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Family therapy ICD-9-CM 94.42 MeSH D005196 Family therapy, also referred to as couple and family therapy, marriage and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with 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. It emphasizes family relationships as an important factor in psychological health.
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.
History and theoretical frameworks 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 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 learning theory 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 D. 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 (see Bateson Project).
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).(See also systems psychology and systemic therapy.
) 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 (see also Reverse psychology). 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.
(See also double bind; family nexus.) By the mid-1960s, a number of distinct schools of family therapy had emerged. From those groups that were most strongly influenced by cybernetics and systems theory, there came MRI Brief Therapy, and slightly later, strategic therapy, Salvador Minuchin's Structural Family Therapy and 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 and somewhat independently, there emerged the various intergenerational therapies of Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, and Norman Paul, which present different theories about the intergenerational transmission of health and dysfunction, but which all deal usually with at least three generations of a family (in person or conceptually), either directly in therapy sessions, or via "homework", "journeys home", etc.
Psychodynamic family therapy - which, more than any other school of family therapy, deals directly with individual psychology and the unconscious 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, and also by the British School of Object Relations and John Bowlby’s work on attachment. Multiple-family group therapy, a precursor of psychoeducational family intervention, emerged, in part, as a pragmatic alternative form of intervention - especially as an adjunct to the treatment of serious mental disorders with a significant biological basis, such as schizophrenia - and represented something of a conceptual challenge to some of the "systemic" (and thus potentially "family-blaming") paradigms of pathogenesis that were implicit in many of the dominant models of family therapy.
The late-1960s and early-1970s saw the development of network therapy (which bears some resemblance to traditional practices such as Ho'oponopono) by Ross Speck and Carolyn Attneave, and the emergence of behavioral marital therapy (renamed behavioral couples therapy in the 1990s; see also relationship counseling) and behavioral family therapy as models in their own right. By the late-1970s, the weight of clinical experience - especially in relation to the treatment of serious mental disorders - had led to some revision of a number of the original models and a moderation of some of the earlier stridency and theoretical purism.
There were the beginnings of a general softening of the strict demarcations between schools, with moves toward rapprochement, integration, and eclecticism – although there was, nevertheless, some hardening of positions within some schools. These trends were reflected in and influenced by lively debates within the field and critiques from various sources, including feminism and post-modernism, that reflected in part the cultural and political tenor of the times, and which foreshadowed the emergence (in the 1980s and 1990s) of the various "post-systems" constructivist and social constructionist approaches.
While there was still debate within the field about whether, or to what degree, the systemic-constructivist and medical-biological paradigms were necessarily antithetical to each other (see also Anti-psychiatry; Biopsychosocial model), there was a growing willingness and tendency on the part of family therapists to work in multi-modal clinical partnerships with other members of the helping and medical professions.
 From the mid-1980s to the present, the field has been marked by a diversity of approaches that partly reflect the original schools, but which also draw on other theories and methods from individual psychotherapy and elsewhere – these approaches and sources include: brief therapy, structural therapy, constructivist approaches (e.g., Milan systems, post-Milan/collaborative/conversational, reflective), solution-focused therapy, narrative therapy, a range of cognitive and behavioral approaches, psychodynamic and object relations approaches, attachment and Emotionally Focused Therapy, intergenerational approaches, network therapy, and multisystemic therapy (MST).
Multicultural, intercultural, and integrative approaches are being developed. Many practitioners claim to be "eclectic", using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s), and there is a growing movement toward a single “generic” family therapy that seeks to incorporate the best of the accumulated knowledge in the field and which can be adapted to many different contexts; however, there are still a significant number of therapists who adhere more or less strictly to a particular, or limited number of, approach(es).
 Ideas and methods from family therapy have been influential in psychotherapy generally: a survey of over 2,500 US therapists in 2006 revealed that of the 10 most influential therapists of the previous quarter-century, three were prominent family therapists and that the marital and family systems model was the second most utilized model after cognitive behavioral therapy. Techniques Family therapy uses a range of counseling and other techniques including: Structural therapy - identifies and re-orders the organisation of the family system Strategic therapy - looks at patterns of interactions between family members Systemic/Milan therapy - focuses on belief systems Narrative therapy - restoring of dominant problem-saturated narrative, emphasis on context, separation of the problem from the person Transgenerational therapy - transgenerational transmission of unhelpful patterns of belief and behaviour communication theory psychoeducation psychotherapy relationship counseling relationship education systemic coaching systems theory reality therapy the genogram The number of sessions depends on the situation, but the average is 5-20 sessions.
