Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychotherapy focused on
families
Family (from ) is a group of people related either by consanguinity (by recognized birth) or affinity (by marriage or other relationship). It forms the basis for social order. Ideally, families offer predictability, structure, and safety as ...
and couples in
intimate relationship
An intimate relationship is an interpersonal relationship that involves emotional or physical closeness between people and may include sexual intimacy and feelings of romance or love. Intimate relationships are interdependent, and the member ...
s to nurture change and development. It tends to view change in terms of the
system
A system is a group of interacting or interrelated elements that act according to a set of rules to form a unified whole. A system, surrounded and influenced by its open system (systems theory), environment, is described by its boundaries, str ...
s 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
Greatness is a concept of a state of exceptional superior (hierarchy), superiority affecting a person or wikt:entity, object in a particular place or area. Greatness can also be attributed to individuals who possess a natural ability to be b ...
.
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
An extended family is a family that extends beyond the nuclear family of parents and their children to include aunts, uncles, grandparents, cousins or other relatives, all living nearby or in the same household. Particular forms include the stem ...
as well as non-
kin members of the
community
A community is a social unit (a group of people) with a shared socially-significant characteristic, such as place, set of norms, culture, religion, values, customs, or identity. Communities may share a sense of place situated in a given g ...
(see for example
Ho'oponopono). Following the emergence of
specialization in various societies, these interventions were often conducted by particular members of a community – for example, a
chief,
priest
A priest is a religious leader authorized to perform the sacred rituals of a religion, especially as a mediatory agent between humans and one or more deity, deities. They also have the authority or power to administer religious rites; in parti ...
,
physician
A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...
, and so on – usually as an ancillary function.
[Broderick, C.B. & Schrader, S.S. (1991). The History of Professional Marriage and Family Therapy. In A. S. Gurman & D. P. Kniskern (Eds.)]
''Handbook of Family Therapy. Vol. 2.''
NY: Brunner/Mazel
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
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
and the
United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
.
[ As a branch of ]psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
, its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movement and marriage counseling.[Sholevar, G.P. (2003). Family Theory and Therapy. In Sholevar, G.P. & Schwoeri, L.D]
''Textbook of Family and Couples Therapy: Clinical Applications.''
Washington, DC: American Psychiatric Publishing Inc. 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'' (the precursor of the AAMFT), and through the work of various independent clinicians and groups – in the United Kingdom (John Bowlby
Edward John Mostyn Bowlby (; 26 February 1907 – 2 September 1990) was a British psychiatrist and psychoanalyst, notable for his interest in child development and for his pioneering work in attachment theory. A ''Review of General Psychology'' ...
at the Tavistock Clinic), the United States ( Donald deAvila Jackson, John Elderkin Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker, Virginia Satir
Virginia Satir (June 26, 1916 – September 10, 1988) was an American author, clinical social worker and psychotherapist, recognized for her approach to family therapy. Her pioneering work in the field of family reconstruction therapy honored h ...
, Ivan Boszormenyi-Nagy), and in Hungary
Hungary is a landlocked country in Central Europe. Spanning much of the Pannonian Basin, Carpathian Basin, it is bordered by Slovakia to the north, Ukraine to the northeast, Romania to the east and southeast, Serbia to the south, Croatia and ...
, D.L.P. Liebermann – who began seeing family members together for observation or therapy sessions.[ There was initially a strong influence from ]psychoanalysis
PsychoanalysisFrom Greek language, Greek: and is a set of theories and techniques of research to discover unconscious mind, unconscious processes and their influence on conscious mind, conscious thought, emotion and behaviour. Based on The Inte ...
(most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry
Social psychiatry is a branch of psychiatry that studies how the social environment impacts mental health and mental illness. It applies a cultural and societal lens on mental health by focusing on mental illness prevention, community-based care, m ...
, and later from learning theory and behavior therapy
Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or oth ...
– 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
Gregory Bateson (9 May 1904 – 4 July 1980) was an English anthropology, anthropologist, social sciences, social scientist, linguistics, linguist, visual anthropology, visual anthropologist, semiotics, semiotician, and cybernetics, cybernetici ...
and colleagues – Jay Haley, Donald D. Jackson, John Weakland
John H. Weakland (8 January 1919 – 18 July 1995) was one of the founders of brief and family psychotherapy. At the time of his death, he was a senior research fellow at the Mental Research Institute (MRI) in Palo Alto, California, co-director o ...
