive-behavioral therapy) a directive form of psychotherapy based on the theory that emotional problems result from distorted attitudes and ways of thinking that can be corrected. Using techniques drawn in part from behavior therapy, the therapist actively seeks to guide the patient in altering or revising negative or erroneous perceptions and attitudes.
collapse therapy a formerly common treatment for pulmonary tuberculosis in which the diseased lung was collapsed in order to immobilize it and allow it to rest. pneumonolysis and thoracoplasty are methods still sometimes used to collapse a lung and allow access during thoracic surgery.
combined modality therapy treatment of cancer using two or more types of therapy, such as with chemoradiotherapy. Called also multimodality therapy.
compression therapy treatment of venous insufficiency, varicose veins, or venous ulceration of the lower limbs by having the patient wear compressing garments such as support hose.
continuous renal replacement therapy hemodialysis or hemofiltration done 24 hours a day for an extended period, usually in a critically ill patient.
convulsive therapy treatment of mental disorders, primarily depression, by induction of convulsions. The type almost universally used now is electroconvulsive therapy (ECT), in which the convulsions are induced by electric current. In the past, drugs were sometimes used.
couples therapy marital t.
diet therapy treatment of disease by regulation of the diet.
electroconvulsive therapy (ECT) (electroshock therapy) see electroconvulsive therapy.
endocrine therapy treatment of disease by means of hormones; called also hormonal or hormone therapy.
estrogen replacement therapy administration of an estrogen to treat estrogen deficiency, such as that occurring after menopause; there are a number of indications, including the prevention of postmenopausal osteoporosis and coronary artery disease, and the prevention and treatment of vasomotor symptoms such as hot flashes and of thinning of the skin and vaginal epithelium, atrophic vaginitis, and vulvar atrophy. In women with a uterus, a progestational agent is usually included to prevent endometrial hyperplasia. Called also hormone replacement therapy.
exercise therapy: ambulation in the nursing interventions classification, a nursing intervention defined as promotion of and assistance with walking to maintain or restore autonomic and voluntary body functions during treatment and recovery from illness or injury.
exercise therapy: balance in the nursing interventions classification, a nursing intervention defined as use of specific activities, postures, and movements to maintain, enhance, or restore balance.
exercise therapy: joint mobility in the nursing interventions classification, a nursing intervention defined as the use of active or passive body movement to maintain or restore joint flexibility.
exercise therapy: muscle control in the nursing interventions classification, a nursing intervention defined as the use of specific activity or exercise protocols to enhance or restore controlled body movement.
family therapy
1. group therapy of the members of a family, exploring and improving family relationships and processes, understanding and modifying home influences that contribute to mental disorder in one or more family members, and improving communication and collective, constructive methods of problem-solving.
2. in the nursing interventions classification, a nursing intervention defined as assisting family members to move their family toward a more productive way of living.
gold therapy chrysotherapy.
group therapy see group therapy.
helium-oxygen therapy see helium-oxygen therapy.
hemodialysis therapy in the nursing interventions classification, a nursing intervention defined as management of extracorporeal passage of the patient's blood through a hemodialyzer. See also hemodialysis.
hemofiltration therapy in the nursing interventions classification, a nursing intervention defined as cleansing of acutely ill patient's blood via a hemofilter controlled by the patient's hydrostatic pressure. See also hemofiltration.
highly active antiretroviral therapy (HAART) the aggressive use of extremely potent antiretroviral agents in the treatment of human immunodeficiency virus infection.
hormonal therapy (hormone therapy) endocrine therapy.
hormone replacement therapy the administration of hormones to correct a deficiency; usually used to denote estrogen replacement therapy occurring after menopause.
host modulating therapy efforts to control periodontal disease by directly targeting the host response; an example is the use of drugs that do this, such as sub-antimicrobial doses of doxycycline, nonsteroidal antiinflammatory drugs, or bisphosphonates.
humidification therapy (humidity therapy) the therapeutic use of air supersaturated with water to prevent or correct a moisture deficit in the respiratory tract; see also humidity therapy.
immunosuppressive therapy therapeutic immunosuppression.
inhalation therapy the term formerly used for respiratory care (def. 3).
intravenous therapy (IV therapy) in the nursing interventions classification, a nursing intervention defined as administration and monitoring of intravenous infusions of fluids and medications.
leech therapy in the nursing interventions classification, a nursing intervention defined as the application of medicinal leeches to help drain replanted or transplanted tissue engorged with venous blood.