A family therapist usually meets several members of the family at the same time. This has the advantage of making differences between the ways family members perceive mutual relations as well as interaction patterns in the session apparent both for the therapist and the family. These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporated into the family system.
Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the unconscious mind or early childhood trauma of individuals as a Freudian therapist would do - although some schools of family therapy, for example psychodynamic and intergenerational, do consider such individual and historical factors (thus embracing both linear and circular causation) and they may use instruments such as the genogram to help to elucidate the patterns of relationship across generations.
The distinctive feature of family therapy is its perspective and analytical framework rather than the number of people present at a therapy session. Specifically, family therapists are relational therapists: They are generally more interested in what goes on between individuals rather than within one or more individuals, although some family therapists—in particular those who identify as psychodynamic, object relations, intergenerational, or experiential family therapists (EFTs)—tend to be as interested in individuals as in the systems those individuals and their relationships constitute.
Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as by pointing out patterns of interaction that the family might have not noticed.
Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to allocate blame to one or more individuals, with the effect that for many families a focus on causation is of little or no clinical utility. It is important to note that a circular way of problem evaluation is used as opposed to a linear route.
Using this method, families can be helped by finding patterns of behaviour, what the causes are, and what can be done to better their situation. Evidence base Family therapy has an evolving evidence base. A summary of current evidence is available via the UK's Association of Family Therapy. According to a 2004 French government study conducted by French Institute of Health and Medical Research, family and couples therapy was the second most effective therapy after Cognitive behavioral therapy.
 The study used meta-analysis of over a hundred secondary studies to find some level of effectiveness that was either "proven" or "presumed" to exist. Of the treatments studied, family therapy was presumed or proven effective at treating schizophrenia, bipolar disorder, anorexia and alcohol dependency. Concerns and criticism The late Frank Pittman, MD, had practiced marriage and family therapy in Atlanta, Georgia for 33 years when he wrote: "One of the horrors of psychotherapy is the affirmation clients may feel from their seemingly neutral therapists that they are 'okay' even when they are doing terrible things to themselves and their loved ones.
Some therapists listen without comment to tales of violence, substance abuse, infidelity, even incest. Their silence is tacit approval. Some therapists do worse than silently accept whatever the customer says or does; some actively affirm that the customer is always right. Therapists, as they ingratiate themselves to their customers, may actually provide 'interpretations' to relieve clients of the guilt they need in order to keep them from hurting others and bringing disaster upon themselves.
.. therapists who do psychotherapy effectively do so because they understand value conflicts and they convey, without having to preach about it, values that work." — Frank Pittman In a 1999 address to the Coalition of Marriage, Family and Couples Education conference in Washington, D.C., University of Minnesota Professor William Doherty said: "I take no joy in being a whistle blower, but it’s time.
I am a committed marriage and family therapist, having practiced this form of therapy since 1977. I train marriage and family therapists. I believe that marriage therapy can be very helpful in the hands of therapists who are committed to the profession and the practice. But there are a lot of problems out there with the practice of therapy - a lot of problems." Doherty suggested questions prospective clients should ask a therapist before beginning treatment: "Can you describe your background and training in marital therapy?" "What is your attitude toward salvaging a troubled marriage versus helping couples break up?" "What is your approach when one partner is seriously considering ending the marriage and the other wants to save it?" "What percentage of your practice is marital therapy?" "Of the couples you treat, what percentage would you say work out enough of their problems to stay married with a reasonable amount of satisfaction with the relationship.
" "What percentage break up while they are seeing you?" "What percentage do not improve?" "What do you think makes the differences in these results?" Licensing and degrees Family therapy practitioners come from a range of professional backgrounds, and some are specifically qualified or licensed/registered in family therapy (licensing is not required in some jurisdictions and requirements vary from place to place).
In the United Kingdom, family therapists will have a prior relevant professional training in one of the helping professions usually psychologists, psychotherapists, or counselors who have done further training in family therapy, either a diploma or an M.Sc. In the United States there is a specific degree and license as a marriage and family therapist; however, psychologists, nurses, psychotherapists, social workers, or counselors, and other licensed mental health professionals may practice family therapy.
In the UK, family therapists who have completed a four-year qualifying programme of study (MSc) are eligible to register with the professional body the Association of Family Therapy (AFT), and with the UK Council for Psychotherapy (UKCP). A master's degree is required to work as an MFT in some American states. Most commonly, MFTs will first earn a M.S. or M.A. degree in marriage and family therapy, counseling, psychology, family studies, or social work.
