What are some common family problems?
Although families can struggle with a huge array of problems, there are really just a few common, core issues that may be going on:
Significant problems with a single family member that affects others
Poor personal boundaries
Instrumental problems (everyday decisions)
Affective issues (concerns about a family member's feeling or emotions)
Combinations of these
What is family therapy?
Family therapy is really a way of thinking, an epistemology rather than about how many people sit in the room with the therapist. Family therapists are relational therapists, they are interested in what goes between people rather than in people. Depending on circumstances, a therapist may point out to the family interaction patterns that the family might have not noticed; or suggest different ways of responding to other family members. These changes in the way of responding may then trigger repercussions in the whole system, leading to a more satisfactory system state.
How did family therapy develop into what it is today?
Family therapy is a form of psychotherapy that involves all the members of a nuclear or extended family. It may be conducted by a pair or team of marriage and family therapists who have come from a wide variety of educational backgrounds including psychology, psychiatry, social work, nursing, pastoral counseling and education. In many cases the marriage and family therapy team consists of a man and a woman in order to treat gender-related issues or serve as role models for family members. Although some types of family therapy are based on behavioral or psychodynamic principles, the most widespread form is based on family systems theory. This approach regards the family as a whole as the unit of treatment, and emphasizes such factors as relationships and communication patterns rather than traits or symptoms in individual members.
Family therapy is a relatively recent development in psychotherapy. It began shortly after World War II, when doctors treating schizophrenic patients noticed that the patients' families communicated in disturbed ways. The doctors also found that the patients' symptoms increased or decreased according to the level of tension between their parents. These observations led to the consideration of a family as a system with its own internal rules, patterns of functioning, and tendency to resist change.
The therapists started to treat the families of schizophrenic patients as whole units rather than focusing on the hospitalized member. They found that in many cases the family member with schizophrenia improved when the "patient" was the family system. (This should not be misunderstood to mean that schizophrenia is caused by family problems, although family problems may worsen the condition.) This approach of involving the entire family in the treatment plan and therapy was then applied to families with problems other than the presence of schizophrenia.
Family therapy is becoming more common as changes in American society are reflected in evolving family structures. The treatment philosophy has led to the development of couples therapy, which treats relationship problems between partners; and to the treatment of groups that resemble families (such as religious communities).
Family therapy tends to be brief (averaging only about 9 sessions)-requiring less time than the average individual treatment of 13 sessions. Nearly 65.6% of the cases are completed within 20 sessions, 87.9% within 50 sessions. The treatment focuses on resolving specific problems such as eating disorders, difficulties with school, or adjustments to bereavement or geographical relocation. Research indicates that marriage and family therapy is more effective than individual treatment for many mental health problems such as schizophrenia, alcoholism and drug abuse, children's conduct disorders, adolescent drug abuse, anorexia in young adult women, childhood autism, chronic physical illness in adults and children, and marital distress and conflict.
In family therapy sessions, all members of the family and both therapists (if there is more than one) are present at most sessions. The therapists seek to analyze the process of family interaction and communication as a whole; they don't take sides with specific members. They may make occasional comments or remarks intended to help family members become more conscious of patterns or structures that had been previously taken for granted. Family therapists who work as a team model new behaviors for the family through their interactions with each other during sessions.
What can a family do to solve its problems?
Problem-solving is the family's ability to resolve problems on a level that maintains effective family functioning). Problem-solving One of the keys to successful family functioning is the family's ability to solve problems. All families have problems to deal with. However, research indicates that competent families solve problems as they arise; whereas, families that avoid problem-solving, or seem incapable of dealing with many of their problems have more difficulties
Types of Family Problems or Issues
Problem-solving is the family's ability to resolve problems on a level that maintains effective family functioning
Family problems come in all shapes and sizes. Some problems involve everyday decisions about money or transporting the children to and from school. These are called instrumental problems.
Other problems may be concerned with a family member's feelings and emotions and are called affective issues. Some problems may involve both. For example, getting a child to day care for the first time may require dealing with instrumental issues regarding transportation and affective issues regarding the child's fear of being left at a strange place for the first time.
