Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of psychotherapy that works with 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. It emphasizes family relationships as an important factor in psychological health.
What the different schools of family therapy have in common is 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 is often beneficial. 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 catalyzes 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.
Family therapy has been used effectively in the full range of human dilemmas; there is no category of relationship or psychological problem that has not been addressed with this approach.
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 (see for example Ho'oponopono). Following the emergence of specialization in various societies, these interventions were often conducted by particular members of a community â€“ for example, a 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 England 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 to 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 England (John Bowlby at the Tavistock Clinic), the US (John Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker, Virginia Satir), and Hungary (D.L.P. Liebermann) - who began seeing family members together for observation or therapy sessions. There was initially a strong influence from psychoanalysis (most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry, and later from learning theory 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 in the mid-1950s through the work of anthropologist Gregory Bateson and colleagues â€“ Jay Haley, Donald D. Jackson, John Weakland, William Fry, and later, Virginia Satir, Paul Watzlawick and others â€“ at Palo Alto in the US, who introduced ideas from cybernetics and general systems theory into social psychology and psychotherapy, focusing in particular on the role of communication (see Bateson Project). This approach eschewed the traditional focus on individual psychology and historical factors â€“ that involve so-called linear causation and content â€“ and emphasized instead feedback and homeostatic mechanisms and â€œrulesâ€ in here-and-now interactions â€“ so-called circular causation and process â€“ that were thought to maintain or exacerbate problems, whatever the original cause(s). (See also systems psychology and systemic therapy.) 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 (like the founders of a number of other schools of family therapy, including Carl Whitaker, Murray Bowen, and Ivan BÃ¶szÃ¶rmÃ©nyi-Nagy) 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 (e.g., pseudo-mutuality, pseudo-hostility, schism and skew) in families of schizophrenics 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, or even society's, problems. (See also double bind; family nexus.)
By the mid-1960s a number of distinct schools of family therapy had emerged. From those groups that were most strongly influenced by cybernetics and systems theory, there came strategic therapy, and slightly later, Salvador Minuchin's structural therapy and the Milan systems model. 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 (including the subconscious), authentic communication, spontaneity, creativity, total therapist engagement, and often included the extended family. Concurrently and somewhat independently, there emerged the various intergenerational therapies of Murray Bowen, Ivan BÃ¶szÃ¶rmÃ©nyi-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 Bowlbyâ€™s work on attachment. 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 disorders with a significant biological basis, such as schizophrenia - and represented something of a conceptual challenge to some of the "systemic" (and thus potentially "family-blaming") 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 (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 couple 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 disorders - 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, integration, and eclecticism â€“ 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 (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; Biopsychosocial model), 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 â€“ these approaches and sources include: brief therapy, structural therapy, constructivist approaches (eg, Milan systems, post-Milan/collaborative/conversational, reflective), solution-focused therapy, narrative therapy, a range of cognitive and behavioral approaches, psychodynamic and object relations approaches, attachment and Emotionally Focused Therapy, intergenerational approaches, network therapy, and multisystemic therapy (MST). Multicultural, intercultural, and integrative approaches are being developed. 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 â€œgenericâ€ 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).
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 ten most influential therapists of the previous quarter-century, three were prominent family therapists, and the marital and family systems model was the second most utilized model after cognitive behavioral therapy.
Family therapy uses a range of counseling and other techniques including:
- communication theory
- relationship education
- systemic coaching
- systems theory
- reality therapy
- media psychology
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 or early childhood trauma of individuals as a Freudian 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 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, object relations, intergenerational, EFT, or experiential family therapists -- 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. Media and the Family has been emerging as an important area since the introduction of the topic by Bernard Luskin at the spring 2008 CAMFT Conference. The effect of media on behavior has become so pervasive now that those studying family therapy are now studying the subject.
Public understanding of issues affecting the family is important for purposes of education and to aid in communication. Media studies in the field of marriage and family therapy is growing and developing a more important role in improving cultures across the globe.
Family therapy journals include: Family Process, Journal of Systemic Therapies, Journal of Marital and Family Therapy, Journal of Family Therapy, The Australian & New Zealand Journal of Family Therapy, The Psychotherapy Networker, The Journal of Sex and Marital Therapy, The Australian Journal of Family Therapy, The International Journal of Narrative Therapy and Community Work, Journal for the Study of Human Interaction and Family Therapy
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, family therapists are usually psychologists, nurses, psychotherapists, social workers, or counselors who have done further training in family therapy, either a diploma or an M.Sc.. However, in the United States there is a specific degree and license as a Marriage and Family therapist.
Prior to 1999 in California, 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.
A master's degree is required to work as an MFT in some American states. Most commonly, MFTs will first earn a M.S. or M.A. degree in marriage and family therapy, psychology, family studies, or social work. After graduation, prospective MFTs work as interns under the supervision of a licensed professional and are referred to as an MFTi.
Marriage and family therapists in the United States and Canada 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. For accredited programs, click here.
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. In Ohio, for example, Marriage and Family Therapists are not allowed to diagnose and treat mental and emotional disorders, practice independently, or bill insurance. 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 â€“ 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 in family therapy
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 therapistâ€™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. 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, connectedness and independence, "functioning" versus "authenticity", and questions about the degree of the therapistâ€™s "pro-marriage/family" versus "pro-individual" commitment.
- 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
- 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.
- Silverman, M. & Silverman, M. Psychiatry Inside the Family Circle. Saturday Evening Post, 46-51. 28 July 1962.
- Guttman, H.A. (1991). Systems Theory, Cybernetics, and Epistemology. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel
- Becvar, D.S., & Becvar, R.J. (2008). Family therapy: A systemic integration. 7th ed. Boston: Allyn & Bacon.