After graduation, prospective MFTs work as interns under the supervision of a licensed professional and are referred to as an MFTi. Prior to 1999 in California, counselors who specialized in this area were called Marriage, Family and Child Counselors. Today, they are known as Marriage and Family Therapists (MFT), and work variously in private practice, in clinical settings such as hospitals, institutions, or counseling organizations.
Marriage and family therapists in the United States and Canada often seek degrees from accredited Masters or Doctoral programs recognized by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), a division of the American Association of Marriage and Family Therapy. Requirements vary, but in most states about 3000 hours of supervised work as an intern are needed to sit for a licensing exam.
MFTs must be licensed by the state to practice. Only after completing their education and internship and passing the state licensing exam can a person call themselves a Marital and Family Therapist and work unsupervised. License restrictions can vary considerably from state to state. Contact information about licensing boards in the United States are provided by the Association of Marital and Family Regulatory Boards.
There have been concerns raised within the profession about the fact that specialist training in couples therapy – as distinct from family therapy in general - is not required to gain a license as an MFT or membership of the main professional body, the AAMFT. Values and ethics Since issues of interpersonal conflict, power, control, values, and ethics are often more pronounced in relationship therapy than in individual therapy, there has been debate within the profession about the different values that are implicit in the various theoretical models of therapy and the role of the therapist’s own values in the therapeutic process, and how prospective clients should best go about finding a therapist whose values and objectives are most consistent with their own.
 Specific issues that have emerged have included an increasing questioning of the longstanding notion of therapeutic neutrality, a concern with questions of justice and self-determination, connectedness and independence, "functioning" versus "authenticity", and questions about the degree of the therapist’s "pro-marriage/family" versus "pro-individual" commitment.
 The American Association for Marriage and Family Therapy requires members to adhere to a "Code of Ethics", including a commitment to "continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship." Founders and key influences Some key developers of family therapy are: Alfred Adler (individual psychology) Nathan Ackerman (psychoanalytic) Tom Andersen (reflecting practices and dialogues about dialogues) Harlene Anderson (postmodern collaborative therapy and Collaborative Language Systems) Harry J Aponte (Person-of-the-Therapist) Jack A.
Apsche (family mode deactivation therapy, FMDT) Gregory Bateson (1904–1980) (cybernetics, systems theory) Ivan Boszormenyi-Nagy (contextual therapy, intergenerational, relational ethics) Murray Bowen (systems theory, intergenerational) Steve de Shazer (solution focused therapy) Milton H. Erickson (hypnotherapy, strategic therapy, brief therapy) Richard Fisch (brief therapy, strategic therapy) James Framo (object relations theory, intergenerational) Edwin Friedman (family process in religious congregations) Harry Goolishian (postmodern collaborative therapy and collaborative language systems) John Gottman (marriage) Robert-Jay Green (LGBT, cross-cultural issues) Douglas Haldane (Attachment-based couple therapist) Jay Haley (strategic therapy, communications) Lynn Hoffman (strategic, post-systems, collaborative) Don D.
Jackson (systems theory) Sue Johnson (emotionally focused therapy, attachment theory) Walter Kempler (Gestalt psychology) Cloe Madanes (strategic therapy) Salvador Minuchin (structural family therapy) Braulio Montalvo (structural family therapy) Virginia Satir (communications, experiential, conjoint and co-therapy) Mara Selvini Palazzoli (Milan systems) Robin Skynner (group analysis) Paul Watzlawick (brief therapy, systems theory) John Weakland (brief therapy, strategic therapy, systems theory) Carl Whitaker (family systems, experiential, co-therapy) Michael White (narrative therapy) Lyman Wynne (schizophrenia, pseudomutuality) Summary of theories and techniques (references:) Theoretical model Theorists Summary Techniques Adlerian family therapy Alfred Adler Also known as "individual psychology".
Sees the person as a whole. Ideas include compensation for feelings of inferiority leading to striving for significance toward a fictional final goal with a private logic. Birth order and mistaken goals are explored to examine mistaken motivations of children and adults in the family constellation. Psychoanalysis, typical day, reorienting, re-educating Attachment theory John Bowlby, Mary Ainsworth, Douglas Haldane Individuals are shaped by their experiences with caregivers in the first three years of life.
Used as a foundation for Object Relations Theory. The Strange Situation experiment with infants involves a systematic process of leaving a child alone in a room in order to assess the quality of their parental bond. Psychoanalysis, play therapy Bowenian family systems therapy Murray Bowen, Betty Carter, Philip Guerin, Michael Kerr, Thomas Fogarty, Monica McGoldrick, Edwin Friedman, Daniel Papero Also known as "intergenerational family therapy" (although there are also other schools of intergenerational family therapy).
