Family Systems Therapy
By Dr. R. Y. Langham, Ph.D., licensed marriage and family therapist, author.
What is Family System Therapy?
The primary goal of Family Systems Therapy, usually referred to as Family Therapy, Couples Therapy, or Relationship Counseling, is to help people work through issues, as a family. Unlike many other traditional therapies, family therapy focuses on the whole family, rather than solely on the presenting individual. In other words, it focuses on the complete unit (the whole family system), rather than one part of the system (the individual exhibiting the symptoms). Family therapy treatment typically involves everyone in the family-of-origin, including extended family members and close family friends.
Family therapists treat both families and couples, however, if some or none of the family members are available or willing to participate in family therapy sessions, a therapist may opt to treat the presenting individual with non-familial individual’s life that play an important role in their growth and development, such as religious leaders, teachers, close family friends, romantic partners, long-term co-workers, neighbors, coaches, etc.
The hope is that with steady family therapy, the presenting individual, along with their family members will learn healthier coping, conflict-resolution, and communication skills that will trigger healthier and more positive family interactions, so the presenting individual no longer displays the distressing, and possibly destructive or dangerous behaviors and symptoms.
Family therapists strongly encourage whole family (system) participation during treatment, because they believe that the problem lies within the family, not solely within the individual.
Note: The term “family” refers to couples, non-biological families, such as adoptive families, foster families, step-families, long-term friends, people who behave like family members, half-siblings, and biological families (including full siblings, cousins, aunts, uncles, grandparents, and parents).
What issues do family therapists treat?
Family therapists treat a variety of issues such as:
- Dysfunctional, unhealthy, and abusive relationships – i.e. romantic, familial, friendships
- Communication, conflict resolution, and unhealthy coping issues
- Financial/debt issues that are negatively affecting the couple/family
- Sexual dysfunction, disorders, and issues that may be affecting physical and/or emotional intimacy within a marriage or romantic relationship
- Parenting challenges
- Substance abuse and addiction – i.e. excessive eating, gambling, sex, and drugs and alcohol that may be damaging the marriage, relationship, and/or family unit
- Anger management or an inability to exhibit anger and frustration in a positive way
- Infidelity and divorce
Common Approaches Used in Family Therapy:
Family therapists use a wide variety of techniques, methods, and approaches to treat struggling families. Some of these tactics include the following:
Structural Therapy
Structural Therapy is a form of family therapy that (1) evaluates the power dynamics within the family, and (2) explores each family member’s allocated “role” within that family unit. Once the family therapist has a good idea of how the family functions, they help the family redistribute the power structure in the family, so each member is an equal contributor to its function and well-being. The goal of Structural Therapy is to provide the necessary tools to the family so that each person feels empowered and respected.
Milan Therapy
Milan Therapy focuses on analyzing the belief systems within the family – especially the unhealthy and destructive ones. These belief systems tend to be adopted by family members, although sometimes, only a few members harbor these beliefs. The goal of this technique is to question and challenge unhealthy family beliefs, rituals, and behaviors that elicit disharmony within the family. In other words, this technique aims to break apart and demolish belief systems that trigger conflict within the family unit.
Generational Therapy Approach
Generational Therapy approach is usually used in tandem with the Milan Therapy Technique. The goal of this approach is to explore in-depth generational relationships (i.e. between parents and grandparents, parents and children, and different generations) that are passed down from generation-to-generation. Sometimes generational beliefs and practices cause problems and conflicts within the family unit. As a result, a family therapist closely explores and breaks down unhealthy, destructive, negative, and outdated belief systems that are causing problems within the family.
Solution-Based Approach
The Solution-Based approach is used to help people alter their perceptions on how “change” actually occurs within a family unit. The goal of this approach is to help families learn from past mistakes and things that actually worked to resolve issues within the family. The aim is also to help families better understand why some attempts worked and while others did not, so they can repeat the actions that worked, and avoid the ones that didn’t in the future. Basically, a family therapist helps the family analyze the best way to resolve conflict.
Behavioral Method
The Behavioral Method focuses on reinforcing desired positive behaviors, such as better communication amongst family members. It does not focus on undesired, negative behaviors, such as conflict, violence, and dysfunction. This method centers on the belief that behaviors are learned from past experiences. Therefore, a family therapist uses this method to encourage struggling families to focus on the present – not the past. The past is the past. There’s nothing the family can do about that, but they can “change” the present and the future. During this session, family therapists use positive reinforcement to help families learn how to better communicate with one another through behavioral changes.
