Introduction

Family Therapy is a form of intervention used to help families. The “client” in family therapy is not an individual, rather the whole family. The therapy itself addresses issues related to family functioning and dynamic.

Family therapy utilizes techniques from other types of therapies such as cognitive, behavioral, interpersonal, etc.

The most common types of family therapies are:

  • Bowenian Systemic/Extended Family Therapy
  • Minuchin Structural Family Therapy
  • Milan Systemic Family Therapy
  • Haley Strategic Family Therapy

Bowenian Systemic/Extended Family Therapy

Bowen believed that the cause of individual problems was the family emotional system extending over many generations. Through multigenerational transmission, each generation moved towards a lower level of differentiation. He further believed that groupthink occurred in families where individuals do not employ their own thinking, rather the family unit thinks as a whole. Some important concepts from Bowen include:

  • Differentiation is how much an individual is intellectually and emotionally separate from others. Bowen emphasized a balance between dependence on family for emotional expression and being completely independent. The opposite of differentiation is fusion.
  • Triangulation is when two family members will recruit a third person (creating a triangle) either to decrease their anxiety (increase stability) or to increase anxiety (decrease stability). Sometimes the triangle is formed without any effort (birth of a child that increases stress for the couple). With decreased differentiation of individuals, there is an increased chance of triangulation.
  • According to Bowen, individuals will have a tendency to repeat in their marital choices the same patterns they learned as children from their families of origin. This is referred to as Nuclear Family Emotional System.
Therapy

The first stage in this style of therapy is to assess and evaluate the entire family without becoming therapeutically involved. Therapist is assessing for differentiation of family members as well as Multigenerational Transmission Process that may have occurred within a family through their connection with the extended families from parents/couples.

The Genogram can be used to create a visual outline of the entire family depicting fusion of family members as well as emotional patterns.

The goal of therapy is to reduce anxiety through symptom reduction and increase differentiation of each family member.

Minuchin Structural Family Therapy

Minuchin’s approach is different from Bowen because it focuses on the structure of the entire family instead of individual’s level of differentiation. The goal of therapy is to specify appropriate boundaries and improve communication patterns within the family. The therapist acts as an active agent in the process of restructuring.

According to this theory, Family Rules are the “invisible” demands within the family that guide how family members will interact with one another. These include: boundaries, coalitions, and power hierarchies.

Boundaries can be clear, rigid, or diffuse.

Therapy

The goal of therapy is to restructure the family system (through unbalancing the system) into becoming more flexible in dealing with problems. The restructuring is done within the session by repositioning the seating of the family members or by having family members, that are not part of the substructure, leave the room. Some of the specific techniques used by Minuchin’s Family Therapy are:

  • Joining: the therapist “joins” the family’s system and remains as part of it the entire time.
  • Reframing: the problem is put into different perspectives to help family members identify and enact alternative transactions.
  • Enactment: the process of portraying the transactional pattern with the help of the therapist in an attempt to disrupt the existing patterns and accommodate alternative rules.

Milan Systemic Family Therapy

Developed by the Milan team, this type of therapy is based on the premise that families are self-regulating systems. These systems work on a set of rules that have been developed over the years and determine the acceptability of behaviors. By following these rules, the system engages in homeostasis and becomes resistant to change.

Therapy

The goal of therapy then is to increase insight into the struggles that family members feel over trying to control family relationships.

Positive Connotation is the therapist’s attempt to reframe behaviors in a positive light by explaining that any behavior (positive or negative) is inspired by the common goal of preserving family values and cohesion.

Family Rituals are prescribed by the therapist for the whole family with the goal of modifying rules of the family that have been present in the past.

The therapist utilizes hypothesizing to asses information obtained from the family and develop questions for the family members. It also serves to develop a plan and implement interventions. The hypotheses may look at deeper values within the family and other issues such as coalitions and patterns for communication.

Circularity is being able to obtain feedback from family members about relationships and differences in order to conduct investigation into the family system. Hence, the therapist uses Circular Questions to assess relational dynamics within a family with the goal of outlining the structure of the relationships and to emphasize their circular nature.

By not taking on any sides or positions, the therapist engages in Neutrality and leads to better understanding of the family system.

Sessions are divided into five parts: precession, session, intersession, conclusion, and postsession.

Haley Strategic Family Therapy

Haley’s family therapy model focuses on complex interactional patterns that exist within dysfunctional families. Cybernetics is a study of how systems are controlled by feedback loops and Haley and his team saw this as an important factor in family’s patterns of interactions. This is a problem-centered and solution-focused approach that increases insight into family directives.

Negative Feedback Loops allow the family members to return to the traditional functioning state of homeostasis by correcting a behavior that may be deviant. Positive Feedback Loops take place when new information is added to the family system in order to learn and grow or create complexity. They’re positive because they grow and worsen problems.

Therapy

At first, family’s patterns of interaction are modified behaviorally. This leads to an alteration in the Family Rules through reframing. 

Paradoxical Interventions ask the family to do the opposite of what would be considered the treatment goal in an attempt to increase insight.