Historical Family Therapy
The practice
of treating psychological problems in the context of the family
did not actually begin until the mid 1950's. However, the
developmental roots of family therapy were founded much earlier
in social and theoretical changes and developments in the field
of psychology. Family therapy evolved out of the reigning
paradigm of psychoanalysis and the medical psychiatric model as
patients' treatment needs seemed to go beyond the psychoanalytic
workroom (Nichols & Schwartz, Family Therapy: Concepts and
Methods. Fourth edition. Allyn & Bacon). Today more contemporary
cultural influences such as managed health care have favored the
usually quicker approach of treating the entire family as
opposed to each individual member.
The earliest approaches to psychotherapy prevalent in the 20th
Century focused on individual therapy and the patient-therapist
relationship as the best way to treat psychological problems.
Leading therapists such as Freud and Rogers believed that while
family life does shape one's personality, the most influential
and dominant forces controlling human behavior were the internal,
subjective beliefs that patients had about their families. Freud
and Rogers believed that psychological problems were the result
of neurotic conflicts and destructive interactions in one's
family of origin and that treatment would be most effective if
conducted in isolation from the harmful influences of relatives.
Therefore, patients were segregated from their families for
therapy and treatment focused on their individual symptomatic
behaviors.
The advent of family therapy ushered in a whole new way of
understanding and explaining human behavior. Family therapists
proposed that psychological problems were developed and
maintained in the social context of the family. This new
contextual perspective relocated the responsibility for the
problems and the focus of treatment from the internal world of
the individual patient to the entire family. This shift in
understanding human events in terms of interactional patterns of
behavior also called for a new way to explain the existence of
emotional distress. The biological and psychoanalytic models
advocated a causal, linear model of understanding human illness,
which emphasized internal dysfunction and failed to take into
account the reciprocal nature of interpersonal relations (Nichols
& Schwartz, Family Therapy: Concepts and Methods. Fourth Edition.
Allyn & Bacon 1998). Family therapists proposed that
psychological problems were best explained in terms of circular,
recursive events that focused on the mutually influential and
interpersonal context in which they developed.
Several concepts and movements in the field of psychology
influenced the evolution of family therapy and shifted the view
of life and problems from an individual to a systemic
perspective. Among the most instrumental events were studies of
small group dynamics, the child guidance movement, social work
practices, research on family dynamics and the etiology of
schizophrenia, and marriage counseling.
Social psychologists studied small group dynamics in the 1920's
to enhance their understanding of political problems and group
structure and boundaries. Research by Kurt Lewin led to his
conceptualization that a group is more than the sum of its parts
and suggested that group discussions were more effective then
lecturing in changing behavior and ideas. Furthermore, because
interdependence among group members seemed to stabilize
maladaptive patterns of behavior, changes in group behavior were
brought about only after disrupting the group's accepted habits
and beliefs. The principles of group dynamics are highly
relevant to family therapists who must not only work with
individuals, but with entire family systems (Nichols & Schwartz,
Family Therapy: Concepts and Methods. Fourth Edition. Allyn &
Bacon 1998).
Two of the most important concepts of small group dynamics that
influence family therapy were: (a) the distinction between the
process and content of group discussions, and (b) role theory.
Therapists recognized that need to understand not just what the
group members said (content), but how these ideas were
communicated (process). By focusing on the process of their
discussions, therapists can help families improve the way they
relate and thus enhance their own capacity to deal with the
content of their problems. Virginia Satir expanded on the
concept of how individuals behave and communicate in groups by
describing several family roles that can serve to stabilize
expected characteristic behavior patterns in a family. For
example, if one child is a troubled "rebel child," a sibling may
take on the role of the "good child" to alleviate some of the
stress in the family. This concept of role reciprocity is
helpful to understanding family dynamics because of the
complementary nature of roles makes behaviors more resistant to
change.
Several other aspects of group dynamics contributed to the
treatment approaches developed in family therapy, some of which
are still used today. These include: acting out familial
conflicts with the group instead of discussing them; and
instructing individual group members to imagine that the group
is their family of origin, with the intention of enabling group
members to allow unresolved family and emotional issues to
surface and be dealt with in a more objective setting. All of
these applications of group dynamics to family therapy involved
shifting the focus of treatment from individuals to the group
itself, and involved a growing understanding of themes and
dynamics common to all members.
The child guidance movement was also highly influential in the
history of family therapy. Child guidance clinics were
established on the premise that psychological problems begin in
childhood and early intervention is the best way to prevent the
future occurrence of mental illness. At first, child guidance
clinics treated children and parents separately; the family was
viewed as an extension of the child. However, it became apparent
that treating the child did not make the family's problems go
away. Eventually, child guidance workers such as John Bowlby
determined that a child's symptoms were usually a function of
emotional distress in the family. Bowlby began the transition
from individual to family therapy by facilitating communication
between parents and children in conjoint interviews.
The field of social work has also made significant contributions
to the evolution of family therapy. Social workers often visited
clients in their homes and were trained to interview each
individual family member to gain as complete an understanding of
the family's problems as possible. Many family therapists
entered the field of family therapy after being trained as
social workers, and their family-oriented training model
undoubtably shaped the ideas they brought to the developing
field of family therapy.
