A review of Family Systems therapy

Many different variants of family therapy have been developed and practiced, three main styles are; ahistorical, reviewing the here and now with limited reflection on family history; Historical, emphasising family history and its current impact; Experiential, which reviews the personal growth both in and out of the session (Pomerantz, 2019). Contemporary psychotherapy is used in each of these approaches, which includes solution focused therapy to narrative therapy. This essay will critically examine the efficacy of family therapy, through the introduction of a case the learner will demonstrate the introduction and impact of using a Genogram as a tool in family therapy.   

Systemic, or Family therapy began gaining momentum in the 1950’s. Families are our fist vehicle of exploration, they are inherent in our development and change, it is through understanding these inextricable interconnections that we, as psychotherapists, can begin to understand a persons behaviour, motive and presence (Corey, 2013). Family therapy, more closely inspected could be referred to as relationship therapy as it is these relationships that hold to key to unlocking family function in this unit (Becvar and Becvar, 2009). This therapy looks to explore the family system for process and rules, a tool for this is the genogram, the primary focus during the therapy is on the family relationships and the transgenerational meanings, cultural and general perspectives held by the family with a view to changing the context for the client (Corey, 2013)

Carr (2016) postulated that systemic interventions are effective in approximately 66% of cases, in cases were no systemic therapy was used only 33% of cases improved and in 10% of cases deteriorated with systemic therapy. However, there is limited services offering systemic or family intervention, research has shown that less than 20% of care services in the United Kingdom offer any family intervention (Barnes, Hall, & Evans, 2008). In research-informed family therapy, the primary focus is the resolution of the main presenting problem, rather than on broader goals or an unfocused exploration of family issues. Therapy goals are usually explicit and relate directly to the main presenting problem (Carr, 2016). It is accepted that the client in family therapy is connected to living systems, change is best facilitated when looking at the family or set of relationships. When reviewing care facilities psychotherapists noted that 20% of their clients presented with relational difficulties (Cape & Parham, 2001). Research suggests that this is universal, clients present due to relational difficulties, there is limited research to explore this with systemic interventions, it needs to be considered that is individual-focused therapy enough? (Smith, Moller and Vossler, 2017).

Family therapy allows therapeutic understanding from a multicultural framework, this is due to many ethnic groups placing a great value on nuclear and extended family (Pomerantz, 2019). It is, however, imperative to remember that although the western model of a family may be the experience of the therapist it is not universal, and each family needs to be considered it its own multicultural lens for interventions to be successful. Some psychotherapists have argued that more utilisation of reflecting teams in both practice and training would be ‘incredibly useful’ but conceded that this was not financially possible or practical, because of limited return on investment for therapists (Smith, Moller and Vossler, 2017).

A key strength of family systems theory is its flexibility and durability, it allows the therapist to be part of the system to help in its recovery, it is up to the therapist to be person-centred in approach to allow for a relationship of trust to form. All interventions within family therapy are receptive to the uniqueness that is the family, this allows for a more cohesive working relationship between the family and therapist (McGoldrick et al., 2005). It is imperative that therapists working with families are aware of their own values and monitor these through their own biases to ensure they understand how these values influence the practice with families (Faddis and Cobb, 2016).  Family therapy has also been thought to improve clients with presentations of schizophrenia, clinical trials have demonstrated that family-oriented interventions produce superior outcomes, including increased medication compliance and reduced symptom severity with a reduced likelihood of relapse (Park, Park and Park, 2017). Further to this, there is evidence outlining the effectiveness of systemic interventions with alcohol and drug problems, mood disorders, anxiety disorders, adjustment to, and acceptance of illness (Carr, 2016).

Most family therapies tend to be brief as families who seek professional help generally want a solution of a presenting problem, as such the main focus is on the here-and-now interactions within the family system (Corey, 2013). The perspective of family systems therapy is grounded in the assumption that a client’s behaviour may serve a purpose to the family; be unintentionally maintained by the family; be a function of the families inability to function or be a symptom of intergenerational dysfunction (Corey, 2013 ; Pomerantz, 2019). Families should be viewed as unique cultures whose induvial practices must be understood (McGoldrick et al., 2005). Interventions offered are tailored to this understanding and the therapy experienced by the family, and indeed the individuals is as unique as the system which they are enmeshed in (Corey, 2013).

It is imperative that psychotherapists are aware of their own biases, especially those that relate to any potential “discrimination”, Burnham (2009) offers the acronym “Social GRRAAACCEEESS” to identify awareness surrounding biases on gender, geography, race, religion, age, ability, appearance, class, culture, ethnicity, education, employment, sexuality, sexual orientation and spirituality (Krause, 2013). When working with families it is important to form hypothesis about people, systems and families that offer focus in a meaningful way, in family therapy hypothesizing grows from understanding garnered in the assessment process (Corey, 2013; Krause, 2013). It is important that therapists realise their ownership of the process and take responsibility for how therapy is conducted (Satir and Bitter, 2000). Therapists need to review what they see, and what they don’t see, then speculate as to why, if class is not identified its significance needs to be explored (Krause, 2013). All aspects of the familial culture should be present and used to offer news of a difference to the family.

The hypothesis will form circular questions which are crucial in Family Therapy, the therapist asks circular questions to the entire family to encourage exploration of different perceptions about both the relationships and events, through understanding these the family members empathically experience the family through the eyes of another member (Scheel and Conoley, 1998; Faddis and Cobb, 2016). A reflecting team can be used in Family Therapy, this allows for a deeper exploration of the experiences within the family, these observations and reflections re shared with the family hoping to offer ‘news of a difference’. Utilising this approach each family member has a voice and are viewed subjectively by the participants with a view to understanding that there is not one individual that is responsible but a familial effort that has caused the distress (Dallos & Draper, 2010; Faddis and Cobb, 2016).

The families current developmental stage needs to be considered during Family Therapy, McGoldrick (2004) suggests that most middle-class American families process through the following six stages; Leaving home, joining through marriage, families with young children, families with adolescents, launching children and families in later life. “These stages represent family members’ entry into or separation from the family system, and their development and functioning within it” (Finklestein, 2016).  Whist this is typical the variances and nuances in family dynamics and set ups needs to also be considered (Pomerantz, 2019). It is imperative that family system dynamics are understood in the various family life cycle stages along the life span, as this is a potential indicator to the focus and functioning of the family (Finklestein, 2016). Family adaptation is an ongoing process, resilience is inherent in families to some degree, it is family expose to trauma or any adverse context which may cause distress and potential presentation to Family Therapy (Corso and Lanz, 2013). McLeod (1998) suggests that reviewing how the family historically worked through similar events or trauma may offer insight to how the family is currently operating.

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