Families with a problem-solving process in place are more likely to resolve both types of issues. It is important for families who become stuck and are unable to resolve an issue to learn and implement a problem-solving process.
The Problem-solving Process
Families who successfully and quickly resolve problems have developed skills to manage their difficulties. They are aware of the steps in the problem-solving process and they consistently implement them to resolve problems. Problem-solving is a process skill that, like other skills, can be learned by the family. The following six steps will assist you in establishing a problem-solving process in your family.
Problem Identification and Agreement
The first step in the problem-solving process is problem identification. Knowing the real problem or issue is half the battle. Although this may seem like a simple first step, many families have difficulty with it. Many families tend to blame someone in the family for the problem. Instead, families need to define and agree on what type of problem they are dealing with. For example, is it an instrumental issue related to how the family accomplishes a task, or is it an affective (feeling and emotions) issue? In some cases it may be both. Families may identify the instrumental problem but miss the affective side and wonder why the issue wasn't resolved. A family member may feel his/her feelings were not heard or addressed and will not agree to go along with the solution until the hurt feelings are dealt with. Therefore, families must practice problem identification and agreement as the first step in problem-solving.
Creating Options and Alternatives
The second step in the problem-solving process is creating options. By brainstorming, the family generates options or alternatives surrounding the identified problem. What are some things the family or family members can do to resolve the issue? What are some of the possible solutions to the problem? Make a list of your alternatives. Encourage brainstorming without evaluating the ideas until many options are on the table. The creative options step leads to effective solutions to problems. Options should take into account both instrumental and emotional issues and should include all family members who are affected by the issue.
Step three is evaluating the alternatives the family has generated. Ask what your family thinks of each of the options. Each family member should give his/her opinion of the idea. Eliminate the alternatives that the family is unwilling to try. The goal is to find an option that each family member will agree to consider. Next, decide whether or not the family has the resources to carry out the alternative. The goal is to find an alternative that each family member will agree to consider.
Choose A Solution
Once you have evaluated all the alternatives, decide as a family which idea or ideas you are willing to follow. This is known as the action plan. The action plan includes what the family is going to do, which family member is going to do it, and when it will be done. Once you have chosen a solution, write down a summary of it. This will help your family remember what the plan is supposed to do. Putting the plan in writing enables everyone to better understand the plan and their part in resolving the problem or issue. A written plan is also helpful for monitoring your family's solution, which is the next step in the problem-solving process.
Monitoring the Solution
Monitoring the solution is critical to the problem-solving process. By monitoring the action plan, your family can keep track of their progress. This will remind you of what the family decided to do, which family member is going to do it, and when it will be done.
Evaluating the Success of the Plan
The final stage in the problem-solving process is to evaluate the success of the family action plan. This stage involves reviewing what happened in order to learn from the situation. The review helps the family to make adjustments to the plan and to evaluate what worked and what didn't. Parents who teach problem-solving skills to their children promote resiliency in their children.
Focus on Family Strengths
Problem-solving is a key to successful family functioning. Research indicates that families who practice problem-solving techniques are more likely to pass this skill on to their children.
Research has identified problem-solving as a factor that promotes resiliency in children Problem-solving skills among family members will lead to more effective resolution of both instrumental and emotional family problems.
Family therapy is based on family systems theory, which understands the family to be a living organism that is more than the sum of its individual members. Family therapy uses "systems" theory to evaluate family members in terms of their position or role within the system as a whole. Problems are treated by changing the way the system works rather than trying to "fix" a specific member. Family systems theory is based on several major concepts:
The "identified patient" is the family member with the symptom that has brought the family into treatment. Family therapists work hard to keep the family from picking on the identified patient or using him or her as a way of avoiding problems in the rest of the family.
The family as a whole usually tries to maintain its organization and functioning, and will tend to resist change. The family therapist can use this concept to explain why a certain family symptom has surfaced at a given time, why a specific member has become the identified patient, and what is likely to happen when the family begins to change.
The family therapist will also work with the "extended family field"-the nuclear family plus grandparents and other members of the extended family. Looking at the extended family can help explain the intergenerational transmission of attitudes, problems, behaviors, and other issues.