Gregory Bateson was the leading figure in the schizophrenia
research project in Palo Alto, California, which had a strong
impact in shaping the course of family therapy. Along with Jay
Haley, John Weakland, William Fry, and Don Jackson, Bateson
developed a theory of communication to explain the development
of schizophrenic behavior within the familial environment. The
group hypothesized that symptoms of schizophrenia function to
maintain a homeostatic balance in families, and must therefore
be a result of interactions among family members.
In 1956, Bateson and his colleagues introduced the concept of
the double bind to describe how schizophrenic symptoms could be
explained in the context of families. While many of these
assumptions about the family's role in schizophrenia later
proved to be incorrect, the group's research was a springboard
for the developing field of family therapy. The Palo Alto group
research project resulted in some of the earliest observations
of communication and organization among family members.
Theodore Lidz's investigations of the family dynamics of
schizophrenia introduced a new element to the earlier studies
conducted by the Palo Alto group. Whereas previous efforts to
understand the role of the family had focused on mothers'
relationships to their children, Lidz discovered that fathers
too had a profound -- though often unfortunate -- influence on
the development of symptoms in their children. Lidz found that a
large proportion of schizophrenic patients in his studies came
from broken homes and experienced destructive relationships with
their families, particularly with their fathers. He also
observed that the parental marital relationships often did not
function as a cooperative unit. Lidz's studies of family
dynamics and the interactional patterns that may contribute to
symptomatic behavior helped pave the way for family therapy.
Professional marriage counseling is another area of research and
clinical practice that contributed tot he development of family
therapy. The first institutes for marriage counseling were
established in the early 1930's as clinicians recognized the
advantages and efficiency of treating married couples in
conjoint sessions. This growing appreciation for patterns of
relationships in families led to numerous studies on marital
conflict and dynamics and the effects on children's development.
http://www.abacon.com/famtherapy/history.html
What is family therapy?
Family therapy is a type of psychotherapy. It helps families or individuals within a family understand and improve the way family members interact with each other and resolve conflicts.
Family therapy is usually provided by therapists known as marriage and family therapists. These therapists provide the same mental health services as other therapists, simply with a different focus — family relationships.
Family therapy is often short term. You usually attend one session a week, typically for three to five months. In some cases, though, families may need more intensive treatment.
Who can benefit from family therapy?
In general, anyone who wants to improve troubled relationships can benefit from family therapy. Family therapy can help with such issues as:
- Marital problems
- Divorce
- Eating disorders, such as anorexia or bulimia
- Substance abuse
- Depression or bipolar disorder
- Chronic health problems, such as asthma or cancer
- Grief, loss and trauma
- Work stress
- Parenting skills
- Emotional abuse or violence
- Financial problems
Family therapy may be an addition to other types of treatment, particularly for certain mental disorders that require more in-depth treatment. Family therapy shouldn't substitute for other necessary treatments. For instance, family therapy can help family members cope if a relative has schizophrenia. But the person with schizophrenia should continue with his or her individualized treatment plan, such as medication and possibly hospitalization.
In some cases, family therapy may be ordered by the legal system. Adolescents in trouble with the law may be ordered into family therapy rather than serving jail time, for instance. Violent or abusive parents are sometimes spared jail if they enter family therapy. Divorcing couples may also be required to attend family therapy.
How does family therapy work?
Family therapy often brings entire families together in therapy sessions. However, family members may also see a family therapist individually, and family therapy may include nonfamily members, such as schoolteachers, other health care providers or representatives of social services agencies.
Working with a family therapist, you and your family will examine your family's ability to solve problems and express thoughts and emotions. You may explore family roles, rules and behavior patterns in order to spot issues that contribute to conflict. Family therapy may help you identify your family's strengths, such as caring for one another, and weaknesses, such as an inability to confide in one other.
For example, say that your adult son has depression. Your family may not understand the roots of his depression or how best to offer help. Although you're worried about your son's health, you have such deep-rooted family conflicts that conversations ultimately erupt into arguments. You're left with hurt feelings, decisions go unmade, and the rift grows wider.
Family therapy can help you pinpoint your specific concerns and assess how your family is handling them. Guided by your therapist, you'll learn new ways to interact and overcome old problems. You'll set individual and family goals and work on ways to achieve them. In the end, your son may be better equipped to cope with his depression, you'll understand his needs better, and you, your spouse and your son may all get along better.
How do you choose a family therapist?
Like other psychotherapists, family therapists are licensed mental health professionals. Although different states have different licensing or credentialing requirements, most require advanced training, including a master's or doctoral degree, graduate training in marriage and family therapy, and training under the supervision of other experts. Many marriage and family therapists opt to become credentialed by the American Association for Marriage and Family Therapy (AAMFT), which sets specific eligibility criteria.
Most family therapists work in private practice. They may also work in clinics, mental health centers, hospitals and government agencies.
How do you find a family therapist who's right for you? The same way you'd find a psychiatrist, psychologist or other therapist: Ask lots of questions. Among them:
- Are you a clinical member of the AAMFT or licensed by the state, or both?
- What is your educational and training background?
- What is your experience with my type of problem?
- How much do you charge?
- Are your services covered by my health insurance?
- Where is your office, and what are your hours?
- How long is each session?
- How often are sessions scheduled?
- How many sessions should I expect to have?
- What is your policy on canceled sessions?
- How can I contact you if I have an emergency?
Ask your primary care doctor for a referral to a marriage or family therapist. Family and friends also may give you recommendations based on their experiences. Your health insurer, employee assistance program, clergy or state or local agencies also may offer recommendations.
http://www.mayoclinic.com/health/family-therapy/HQ00662
