Family therapy
Family therapy is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.
The different schools of family therapy have in common a belief that, regardless of the origin of the problem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families in solutions often benefits clients. This involvement of families is commonly accomplished by their direct participation in the therapy session. The skills of the family therapist thus include the ability to influence conversations in a way that catalyses the strengths, wisdom, and support of the wider system.
In the field's early years, many clinicians defined the family in a narrow, traditional manner usually including parents and children. As the field has evolved, the concept of the family is more commonly defined in terms of strongly supportive, long-term roles and relationships between people who may or may not be related by blood or marriage.
The conceptual frameworks developed by family therapists, especially those of
family systems theorists, have been applied to a wide range of human behavior, including organisational dynamics and the study of greatness.
History and theoretical frameworks
Formal interventions with families to help individuals and families experiencing various kinds of problems have been a part of many cultures, probably throughout history. These interventions have sometimes involved formal procedures or rituals, and often included the extended family as well as non-kin members of the community. Following the emergence of specialization in various societies, these interventions were often conducted by particular members of a community—for example, a tribal chief, priest, physician, and so on—usually as an ancillary function.Family therapy as a distinct professional practice within Western cultures can be argued to have had its origins in the social work movements of the 19th century in the United Kingdom and the United States. As a branch of psychotherapy, its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movement and marriage counseling. The formal development of family therapy dates from the 1940s and early 1950s with the founding in 1942 of the American Association of Marriage Counselors, and through the work of various independent clinicians and groups—in the United Kingdom, the United States, and in Hungary, D.L.P. Liebermann—who began seeing family members together for observation or therapy sessions. There was initially a strong influence from psychoanalysis and social psychiatry, and later from behaviorism and behavior therapy—and significantly, these clinicians began to articulate various theories about the nature and functioning of the family as an entity that was more than a mere aggregation of individuals.
The movement received an important boost starting in the early 1950s through the work of anthropologist Gregory Bateson and colleagues—Jay Haley, Donald deAvila Jackson, John Weakland, William Fry, and later, Virginia Satir, Ivan Boszormenyi-Nagy, Paul Watzlawick and others—at Palo Alto in the United States, who introduced ideas from cybernetics and general systems theory into social psychology and psychotherapy, focusing in particular on the role of communication. This approach eschewed the traditional focus on individual psychology and historical factors—that involve so-called linear causation and content—and emphasized instead feedback and homeostatic mechanisms and "rules" in here-and-now interactions—so-called circular causation and process—that were thought to maintain or exacerbate problems, whatever the original cause. This group was also influenced significantly by the work of US psychiatrist, hypnotherapist, and brief therapist Milton H. Erickson—especially his innovative use of strategies for change, such as paradoxical directives. The members of the Bateson Project had a particular interest in the possible psychosocial causes and treatment of schizophrenia, especially in terms of the putative "meaning" and "function" of signs and symptoms within the family system. The research of psychiatrists and psychoanalysts Lyman Wynne and Theodore Lidz on communication deviance and roles in families of people with schizophrenia also became influential with systems-communications-oriented theorists and therapists. A related theme—applying to dysfunction and psychopathology more generally—was that of the "identified patient" or "presenting problem" as a manifestation of or surrogate for the family's problems.
By the mid-1960s, a number of distinct schools of family therapy had emerged. From the groups that were most strongly influenced by cybernetics and systems theory there came Mental Research Institute brief therapy, strategic therapy, Salvador Minuchin's structural family therapy and the model proposed by Mara Selvini Palazzoli. Partly in reaction to some aspects of these systemic models came the experiential approaches of Virginia Satir and Carl Whitaker, which downplayed theoretical constructs and emphasized subjective experience and unexpressed feelings, authentic communication, spontaneity, creativity, total therapist engagement, and often included the extended family. Concurrently, intergenerational therapies by Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, and Norman Paul emerged. They proposed different theories on the intergenerational transmission of health and dysfunction, usually involving three generations in therapy or through "homework" and "journeys home." Psychodynamic family therapy—which, more than any other school of family therapy, deals directly with individual psychology and the unconscious mind in the context of current relationships—continued to develop through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, the British school of object relations theory, and John Bowlby's work on attachment theory.
