Elaine McGoldrick, Family Therapist shares an overview of family therapy and how it can help clients and and their families.
What is family therapy?
Family therapy addresses the problems people present within the context of their relationships with significant people in their lives and within their wider social networks.
Family therapists believe that individual problems must be addressed within the framework of interpersonal relationships. This is in contrast with other psychotherapy approaches, such as psychodynamic or cognitive behavioural psychotherapy, which focus on the individual, and what is going on within the individual. Family therapy views problems as arising through, and being maintained by, our patterns of interactions with others; and being resolved through changes in these patterns of interaction, and through the promotion of open, direct and clear communication between family members.
Family therapy is also referred to as systemic psychotherapy. It is based on systems theory; that is where a system consisting of different parts is organised to accomplish shared goals and where a change in one part of the system affects the whole system. Within family or systemic therapy, the family is considered a system of different parts; for instance, a change in one part of the family will affect the whole family. This means that, in terms of a family member who experiences a mental health difficulty, all members of the family will be affected.
How does a mental health difficulty affect the family?
A mental health difficulty disrupts the atmosphere at home, not just for the individual, but for the whole family. It can cause a change in the structure of a family and a change in roles within the family. in much the same way as a high conflict separations and divorce can cause changes in the roles and structure of a family.
As the family becomes focused on the needs of the family member with a mental health difficulty, the needs of others in the family may become neglected. If one parent is experiencing a mental health difficulty, the other parent may have to take on a wider role within the family, including tasks that the other parent used to do. This can lead to conflict, role strain and resentment. Mental health difficulties of a family member may also be associated with financial issues where the affected family member is unable to work for a time. Where a child is experiencing mental health difficulties, other siblings may resent their parents’ focus on their sibling.
A mental health difficulty within the family not only disrupts family life emotionally, but also socially. Families may withdraw from those outside the family and the wider community, due to feelings of embarrassment and stigma. Equally, they may not have the energy or time to focus on relationships outside the family, thereby cutting the family off from important supports at a time when they need it most.
How can family therapy help?
Family therapy seeks to help the family make the necessary affective, cognitive, environmental and relational or interpersonal changes to support their family member’s recovery.
Many families might not know how best to support their families, or feel they lack the skills needed to initiate change. Psychoeducation about their loved one’s mental health is an important first step in family therapy.
Families may also be inadvertently contributing to the continuation of their family member’s mental health difficulty; for example, through high expressed emotion such as anger, hostility or criticism. Other examples of this could be helping someone experiencing panic attacks to avoid situations that trigger them, accommodating lengthy Obsessive Compulsive Disorder (OCD) rituals, or allowing someone with an eating disorder to dictate how foods are cooked or only having certain foods available at home.
The aim of family therapy is to reduce the extent to which other family members engage in behaviours that may enable or perpetuate the mental health difficulty of a family member. Family therapy also aims to encourage the person with the mental health difficulty, and each family member, to take responsibility for their contribution to problem-maintaining behaviours.
This approach involves establishing boundaries, such as being clear about expectations of each other and discussing how each person in the family can support the person with a mental health difficulty, while also being mindful of their own needs, their own health and the limits to the assistance that they can give.
The goals of family therapy are to improve family relationships and family functioning through:
- Promoting open, clear and direct communication
- Enhancing empathy and fostering emotional support among family members through understanding each other’s views, experiences and needs
- Fostering cohesion, connection and adaptability within the family through changing negative interactional patterns and engaging in meaningful interactions that permit family members to reveal their feelings and needs
- Facilitating problem-solving: supporting families to consider things like “how can I help you?” or “how can you help me?”, and trying to identify the ‘win-win’ solutions that satisfy all family members, so that each family members’ needs are met, and each family members’ limits and expectations are respected
- Building on family strengths through open communication and appropriate management of conflict, and through fostering trust, co-operation, acceptance and appreciation of each other.
Family therapy has been show to improve recovery rates for the person with the mental health difficulty, reduce the risk of relapse and improve the happiness and well-being of families. Family therapy has been recommended by the National Institute for Health and Care Excellence (NICE) Clinical Guidelines for:
- alcohol dependence and harmful alcohol use
- antenatal and postnatal mental health difficulties
- anti-social behaviour and conduct disorders in children and young people
- bipolar disorder
- depression in adults
- depression in children and young people
- psychosis and schizophrenia
- eating disorders in children and young adults.