In treating the family, the therapist will look at how well each family member maintains his or her own sense of self, while remaining emotionally connected to the family. One mark of a healthy family is its capacity to allow members to differentiate, while everyone still feels they are an important part of the family.
Family therapists believe that emotional relationships in families usually involve three people. Whenever any two people in the family system have problems with each other, they will "triangle in" a third member as a way of stabilizing their own relationship. The triangles in a family system usually interlock in a way that maintains the family status quo. Common family triangles include a child and both parents; two children and one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law.
In some instances the family may have been referred to a specialist in family therapy by their pediatrician or other health care provider. It is estimated that as many as 50% of office visits to pediatricians have to do with developmental problems in children that are affecting their families. Some family doctors use symptom checklists or psychological screeners to assess a family's need for therapy.
Family therapy is often recommended in the following situations:
During treatment of a patient with schizophrenia or multiple personality disorder (MPD) to help other family members understand the disorder and adjust to the person's psychological changes
Families with trouble across generations, such as problems caused by parents sharing housing with grandparents or children being raised by grandparents
Families who deviate from social norms (common-law relationships, gay couples rearing children) who may be troubled by outsiders'attitudes
Families with members from different racial, cultural, or religious backgrounds
Families who are "picking on" one member or undermining the treatment of a member in individual therapy
Families who seem inextricably tied to problems of an identified patient
Blended families with adjustment problems
Some families are not considered suitable candidates for family therapy, including:
Families in which one or both of the parents is psychotic, antisocial or paranoid
Families whose cultural or religious values are opposed to, or suspicious of psychotherapy
Families with members who can't participate in treatment sessions because of physical illness or similar limitations
Families with members with very rigid personality structures who are at risk for an emotional or psychological crisis
Families whose members can't or won't be able to meet regularly for treatment
Unstable families or those on the verge of breakup.
The family therapist will usually evaluate a family for treatment by scheduling a series of interviews with the members of the immediate family, including young children, and significant or symptomatic members of the extended family. This process allows the therapist(s) to find out how each member of the family sees the problem, as well as to form first impressions of the family's functioning. Family therapists typically look for the level and types of emotions, patterns of dominance and submission, the roles played by family members, communication styles, and the locations of emotional triangles. They will also note whether these patterns are rigid or relatively flexible.
Preparation also usually includes drawing a genogram, which is a diagram that depicts significant persons and events in the family's history. Genograms also include annotations about the medical history and major personality traits of each member. Genograms help in uncovering intergenerational patterns of behavior, marriage choices, family alliances and conflicts, the existence of family secrets, and other information that sheds light on the family's present situation.
The chief risk in family therapy is the possible unsettling of rigid personality defenses in individuals, or couple relationships that had been fragile before the beginning of therapy. Intensive family therapy may also be difficult for psychotic family members.
The federal government has designated marriage and family therapy as a core mental health profession along with psychiatry, psychology, social work and psychiatric nursing. Currently, 42 states regulate the profession by licensing or certifying marriage and family therapists; many other states considering licensing bills.
The joint treatment of two or more members of the same family in order to change unhealthy patterns of communication and interaction.
Family therapy is generally initiated because of psychological or emotional problems experienced by a single family member, often a child or adolescent. These problems are treated as symptomatic of dysfunction within the family system as a whole. The therapist focuses on the interaction between family members, analyzing the role played by each member in maintaining the system. Family therapy can be especially helpful for dealing with problems that develop in response to a particular event or situation, such as divorce or remarriage, or the birth of a new sibling. It can also be an effective means to draw individuals who feel threatened by individual therapy into a therapeutic setting.
Family therapy has a variety of origins. It is related to the long-standing emphasis of psychoanalysis and other psychodynamic approaches on the central role that early family relationships play in the formation of personality and the manifestation of psychological disorders. Family therapy also grew out of the realization that progress made by patients staying in treatment centers was often reversed when they returned to their families. As a result, a number of therapists became dissatisfied treating clients individually with no opportunity to actively address the harmful family relationships that were often the source of their clients' problems.