marital therapy a type of family therapy aimed at understanding and treating one or both members of a couple in the context of a distressed relationship, but not necessarily addressing the discordant relationship itself. In the past, the term has also been used in a narrower sense to mean what is defined as marriage therapy, but that is increasingly considered a subset of marital therapy. Called also couples therapy.
marriage therapy a subset of marital therapy that focuses specifically on the bond of marriage between two people, enhancing and preserving it.
milieu therapy
1. treatment, usually in a psychiatric treatment center, that emphasizes the provision of an environment and activities appropriate to the patient's emotional and interpersonal needs.
2. in the nursing interventions classification, a nursing intervention defined as the use of people, resources, and events in the patient's immediate environment to promote optimal psychosocial functioning.
multimodality therapy combined modality therapy.
music therapy
1. the use of music to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems. Music therapy is used for a wide variety of conditions, including mental disorders, developmental and learning disabilities, Alzheimer's disease and other conditions related to aging, brain injury, substance abuse, and physical disability. It is also used for the management of acute and chronic pain and for the reduction of stress.
2. in the nursing interventions classification, a nursing intervention defined as using music to help achieve a specific change in behavior or feeling.
neoadjuvant therapy in single-agent therapy or combined modality therapy for cancer, initial use of one modality, such as chemotherapy or radiotherapy, to decrease tumor burden prior to use of another modality, usually surgery.
nutrition therapy in the nursing interventions classification, a nursing intervention defined as administration of food and fluids to support metabolic processes of a patient who is malnourished or at high risk for becoming malnourished. See also nutrition.
occupational therapy see occupational therapy.
optometric vision therapy a treatment plan prescribed to correct or improve specific dysfunctions of the vision system; it includes, but is not limited to, the treatment of strabismus (turned eye), other dysfunctions of binocularity (eye teaming), amblyopia (lazy eye), accommodation (eye focusing), ocular motor function (general eye movement ability), and visual-motor and visual-perceptual abilities.
oral rehydration therapy (ORT) oral administration of a solution of electrolytes and carbohydrates in the treatment of dehydration.
oxygen therapy see oxygen therapy.
peritoneal dialysis therapy in the nursing interventions classification, a nursing intervention defined as administration and monitoring of dialysis solution into and out of the peritoneal cavity. See also peritoneal dialysis.
physical therapy see physical therapy.
play therapy see play therapy.
pulp canal therapy root canal therapy.
PUVA therapy [psoralen + ultraviolet A], a form of photochemotherapy for skin disorders such as psoriasis and vitiligo; oral psoralen administration is followed two hours later by exposure to ultraviolet a radiation.
radiation therapy see radiation therapy.
recreation therapy in the nursing interventions classification, a nursing intervention defined as the purposeful use of recreation to promote relaxation and enhancement of social skills.
reminiscence therapy in the nursing interventions classification, a nursing intervention defined as using the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life, or adaptation to present circumstances.
renal replacement therapy therapy such as hemodialysis or transplantation that takes the place of nonfunctioning kidneys. See also continuous renal replacement therapy.
replacement therapy treatment to replace deficient formation or loss of body products by administration of the natural body products or synthetic substitutes. See also replacement. Called also substitution therapy.
respiratory therapy respiratory care.
root canal therapy that aspect of endodontics dealing with the treatment of diseases of the dental pulp, consisting of partial (pulpotomy) or complete (pulpectomy) extirpation of the diseased pulp, cleaning and sterilization of the empty root canal, enlarging and shaping the canal to receive sealing material, and obturation of the canal with a nonirritating hermetic sealing agent. Called also pulp canal therapy.
shock therapy obsolete term for convulsive therapy.
simple relaxation therapy in the nursing interventions classification, a nursing intervention defined as the use of techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, or anxiety.
speech therapy the use of special techniques for correction of speech disorders.
substitution therapy replacement therapy.
swallowing therapy in the nursing interventions classification, a nursing intervention defined as facilitating swallowing and preventing complications of impaired swallowing.
thrombolytic therapy the administration of drugs for thrombolysis (dissolution of a thrombus in an artery), to reduce the size of occlusion and thereby reduce damage to muscular tissue; the coronary artery is a commonly used site. Agents commonly used are streptokinase and tissue plasminogen activator (t-PA).
thyroid replacement therapy treatment of hypothyroidism by administration of thyroxine, usually in the form of levothyroxine sodium. Called also thyrotherapy.
ultraviolet therapy see ultraviolet therapy.

