Family Therapy

by Alan Brandis, Ph.D.

Virginia Satir, in her pioneering work Peoplemaking, tried to bring the concepts of family therapy to the masses so that people could understand how families shape (and unintentionally distort) their members' feelings and behavior. Before that, a number of well-known therapists spent many years working with entire families to develop their ideas of how the family system operates and how its functioning can be altered for the better, including Satir, Salvador Minuchin, Paul Watzlawick, Carl Whittaker, and many others.

The core concept of Family Therapy is that the family is more than a conglomerate of different individuals - it is a system composed of interdependent people who are constantly affecting and influencing each other in many ways, both subtle and obvious. When one member of a family is hurting, everyone ends up being hurt since whatever happens to one part of the system happens to the whole system. The challenge for the family, then, is to respond to the hidden pain of one member (expressed through symptoms) by recognizing it as pain and teaming up to alleviate it.

The Family Systems approach to therapy recognizes and utilizes this philosophy. According to this view, symptoms (the problems that bring people into the office) are the result of legitimate attempts to influence or affect others, which somehow go awry. Thus, if more direct and effective ways to influence each other can be taught to (and learned by) the family, the need for symptoms should diminish.

An Example

As an example, let's postulate a case in which an eight-year-old child is brought in for Attention-Deficit Disorder and acting-out behavior in school (despite good academic performance). This child, we find upon further investigation, had undergone in the last year a series of losses including the death of a grandparent, a move from one state to another (which includes the loss of neighborhood, house, room, friends, school and teachers), a parent who now has to travel on business most of the time, and the addition to the family of a baby sister (which causes a loss of Mom's time and attention).

Although the school suggested that this child be tested for Attention-Deficit Disorder, since his behavior looked similar to that of ADHD kids, when we saw the number of losses he had experienced it became clear what was really going on - he was angry and sad and had no way to express it. Dad was gone a lot, Mom was preoccupied with baby sister, his friends were far away and it was just too expensive to call them much, grandma was still sad about grandpa's death and he didn't want to make her cry any more than she already did. His symptoms were an expression of his unhappiness, and they certainly had an effect on the other family members.

When he got in trouble at school, Mom was called and she had to stop whatever she was doing with baby sister and come to school to pick him up. He got to go home early and stay close to Mom. While it was true that Mom was mad, at least she was paying attention to him and there was a certain satisfaction in knowing that now she felt as angry as he did. And boy, was Dad mad when the boy got suspended and he had to cut short one of his business trips and come home to give his son a long lecture!

The symptoms - negative behavior, not paying attention - had a purpose and they were serving that purpose quite well. They were keeping him in Mom's attention. They were indirectly expressing his anger at all the things that had happened to him. (You can tell when anger is being expressed to you indirectly: you get angry at someone's behavior which affects you negatively, but they have not started a direct confrontation with you.) And the symptoms were putting the child in control of things, at a time when he felt like he could not control anything. Although it was negative attention, the boy was in control of when and how much of it he got; the rest of the time, he had no control at all over who paid attention to him or spent time with him.

The Solution

Of course, the solution is to first help the family identify how they are feeling, and then to help them find safe and constructive ways to express their feelings to each other. This is not as easy as it sounds, because most of us have been taught that directly expressing our feelings hurts others' feelings or makes them get angry at us. We often have to retrain the family through exercises in communication, or through moderating the discussion so that it stays safe for everyone to say what they really feel. We also have to teach parents how to talk to a child so that the child will understand and really hear what they are saying.

Another facet of treatment is to help the family respond to the boy's feelings, as well as the boy's behavior problems, in a constructive and supportive way rather than in a punitive manner. Once they understand that his symptoms are a "cry for help" rather than a purposeful or malicious disruption, they can respond with consequences instead of punishment (helping him take responsibility for his behavior without making him feel worse because of it). Mom and Dad will probably be happy to provide him with more of their time and attention on their timetables rather than on his. As he begins to feel heard and responded to, the symptoms should diminish rapidly and he should begin to make friends in his new location.

Family Therapy can help tremendously in creating safer, more satisfying family relationships. If you have questions concerning whether therapy which includes one or more members of your family might be beneficial, ask your therapist.