Multiple-family group therapy, a precursor of psychoeducational family intervention, emerged, in part, as a pragmatic alternative form of intervention—especially as an adjunct to the treatment of serious mental illnesses with significant biological underpinnings, such as schizophrenia—and represented something of a conceptual challenge to some of the systemic paradigms of pathogenesis that were implicit in many of the dominant models of family therapy. The late 1960s and early 1970s saw the development of network therapy by Ross Speck and Carolyn Attneave, and the emergence of behavioral marital therapy and behavioral family therapy as models in their own right.
By the late 1970s, the weight of clinical experience—especially in the treatment of serious mental disorders—had led to revisions of several of the original models and a moderation of earlier stridency and theoretical purism. There were the beginnings of a general softening of the strict demarcations between schools, with moves toward rapprochement, integration, and eclecticism—although there was, nevertheless, some hardening of positions within some schools. These trends were reflected in and influenced by lively debates within the field and critiques from various sources, including feminism and post-modernism, that reflected in part the cultural and political tenor of the times, and which foreshadowed the emergence of the various post-systems constructivist and social constructionist approaches. While there was still debate within the field about whether, or to what degree, the systemic-constructivist and medical-biological paradigms were necessarily antithetical to each other , there was a growing willingness and tendency on the part of family therapists to work in multi-modal clinical partnerships with other members of the helping and medical professions.
From the mid-1980s to the present, the field has been marked by a diversity of approaches that partly reflect the original schools, but which also draw on other theories and methods from individual psychotherapy and elsewhere—these approaches and sources include: brief therapy, structural therapy, constructivist approaches, bringforthist approach, solution focused brief therapy, narrative therapy, a range of cognitive behavioral therapy approaches, psychodynamic and object relations approaches, attachment and emotionally focused therapy, intergenerational approaches, network therapy, and multisystemic therapy. Multicultural, intercultural, and integrative approaches are being developed, with Vincenzo Di Nicola weaving a synthesis of family therapy and transcultural psychiatry in his model of cultural family therapy, A Stranger in The Family: Culture, Families, and Therapy. Many practitioners claim to be eclectic, using techniques from several areas, depending upon their own inclinations and/or the needs of the client, and there is a growing movement toward a single "generic" family therapy that seeks to incorporate the best of the accumulated knowledge in the field and which can be adapted to many different contexts. Nonetheless, there are still a significant number of therapists who adhere more or less strictly to a particular, or limited number of, approach.
The liberation-based healing framework for family therapy offers a complete paradigm shift for working with families while addressing the intersections of race, class, gender identity, sexual orientation, and other socio-political identity markers. This theoretical approach and praxis is informed by critical pedagogy, feminism, critical race theory, and decolonizing theory. It necessitates an understanding of the ways colonization, cisheteronormativity, patriarchy, white supremacy and other systems of domination impact individuals, families and communities and centers the need to disrupt the status quo in how power operates. Traditional Western models of family therapy have historically ignored these dimensions, and when white, male privilege has been critiqued, largely by feminist theory practitioners, it has often been to the benefit of middle-class, white women's experiences. While an understanding of intersectionality is of particular significance in working with families with violence, a liberatory framework examines how power, privilege and oppression operate within and across all relationships. Liberatory practices are based on the principles of critical consciousness, accountability, and empowerment. These principles guide not only the content of therapeutic work with clients but also the supervisory and training processes for therapists. Rhea Almeida developed the cultural context model as a way to operationalize these concepts into practice through the integration of culture circles, sponsors, and a socio-educational process within the therapeutic work.
Ideas and methods from family therapy have been influential in psychotherapy generally: a survey of over 2,500 US therapists in 2006 revealed that of the 10 most influential therapists of the previous quarter-century, three were prominent family therapists and that the marital and family systems model was the second-most-utilized model after cognitive behavioral therapy.