Family Therapy: Why Bother?
By Irem and Stephen BRAY, 'The Family Business School'

Let’s face it, although family therapy dates back to the 1930s for many it’s still the bête noire of psychotherapy. There are many reasons for this, and if you want to practice family therapy you need to recognise them, and then move forward and understand why family therapy is such an important discipline.

Seven Reasons why clinicians avoid practicing family therapy:

1. Clients tend to ask for help as individuals, or for individuals such as children or elderly people. Historically psychotherapy has responded to this request by treating the individual.

2. In many respects a family is more difficult to engage, and retain information from than an individual. Where an individual will present a, mainly, coherent story the perceptions and accounts from different family members vary, which may lead to confusion.

3. Family therapy is based upon a different set of theoretical models than are commonly taught in psychiatry, clinical psychology, counselling and education. This means that people need to learn these in order to be able to practice safely.

4. Other professionals frequently have misconceptions about what family therapy is; the problems that may be addressed through it; and the abilities of those who practice as family therapists.

5. As family therapy skills are based upon a number of distinct, but interlocking, theories as an approach it presents more difficulties in research than approaches based upon unified approaches such as C.B.T.

6. Family therapy presents challenges to the hierarchy of some institutions since its practitioners may be of different disciplines than those with clinical, or administrative responsibility. In other words medical practitioners or teachers may be challenged when the ‘family therapist’ identifies them as contributing to a particular family’s problem.

7. The approach requires some investment in technology, and is best carried out with colleagues in teams. These may be obstacles.

Should we then abandon all attempts to practice and become psychoanalysts, or behaviourists and simply treat individuals. The answer to this must be a resolute ‘No!’

Seven reasons to learn how to practice family therapy properly:

1. Research undertaken in peace studies show that many of the wars nations fight today have their roots in familial disputes that occurred in past millennia. Schisms in today’s families when properly healed have the power to prevent wars tomorrow.

2. Our first experiences of the world occur in families. Our mother-self bond deeply influences our personality, and the ways in which our relatives relate to us mark out our neural pathways creating deep conditioning impacting our perception of how it is to live. Family therapy helps to repair damaged relationships, or ameliorate the damage caused by schisms. It is therefore a profoundly helpful discipline for the young and old alike.

3. When a family is helped to become creatively self-organizing it is a resource for each of its members, and also the community at large. Such families are likely to make fewer demands upon costly medical, or social, services.

4. Entrenched family beliefs and communication patterns that may undermine individual therapies can be addressed by family therapy. For example clinical depression in couples, according to research, has a better chance of successful treatment via family therapy than when tackled with medication, or CBT.

5. A skilled family therapist is usually also an adept therapist with individuals. Systemic and narrative skills that form part of the core training of family therapists may also be used to treat individuals. Models of individual psychotherapy, however, rarely work with families unless they are augmented by family therapy skill-sets.

6. Family therapists seek to meet those they counsel in the counselees’ models of the world. This means that therapy from the outset is natural and conversational, requiring no special induction of family members before they can participate. For example family members aren’t required to learn special jargon, or theoretical concepts.

7. Trained family therapists have at their disposal a range on interlocking models so when one model isn’t producing fast results another may be substituted without the need for the family to be referred to a different therapist.

Professor Peter Stratton from The University of Leeds has been researching the efficacy of family therapy for over twenty years. Writing recently in England’s ‘Guardian Newspaper’ he points out that individual therapy cannot be the answer to relational problems:

“[Some continue] to insist, wrongly, that all the evidence points to cognitive behavioral therapy (CBT) as the only treatment worth considering for anxiety and depression. This is a therapy that aims to cure individuals of their unhelpful thinking. It does not draw on the social and relational contexts that are crucial resources to support recovery. Neither is CBT a "cure-all", and its promotion as such misses the point that people thrive in relationships - and that relational impoverishment requires relational nourishment.”

Pointing to the evidence for the efficacy of Family Therapy he continues:

“Family therapy is inadequately and patchily provided in the NHS despite clear evidence of its long-term effectiveness and "value for money". Research support is provided for individually oriented therapies, but rarely for therapies that work through relationships. So there is most research on CBT, and that is taken to prove that CBT is best. It doesn't. It just proves that if you shine all of your light under one particular bush you will fail to see what value lies elsewhere.”

I can only agree, however, there must be research that we can undertake at local levels that doesn’t require too many costly grants. The Family Business School, [FamBusCo], is currently are considering a number of ideas about this.

Dr. Peter Stratton is Professor of Family Therapy, School of Psychology, University of Leeds, LS2 9JT, United Kingdom.