Parenting & Family Therapy

Family is not an important thing. It's everything.

Michael J. Fox¹

Most people don’t live in total isolation, so when we have problems, we experience them within a social environment and among those we live and interact with - among family.

And sometimes, distress in the family system can cause one or more members to develop a worrisome problem, like acting out or substance abuse.

So...

• When you experience emotional pain or conflict, you can either address this pain in isolation, as something separate from your everyday social environment and relationships.

Or

• You can strive to understand your problems as a part of a social whole (the family) and each member of the family can learn new ways of interacting and communicating to work together effectively as a cohesive system.
  

Family therapists work with each individual member of the family, as they would in conventional one-on-one therapy, but they also address the family as a functioning unit or system. In this way, people who love each other also learn how to help one another.

In family therapy:

• You focus on the present, not on dredging up the past 
• You identify the problems and work toward a solution
• You avoid blaming...the therapist works with the family, not on the family

When to Consider Family Therapy

You should consider family therapy whenever you face a situation as a family that causes excessive stress, grief, anger, conflict or dysfunction.²

For example, when:

• Conflict between the parents is affecting the health and happiness of the family as a whole
• Any child in the family has serious behavior problems, at home or at school
• There are serious conflicts between siblings
• Any family member has a chronic mental illness, an eating disorder or addiction/alcoholism³
• Any family member has serious illness or disability
• There are parenting issues, blended family issues or issues with divorce or separation
• There is any domestic violence
• Any person in the family engages in self-harm behaviors⁴

You may also consider family therapy even before you have serious conflict or pain in the family, such as when:

• You are preparing for a major life change
• You want to increase the overall happiness of the family and reduce discord and conflict

Problems within the family system can cause one or more family members to exhibit symptoms of distress, like substance abuse. In such cases, treating the substance abuse only would be analogous to giving aspirin to a person with a brain tumor…it might stop the headaches - but it won’t do much for the bigger problem.

Is Your Family System in Distress?

The family is a system, and when the system breaks down, you see symptoms of distress.

Does your family exhibit symptoms of distress?

According to marriage and family therapists John W. Engel and Herbert G. Lingren, to find out if your family shows signs of worrisome conflict or distress, ask yourself the following 12 questions – the more yes answers you rack-up, the greater the likelihood of distress in the family system and the more seriously you may want to consider seeking some assistance.

1. Does any member of the family abuse drugs (whether prescription or illicit) or alcohol?
2. Does any member of the family frequently complain about unexplained illness or excessive fatigue?
3. Does any family member frequently feel depressed or lonely, or excessively moody?
4. Does any member of the family frequently have unexplained or questionable injuries?
5. Do discussions between spouses or any family members frequently cause stress, blaming or fact-finding? Can the family communicate openly together, or are discussions closed off from certain members?
6. Is any member of the family acting out with excessive anger, or has anyone become excessively withdrawn?
7. Is any member of the family engaged in self-destructive behaviors, such as self-harm, or the abuse of food?
8. Is there low marital satisfaction?
9. Do problems in your family persist, even though you’ve tried to address and solve them?
10. Does any child have learning or behavioral problems? Is any child performing significantly below abilities at school?
11. Has any child gotten in trouble with the law or run away from home?
12. Does any member of the family act inappropriately for their age or stage in life?⁵

What Are the Benefits of Family Therapy?

• In some cases, family interactions directly cause, contribute to or worsen a problem or mental illness. In such cases, getting the family to modify maladaptive behaviors is vital to bettering the situation.
• When one member of a family develops a serious challenge the family tends to focus excessively on the needs of this one person – to the detriment of others in the family. Family therapy teaches ways to balance this inequality, to ensure that all people get what they need from the family system.
• Through family therapy, problems and conflicts get clearly identified (rather than staying obscured but influential, below the surface). Once identified, the family can learn prevention and resolution techniques and strategies to minimize their impact.
• The learning and adopting of healthier and more effective conflict resolution strategies.
• Giving all members of the family a voice in solving problems
• Balancing imbalances of family power
• Strengthening the family to more effectively support any person facing psychiatric or serious physical illness
  

How Long Does Family Therapy Take?