, William Fry, and later, Virginia Satir
Virginia Satir (June 26, 1916 – September 10, 1988) was an American author, clinical social worker and psychotherapist, recognized for her approach to family therapy. Her pioneering work in the field of family reconstruction therapy honored h ...
, Ivan Boszormenyi-Nagy, Paul Watzlawick
Paul Watzlawick (July 25, 1921 – March 31, 2007) was an Austrian-American family therapist, psychologist, communication theorist, and philosopher. A theoretician in communication theory and radical constructivism, he commented in the fields o ...
and others – at Palo Alto
Palo Alto ( ; Spanish language, Spanish for ) is a charter city in northwestern Santa Clara County, California, United States, in the San Francisco Bay Area, named after a Sequoia sempervirens, coastal redwood tree known as El Palo Alto.
Th ...
in the United States, who introduced ideas from cybernetics
Cybernetics is the transdisciplinary study of circular causal processes such as feedback and recursion, where the effects of a system's actions (its outputs) return as inputs to that system, influencing subsequent action. It is concerned with ...
and general systems theory
Systems theory is the transdisciplinary study of systems, i.e. cohesive groups of interrelated, interdependent components that can be natural or artificial. Every system has causal boundaries, is influenced by its context, defined by its struc ...
into social psychology
Social psychology is the methodical study of how thoughts, feelings, and behaviors are influenced by the actual, imagined, or implied presence of others. Although studying many of the same substantive topics as its counterpart in the field ...
and psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
, focusing in particular on the role of communication
Communication is commonly defined as the transmission of information. Its precise definition is disputed and there are disagreements about whether Intention, unintentional or failed transmissions are included and whether communication not onl ...
(see Bateson Project). This approach eschewed the traditional focus on individual psychology and historical factors – that involve so-called linear causation and content – and emphasized instead feedback
Feedback occurs when outputs of a system are routed back as inputs as part of a chain of cause and effect that forms a circuit or loop. The system can then be said to ''feed back'' into itself. The notion of cause-and-effect has to be handle ...
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(s).[Becvar, D.S., & Becvar, R.J. (2008)]
''Family therapy: A systemic integration.''
7th ed. Boston: Allyn & Bacon. ''(See also systems psychology
Systems psychology is a branch of both theoretical psychology and applied psychology that studies human behaviour and experience as complex systems. It is inspired by systems theory and systems thinking, and based on the theoretical work of Roger ...
and systemic therapy
Systemic therapy is a type of psychotherapy that seeks to address people in relationships, dealing with the interactions of groups and their interactional patterns and dynamics.
Early forms of systemic therapy were based on cybernetics and syste ...
.)'' This group was also influenced significantly by the work of US psychiatrist
A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly ...
, hypnotherapist
Hypnotherapy, also known as hypnotic medicine, is the use of hypnosis in psychotherapy. Hypnotherapy is generally not considered to be based on scientific evidence, and is rarely recommended in clinical practice guidelines. However, several p ...
, and brief therapist Milton H. Erickson – especially his innovative use of strategies for change, such as paradoxical directives The members of the Bateson Project (like the founders of a number of other schools of family therapy, including Carl Whitaker, Murray Bowen, and Ivan Boszormenyi-Nagy) had a particular interest in the possible psychosocial
The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...
causes and treatment of schizophrenia
Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
, especially in terms of the putative "meaning" and "function" of sign
A sign is an object, quality, event, or entity whose presence or occurrence indicates the probable presence or occurrence of something else. A natural sign bears a causal relation to its object—for instance, thunder is a sign of storm, or me ...
s and symptom
Signs and symptoms are diagnostic indications of an illness, injury, or condition.
Signs are objective and externally observable; symptoms are a person's reported subjective experiences.
A sign for example may be a higher or lower temperature ...
s within the family system. The research of psychiatrist
A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly ...
s and psychoanalyst
PsychoanalysisFrom Greek: and is a set of theories and techniques of research to discover unconscious processes and their influence on conscious thought, emotion and behaviour. Based on dream interpretation, psychoanalysis is also a talk th ...
s Lyman Wynne and Theodore Lidz on communication deviance and roles (e.g., pseudo-mutuality, pseudo-hostility, schism and skew) in families of people with schizophrenia
Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
also became influential with systems-communications-oriented theorists and therapists.[Barker, P. (2007)]
''Basic family therapy''
5th edition. Wiley-Blackwell. A related theme, applying to dysfunction and psychopathology
Psychopathology is the study of mental illness. It includes the signs and symptoms of all mental disorders. The field includes Abnormal psychology, abnormal cognition, maladaptive behavior, and experiences which differ according to social norms ...
more generally, was that of the "identified patient
Identified patient (IP) is a clinical term often used in family therapy discussion. It describes one family member in a dysfunctional family who is used as an expression of the family's authentic inner conflicts. As a family system is dynamic, th ...