- Barker, P. (2007). Basic family therapy; 5th edition. Wiley-Blackwell.
- Nichols, M.P. & Schwartz, R.C. (2006). Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon.
- Sprenkle, D.H., & Bischof, G.P. (1994). Contemporary family therapy in the United States. Journal of Family Therapy, 16(1): 5-23(19)
- Dattilio, F.R. (Ed.) (1998). Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives. Guildford Press: New York.
- Gurman, A.S. & Fraenkel, P. (2002). The history of couple therapy: a millennial review. Family Process, 41(2): 199-260(62)
- Couple therapy Harvard Mental Health Letter 03/01/2007.
- Attachment and Family Systems. Family Process. Special Issue: Fall 2002 41(3)
- Denborough, D. (2001). Family Therapy: Exploring the Field's Past, Present and Possible Futures. Adelaide, South Australia: Dulwich Centre Publications.
- Crago, H. (2006). Couple, Family and Group Work: First Steps in Interpersonal Intervention. Maidenhead, Berkshire; New York: Open University Press.
- Van Buren, J. Multisystemic therapy. Encyclopedia of Mental Disorders. retrieved 29 Oct. 2009
- McGoldrick, M. (Ed.) (1998). Re-Visioning Family Therapy: Race, Culture, and Gender in Clinical Practice.Guilford Press: New York.
- Dean, R.G. (2001). The Myth of Cross-Cultural Competence. Families in Society: The Journal of Contemporary Human Services. 82(6): 623-30.
- Krause, I-B. (2002). Culture and System in Family Therapy. London; New York: Karnac.
- Ng, K.S. (2003). Global Perspectives in Family Therapy: Development, Practice, and Trends. New York: Brunner-Routledge.
- McGoldrick, M., Giordano, J. & Garcia-Preto, N. (2005). Ethnicity & Family Therapy, 3rd Ed.: Guilford Press.
- Nichols, M.P. & Schwartz, R.C. (2006). Recent Developments in Family Therapy: Integrative Models; in Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon.
- Lebow, J. (2005). Handbook of clinical family therapy. Hoboken, NJ: John Wiley and Sons.
- Booth, T.J. & Cottone, R.R. (2000). Measurement, Classification, and Prediction of Paradigm Adherence of Marriage and Family Therapists. American Journal of Family Therapy. 28(4): 329-346.
- The Top 10: The Most Influential Therapists of the Past Quarter-Century. Psychotherapy Networker.: 2007, March/April (retrieved 11 Sept 2007)
- Therapy Center:Credentials. Psychology Today. Retrieved on 2008-08-13.
- Doherty W (2002). "Bad Couples Therapy and How to Avoid It: Getting past the myth of therapist neutrality". Psychotherapy Networker 26 (Nov-Dec): 26â€“33.
- Doherty, W., & Boss, P. (1991). Values and ethics in family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of Family Therapy. Vol. 2. NY: Brunner/Mazel
- Dueck A (1991). "Metaphors, models, paradigms and stories in family therapy", in Vande Kemp H: Family therapy: Christian perspectives. Grand Rapids, MI: Baker Book House, 175â€“207. ISBN 0-8010-9313-9.
- Wall J, Needham T, Browning DS, James S (Apr 1999). "The Ethics of Relationality: The Moral Views of Therapists Engaged in Marital and Family Therapy". Family Relations 48 (2): 139â€“49. doi:10.2307/585077.
- Grosser GH, Paul NL (Oct 1964). "Ethical issues in family group therapy". Am J Orthopsychiatry 34: 875â€“84. PMID 14220517.
- Hare-Mustin RT (Jun 1978). "A feminist approach to family therapy". Fam Process 17 (2): 181â€“94. doi:10.1111/j.1545-5300.1978.00181.x?journalCode=famp. PMID 678351.
- Gottlieb, M.C. (1995). Developing Your Ethical Position in Family Therapy: Special Issues. Paper presented at the Annual Meeting of the American Psychological Association (103rd, New York, NY, August 11-15, 1995).
- Melito, R. (2003). Values in the role of the family therapist: Self determination and justice. Journal of Marital and Family Therapy. 29(1):3-11.
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- USA Today 6/21/2005 Hearts divide over marital therapy.
Included in this list are the main professional associations in the US and internationally; they reflect to some degree the different theoretical, ideological, and cross-cultural views of family therapy theory and practice.
- American Association for Marriage and Family Therapy: main professional association in US
- American Family Therapy Academy: main research-oriented professional association in US
- Association for Family Therapy and Systemic Practice in the UK
- Australian and New Zealand Journal of Family Therapy: the de facto professional association for Australia and New Zealand
- Bowen Theory from the Bowen Center for the Study of the Family.
- California Association of Marriage and Family Therapists
- European Family Therapy Association
- International Family Therapy Association
- Historical overview of the field; Therapist profiles; Timeline from Allyn and Bacon/Longman publishing.
- Family Support Partnership - An Overview of Family Therapy and Mediation
- Dulwich Centre: Gateway to Narrative Therapy & Community Work
- "Mind For Therapy" group devoted to creative origins of Family Therapy
- Family Process
- Journal of Child and Family Studies, ISSN: 1062-1024 (Print) 1573-2843 (Online), Springer
- Journal of Marital and Family Therapy
- Journal of Family Psychology
- Family Relations
- Contemporary Family Therapy
- Family Matters, Australian Institute of Family Studies
- Journal of Comparative Family Studies, ASIN: B00007M2W5, Univ of Calgary/Dept Sociology
- Journal of Family Studies, ISSN: 1322-9400, eContent Management Pty Ltd
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