Systemic Family Psychotherapy (usually known simply as Family Therapy) is a form of psychotherapy that has evolved since the 1950s to become an approach with a considerable evidence base (Stratton, 2016) for helping people deal with a range of difficulties.
Family therapy has transformed over the years from being a very much ‘expert led’ approach where therapists would try to ‘fix’ faulty communication within families, to a much more collaborative approach that recognises that people are the experts on their own lives, with an emphasis on seeking to support families, couples and individuals discover and access resources that are unique to them. More recently, family therapists have welcomed and integrated ideas from other approaches, and regularly consider psychodynamic aspects - for example attachment theory - within their practice.
Qualified family therapists, unlike most other modalities of therapy, are equipped to work with individuals, couples and families, and are frequently employed in both statutory and non-statutory agencies; for example, in outpatient and inpatient child and adolescent mental health services (CAMHS) or adult mental health services, and they are increasingly employed by social services to support social work with families, too. Many charitable agencies also employ family therapists.
Family therapists often work in teams with the intention of making available more ideas and thinking about the family’s difficulties, where the team may offer reflections, ideas and thoughts about the family’s situation. Some family therapists work alone, but, as with any regulated therapy, all family therapists are required to have regular supervision, abide by the Association for Family Therapy and Systemic Practice’s (AFT) Code of Ethics and Practice and the UKCP Ethical Principles and Code of Professional Conduct.
Most family therapists would consider that many of the problems people experience are not ‘inside’ the person experiencing the dysfunction, instead seeing the difficulties as being relational, usually within the family context - the environment which can both be the most challenging and also the most supportive.
Family therapists are aware of how different milestones within the life cycle of a family, and the changing developmental needs of children as they grow up, require the whole family to respond to these challenges. Therapists will consider how the family’s past (including previous generations) may be influencing the present situation, they will also look at how processes within a family operate and will usually make these apparent to the family and support them in discovering more helpful alternatives or resources they may not have previously been aware of.
Sometimes this can be relatively uncomplicated, for example using a dialogical approach in supporting both partners in a couple to listen to, and think about, the other’s history, and how that has impacted upon their current dilemmas and responses. Sometimes the work can be quite complex, for example working with families or couples where there has been trauma or abuse, or a young person within the family has distressing symptoms such as self-harm or an eating disorder, where the therapist will work to support the family in supporting each other more helpfully.
The position a family therapist takes in relation to their clients is very important; when working with more than one person in the room, it is important to be able to engage effectively with everyone present. Family therapists work from a position of curiosity; rather than assuming they know the answers, they engage in dialogue with family members (modelling good listening skills) and try to help the family find new meanings and understandings about their situation.
Family therapy can provide a safe, containing space in which people can talk and listen to each other about sometimes very painful and distressing experiences, enabling them to appreciate that other people may have different views. The therapist’s role is not to judge who is ‘right’ and who is ‘wrong’ but instead hold and respect sometimes very opposing views, helping family members understand that these different perceptions are OK, and that engaging in the process of dialogue can often lead to new understanding.
Sometimes patterns of interaction within a family can contribute to the maintenance, rather than the resolution, of a problem. In one recent case, the parents of a young person with anorexia had some relationship difficulties; the father could be quite verbally aggressive and the mother had withdrawn from him. Developing a good therapeutic relationship with all the family members enabled safe exploration of the parents' relationship and some gentle challenging of the father’s behaviour. This resulted in considerable positive change for all the family, not just the young person with the identified problem.
Finally, it is worth mentioning that there is clear evidence that there are general health benefits for all the members of families that experience family therapy; a large-scale US study with frequent health service users who participated in family inclusive therapy showed significant reductions of 68% for health screening visits, 38% for illness visits, 56% for laboratory/X-ray visits, and 78% for urgent care visits.
If you are interested in discovering more about family therapy, the AFT website has some really helpful resources. http://www.aft.org.uk/
Crane D.R. & Christenson, J.D. (2008) The medical offset effect: Patterns in outpatient services reduction for high utilizers of health care. Contemporary Family Therapy. 30: 217-138.
Stratton, P (2016) The Evidence Base of Family Therapy and Systemic Practice. Association for Family Therapy, UK