" or "presenting problem" as a manifestation of or surrogate for the family's, or even society's, problems. ''(See also double bind
A double bind is a dilemma in communication in which an individual (or group) receives two or more mutually conflicting messages. In some scenarios (such as within families or romantic relationships), this can be emotionally distressing, creati ...
; family nexus
In psychology, a family nexus is a common viewpoint held and reinforced by the majority of family members regarding events in the family and relationships with the world. The term was coined by R. D. Laing, who believed that this nexus "exists on ...
.)''
By the mid-1960s, a number of distinct schools of family therapy had emerged. From those groups that were most strongly influenced by cybernetics
Cybernetics is the transdisciplinary study of circular causal processes such as feedback and recursion, where the effects of a system's actions (its outputs) return as inputs to that system, influencing subsequent action. It is concerned with ...
and systems theory
Systems theory is the Transdisciplinarity, transdisciplinary study of systems, i.e. cohesive groups of interrelated, interdependent components that can be natural or artificial. Every system has causal boundaries, is influenced by its context, de ...
, there came MRI Brief Therapy, and slightly later, strategic therapy, Salvador Minuchin's structural family therapy
Structural family therapy (SFT) is a method of psychotherapy developed by Salvador Minuchin which addresses problems in functioning within a family. Structural family therapists strive to enter, or "join", the family systems theory, family system ...
and the Milan systems model. Partly in reaction to some aspects of these systemic models, came the experiential approaches of Virginia Satir
Virginia Satir (June 26, 1916 – September 10, 1988) was an American author, clinical social worker and psychotherapist, recognized for her approach to family therapy. Her pioneering work in the field of family reconstruction therapy honored h ...
and Carl Whitaker, which downplayed theoretical constructs, and emphasized subjective experience
Experience refers to Consciousness, conscious events in general, more specifically to perceptions, or to the practical knowledge and familiarity that is produced by these processes. Understood as a conscious event in the widest sense, experience i ...
and unexpressed feeling
According to the '' APA Dictionary of Psychology'', a feeling is "a self-contained phenomenal experience"; feelings are "subjective, evaluative, and independent of the sensations, thoughts, or images evoking them". The term ''feeling'' is closel ...
s (including the subconscious
In psychology, the subconscious is the part of the mind that is not currently of focal awareness. The term was already popularized in the early 20th century in areas ranging from psychology, religion and spirituality. The concept was heavily popu ...
), authentic communication, spontaneity, creativity, total therapist engagement, and often included the extended family
An extended family is a family that extends beyond the nuclear family of parents and their children to include aunts, uncles, grandparents, cousins or other relatives, all living nearby or in the same household. Particular forms include the stem ...
. Concurrently and somewhat independently, there emerged the various intergenerational therapies of Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, and Norman Paul, which present different theories about the intergenerational transmission of health and dysfunction, but which all deal usually with at least three generations of a family (in person or conceptually), either directly in therapy sessions, or via "homework", "journeys home", etc. Psychodynamic family therapy – which, more than any other school of family therapy, deals directly with individual psychology and the unconscious 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, and also by the British School of Object Relations and John Bowlby
Edward John Mostyn Bowlby (; 26 February 1907 – 2 September 1990) was a British psychiatrist and psychoanalyst, notable for his interest in child development and for his pioneering work in attachment theory. A ''Review of General Psychology'' ...
's work on attachment. Multiple-family ''group therapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, i ...