Family therapy, either alone or in conjunction with other types of treatment, has been effective in the treatment of children suffering from a variety of problems, including anxiety, enuresis (bed-wetting), and eating disorders, and also in working with victims of child abuse. In addition to alleviating the child's initial complaint and improving communication within the family unit, family therapy can also help reduce stress and conflict by helping families improve their coping skills.
There are a number of approaches to family therapy. Perhaps the best known is structural family therapy, founded by Salvador Minuchin. A short-term method that focuses on the present rather than the past, this school of therapy views a family's behavior patterns and rituals as central to the problems of its individual members. Poor communication skills play a key role in perpetuating destructive interactions within families, such as the formation of alliances among some family members against others. The goals of structural family therapy include strengthening parental leadership, clarifying boundaries, enhancing coping skills, and freeing family members from their entrenched positions within the family structure. Minuchin divided families' styles of interacting into two basic types-enmeshed and disengaged, considering behavior at either extreme as pathological, with most families falling somewhere on a continuum between the two. Minuchin believed that the functioning of family systems prevented individuals from becoming healthier emotionally, because the family system relied on its troubled member to play a particular role in order to function in its accustomed way. This stability is disrupted if an individual changes significantly.
Psychodynamically oriented family therapy emphasizes unconscious processes (such as the projection of unacceptable personality traits onto another family member) and unresolved conflicts in the parents' families of origin. The lasting effects of such traumatic experiences as parental divorce and child abuse are explored. This type of therapy focuses more on family history and less on symptoms, resulting in a lengthier therapeutic process. Therapists who employ an object relations approach emphasize the importance of having the parents in a family work out conflicts with their own parents. Some practitioners include grandparents in their work with families in order to better understand intergenerational dynamics and deeply rooted behavior patterns. Ivan Boszormenyi-Nagy, a well-known proponent of this orientation, would only treat families when members of three generations could participate in therapy sessions.
Behavioral family therapy views interactions within the family as a set of behaviors that are either rewarded or punished. The behavioral therapist educates family members to respond to each others' behavior with positive or negative reinforcement. A child might be discouraged from repeating a negative behavior, for example, by losing some privileges or receiving a "time-out." Positive behavior might be rewarded with the use of an incentive chart on which points or stickers are accrued and eventually exchanged for a reward. Behavioral approaches sometimes involve the drawing up of behavioral "contracts" by family members, as well as the establishment of rules and reinforcement procedures.
Several other family therapy approaches, including that of Virginia Satir, are primarily concerned with communication. Satir's system combines the teaching of family communication skills, the promotion of self-esteem, and the removal of obstacles to the emotional growth so that family members can have full access to their innate resources.
A Paradigm Shift From Lines To Circles: Twelve Characteristics of a Family System
1. Organized around interactions and within a hierarchy of interrelated subsystems. In the family, the executive subsystem is that of the parents; the sibling subsystem is that of the children. Invisible boundaries--unspoken rules about who does what with whom--are drawn around each (and around the immediate family itself) so that each subsystem can carry out its family-stabilizing tasks while remaining connected to the others. One of the most common family problems is a weak boundary between subsystems. A woman making several calls a day from work to instruct her teenagers on how to dress for school, what to say when they turn in homework, and so forth indicates overinvolvement with the sibling subsystem; a man who calls or visits his mother every time he argues with his wife shows a weak boundary between the immediate and extended families.
2. Wholeness: the system is greater than sum of the parts. In therapy it's quite common to see, say, a little boy suddenly make everyone laugh at precisely the moment the therapist is asking the uncomfortable parents how their marriage is going. Without knowing it, the boy, usually prompted by some subtle signal from his parents, protects the family by taking the heat off them and their fragile relationship. The therapist, seeing the family operating as a whole (self-preservation through distraction) rather than as isolated individuals (Mom, Dad, the son), might then comment on the behavior and praise the family for being so resonant and close-knit.