How do I know if I should seek family therapy?
It depends… If someone in your family is “acting out” or exhibiting unhealthy, destructive, and/or possibly dangerous behaviors, then yes, your whole family should definitely seek family therapy ASAP.
Because the family is such an important part of a person’s life – i.e. self-esteem and self-confidence, social support network, work productivity, family interactions, communication, conflict-resolution skills, stress and health management, friendships, romantic relationships, etc., family therapy can be highly beneficial for those suffering from a variety of issues – even ones like chronic illnesses and financial problems. Remember, family therapists, focus on the entire family – not just the person exhibiting the symptoms and behaviors. That is why a healthy family can improve the quality of all of its members while lowering stress levels at the same time. In fact, studies suggest that adults, who grew up in dysfunctional or poorly functioning families, may actually benefit from both individual therapy and family therapy, especially as they begin to date, marry, and form their own nuclear families.
What if I think my family could benefit from family therapy?
Search around for a highly qualified family therapist. Make sure to check his/her references, education, and experience. And, then schedule a consultation with him/her. You will probably want to meet with several potential therapists, before settling on one. However, once you have a good idea of which one fits with your family – schedule your first session with him/her. It is important that all family members feel comfortable with the therapist because trust is paramount for success. The good news is you can find qualified family therapists in your area by clicking this link.
What to expect during my first family therapy session?
The truth is family therapists use a variety of methods, techniques, and approaches to treat distressed families. There is one thing that all family therapists share in common – a focus on rebuilding, strengthening, and improving the family unit (as a whole). Therefore, the way a therapist treats the family depends on the issues it is having and the goals it would like to see accomplished.
As a result, some or all of the following steps may take place during your first family therapy session:
When you schedule your first appointment, the receptionist will either send all of your intake papers (forms that tell a little about yourselves and what issues you may be having in your personal life, romantic life, work life, and family).
The intake forms will ask about your health history (medical and mental health background, along with the medical and mental health background of direct family members), sexual behaviors, relationship status, if you have any children, age, gender, name, phone numbers and email address, physical address, medications, doctors’ names and contact information, educational level, disabilities, etc.
You will be expected to fill out the forms and send them back in, if possible, before your first session. If this is not possible, tell the receptionist, and she will have an intake specialist call you and write down your answers, while on the phone.
Your family therapist will most likely “break the ice” first. What does that mean? Well, it means they may introduce themself and allow everyone in the room to introduce themselves too. Then, they will probably ask everyone to share a little about what they like – i.e. what you like to eat, watch on television, what sports teams you like, and what you like to do for fun – individually and as a family.
The therapist may crack a light joke to lighten the mood. Don’t worry, it won’t have anything to do with why you are seeking therapy or any issues you may have. The goal of this part of the session is to loosen everyone up so everyone feels safe and comfortable in the room. Then, the therapist may ask everyone (one at a time) what brought you to therapy, and what you would like to accomplish from it.
Each person will be able to share their thoughts – without interruptions. If interruptions occur, the therapist will intervene and ask others to hold their thoughts and opinions until later. During this process, the therapist may video and/or audio record (with everyone’s permission) the session, or jot down notes so that they can properly address any issues and develop a proper treatment plan for the family.
Note: It is illegal and unethical to video and/or record therapy sessions without your permission, so if you opt to be recorded, so the therapist can give you all of his/her attention, you, along with the rest of your family members, will need to sign waivers granting permission for any recordings. All recordings are confidential and will be destroyed after 7 years.
After everyone has had an opportunity to share their thoughts and goals. The therapist will then explain the therapy process in-detail and explain that the next time the family comes to therapy; they will have a treatment plan for the family that will help it get back on track. They will also explain how long therapy will last, and any goals that will be worked on throughout the therapy process.
They may or may not assign “homework” for the family for the next session. The therapist will also explain confidentiality and informed consent laws – in-depth and in a way that you and your family members can understand. They will explain that you and your family members always have the option to stop the session or quit therapy – without question or judgment – at any time.
Note: The billing specialist will probably come in and explain the hourly costs, and if your insurance will pay for some or all of the services – it depends on your insurance company, however, it is important to note, most health insurances do not pay for non-clinical psychotherapy, so you may be required to pay out of pocket for services. Check with your insurance company.
If everything is satisfactory, everyone will be required to sign consent papers and waivers.