'', 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 disorder
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s with a significant biological
Biology is the scientific study of life and living organisms. It is a broad natural science that encompasses a wide range of fields and unifying principles that explain the structure, function, growth, origin, evolution, and distribution of ...
basis, such as schizophrenia
Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
– and represented something of a conceptual challenge to some of the systemic (and thus potentially "family-blaming") paradigm
In science and philosophy, a paradigm ( ) is a distinct set of concepts or thought patterns, including theories, research methods, postulates, and standards for what constitute legitimate contributions to a field. The word ''paradigm'' is Ancient ...
s 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 (which bears some resemblance to traditional practices such as Ho'oponopono) by Ross Speck and Carolyn Attneave, and the emergence of behavioral marital therapy (renamed behavioral couples therapy in the 1990s) and behavioral family therapy as models in their own right.[
By the late 1970s, the weight of clinical experience – especially in relation to the treatment of serious ]mental disorder
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
s – had led to some revision of a number of the original models and a moderation of some of the earlier stridency and theoretical purism. There were the beginnings of a general softening of the strict demarcations between schools, with moves toward rapprochement
In international relations, a rapprochement, which comes from the French word ''rapprocher'' ("to bring together"), is a re-establishment of cordial relations between two countries. This may be done due to a mutual antagonist, as the German Empire ...
, integration, and eclecticism
Eclecticism is a conceptual approach that does not hold rigidly to a single paradigm or set of assumptions, but instead draws upon multiple theories, styles, or ideas to gain complementary insights into a subject, or applies different theories i ...
– 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
Feminism is a range of socio-political movements and ideology, ideologies that aim to define and establish the political, economic, personal, and social gender equality, equality of the sexes. Feminism holds the position that modern soci ...
and post-modernism, that reflected in part the cultural and political tenor of the times, and which foreshadowed the emergence (in the 1980s and 1990s) 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 ''(see also Anti-psychiatry
Anti-psychiatry, sometimes spelled antipsychiatry, is a movement based on the view that psychiatric treatment can often be more damaging than helpful to patients. The term anti-psychiatry was coined in 1912, and the movement emerged in the 1960s, ...
; Biopsychosocial model
Biopsychosocial models (BPSM) are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio- environmental factors. These models specifically examine how these aspects play a role in a range o ...
)'', 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
Helping behavior refers to voluntary actions intended to help others, with reward regarded or disregarded. It is a type of prosocial behavior (voluntary action intended to help or benefit another individual or group of individuals, such as sharing ...
and medical
Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
professions.[Nichols, M.P. & Schwartz, R.C. (2006)]
''Family therapy: concepts and methods.''
7th ed. Boston: Pearson/Allyn & Bacon.
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
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
and elsewhere – these approaches and sources include: brief therapy
Brief psychotherapy (also brief therapy, planned short-term therapy) is an umbrella term for a variety of approaches to short-term, solution-oriented psychotherapy.
Overview
Brief therapy differs from other schools of therapy in that it emphasi ...
, structural therapy, constructivist approaches (e.g., Milan systems, post-Milan/collaborative/conversational, reflective), Bring forthism approach (e.g. Dr. Karl Tomm's IPscope model and Interventive interviewing), solution-focused therapy, narrative therapy
Narrative therapy (or narrative practice) is a form of psychotherapy that seeks to help patients identify their values and the skills associated with them. It provides the patient with knowledge of their ability to embody these values so they ca ...
, a range of cognitive and behavioral approaches, psychodynamic
Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
and object relations
Object relations theory is a school of thought in psychoanalytic theory and psychoanalysis centered around theories of stages of ego development. Its concerns include the relation of the psyche to others in childhood and the exploration of re ...
approaches, attachment and emotionally focused therapy
Emotionally focused therapy and emotion-focused therapy (EFT) are related Humanistic psychology, humanistic approaches to psychotherapy that aim to resolve emotional and relationship issues with individuals, couples, and families. These therapies ...
, intergenerational approaches, network therapy, and multisystemic therapy (MST). Multicultural
Multiculturalism is the coexistence of multiple cultures. The word is used in sociology, in political philosophy, and colloquially. In sociology and everyday usage, it is usually a synonym for ''ethnic'' or cultural pluralism in which various e ...
, intercultural
Cross-cultural communication is a field of study investigating how people from differing cultural backgrounds communicate, in similar and different ways among themselves, and how they endeavor to communicate across cultures. Intercultural communi ...
, and integrative approaches are being developed, with Vincenzo Di Nicola
Vincenzo Di Nicola is an Italian-Canadian psychologist, psychiatrist and family therapist, and philosopher of mind.
Di Nicola is a tenured Full Professor in the Dept. of Psychiatry & Addiction Medicine at the University of Montreal, where he ...
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(s), 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; however, there are still a significant number of therapists who adhere more or less strictly to a particular, or limited number of, approach(es).
