History of the Field
Family therapy is a relatively young field that evolved in the latter part of the 20th century. Its beginnings are associated with several key figures who, in different parts of the United States from the 1930s through the 1950s, began challenging the conventions of psychiatry by including whole families in the therapy of individuals. These early family therapists recognized the powerfully shaping influence families have on the development of children and adults and sought to find ways to harness that power in the service of therapeutic treatment. Most of these early therapists went against the grain of the psychotherapeutic establishment. Many were charismatic and colorful figures whose ideas at the time seemed revolutionary.
Family therapy derived its theoretical foundations from the emergent, cross disciplinary body of knowledge called systems theory. Systems theory proposes that all phenomena are interconnected and cannot be known without reference to their context. Simply put, there is nothing-no person, no thing-that stands apart from its networks of relationships. Individuals cannot be understood without reference to their past and present relationships, especially their families. This idea had real importance for early family therapists who were seeking a new and more effective ways of helping. As family therapy developed, attention was paid to the effect of other significant influences on families, including such areas as culture, ethnicity, religion, and socioeconomic class.
Family Therapy Today
In the early days, family therapy sought both to explain why people developed problems, and to create an effective method of treatment. Family therapists today focus on how family members have a mutually shaping influence on one another. Families are seen as social groups whose members "belong to one another" and "fit together" in ways that range from optimal to problematic. Family therapists do not look at families as "causing problems," but are rather more interested in the family patterns of interactions that perpetuate and influence problems. These days family therapists appreciate the complex multiple influences that affect family members. Attention is paid, as always, to family interaction, but therapists have a greater appreciation for the effects of individual differences in such areas as temperament and cognitive organization.
What to Expect
Family therapy is a unique experience. For family members to sit down together and reflect on who they are and how they are as a family is an unusual process for most families. Families entering family therapy should expect that their therapist will take ample time to get to know them. She will do this by asking questions and inviting all members to describe their experience and perspective. Some family therapists use a tool called the genogram to make a visual map of family history, patterns, problems and themes. Once the therapist has gotten to know you, she will work collaboratively with you to make changes in the patterns of interaction that are relevant to the problem. These patterns of interaction involve behaviors, thought processes, emotions, and meanings that are influenced by and, in turn, influence the family as a whole. The therapist will work towards eliciting, accessing and utilizing inherent family strengths and resources to help you make changes. The goal of family therapy often goes beyond the resolution of discrete problems towards the fostering of growth and well-being for all family members.
Common Questions and Concerns
When should I consider family therapy?
Family therapy can be the logical place to start for most child and adolescent problems (and many adult problems as well). Families are certainly among the most important relational contexts for the development of well-being in children and are thus a tremendous resource for change. However, family therapy alone is not always sufficient. A good therapist knows when to refer for additional services or to a more appropriate treatment if needed. Family therapy works quite well in collaboration with other psychological and psychiatric treatments.
Will I be blamed for causing my child's difficulties?
Blame and shame are rarely helpful and are more often destructive. Family therapy is constructive, focused on change rather than on assigning blame. The majority of problems cannot be reduced to simple explanations. Family therapists are primarily interested in helping families mobilize to make positive changes.
What if not everyone agrees to come?
It sometimes happens that not all family members are willing to come to therapy. Most family therapists start with whatever constellation of members agrees to attend and then work towards engaging others. While sometimes missing a crucial family member is an impediment to therapy, much good work can still be accomplished. Experienced family therapists have many skills to engage recalcitrant members. Oftentimes these missing members are afraid of being blamed, and once they experience the therapy as non-blaming, are willing to attend.
How long does family therapy last?
Family therapy is often short-term. Many family therapists start out by seeing a family once a week and then reduce the frequency over time as the family takes charge of the process and the problem is addressed.
References
1. Beels, C. (2002). Notes for a Cultural History of Family Therapy. Family Process Vol 41(1), pp. 67-82.
2. Hoffman, L. (1981). Foundations of Family Therapy. New York: Basic Books.
3. Nichols, M. & Schwartz, R. (1998). Family Therapy: Concepts and Methods. Boston: Allyn & Bacon.
About the NYU Child Study Center
The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at www.aboutourkids.org.
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Reprinted with the permission of the NYU Child Study Center. © NYU Child Study Center.
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