“All family life is organized around the most damaged person in it.”
– Sigmund Freud
Actually, Freud felt that patients should be treated away from the confusing and confounding effects of their family.1
Freud said, “In psycho-analytic treatment the intervention of the relatives is a positive danger and, moreover, one which we do not know how to deal with.”
Yet people do exist as part of wider patterns. People are parts of systems that influence one another.
Now, family therapy, or at least taking account of our individual client’s family dynamics, is considered important when working towards better human welfare.
Systems theory, specifically systemic therapy, shows us that when you help change one part of a system, all parts of the system change. Try moving one square on a Rubik’s cube without affecting the other parts. A family is, at least in one sense, a system.
What is family therapy?
Family therapy is a form of psychotherapy that focuses on the system dynamics and interactions within a family. The goal of family therapy is to improve communication, resolve conflicts, and promote understanding and empathy among family members.
It involves the participation of some or all family members, including parents, children, siblings, and sometimes even extended family members or close friends.
Even if I don’t see many, or even any, of the other family members, I’ll always want to know about my client’s family and social circumstances.
- Do they have a supportive and loving family?
- How has their problem impacted their family?
- What are their family members’ attitudes to their problem?
- How do they imagine the family will respond as they start to overcome their problem?
Sometimes a client’s problem is the family dynamic. You may, as a practitioner, be asked to see more than one family member. If so, I think the following principle is vitally important.
Work with the most motivated family member
You’ll often find when working with families that one family member is more motivated than the others. People will only change if they feel it’s in their interests to do so.
A vital principle when helping families, then, is to focus on the most motivated family member. Doing so will often, as a knock-on effect, help motivate the others too. Here’s a perfect case in point.
The motivated mother
Vicky, a single mother, dragged her 17-year-old son into therapy. She’d told me privately that she was becoming depressed and couldn’t bear living with him. (She didn’t state this in front of him, though!)
The boy, Dylan, didn’t really engage with me or his mother much. He said he “didn’t see what the problem was” and thought we were wasting his time. After 30 minutes he left, as he was “sick and tired” of this.
So we had a family dynamic which was clearly not working for the mother, who was therefore the motivated client. But as I was to discover, it was working for her son. ‘Working’ in the sense that he didn’t feel anything needed to change. The challenge was to work through the mum to enable both of them to change.
So what exactly was the problem?
Inconsiderate, lazy, and rude
Vicky, once her son had left, told a tale of her son coming home most nights at 3 am – four hours before Vicky had to be up for work! He would bang on the door until she answered, and when she finally got up to let him in he would speak to her rudely and aggressively.
Dylan had a key, but rarely bothered to take it with him. When he finally got home, he would play loud music for an hour or so before finally going to sleep.
Vicky related bitterly how he would constantly demand her money, as he didn’t work or attend college. He never cleaned up after himself. She was constantly washing and cleaning up after him. He was always rude and surly and showed her no respect.
The mother asked desperately how she and I could get her son to change. But she was the most motivated family member. He would change only if she did.
I looked at Vicky steadily and told her she could get him to change. But she’d need to work with me to do so.
I gave, and then wrote down, the following instructions for Vicky. She was to:
- Give the boy an allowance of 10 pounds every Monday morning, and no more. This was to be withheld if he didn’t comply with her other requirements.
- Never open the door to him after midnight.
- Switch the electricity off at the fuse box if he played loud music at night and refused to turn it down.
- Telephone the police if he caused a commotion.
- Stop doing his washing up and washing his clothes unless he asked her politely.
- Wake him up if he slept later than 10.30 am on a weekday.
Vicky looked shocked and said, “You mean I’ve got to change?!”
“Do you want him to change or not?” I asked her.
With many misgivings, she said she would follow the instructions. She said she really did want things to be different and would even risk her son leaving the house.
I wondered what would happen.
Chaos leads to calm
I got a call from Vicky two weeks later.
“How’s it going?” I asked, hopefully hiding my doubts.
She sounded excited, breathless. I knew something important had happened.
She’d followed the instructions to the letter.
Dylan had awoken her in the early hours of the morning with his usual banging. With incredible self-control, she refused, as she had told him she would, to answer.
He’d banged for so long and so loudly that the police were called by a neighbour. This unnerved him and, furious with her, he’d left and slept the rest of the night on a railway embankment.
Vicky had a sleepless night wracked by “terrible guilt“.
But when he returned the next morning she simply reminded him of the rule. He was angry and abusive but could see her determination and, after a few more nights of not being let in, began to use his key.
When he refused to turn his music down when she was trying to sleep, she switched off the electricity and locked the door to the fuse box.
He was livid and tried to kick the door down. She began to phone the police, which, again, unnerved him to the point where he settled down. She told him firmly that this was how it was going to be from now on.
After these experiences he wasn’t surprised and didn’t complain when she gave him only 10 pounds on the following Monday.
Vicky stopped doing all the washing up, saying that she would do it on Thursdays, Fridays, Saturdays, and Sundays, and it was “his turn” to do it on the other days.
For a while he refused to do any. (Fortunately Vicky had thought ahead and bought herself some disposable paper plates with the money from his allowance!) Then finally, on Wednesday night, he did the washing up. He asked her politely if she would do his clothes washing for him, to which she replied (beginning to relish her role!) that she would show him how to do it.