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
Critical pedagogy is a philosophy of education and social movement that developed and applied concepts from critical theory and related traditions to the field of education and the study of culture.
It insists that issues of social justice and de ...
, feminism, critical race theory
Critical race theory (CRT) is an academic field focused on the relationships between Social constructionism, social conceptions of Race and ethnicity in the United States census, race and ethnicity, Law in the United States, social and political ...
, and decolonizing theory. This framework necessitates an understanding of the ways colonization, cis-heteronormativity, patriarchy
Patriarchy is a social system in which positions of authority are primarily held by men. The term ''patriarchy'' is used both in anthropology to describe a family or clan controlled by the father or eldest male or group of males, and in fem ...
, white supremacy
White supremacy is the belief that white people are superior to those of other races. The belief favors the maintenance and defense of any power and privilege held by white people. White supremacy has roots in the now-discredited doctrine ...
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
Intersectionality is an analytical framework for understanding how groups' and individuals' social and political identities result in unique combinations of discrimination and privilege. Examples of these intersecting and overlapping factor ...
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
Critical consciousness, conscientization, or in Portuguese (), is a popular education and social concept developed by Brazilian pedagogue and educational theorist Paulo Freire, grounded in neo-Marxist critical theory. Critical consciousness foc ...
, Accountability and Empowerment. These principles guide not only the content of the therapeutic work with clients but also the supervisory and training process of therapists. Dr. 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
Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders.
Cognitive behavioral therapy focuses on challenging and chang ...
.
Techniques
Family therapy uses a range of counseling
Counseling is the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes.
This is a list of c ...
and other techniques including:
* Structural therapy – identifies and re-orders the organisation of the family system
* Strategic therapy – looks at patterns of interactions between family members
* Systemic/Milan therapy – focuses on belief systems
* Narrative therapy – restorying of dominant problem-saturated narrative, emphasis on context, separation of the problem from the person
* Transgenerational therapy – transgenerational transmission of unhelpful patterns of belief and behaviour
*IPscope model and Interventive Interviewing
*Communication theory
Communication theory is a proposed description of communication phenomena, the relationships among them, a storyline describing these relationships, and an argument for these three elements. Communication theory provides a way of talking about a ...
*Psychoeducation
Psychoeducation (a portmanteau of psychological education) is an evidence-based therapeutic intervention for patients and their loved ones that provides information and support to better understand and cope with illness. Psychoeducation is most of ...
*Psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
*Relationship counseling
*Relationship education
Relationship education and premarital counseling promote practices and principles of premarital education, relationship resources, relationship restoration, relationship maintenance, and evidence-based marriage education.
History
The formal orga ...
* Systemic coaching
*Systems theory
Systems theory is the Transdisciplinarity, transdisciplinary study of systems, i.e. cohesive groups of interrelated, interdependent components that can be natural or artificial. Every system has causal boundaries, is influenced by its context, de ...
*Reality therapy
Reality therapy (RT) is an approach to psychotherapy and counseling developed by William Glasser in the 1960s. It differs from conventional psychiatry, psychoanalysis and medical model schools of psychotherapy in that it focuses on what Glasser ...
* the genogram
The number of sessions depends on the situation, but the average is 5–20 sessions. A family therapist usually meets several members of the family at the same time. This has the advantage of making differences between the ways family members perceive mutual relations as well as interaction patterns in the session apparent both for the therapist and the family. These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporated into the family system. Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the unconscious mind
In psychoanalysis and other psychological theories, the unconscious mind (or the unconscious) is the part of the psyche that is not available to introspection. Although these processes exist beneath the surface of conscious awareness, they are t ...
or early childhood trauma of individuals as a Freud
Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies seen as originating from conflicts in t ...
ian therapist would do – although some schools of family therapy, for example psychodynamic and intergenerational, do consider such individual and historical factors (thus embracing both linear and circular causation) and they may use instruments such as the genogram
A genogram, also known as a family diagram, is a pictorial display of a person's position and ongoing relationships in their family's hereditary hierarchy. It goes beyond a traditional family tree by allowing the user to visualize social patterns ...
to help to elucidate the patterns of relationship across generations.
The distinctive feature of family therapy is its perspective and analytical framework rather than the number of people present at a therapy session. Specifically, family therapists are relational therapists: They are generally more interested in what goes on ''between'' individuals rather than ''within'' one or more individuals, although some family therapists – in particular those who identify as psychodynamic
Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
, object relations
Object relations theory is a school of thought in psychoanalytic theory and psychoanalysis centered around theories of stages of ego development. Its concerns include the relation of the psyche to others in childhood and the exploration of re ...