3. Each part of the system affects all others. I've never seen a family with an alcoholic member, but I have seen alcoholic families in which the member who drinks controls the whole family with his behavior. His unavailability, bad health, violence, unpredictability, and self-contempt distort every interaction between family members. The whole family learns to (mal)adapt itself to his drinking--via maneuvers like denial, bailing him out of jail if he drinks and drives, calling in sick for him if he's hung over, walking carefully when he's drunk and angry, unconsciously nominating one child to stand in for him and parent the family...Family therapists use the term IP--Identified Patient--because a dysfunctional family member generally means a destabilizingd family system.
4. Interrelations emphasized more than components; systemwide ripples ("these cause each other") emphasized more than linearity (this causes that). Whatever its components, unresolved stress between parents reverberates down through all family interrelations and normally results in coalitions, emotional parent-child alignments against the other parent and perhaps other children. Example: Mom is a rageaholic, so when she explodes, Dad and Brother console one another and perhaps agree that she's nuts. A linear approach would emphasize Mom's upbringing and lack of anger management skills and thereby ignore the coalition process itself and reinforce its tendency to scapegoat, whereas a systems approach would focus on the present-time context of Mom's explosions, looking at the interractions leading up to it and encouraging Dad and Mom to work out new, nonescalating ways to talk and negotiate--perhaps in couples therapy--rather than blaming her or him or failing to confront and defuse alliances forming elsewhere in the family.
5. Circular (mutual, reciprocal) causality: emphasizes present, process. Linear causality: emphasizes past, content. When a couple in session argues about how it started, I let them know I'm more interested in where it's going: "How will you resolve this here?" With many alcoholics, inherited biology and family stress and low self-esteem and other dynamics all play a part; what counts for the alcoholic isn't looking for causes so much as cutting the feedback circles that maintain drinking. A good clinician will refer the client to AA, consider hospitalization, assess for suicidal intent, advise a physical, ask about weapons in the home, and work on both family and individual levels with interventions aimed at interactions (arguments, nagging, money problems, abuse) that presently maintain the alcoholism.
6. Calibration: setting of a present-oriented, systemwide range limit around a comfortable emotional "bias." A typical situation: an unintense family with a cool emotional atmosphere unconsciously selects a member to turn up the heat; brother and sister start fighting. This turns into an argument between the parents, the drama escalates, and then, before it gets too hot, a child who plays the role of family ambassador calms everybody down. In that family the bias, the emotional level setting, is too low; a good dose of constructive intensity might recalibrate the bias and make explosions unnecessary.
7. Self-regulating via feedback loops--negative (toward stability) and positive (toward change)--that maintain the bias. Every seasoned drug and alcohol counselor knows that when one member of the family stops drinking or using, the family will subtly try to push him back into his old vices--not because they want him sick, but because families, like other organisms, naturally resist changes that might further destabilize the system. So one day the husband says to his abstaining wife, "Why not skip your AA meeting tonight so we can catch a movie?" Or the mother of a teen who's quit using congratulates him on finding a job--in a head shop. Introducing positive (= system-changing) feedback loops into these families might include warning them about enabling, relapses and resistance to change and examining what family members gain from having a malfunctioning member (control? A scapegoat? Distraction from other conflicts? Someone to rescue?).
8. Synergy: interractions and feedback loops add to each other as they combine (a dynamic expression of wholeness). Battery normally begins with emotional or verbal abuse (name-calling, shouting, intimidation, shaming) and escalates over the years from pushing and shoving to beatings and even murder. Abuse gives rise to more abuse, violence to more violence: destructive synergy. In constructive synergy, however, a batterer uses a batterer's group to learn and master rage-control techniques; those enhance his self-esteem; his wife praises his efforts and trusts him more; he feels good about that and shows her more empathy; the two get problems out on the table instead of hiding them; both grow; their affection deepens; their children carry the resulting relationship blueprint into their own relationships. Therapists prime this process by helping clients consciously relate and capitalize on growth-producing thoughts, feelings, and interactions ("Now that you stopped drinking, he feels safer telling you about his sadness; you empathized, so he is listening to you more often and with greater care...good work! How will you keep this rolling?")
