Family therapy

Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.

The different schools of family therapy have in common a belief that, regardless of the origin of the problem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families in solutions often benefits clients. This involvement of families is commonly accomplished by their direct participation in the therapy session. The skills of the family therapist thus include the ability to influence conversations in a way that catalyses the strengths, wisdom, and support of the wider system.

In the field's early years, many clinicians defined the family in a narrow, traditional manner usually including parents and children. As the field has evolved, the concept of the family is more commonly defined in terms of strongly supportive, long-term roles and relationships between people who may or may not be related by blood or marriage.

The conceptual frameworks developed by family therapists, especially those of family systems theorists, have been applied to a wide range of human behavior, including organisational dynamics and the study of greatness.

Formal interventions with families to help individuals and families experiencing various kinds of problems have been a part of many cultures, probably throughout history. These interventions have sometimes involved formal procedures or rituals, and often included the extended family as well as non-kin members of the community (see, for example, Ho'oponopono). Following the emergence of specialization in various societies, these interventions were often conducted by particular members of a community—for example, a tribal chief, priest, physician, and so on—usually as an ancillary function.

Family therapy as a distinct professional practice within Western cultures can be argued to have had its origins in the social work movements of the 19th century in the United Kingdom and the United States. As a branch of psychotherapy, its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movement and marriage counseling. The formal development of family therapy dates from the 1940s and early 1950s with the founding in 1942 of the American Association of Marriage Counselors (the precursor of the AAMFT), and through the work of various independent clinicians and groups—in the United Kingdom (John Bowlby at the Tavistock Clinic), the United States (Donald deAvila Jackson, John Elderkin Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker, Virginia Satir, Ivan Boszormenyi-Nagy), and in Hungary, D.L.P. Liebermann—who began seeing family members together for observation or therapy sessions. There was initially a strong influence from psychoanalysis (most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry, and later from behaviorism and behavior therapy—and significantly, these clinicians began to articulate various theories about the nature and functioning of the family as an entity that was more than a mere aggregation of individuals.

The movement received an important boost starting in the early 1950s through the work of anthropologist Gregory Bateson and colleagues—Jay Haley, Donald deAvila Jackson, John Weakland, William Fry, and later, Virginia Satir, Ivan Boszormenyi-Nagy, Paul Watzlawick and others—at Palo Alto in the United States, who introduced ideas from cybernetics and general systems theory into social psychology and psychotherapy, focusing in particular on the role of communication. This approach eschewed the traditional focus on individual psychology and historical factors—that involve so-called linear causation and content—and emphasized instead feedback and homeostatic mechanisms and "rules" in here-and-now interactions—so-called circular causation and process—that were thought to maintain or exacerbate problems, whatever the original cause(s). This group was also influenced significantly by the work of US psychiatrist, hypnotherapist, and brief therapist Milton H. Erickson—especially his innovative use of strategies for change, such as paradoxical directives. The members of the Bateson Project (like the founders of a number of other schools of family therapy, including Carl Whitaker, Murray Bowen, and Ivan Boszormenyi-Nagy) had a particular interest in the possible psychosocial causes and treatment of schizophrenia, especially in terms of the putative "meaning" and "function" of signs and symptoms within the family system. The research of psychiatrists and psychoanalysts Lyman Wynne and Theodore Lidz on communication deviance and roles (e.g., pseudo-mutuality, pseudo-hostility, schism, and skew) in families of people with schizophrenia also became influential with systems-communications-oriented theorists and therapists. A related theme—applying to dysfunction and psychopathology more generally—was that of the "identified patient" or "presenting problem" as a manifestation of or surrogate for the family's (or even society's) problems.

By the mid-1960s, a number of distinct schools of family therapy had emerged. From the groups that were most strongly influenced by cybernetics and systems theory there came Mental Research Institute brief therapy, strategic therapy, Salvador Minuchin's structural family therapy and the model proposed by Mara Selvini Palazzoli (i.e., the Milan systems model). Partly in reaction to some aspects of these systemic models came the experiential approaches of Virginia Satir and Carl Whitaker, which downplayed theoretical constructs and emphasized subjective experience and unexpressed feelings (including the subconscious), authentic communication, spontaneity, creativity, total therapist engagement, and often included the extended family. Concurrently, intergenerational therapies by Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, and Norman Paul emerged. They proposed different theories on the intergenerational transmission of health and dysfunction, usually involving three generations in therapy or through "homework" and "journeys home." Psychodynamic family therapy—which, more than any other school of family therapy, deals directly with individual psychology and the unconscious mind in the context of current relationships—continued to develop through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, the British school of object relations theory, and John Bowlby's work on attachment theory.