, intergenerational, or experiential family therapists (EFTs) – tend to be as interested in individuals as in the ''systems'' those individuals and their relationships constitute. Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as by pointing out patterns of interaction that the family might have not noticed.
Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to allocate blame to one or more individuals, with the effect that for many families a focus on causation is of little or no clinical utility. It is important to note that a circular way of problem evaluation is used as opposed to a linear route. Using this method, families can be helped by finding patterns of behaviour, what the causes are, and what can be done to better their situation.
Evidence base
Family therapy has an evolving evidence base. A summary of current evidence is available via the UK's Association of Family Therapy. Evaluation and outcome studies can also be found on the Family Therapy and Systemic Research Centre website. The website also includes quantitative and qualitative research studies of many aspects of family therapy.
According to a 2004 French government study conducted by French Institute of Health and Medical Research
The (Inserm, ) is the French National Institute of Health and Medical Research.
History and organisation
Inserm was created in 1964 as a successor to the French National Institute of Health.
Inserm is the only public research institution ...
, family and couples therapy was the second most effective therapy after Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders.
Cognitive behavioral therapy focuses on challenging and chang ...
. The study used meta-analysis
Meta-analysis is a method of synthesis of quantitative data from multiple independent studies addressing a common research question. An important part of this method involves computing a combined effect size across all of the studies. As such, th ...
of over a hundred secondary studies to find some level of effectiveness that was either "proven" or "presumed" to exist. Of the treatments studied, family therapy was presumed or proven effective at treating schizophrenia
Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
, bipolar disorder
Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
, anorexia
Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by Calorie restriction, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.
Individuals wit ...
and alcohol dependency
Alcohol dependence is a previous (DSM-IV and ICD-10) psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol (also chemically known as ethanol).
In 2013, it was reclassified as alcohol use disorder ...
.
Concerns and criticism
In a 1999 address to the Coalition of Marriage, Family and Couples Education conference in Washington, D.C., University of Minnesota
The University of Minnesota Twin Cities (historically known as University of Minnesota) is a public university, public Land-grant university, land-grant research university in the Minneapolis–Saint Paul, Twin Cities of Minneapolis and Saint ...
Professor William Doherty said:
Doherty suggested questions prospective clients should ask a therapist before beginning treatment:
# "Can you describe your background and training in marital therapy?"
# "What is your attitude toward salvaging a troubled marriage versus helping couples break up?"
# "What is your approach when one partner is seriously considering ending the marriage and the other wants to save it?"
# "What percentage of your practice is marital therapy?"
# "Of the couples you treat, what percentage would you say work out enough of their problems to stay married with a reasonable amount of satisfaction with the relationship." "What percentage break up while they are seeing you?" "What percentage do not improve?" "What do you think makes the differences in these results?"
Licensing and degrees
Family therapy practitioners come from a range of professional backgrounds, and some are specifically qualified or licensed/registered in family therapy (licensing is not required in some jurisdictions and requirements vary from place to place). In the United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
, family therapists will have a prior relevant professional training in one of the helping professions usually psychologist
A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and explanation, interpretatio ...
s, psychotherapist
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
s, or counselors who have done further training in family therapy, either a diploma
A diploma is a document awarded by an educational institution (such as a college or university) testifying the recipient has graduated by successfully completing their courses of studies. Historically, it has also referred to a charter or offi ...
or an M.Sc. In the United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
there is a specific degree and license as a marriage
Marriage, also called matrimony or wedlock, is a culturally and often legally recognised union between people called spouses. It establishes rights and obligations between them, as well as between them and their children (if any), and b ...
and family therapist; however, psychologist
A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and explanation, interpretatio ...
s, nurse
Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...
s, psychotherapist
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
s, social work
Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social wo ...
ers, or counselors, and other licensed mental health professionals may practice family therapy. In the UK, family therapists who have completed a four-year qualifying programme of study (MSc) are eligible to register with the professional body the Association of Family Therapy (AFT), and with the UK Council for Psychotherapy (UKCP).
A master's degree is required to work as a Marriage and Family Therapist (MFT) in some American states. Most commonly, MFTs will first earn a M.S. or M.A. degree in marriage and family therapy, counseling
Counseling is the professional guidance of the individual by utilizing psychological methods especially in collecting case history data, using various techniques of the personal interview, and testing interests and aptitudes.
