Family therapy is 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 a type of psychological counseling, what is also called psychotherapy. The purpose of family therapy is to improve the communications of its clients and to resolve conflicts within the family, all of which may involve anger, grief, stress, or other negative emotions. Family therapy may also be called couple and family therapy, family counseling, family systems therapy, and marriage and family therapy.
According to the American Association for Marriage and Family Therapy (AAMFT), just under 6.1 million people visit a family therapist each year in the United States. Of these clients, about 2.3 million are individuals, just over 808,000 are children, more than 750,000 are couples, and about 526,000 are families.
Psychologists, licensed therapists, and clinical social workers conduct sessions of family therapy. Such professionals have attained a master's or doctoral degree and may have credentials from the AAMFT, which is a professional organization that represents over 50,000 marriage and family therapists in the United States and Canada. In North America, some family therapist practitioners are marriage and family therapists, but others, such as counselors, psychologists, psychotherapists, and social workers, may also work as mental health professionals in family therapy.
The family therapist focuses on the interaction between family members, analyzing the role played by each member in maintaining the family system. Family therapy can be especially helpful for dealing with problems that develop in response to a particular event or situation, such as divorce remarriage, birth of a sibling, or long-term illness and death. It can also be an effective means to draw individuals who feel threatened by individual therapy into a therapeutic setting. Disorders commonly treated by family therapists include alcoholism, conduct disorder and delinquency, childhood behavioral and emotional disorders, depression, domestic violence, and substance abuse.
Most sessions for family therapy are 50–60 minutes. In most cases, sessions last for less than six months. However, serious cases can last longer. The frequency and number of sessions will depend on the specific situation and the professional advice of the counselor.
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. Many therapists became dissatisfied with treating clients in isolation without addressing issues in the family as a whole.
Family therapy, either alone or in conjunction with other types of treatment, has been effective in the treatment of children who suffer 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 help family members improve their coping skills.
There are a number of theoretical approaches (models) to family therapy. Popular models include structural family therapy, psychodynamically oriented family therapy, object relations therapy, behavioral family therapy, and several that concentrate on improving communication skills among family members.
Perhaps the best known is structural family therapy, founded by Argentine family therapist Salvador Minuchin (1921–). 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. Structural family therapy works to strengthen parental leadership, clarify boundaries, enhance coping skills, and free family members from confining positions within the family structure.
Minuchin divided families' styles of interacting into two basic types, enmeshed and disengaged. He considered behavior at either extreme pathological, with most families falling somewhere on a continuum between the two. Minuchin believed that the functioning of family systems prevents individuals from becoming healthy emotionally, because the family system relies 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.
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’ family 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 to family therapy 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. Austrian psychoanalyst Otto Rank (1884–1939) is considered the first to develop the modern theory of object relations in the late 1920s. In the early 1950s, Scottish psychiatrist and psychoanalyst Ronald Fairbaim (1889–1964) added to its origins. The theory of object relations was further enhanced in the 1940s and 1950s by other psychiatrics. Hungarian-American psychiatrist Ivan Boszormenyi-Nagy (1920–2007), a wellknown proponent of this orientation (which he called contextual therapy), 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’ behaviors 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 American social worker Virginia Satir (1916–1988), are primarily concerned with communication. Satir's family system therapy 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.
Capuzzi, Dave, and Mark D. Stauffer, editors. Foundations of Couples, Marriage, and Family Counseling. Hoboken, NJ: Wiley, 2015.
Gehart, Diane R. Theory and Treatment Planning in Family Therapy: A Competency-based Approach. Boston: Cengage Learning, 2016.
McCarthy Jane Ribbens, and Rosalind Edwards. Key Concepts in Family Studies. London: SAGE, 2011.
Nichols, Michael P. Family Therapy: Concepts and Methods. Boston: Allyn and Bacon, 2010.
Satir, Virginia. Conjoint Family Therapy. Palo Alto, CA: Science and Behavior Books, 1983.
Walters, Marianne, et. al. The Invisible Web: Gender Patterns in Family Relationships. New York: Guilford Press, 1988.
Wetchler, Joseph L., and Lorna L. Hecker, editors. An Introduction to Marriage and Family Therapy. New York City: Routledge, 2015.
Carr, Alan. “The Evidence Base for Couple Therapy, Family Therapy and Systemic Interventions for Adult-focused problems.” Journal of Family Therapy 36, no. 2 (April 2014): 158–194.
American Association for Marriage and Family Therapy. “Marriage and Family Therapists: The Friendly Mental Health Professionals—AAMFT Therapy Topics.” https://www.therapistlocator.net/iMIS15/AAMFT/Content/Consumer_Updates/Marriage_and_Family_Therapists.aspx (accessed July 27, 2015).
California Social Work Hall of Distinction. “Satir, Virginia (1916–1988).” http://www.socialworkhallofdistinction.org/honorees/item.php?id=33 (accessed July 27, 2015).
Cleveland Clinic. “Marital and Family Issues.” http://my.clevelandclinic.org/services/neurological_institute/center-for-behavorial-health/disease-conditions/marital-family-issues (accessed July 27, 2015).
Mayo Clinic. “Family Therapy.” http://www.mayoclinic.org/tests-procedures/family-therapy/basics/definition/prc-20014423 (accessed July 27, 2015).
MedlinePlus, U.S. National Library of Medicine. “Family Issues.” http://www.nlm.nih.gov/medlineplus/familyissues.html (accessed July 27, 2015).
American Association for Marriage and Family Therapy, 112 South Alfred St., Alexandria, VA, 22314-3061, (703) 838-9808, Fax: (703) 838-9805, https://www.aamft.org/ .
Family Service Association, 702 Pedro Ave., San Antonio, TX, 78212, (210) 299-2400, Fax: (210) 299-4498, Support@family-service.org, http://www.family-service.org/ .
National Council on Family Relations, 1201 West River Pkwy., Suite 200, Minneapolis, MN, 55454-1115, (763) 781-9331, Fax: (763) 781-9348, (888) 781-9348, https://www.ncfr.org/ .
Step Family Foundation, 310 85th St., Suite 1B, New York City, NY, 10024, (212) 877-3244, Stepfamily@aol.com, http://www.stepfamily.org/ .