9. Equipotentiality ("equal in the beginning"): things with the same original conditions can go different ways; members of the same family system can share a very similar upbringing but turn out to be very unlike each other. Even twins eventually take different roads, grow into individuals with their own insights and values, habits and preferences. Consciousness guarantees that what we choose to make of our original conditions is more important than the conditions themselves. The abuse survivor who owns the pain moves on; the one who won't becomes a chronic victim and will probably get into revictimizing situations. Therapists who realize this assume that a client can and should take full responsibility for the work of healing no matter how dangerous or abusive that client's environment may have been.
10. Equifinality (equal in the end): things with different original conditions can turn out the same. I'm an adoptee who grew up with one sister and Lutheran parents, still together, of North European descent; the man who mentors my work with batterers wasn't adopted and grew up with a brother and Catholic parents, both Italian, who divorced; and yet our values, professional goals, criticisms of traditional therapy, and counseling philosophy are very similar and in all important points the same. When I work with clients, I never assume that a violent survivor who grew up in South Central L.A. will be less serious about growth and change or less capable of working toward it than a more "adjusted" client raised in a good home by loving parents. In the end, we are what we make of what we were given.
11. Living systems and all they bring with them--equipotentiality, equifinality, wholeness, feedback loops, and all the other system-enhancing processes--move forward through key "horizontal" (brought about by time and change) transitional stages. Symptoms occur when vertical stressors (old issues, past mistakes, emotional legacies) impinge on the system during a transition. Families are likeliest to be conflicted and symptomatic when key horizontal transitions like marriage, the birth of children, children going to school, children moving away from home, changes of jobs, etc. coincide with a resurfacing of vertical stressors like old emotional baggage. Example: a workaholic husband driven to succeed by high internalized standards (Rogers's "conditions of worth") that equate esteem with production (vertical stressor) puts in even more overtime to stuff the loneliness he feels when his eldest son leaves for college (horizontal stressor). Worried about his health, escalating stress, and increasing distance from her, his wife suggests that they see a family therapist. Part of the therapeutic agenda would include giving the family tools for negotiating the "empty nest syndrome" while helping the husband get in touch with his mourning, examine his expectations of himself, and reconnect with his family.
12. First-order changes are those that help the system stay at its current level of functioning. Second-order changes restructure the system to bring it to a different level. Teaching family members how to use "I" statements and listen empathically demonstrate first-order changes that enhance the family's current functioning. Coaching a widow through the loss of her husband, helping a couple let go of the last child to leave the nest, and restructuring an alcoholic family to eliminate drinking are second-order changes that alter the family fundamentally, bringing it to an entirely new structure and psychological place.
13. Overall, human systems tend to work best when subsystem boundaries are clear (neither too open nor too closed), interactions are clear and nonrepetitive, lines of authority are visible, rules are overt and flexible, changing alignments replace rigid coalitions, and stressors are confronted instead of pushed onto scapegoats.
Yes, there really are families--and extended families and neighborhoods and even companies--that work this way: members are clear about what to expect from one another and neither intrude nor distance themselves, they speak openly and affectionately to one another, they know who's in charge of what, they know and can talk about what is permitted and what isn't, their roles and favorites are flexible and changing, and they feel comfortable and safe getting problems and hurt feelings out in the open where everyone can work on them. When enough families succeed at this, perhaps the systemic impact on whole nations will become irresistible. As Confucius noted long ago:
If there be righteousness in the heart, there will be beauty in the character. If there be beauty in the character, there will be harmony in the home. If there be harmony in the home, there will be order in the nation. If there be order in the nation, there will be peace in the world.
Born and raised in Argentina, Salvador Minuchin began his career as a family therapist in the early 1960's when he discovered two patterns common to troubled families: some are "enmeshed," chaotic and tightly interconnected, while others are "disengaged," isolated and seemingly unrelated. When Minuchin first burst onto the scene, his immediate impact was due to his dazzling clinical artistry. This compelling man with the elegant Latin accent would provoke, seduce, bully, or bewilder families into changing -- as the situation required -- setting a standard against which other therapists still judge their best work. But even Minuchin's legendary dramatic flair didn't have the same galvanizing impact as his structural theory of families.