Family therapy

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 The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page.

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.

Contents

[edit] History and theoretical frameworks

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.[1] 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.[2] The formal development of family therapy dates to the late 1940s and early 1950s with, initially, 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. The movement received a major boost in the mid-1950s through the work of Gregory Bateson and colleagues, who introduced ideas from cybernetics and general systems theory into psychology and psychotherapy. By the mid-1960s a number of distinct schools of family therapy had emerged. From those groups that were most strongly influenced by systems theory, there came strategic therapy, structural therapy, and slightly later, the Milan Systems model. Partly in reaction to some aspects of the systemic models, came the experiential approaches of Virginia Satir and Carl Whitaker. Concurrently and somewhat independently, there emerged the various intergenerational therapies of Murray Bowen, Iván Böszörményi-Nagy, and James Framo. Psychodynamic family therapy continued to develop through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, but also by the British School of Object Relations and John Bowlby’s work on attachment.[2]

By the late 1970s the weight of clinical experience had led to some revision of a number of the original models and a moderation of some of the early theoretical purism, and a softening of the strict demarcations between schools, with moves toward rapprochement, integration, and eclecticism. These trends were also promoted by critiques from various sources, including feminism and post-modernism.[3]

From the 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 (eg, post-Milan systems/collaborative/conversational, reflective), solution-focused therapy, narrative therapy, a range of cognitive and behavioral approaches, psychodynamic and object relations, intergenerational, attachment and Emotionally Focused Therapy.[4][5][6][7][8][9][10] Multicultural, intercultural, and integrative approaches are being developed.[11][12][13][14][15] Many practitioners claim to be "eclectic," using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s), while others adhere more strictly to a particular approach.[16]

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.[17]

[edit] Techniques

Family therapy uses a range of counseling and other techniques including:

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, and they may use instruments such as the genogram to help to elucidate the patterns of relationship across generations.

Family therapy is really a way of thinking, an epistemology rather than about how many people sit in the room with the therapist. Family therapists are relational therapists; they are generally more interested in what goes between people rather than in people. Depending on circumstances, a therapist may point out to the family interaction patterns that the family might have not noticed; or suggest different ways of responding to other family members. These changes in the way of responding may then trigger repercussions in the whole system, leading to a more satisfactory systemic state; it should be noted though, that 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 systems.

Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. A causal focus can be experienced as blaming by some families and is with many issues of questionable 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.

[edit] Publications

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

[edit] 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 and the United States, 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 US 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 psychology, family studies, or social work and then spend two to three years completing a program in specific areas of psychology relevant to marriage and family therapy. After graduation, prospective MFTs work as interns under the supervision of a licensed professional and are referred to as an MFTi.[18]

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 they call themselves MFTs 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.

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.[19]

[edit] Values and ethics in family therapy

Since issues of interpersonal conflict, 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.[20][21][22] Specific issues that have emerged have included an increasing questioning of the longstanding notion of therapeutic neutrality[23],[24][25] a concern with questions of justice and self-determination,[26] connectedness and independence,[27] "functioning" versus "authenticity",[3] and questions about the degree of the therapist’s "pro-marriage/family" versus "pro-individual" commitment.[28]

[edit] Founders and key influences

Some key developers of family therapy are:

[edit] Academic resources

  • Journal of Child and Family Studies, ISSN: 1062-1024 (Print) 1573-2843 (Online), Springer
  • 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

[edit] See also

[edit] References

  1. ^ 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
  2. ^ a b 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.
  3. ^ a b Nichols, M.P. & Schwartz, R.C. (2006). Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon.
  4. ^ Sprenkle, D.H., & Bischof, G.P. (1994). Contemporary family therapy in the United States. Journal of Family Therapy, 16(1): 5-23(19)
  5. ^ Dattilio, F.R. (Ed.) (1998). Case Studies in Couple and Family Therapy: Systemic and Cognitive Perspectives. Guildford Press: New York.
  6. ^ Gurman, A.S. & Fraenkel, P. (2002). The history of couple therapy: a millennial review. Family Process, 41(2): 199-260(62)
  7. ^ Couple therapy Harvard Mental Health Letter 03/01/2007.
  8. ^ Attachment and Family Systems. Family Process. Special Issue: Fall 2002 41(3)
  9. ^ Denborough, D. (2001). Family Therapy: Exploring the Field's Past, Present and Possible Futures. Adelaide, South Australia: Dulwich Centre Publications.
  10. ^ Crago, H. (2006). Couple, Family and Group Work: First Steps in Interpersonal Intervention. Maidenhead, Berkshire; New York: Open University Press.
  11. ^ McGoldrick, M. (Ed.) (1998). Re-Visioning Family Therapy: Race, Culture, and Gender in Clinical Practice.Guilford Press: New York.
  12. ^ Dean, R.G. (2001). The Myth of Cross-Cultural Competence. Families in Society: The Journal of Contemporary Human Services. 82(6): 623-30.
  13. ^ Ng, K.S. (2003). Global Perspectives in Family Therapy: Development, Practice, and Trends. New York: Brunner-Routledge.
  14. ^ McGoldrick, M., Giordano, J. & Garcia-Preto, N. (2005). Ethnicity & Family Therapy, 3rd Ed.: Guilford Press.
  15. ^ 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.
  16. ^ 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.
  17. ^ The Top 10: The Most Influential Therapists of the Past Quarter-Century. Psychotherapy Networker.: 2007, March/April (retrieved 11 Sept 2007)
  18. ^ "Therapy Center:Credentials". Psychology Today. http://therapists.psychologytoday.com/rms/content/therapy_credentials.html. Retrieved on 2008-08-13. 
  19. ^ Doherty W (2002). "Bad Couples Therapy and How to Avoid It: Getting past the myth of therapist neutrality". Psychotherapy Networker 26 (Nov-Dec): 26–33. http://www.smartmarriages.com/badcouples.doherty.html. 
  20. ^ 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
  21. ^ 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. pp. 175–207. ISBN 0-8010-9313-9. http://documents.fuller.edu/sop/integration/Publications/dueck_publications/dueckfam.pdf. 
  22. ^ 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): 139–49. doi:10.2307/585077. http://links.jstor.org/sici?sici=0197-6664%28199904%2948%3A2%3C139%3ATEORTM%3E2.0.CO%3B2-6&size=LARGE&origin=JSTOR-enlargePage. 
  23. ^ Grosser GH, Paul NL (Oct 1964). "Ethical issues in family group therapy". Am J Orthopsychiatry 34: 875–84. PMID 14220517. 
  24. ^ Hare-Mustin RT (Jun 1978). "A feminist approach to family therapy". Fam Process 17 (2): 181–94. doi:10.1111/j.1545-5300.1978.00181.x?journalCode=famp. PMID 678351. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1545-5300.1978.00181.x?journalCode=famp. 
  25. ^ 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).
  26. ^ 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.
  27. ^ Fowers BJ, Richardson FC (1996). "Individualism, Family Ideology and Family Therapy". Theory & Psychology 6 (1): 121–51. doi:10.1177/0959354396061009. http://sptap.highwire.org/cgi/content/abstract/6/1/121. 
  28. ^ USA Today 6/21/2005 Hearts divide over marital therapy.

[edit] External links

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.

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