When she wasn’t working during the day, she woke him early, and he started coming home earlier and getting up earlier. By the time Vicky called me again a month later, Dylan had found a part-time job and was seriously thinking about enrolling in college. He seemed happier and “nicer”. Vicky told me firmly she would stick to the rules – and I believed her.
This was a drastic example of how working with the family member who is motivated can help benefit the ones who are not.
Work with the most motivated to lead others to find the motivation to change.
So what are some of the broader aims of family therapy?
Outcome one: Address communication issues
Communication is essential for healthy relationships, but it can be challenging to maintain effective communication within families.
Misunderstandings, conflicts, and disagreements can all lead to breakdowns in communication, which can result in feelings of frustration, anger, and isolation.
Family therapy can help family members improve their communication skills by teaching them how to actively listen, express their thoughts and feelings, and use ‘I’ statements instead of ‘you’ statements.
I worked with a couple and their two teenage children whose communication had descended into complete chaos. I had to, as far as possible, bring some kind of order to the chaos.
I encouraged each one to talk in turn for two minutes without interruption. This genuinely seemed to be the first time they had actually listened to one another! I further asked them to drop the ‘you’ at the start of their sentences in exchange for ‘I’.
For example, instead of “You never/always do this!” they were to say, “I feel upset when you…” This is less threatening and puts the emphasis on their reaction rather than blanket blaming. When they started to communicate better, they began to relate better.
Outcome two: Manage conflict in relationships
Conflict is a natural part of any relationship, but when it’s not addressed effectively, it can escalate and cause significant damage. Family therapy can help families learn how to manage conflict in a healthy and constructive way.
We need to help family members learn to identify the underlying causes of conflicts, express their needs and emotions without attacking each other, and problem-solve effectively.
This can be done though behavioural therapy, as with Vicky and her son, and through simply teaching better communication skills and boundary setting. We can also teach the family about the nature of criticism and kinder ways of communicating.
Outcome three: Help clients cope with life transitions
Life transitions, such as divorce, remarriage, or the birth of a new child, can be challenging for families.
These transitions can disrupt established routines and relationships, causing stress and anxiety. Family therapy can help families navigate these transitions by providing a safe and supportive environment to discuss feelings and concerns. The therapist can also help families develop coping strategies and work together to create a plan for moving forward.
Whether it’s new relationships with new stepchildren, marital conflict or divorce, the death of a family member, or any other major change, transition times can challenge the foundations of any family.
Helping the family by helping each individual within that family cope in optimal ways can help grow the wellbeing of the family as a whole.
Talking of which…
A family who thrives together survives together
I’d been seeing two parents and their nine-year-old son. We had dealt with many of their issues, including ones related to conflict and life transitions (the boy’s grandmother, his father’s mother, who had lived with them had recently died).
I asked them what they all did together that was fun.
All three of them looked blank. In the nonplussed silence that followed, I recalled the 5/1 rule which states that couples with a stable relationship tend to have five positive interactions – such as shared laughter, pleasant conversation, an enjoyable walk together in nature, affection, and so on – for every one negative interaction, such as a row.
Research has found that this balance strongly favours a healthy and longer-lasting relationship.2 Five good interactions for every not-so-good one.
I suspect that this ratio holds good for families, too.
So I prescribed family fun time. I tasked them with going bowling once a week, then eating in a favourite family restaurant. They all agreed this might be fun.
They started doing this, and found that they did in fact enjoy it. This led to more spontaneous fun family times, such as trips to the beach and even mini vacations. They were beginning to actually enjoy one another!
None of us exist entirely in isolation
Now I could have worked with just the mother in this family. She was starting to feel depressed and had I focused on her individual psychology this may well have helped her cope better.
And yet when she talked to me her concerns and worries all seemed focused on her family. As the wellbeing of her family improved, so too did the mental health of not just her but her husband and son too.
Likewise, I could have tried to treat Vicky as an individual, just focusing on her history and so forth, and not addressed the conflict with her son.
But sometimes the wider ripples in a person’s life here and now need to change in order for them to become happier. Yes, we can adapt our psychology to a lousy family or work situation if nothing can be done at the moment to change it, but sometimes change has to happen in others and in external situations before we can meet our emotional needs fully.
Family therapy is an effective form of treatment for a wide range of mental health and relationship problems. It can help families improve their communication skills, manage conflict, and cope with life transitions. And because families are, on one level, systems, small changes can create large effects.
Work with who is motivated to help those who are yet to become so, and encourage welfare and familial fun and togetherness as well as simply focusing on overcoming problems.
Families are often chaotic, complex, enervating, and exasperating, yet they can also be our greatest source of strength, love, and shared wisdom.
Extend Your Language Skills
Language is the one tool we have as therapists, counsellors or coaches, so it makes sense to hone that skill as much as we can. The wonderful thing is that the use of language is an art which is perhaps infinitely perfectible and there are many fascinating techniques and approaches available to you. Mark’s course Conversational Reframing focuses like a laser on how to create change with clients in the course of normal conversation, without it even seeming like you’re ‘doing therapy’. Read more about this fascinating course here.
Read more therapy techniques »