What's New at CBH
What is Family Therapy? – Answers to Some Common Questions
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.