This is a list of c ...
, psychology
Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...
, family studies, or social work
Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social wo ...
. After graduation, prospective MFTs work as interns under the supervision of a licensed professional and are referred to as an MFTi.
Prior to 1999 in California
California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...
, counselors who specialized in this area were called Marriage, Family and Child Counselors. Today, they are known as Marriage and Family Therapists (MFT), and work variously in private practice, in clinical settings such as hospitals, institutions, or counseling organizations.
Marriage and family therapists in the United States
The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
and Canada
Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
often seek degrees from accredited Masters or Doctoral programs recognized by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), a division of the American Association of Marriage and Family Therapy
The American Association for Marriage and Family Therapy (AAMFT) is a professional association in the field of marriage and family therapy representing more than 50,000 marriage and family therapists throughout the United States, Canada, and abroad ...
.
Requirements vary, but in most states about 3000 hours of supervised work as an intern are needed to sit for a licensing exam. MFTs must be licensed by the state to practice. Only after completing their education and internship and passing the state licensing exam can a person call themselves a Marital and Family Therapist and work unsupervised.
License restrictions can vary considerably from state to state. Contact information about licensing boards in the United States are provided by the Association of Marital and Family Regulatory Boards.
There have been concerns raised within the profession about the fact that specialist training in ''couples therapy'' – as distinct from ''family therapy'' in general – is not required to gain a license as an MFT or membership of the main professional body, the AAMFT.
Values and ethics
Since issues of interpersonal conflict, power, control, values, and ethics are often more pronounced in relationship therapy than in individual therapy, there has been debate within the profession about the different values that are implicit in the various theoretical models of therapy and the role of the therapist's own values in the therapeutic process, and how prospective clients should best go about finding a therapist whose values and objectives are most consistent with their own. An early paper on ethics in family therapy written by Vincenzo Di Nicola
Vincenzo Di Nicola is an Italian-Canadian psychologist, psychiatrist and family therapist, and philosopher of mind.
Di Nicola is a tenured Full Professor in the Dept. of Psychiatry & Addiction Medicine at the University of Montreal, where he ...
in consultation with a bioethicist asked basic questions about whether strategic interventions "mean what they say" and if it is ethical to invent opinions offered to families about the treatment process, such as statements saying that half of the treatment team believes one thing and half believes another. Specific issues that have emerged have included an increasing questioning of the longstanding notion of therapeutic neutrality, a concern with questions of justice and self-determination
Self-determination refers to a people's right to form its own political entity, and internal self-determination is the right to representative government with full suffrage.
Self-determination is a cardinal principle in modern international la ...
, connectedness and independence, functioning versus authenticity,[ and questions about the degree of the therapist's pro-marriage/family versus pro-individual commitment.
The ]American Association for Marriage and Family Therapy
The American Association for Marriage and Family Therapy (AAMFT) is a professional association in the field of marriage and family therapy representing more than 50,000 marriage and family therapists throughout the United States, Canada, and abroad ...
requires members to adhere to a code of ethics
Ethical codes are adopted by organizations to assist members in understanding the difference between right and wrong and in applying that understanding to their decisions. An ethical code generally implies documents at three levels: codes of b ...
, including a commitment to "continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship."
Founders and key influences
Some key developers of family therapy are:
Summary of theories and techniques
(''references:''[Sexton, T. L., Weeks, G. R., & Robbins, M. S. (2003). ''Handbook of family therapy: The science and practice of working with families and couples.'' New York: Brunner-Routledge.])
Journals
* '' Australian and New Zealand Journal of Family Therapy''
* ''Contemporary Family Therapy
''Contemporary Family Therapy'' is a peer-reviewed academic journal covering research on family therapy, focusing on recent applied practice and developments in theory and research that is published quarterly by Springer Science+Business Media. Th ...
''
* ''Family Process
''Family Process'' is a quarterly peer-reviewed academic journal covering research on family system issues, including policy and applied practice. It is published by Wiley-Blackwell on behalf of the Family Process Institute. Since 2007, the journal ...