fam·i·ly ther·a·py

a type of group psychotherapy in which a family in conflict meets as a group with the therapist and explores its relationships and processes; focus is on the resolution of current interactions between members rather than on individual members themselves.

family therapy1

(in psychiatry) a therapy modality that focuses treatment on the process between family members that supports and perpetuates symptoms; a way of conceptualizing human relationship problems that focuses on the context in which an emotional problem is generated.

family therapy2

a nursing intervention from the Nursing Interventions Classification (NIC) defined as assisting family members to move their family toward a more productive way of living. See also Nursing Interventions Classification.

family therapy

Family psychotherapy Psychiatry A treatment model that involves interaction with family members and family interactions as well as with the individual. Cf False memory.

fam·i·ly ther·a·py

(fam'i-lē thār'ă-pē)
A type of group psychotherapy in which a family in conflict meets as a group with the therapist to explore its relationships and processes; focus is on the resolution of current issues between members rather than on individual members.

family therapy

The treatment of behavioural and emotional problems in an individual by involvement of the whole family in the treatment process. Group interview and discussions are guided by an experienced counsellor. Many problems arise from defective interaction within the family and many are affected by the quality of family relationships. Family therapy, in which the whole family participates, can often be more effective than therapy directed only to the most seriously disturbed person.
References in periodicals archive ?
Editor's note: The California Association of Marriage and Family Therapists has licensed marriage and family therapists throughout California who are available for interviews on the topic of bullying.
In honor of Mental Health Awareness Month, the California Association of Marriage and Family Therapists (CAMFT) wants that to change this May.
The blue-collar family therapist welcomes the direction and structure provided by manualized treatments such as Multi-Dimensional Family Therapy, Functional Family Therapy and Multi-Systemic Family Therapy (Aos et al.
Almost every state has a similar board charged with regulating licensed marriage and family therapists.
She has a career, two children and a wonderful husband who supports her ambition to become a family therapist.
Women are more socialized to the idea of sharing," says Edward Dunne, codirector of the Gay and Lesbian Families Project at the Ackerman Institute for the Family in New York City, a not-for-profit family research and treatment agency and a training facility for family therapists.
Children are reassured when they see their parents keeping medical appointments, taking medication on schedule, exercising, getting rest, eating well, and keeping a reasonable pace," said Julie Down, a licensed marriage and family therapist in Oklahoma.
I am a clinical member of the American Association of Marriage and Family Therapists (AAMFT), a licensed professional counselor, and licensed marriage and family therapist in Texas.
However, a major fallacy that many counselors have accepted as true is that in order to use family therapy concepts and techniques one must become a family therapist (Zingaro, 1983).
As she explained, the guidance counselor at school and the family therapist to whom the stepfather had taken her told her to obey her father, that he knew what was best for her.
com, a free resource to find a licensed Marriage and Family Therapist in your area
This is really about being an advocate for your own health care and your own mental health needs," said CAMFT President-Elect Patricia Ravitz, licensed marriage and family therapist.