By Rip McAdams
Family therapy, sometimes called Couple & Family Therapy, Family Systems Therapy, or Family Counseling, is one of the newer branches of psychotherapy that emerged as a formal discipline as recently as the 1940s and 1950s. Family therapists believe that people’s behavioral health problems are often best understood and addressed by looking at the important social systems in their lives and how those social systems can play a role in both the cause of and solution to the problems. They are especially interested in how past and present family relationships may be positively or negatively influencing a person’s success and satisfaction in other aspects of his or her life. For that reason, family therapists typically engage multiple family members in the therapy process rather than only the individual family member who may be experiencing a problem. Although the practice of family therapy is increasing, there are still many people who are unfamiliar with it and who may understandably have questions about what a referral for family therapy means. Several commonly asked questions are addressed below.
1. Isn’t the whole family being blamed for one family member’s problems?
Family therapists do not blame the family for a member’s problems. Rather, they value the family as a key element in solving the presenting problem that one of their members is experiencing. In family therapy, problems are seen as having “circular” rather than “linear” causes. From a linear view, a problem between two people has a distinct cause that can be traced from one person to another. From a circular view a problem between two people is seen as the result of the interaction of those two people with each one contributing equally to the problem and neither one being the sole source or blame for it. From their circular perspective, family therapists look for problematic interactions among family members that are influencing the presenting problem. For solutions, they look equally at all members as having a role in revising their contribution to interactions that promote or support the problem. If anything, families in family therapy might be “blamed” for solving the problem but never for causing it.
2. Why does the whole family have to come to counseling when only one or two members are having a problem?
Family therapy is based upon a “systems” perspective, whereby all the members of the family are seen as having a unique role and contribution in the stability of the total family system. Accordingly, any change in one family member’s role can upset the stability of the entire family system unless all other family members are made aware of the change and can adjust their roles (by doing more or doing less of something) and bring the system back into a stable balance. Even positive behavioral and attitude changes made by one family member can upset family stability if other members are not aware of them (for example, one member’s abrupt positive changes can make others resentful because they now feel that they “look bad” in comparison). However, by having all members of the family participate in the family therapy process, family therapists increase the chances that everyone in the family will know when changes are occurring, and that they will be able to effectively adjust to the changes in positive ways that do not upset the stability of the family system.
3. What if the problem involves extended family or others who live outside our home?
Family therapists are likely to apply a broad meaning to the definition of “family,” and the families they work with frequently include more than just nuclear family members (mother, father, and children). Extended family such as grandparents, aunts, uncles, as well as stepparents and even close friends may be invited to participate in family therapy whenever the family and/or the family therapist feel that their participation would assist in resolving the presenting problems.
4. What if topics arise that are not appropriate for the children to hear?
There are certainly some topics that may arise in family therapy sessions that are not appropriate for children and better reserved for discussion among the adult members of the family. In such cases, family therapists will usually ask to meet with just the adults for all or part of a session. However, except in those cases, family therapists can be expected to emphasize the importance of having all family members present for the reasons described in #2 above.
5. How can a family therapist tell us what is best for our family?
The bottom line is that a family therapist cannot tell you what is best for your family. The goal of family therapy is not for the therapist to tell families what is best for them. Rather, the role of the family therapist is to apply his or her training and experience to assist families in generating alternatives to patterns of interaction that are proving to be problematic for them. In the end, it will be the family’s decision to accept or reject changes that are discussed during the therapy process—not the therapist’s.
For many people, their family is the place where others know them better than anywhere else—for better or for worse, and the idea of having such intimate knowledge discussed openly with an “outsider” (the therapist) in family therapy can sometimes be of great concern. It is important to remember, however, that a family therapist will be well aware of this concern, and will always maintain strict confidentiality around information disclosed in sessions, except in cases where certain information could be directly harmful to someone (for example, direct threats of violence, abuse, etc.). Through their training, family therapists come to understand and respect the many obstacles that confront families today, and families will never be negatively judged or labeled because of the problems they are experiencing. If you and your family are referred for family therapy, you can expect that your therapist will be one person who will have great respect for the challenges you are facing, deep admiration for you and your family’s willingness to work together to overcome the challenges, and steadfast optimism that the challenges can be overcome.
Rip McAdams is a professor of Marital, Couples, and Family Counseling at The College of William & Mary, a Licensed Professional Counselor and Marriage & Family Therapist, and Co-Director of the New Horizons Family Counseling Center. He can be contacted at crmcad@wm.edu.