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 these in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health. As such, family problems have been seen to arise as an emergent property of systemic interactions, rather than to be blamed on individual members. Marriage and Family Therapists (MFTs) are the most specifically trained in this type of psychotherapy.
Family therapists may focus more on how patterns of interaction maintain the problem rather than trying to identify the cause, as this can be experienced as blaming by some families. It assumes that the family as a whole is larger than the sum of its parts. Family therapy may also be used to draw upon the strengths of a social network to help address a problem that may be completely externally caused rather than created or maintained by the family.
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 UK, 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 U.S., there is a specific license as a Marriage and Family therapist.
Family therapy has been used effectively where families, and or individuals in those families experience or suffer:
- serious psychological disorders (e.g. schizophrenia, anxiety, depression, personality disorders, conduct disorders, ADHD, addictions and eating disorders);
- interactional and transitional crises in a family’s life cycle (e.g. conflict, estrangement, divorce, child and adolescent issues);
- as a support of other psychotherapies and medication.
It uses a range of counseling and other techniques including:
The basic theory of classical systemic family therapy was derived mainly from systems theory and cybernetics, and secondarily from behavioral therapy and cognitive psychotherapy, although most of the founders of the field had psychoanalytic backgrounds. More recent developments have come from feminist, postmodernist, narrative, psychodynamic and attachment theories.
Important schools of family therapy include structural family therapy, strategic family therapy, a range of cognitive and behavioral approaches, constructivist (eg, Milan systems, post-systems/collaborative/conversational, reflective), solution-focused therapy, psychodynamic, object relations, intergenerational (Bowen systems theory, Contextual therapy), EFT (emotionally focused therapy), and experiential therapy. Multicultural, intercultural, and integrative approaches are being developed. Most practitioners claim to be "eclectic", using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s).
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; (conjoint family therapy is used in the approach of Virginia Satir and others.) 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.
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 that identify as psychodynamic, object relations, intergenerational, EFT, or experiential family therapists - tend to be as interested in individuals as in systems.
A novel development in the field of couples therapy in particular, has involved the introduction of insights gained from affective neuroscience and psychopharmacology into clinical practice. There has been particular interest in use of the so-called love hormone – oxytocin – during therapy sessions, although this is still largely experimental and somewhat controversial.
In the United States
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, (MFTs) 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 states. Most commonly, MFTs will first earn a B.S. or B.A. degree in psychology, and then spend 2 to 3 years completing a program in specific areas of psychology relevant to marriage and family therapy. After graduation, prospective MFTs work as interns.
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 currently not allowed to diagnose and treat mental and emotional disorders, practice independently, or bill insurance. MFTs in Ohio face a long road of fighting for equality.
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 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. 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 therapist’s "pro-marriage/family" versus "pro-individual" commitment.
Founders and key influences
Some key developers of family therapy are:
- Nathan Ackerman (psychoanalytic)
- Tom Andersen (Reflecting practices and dialogues about dialogues)
- Harlene Anderson (Postmodern Collaborative Therapy and Collaborative Language Systems)
- Gregory Bateson (1904 – 1980) (cybernetics, systems theory)
- Insoo Kim Berg (solution focused therapy)
- Iván Böszörményi-Nagy (Contextual therapy, intergenerational, relational ethics)
- Murray Bowen (Systems theory, intergenerational)
- John Bradshaw (author) (systems theory)
- Milton H. Erickson (hypnotherapy, strategic therapy, brief therapy)
- Richard Fisch (brief therapy, strategic therapy)
- James Framo (object relations theory, intergenerational)
- Harry Goolishian (Postmodern Collaborative Therapy and Collaborataive Language Systems)
- John Gottman (marriage)
- Jay Haley (strategic therapy, communications)
- Lynn Hoffman (strategic, post-systems, collaborative)
- Don D. Jackson (systems theory)
- Susan Johnson (Emotionally focused therapy, attachment theory)
- Walter Kempler (Gestalt psychology)
- Salvador Minuchin (structural)
- Braulio Montalvo (structural)
- Virginia Satir (communications, experiential, conjoint and co-therapy)
- Mara Selvini Palazzoli (Milan systems)
- Robin Skynner (Group Analysis)
- Paul Watzlawick (Brief therapy, systems theory)
- John Weakland (Brief therapy, strategic therapy, systems theory)
- Carl Whitaker (Family systems, experiential, co-therapy)
- Michael White (narrative therapy)
- Lyman Wynne (Schizophrenia, pseudomutuality)
- Maria Martiroysan
- Child abuse
- Conflict resolution
- Domestic violence
- Dyadic Developmental Psychotherapy
- Family Life Space
- Group therapy
- Internal Family Systems Model
- Interpersonal psychotherapy
- Interpersonal relationship
- Intimate relationship
- Mental health professional
- Relationship counseling
- Relationships Australia
- Systemic therapy
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- Gurman, A.S. & Fraenkel, P. (2002). The history of couple therapy: a millennial review. Family Process, 41(2): 199-260(62)
- Attachment and Family Systems. Family Process. Special Issue: Fall 2002 41(3)
- Sholevar, G.P. & Schwoeri, L.D. (2003). Textbook of Family and Couples Therapy: Clinical Applications. Washington, DC: American Psychiatric Publishing Inc.
- 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.
- 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.
- 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.
- Atkinson, B., Atkinson, L., Kutz, P., et al. (2005). Rewiring Neural States in Couples Therapy: Advances from Affective Neuroscience.Journal of Systemic Therapies. 24 (3): 3-16.
- Resnikoff, R. (2002). Couples Therapy and Psychopharmacology. Psychiatric Times. 19 (7).
- Smith, D. Clashing couples to get a spray of love. Sydney Morning Herald May 26, 2007.
- 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.
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- Wall, J., Needham, T., Browning, D.S., & James, S. (1999). The Ethics of Relationality: The Moral Views of Therapists Engaged in Marital and Family Therapy. Family Relations, Vol. 48, No. 2 (Apr.), 139-149.
- Grosser, G.H. & Paul, N.L. (1964). Ethical issues in family group therapy. American Journal of Orthopsychiatry. 34 (Oct): 875-884.
- Hare-Mustin, R.T. (1978). A Feminist Approach to Family Therapy. Family Process. 17 (2), 181–194.
- 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.
- Fowers, B.J. & Richardson, F.C. (1996). Individualism, Family Ideology and Family Therapy. Theory & Psychology, 6 (1): 121-151.
- Nichols, M.P. & Schwartz, R.C. (2006). The Evaluation of Family Therapy: Comparative Analysis; in Family therapy: concepts and methods. 7th ed. Boston: Pearson/Allyn & Bacon.
- USA Today 6/21/2005 Hearts divide over marital therapy.
- American Association for Marriage and Family Therapy
- American Family Therapy Academy
- Association for Family Therapy and Systemic Practice in the UK
- Australian and New Zealand Journal of Family Therapy
- Bowen Theory
- Mental Research Institute
- California Association of Marriage and Family Therapists
- European Family Therapy Association
- International Family Therapy Association
- Historical overview of field; Therapist profiles; Timeline
- Harvard Mental Health Letter article on Couple Therapy