Keep in mind, your therapist will be continually observing how you all interact with one another. They will also be making mental notes of areas of strength and improvement within your family unit. Moreover, your therapist will also be paying close attention to the “roles” each person plays in the family unit – and how the family functions, as a whole. It is important that the therapist be able to get a comprehensive perspective on your family – from a variety of angles. For instance, how it works in a multitude of dimensions. The goal is not just to focus on the presenting problem, but to explore the background of the family, as well.
After the first session, the therapist may request to see the various family sub-units separately for a few sessions, for instance, they may want to see parents alone, siblings alone, close friends alone, children alone, couples individually, grandparents alone, other relatives alone, coaches alone, the presenting individual alone, etc. This will help him/her get a full perspective of what is truly happening in the family.
What Should I Do After the First Session?
Once you leave the therapy session, it will be time to evaluate if the therapist is right for your family. Did you feel unfairly blamed? Or, did you feel the therapist was competent, fair, professional, and compassionate? Did you feel comfortable and did they properly explain the process in a way that could understand it? Do you feel hopeful that things are going to improve in your family with this therapist’s help and guidance? If so, then continue going. If not, continue searching.
CASE STUDY
Post-Pandemic Update on Family Systems
Many families experienced hardships during COVID. Because most people did not fully know what COVID is or what it could do, fear, anxiety, depression, and high levels of stress were rampant. Couples, who rarely argued began arguing, families, who were close-knit drifted away from each other due to political beliefs and whether or not the COVID vaccine was effective or even needed. Some family members believed that COVID was a serious illness that could lead to long-term symptoms (long-haul COVID) or death, while others equated it to a version of the flu, and therefore, did not see the necessity of taking the vaccine.
Some families or family members believed that COVID and COVID vaccines were a hoax perpetrated by the current administration and democrats, in general. This caused major rifts in some families, especially when one group favored vaccines and the other did not. Some families experienced even more emotional distress when children were kept from a parent, grandparents, and other family members due to their vaccination statuses. Families also experienced high levels of stress, anxiety, and depression when family members contracted COVID, and they were unable to be with them at the hospital. Being separated from loved ones due to being unvaccinated or being in the hospital was torturous for these families.
Grandchildren missed their grandparents and grandparents missed their grandchildren, both grieving the time lost together. Grandparents, who were unable to see their loved ones and grandchildren, tended to feel isolated and depressed. Gone were the days of spending birthdays, holidays, and other milestones (i.e., graduations, baby or bridal showers, weddings, etc.) together as a “family.” Now, these special occasions were marked with Zoom or video calls, phone calls, and text messages. When families could get together, it typically occurred outdoors – 6ft. apart. Because COVID, has been around for over 2 years, families have begun to drift away from each other.
Thus, family system therapy or “family therapy” has become a mainstay in the counseling field. Because family systems therapy focuses on the entire family instead of just the affected person, it became increasingly popular during COVID and remains popular today. COVID has torn families apart, so the goal of family systems therapists is to help repair the damage the pandemic caused these families.
Families, who were sequestered together during COVID, experienced chaos and conflicts. These families were “forced” to be around each other for long periods, which caused stress for some family members. This was especially true with families, who were not used to being around each other in close quarters, for instance families, who decided to move in together at the beginning of COVID – i.e., to care for elderly parents or disabled loved ones. Being home and having to care for elderly or disabled loved ones added extra stress to their family caregivers, who were tasked with tending to their needs in the absence of home health nurses.
Differing beliefs stemming from different ideologies, generational gaps, or political affiliations caused rifts in some families. Even before COVID, some families had a hard time compromising and “agreeing to disagree,” but COVID made everything worse, and when one or a couple of family members disagreed with what to do about COVID, the rest of the family tended to blame, judge, or chastise them because of their different perspective.
During COVID, many families were struggling, and because a lot of therapy offices were closed down to COVID mandates, small cracks in the family turned into large rifts. While some families were able to seek family systems therapy via “telehealth” services, others suffered in silence. These beliefs were probably present before COVID, however, the rise of COVID highlighted these differences. Families that used to talk and spend time together before the pandemic, no longer spoke to one another.
Thus, family systems therapy seeks to close the gap in families brought to light during COVID. The goal of family systems therapists is to help families communicate with each other more effectively, accept differences (i.e., beliefs) among family members, teach families healthy problem-solving and coping strategies, and help loved ones “reconnect” post-COVID. The aim of this type of therapy is to help families reach a compromise or a “cease fire,” because families need each other.
References
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