Families are composed of units of individuals engaged in continuing interrelationships that significantly influence mutual behaviors. Pathology in one member can have a determining effect on the entire family system, which, in turn, will modulate the degree and form of individual dysfunctions.
What to expect?
Therapeutic interventions therefore must concern themselves with the organizational distortions of the family as a system. It follows from this that correction of psychopathology in any one or more members presupposes a restructuring of the family organization, which is, to say the least, a difficult undertaking. At the start of treatment, the therapist is usually confronted with the fact that the family, dysfunctional as it may be, has reached a level of stability (homeostasis) that tends to resist modification.
How does it work?
During treatment the therapist must skillfully weave back and forth among the various members as resistance, transference, and defensive manifestations break loose. Countertransference is a fluid phenomenon in the process; identification with one or more the patients in the group commonly occurs. Problems are not regarded as the tip of the iceberg, so to speak, emerging from buried inner manifestations, but as the iceberg itself. A good number of the therapeutic interventions are directed at the activities that are being used as “solutions” to control or eliminate undesired behavior. These activities usually sustain and reinforce the difficulty. Since such solutions often serve merely to aggravate the problem, therapy is concentrated on eliminating these futile solutions. New problem-solving methods are encouraged, focused on behavioral alterations rather than intellectual insights. A behavioral change in any member of a system can produce a change in the entire system. Accordingly, treatment may concentrate on the member who is most responsible for bringing about difficulties in the system, although the family as a whole is taken into consideration. Understandably, therapists have special ways of looking at family pathology and they organize their ideas, as has been pointed out, around favorite systems, such as behavioral family therapy, structural family therapy, psychodynamically oriented family therapy, and systems family therapy. This results in many different forms of practice that vary in such areas as selection of the unit of intervention (i.e., identified patient and parents, or total immediate family including siblings, extended family, distant relatives, etc.); time allotted to sessions (1 hour to several days [marathon family therapy]); duration of therapy (one session to many months); activity during sessions (listening, supporting, challenging, confronting, guiding, advising, censoring, praising, reassuring, etc.); relative emphasis on insight and behavioral alteration; and employment of adjunctive procedures (videotaping, use of one-way mirrors, role-playing, etc.).
When is it used?
Sometimes family therapy is undertaken in clinics and family organizations, particularly those dealing with children for the purpose of reducing waiting lists. Multiple therapists are often employed, circumventing to an extent the countertransference that develops in a one-to-one relationship. Individual therapy may be done concurrently by the different members of the team with selected members of the family (Hammer, 1967).
Role of the therapist:
Some family therapists insist that the initial consultation include all family members. This is possible where family therapy is specifically requested. Dealing with the resistance of a family to the securing of help, or of a patient to involving the family will call for skillful explanation and negotiation. All members of the immediate family and important members of the extended family as well as intimate friends are best included at least at the beginning. The therapist must be prepared to deal with explosive anger and accusations, channeling and defusing these to prevent the withdrawal of key members and breakup of treatment before it gets a start.