How long the process takes depends on a number of factors, like your availability, the issues you’re facing, your willingness to do homework/outside assignments and the progress you make.

In general, however:

• Family therapy is brief and solution focused. When you start the process you’ll identify problems you wish to solve and goals to work toward, and then you’ll work, over a period of weeks and months, to achieve the goals you’ve set (you can expect outside of session homework assignments).
• According to the American Association of Marriage and Family Therapists, the average course of family therapy takes 9 sessions, and 87.9% of therapy courses finish within 50 sessions.⁶

Does the Whole Family Have to Go?

It’s advantageous, but not strictly necessary, to have all members of the family involved in the therapeutic process.

However, most therapists do not require, or even desire, that all family members come to all sessions.

• Some sessions will involve the whole family
• Some may involve parents only
• Some may involve individual adults
• Some may involve individual children
• Some may involve differing combinations of members of the family⁷

How Well Does Family Therapy Work?

Systemic family and relationship therapy is an evidence based intervention. Research supports the use of systemic family or relationship therapy for adult:

• Relationship distress
• Psychosexual disorders
• Eating disorders
• Domestic violence
• Anxiety and panic disorders (agoraphobia)
• OCD
• Depression
• Bipolar
• Schizophrenia
• Alcohol abuse
• Chronic illness and pain⁸

And for adolescent or child:

• Depression (as a second line treatment)
• Substance abuse
• Conduct disorders, including oppositional defiant disorder
• Chronic physical illness (second line treatment)
• Eating disorders
• Physical abuse or neglect
• Issues dealing with ADHD
• Bereavement issues
• Psychosomatic disorders⁹

Family Therapy for Adolescent Anorexia

1. There is a strong base of evidence supporting family therapy for the treatment of adolescent anorexia.
2. Currently, family therapy is considered a first-line treatment for adolescent anorexia and a very promising treatment for other eating disorders.¹⁰

Some of the benefits of significant family involvement in the therapeutic process include:

• An accelerated development of a therapeutic alliance - Adolescent children may have difficulty trusting and opening up to care providers. When adolescents can sense that parents respect and trust care providers, they also may become more open, compliant and trusting.
• Family therapy gives an adolescent a significant voice in the process
• The demystification of eating disorders – Parents may see EDs as complex psychiatric problems that can only be managed by professionals. Once parents understand the true nature of the disorders, they start to realize how much power they have to help.
• Helping parents work as a supportive team – Blame, shame and conflict hinder progress, so helping parents to resolve differences and work together facilitates the recovery process.
• Teaching parenting skills – Parents often aren’t sure how to parent around eating issues
• Family therapy can build and maintain whole-family hope and motivation.
• In family therapy, parents and other family members can examine and work on personal and relational issues which may be affecting the eating disorder.
• Parents and siblings are also affected by the eating disorder, and so including the whole family in the therapy process lets all stakeholders reduce conflict and feel cared-for.
• Whole family involvement ensures accurate communication and understanding between family members and to and from the healthcare workers.¹¹

Family Therapy with Younger Children

It’s helpful to get all family members involved in the therapy process, even from quite a young age. Young children won’t be involved in all sessions and when they are involved the family may engage in therapeutic techniques designed to put younger children at ease and which allow them to communicate their hopes, worries and feelings in a non threatening manner.

For example:

• With therapeutic games
• With puppets
• Through art activities
• With Role plays

Although some of these activities may seem a bit odd, the activities themselves are not necessarily therapies, they are merely techniques which facilitate processing and communication and which help all members of the family work through family issues.¹²

Who Can Provide Family Therapy?

You can get family therapy from a professional called a ‘marriage and family therapist’.

Marriage and family therapists must have a master’s degree or higher from an accredited family therapy program, at least 2 years of post-degree supervised clinical experience and each must also pass a state or federal licensing exam.