''
* '' Family Relations''
* '' Family Relations'', Interdisciplinary Journal of Applied Family Studies
* '' Journal of Family Therapy''
* ''Marriage Fitness''
* ''Murmurations: Journal of Transformative Systemic Practice''
* '' Sexual and Relationship Therapy''
* '' Journal of Marital & Family Therapy''
* '' Families, Systems and Health''
See also
* Alternative dispute resolution
Alternative dispute resolution (ADR), or external dispute resolution (EDR), typically denotes a wide range of dispute resolution processes and techniques that parties can use to settle disputes with the help of a third party. They are used for ...
* Acceptance and commitment therapy
Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically-based psychological intervention that uses acceptance and mindfu ...
* CAMFT
*Child abuse
Child abuse (also called child endangerment or child maltreatment) is physical abuse, physical, child sexual abuse, sexual, emotional and/or psychological abuse, psychological maltreatment or Child neglect, neglect of a child, especially by a p ...
*Conflict resolution
Conflict resolution is conceptualized as the methods and processes involved in facilitating the peaceful ending of Conflict (process), conflict and Revenge, retribution. Committed group members attempt to resolve group conflicts by actively co ...
* Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders.
Cognitive behavioral therapy focuses on challenging and chang ...
*Deinstitutionalisation
Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the 1950 ...
*Domestic violence
Domestic violence is violence that occurs in a domestic setting, such as in a marriage
Marriage, also called matrimony or wedlock, is a culturally and often legally recognised union between people called spouses. It establishes r ...
*Dysfunctional family
In psychology, abnormality (also dysfunctional behavior, maladaptive behavior, or deviant behavior) is a behavioral characteristic assigned to those with conditions that are regarded as dysfunctional. Behavior is considered to be abnormal when i ...
*Emotionally focused therapy
Emotionally focused therapy and emotion-focused therapy (EFT) are related Humanistic psychology, humanistic approaches to psychotherapy that aim to resolve emotional and relationship issues with individuals, couples, and families. These therapies ...
* ENRICH
* Family Environment Scale
*Family Life Education
Family life education is defined by the National Council on Family Relations (NCFR) as "the educational effort to strengthen individual and family life through a family perspective. The objective of Family Life Education is to enrich and improve ...
* Family Life Space
*Identified patient
Identified patient (IP) is a clinical term often used in family therapy discussion. It describes one family member in a dysfunctional family who is used as an expression of the family's authentic inner conflicts. As a family system is dynamic, th ...
* Impact Therapy
*Internal Family Systems Model
The Internal Family Systems Model (IFS) is an integrative approach to individual psychotherapy developed by Richard C. Schwartz in the 1980s. It combines systems thinking with the view that the mind is made up of relatively discrete subperson ...
*Interpersonal psychotherapy
Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and achieving symptomatic recovery. IPT is an empirically supported treatment (EST) that follows a highly structured and ...
*Interpersonal relationship
In social psychology, an interpersonal relation (or interpersonal relationship) describes a social association, connection, or affiliation between two or more people. It overlaps significantly with the concept of social relations, which a ...
*Mediation
Mediation is a structured, voluntary process for resolving disputes, facilitated by a neutral third party known as the mediator. It is a structured, interactive process where an independent third party, the mediator, assists disputing parties ...
* Mindfulness-based cognitive therapy
* Multisystemic Therapy (MST)
*Positive psychology
Positive psychology is the scientific study of conditions and processes that contribute to positive psychological states (e.g., contentment, joy), well-being, Positive psychology of relationships, positive relationships, and positive institutio ...
*Relationship education
Relationship education and premarital counseling promote practices and principles of premarital education, relationship resources, relationship restoration, relationship maintenance, and evidence-based marriage education.
History
The formal orga ...
*Relationships Australia
Relationships Australia (RA) is an Australian not-for profit organisation providing professional services to support relationships across Australia that began in 1948 under the name of Marriage Guidance Council. Initially providing counselling ...
* Strategic Family Therapy
*Abnormal Psychology
Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of ps ...
Footnotes
Further reading
* Deborah Weinstein, ''The Pathological Family: Postwar America and the Rise of Family Therapy.'' Ithaca, NY: Cornell University Press, 2013.
* Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir Model: Family Therapy and Beyond. Palo Alto, CA: Science and Behavior Books.
* The Systemic Thinking and Practice Series. Routledge
* Gehring, T. M., Debry, M. & Smith, P. K. (Eds.). (2016). The Family System Test FAST. Theory and application. Hove: Brunner-Routledge.
{{DEFAULTSORT:Family Therapy
Family
Psychotherapy by type
Relationship counseling
Cybernetics
sr:Породична терапија