Family members are driven to achieve a balance of internal and external differentiation, causing anxiety, triangulation, and emotional cutoff. Families are affected by nuclear family emotional processes, sibling positions and multigenerational transmission patterns resulting in an undifferentiated family ego mass. Detriangulation, nonanxious presence, genograms, coaching Cognitive behavioral family therapy John Gottman, Albert Ellis, Albert Bandura Problems are the result of operant conditioning that reinforces negative behaviors within the family’s interpersonal social exchanges that extinguish desired behavior and promote incentives toward unwanted behaviors.
This can lead to irrational beliefs and a faulty family schema. Therapeutic contracts, modeling, systematic desensitization, shaping, charting, examining irrational beliefs Collaborative language systems therapy Harry Goolishian, Harlene Anderson, Tom Andersen, Lynn Hoffman, Peggy Penn Individuals form meanings about their experiences within the context of social relationship on a personal and organizational level.
Collaborative therapists help families reorganize and dis-solve their perceived problems through a transparent dialogue about inner thoughts with a "not-knowing" stance intended to illicit new meaning through conversation. Collaborative therapy is an approach that avoids a particular theoretical perspective in favor of a client-centered philosophical process. Dialogical conversation, not knowing, curiosity, being public, reflecting teams Communications approaches Virginia Satir, John Banmen, Jane Gerber, Maria Gomori All people are born into a primary survival triad between themselves and their parents where they adopt survival stances to protect their self-worth from threats communicated by words and behaviors of their family members.
Experiential therapists are interested in altering the overt and covert messages between family members that affect their body, mind and feelings in order to promote congruence and to validate each person’s inherent self-worth. Equality, modeling communication, family life chronology, family sculpting, metaphors, family reconstruction Contextual therapy Ivan Boszormenyi-Nagy Families are built upon an unconscious network of implicit loyalties between parents and children that can be damaged when these "relational ethics" of fairness, trust, entitlement, mutuality and merit are breached.
Rebalancing, family negotiations, validation, filial debt repayment Emotion-focused therapy Sue Johnson, Les Greenberg Couples and families can develop rigid patterns of interaction based on powerful emotional experiences that hinder emotional engagement and trust. Treatment aims to enhance empathic capabilities of family members by exploring deep-seated habits and modifying emotional cues. Reflecting, validation, heightening, reframing, restructuring Experiential family therapy Carl Whitaker, David Kieth, Laura Roberto, Walter Kempler, John Warkentin, Thomas Malone, August Napier Stemming from Gestalt foundations, change and growth occurs through an existential encounter with a therapist who is intentionally "real" and authentic with clients without pretense, often in a playful and sometimes absurd way as a means to foster flexibility in the family and promote individuation.
Battling, constructive anxiety, redefining symptoms, affective confrontation, co-therapy, humor Family mode deactivation therapy (FMDT) Jack A. Apsche Target population adolescents with conduct and behavioral problems. Based on schema theory. Integrate mindfulness to focus family on the present. Validate core beliefs based on past experiences. Offer viable alternative responses. Treatment is based on case conceptualization process; validate and clarify core beliefs, fears, triggers, and behaviors.
Redirect behavior by anticipating triggers and realigning beliefs and fears. Cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, dialectical behavior therapy, defusion, validate-clarify-redirect Feminist family therapy Sandra Bem Complications from social and political disparity between genders are identified as underlying causes of conflict within a family system. Therapists are encouraged to be aware of these influences in order to avoid perpetuating hidden oppression, biases and cultural stereotypes and to model an egalitarian perspective of healthy family relationships.
Demystifying, modeling, equality, personal accountability Milan systemic family therapy Luigi Boscolo, Gianfranco Cecchin, Mara Selvini Palazzoli, Giuliana Prata A practical attempt by the "Milan Group" to establish therapeutic techniques based on Gregory Bateson's cybernetics that disrupts unseen systemic patterns of control and games between family members by challenging erroneous family beliefs and reworking the family’s linguistic assumptions.
Hypothesizing, circular questioning, neutrality, counterparadox MRI brief therapy Gregory Bateson, Milton Erickson, Heinz von Foerster Established by the Mental Research Institute (MRI) as a synthesis of ideas from multiple theorists in order to interrupt misguided attempts by families to create first and second order change by persisting with "more of the same", mixed signals from unclear metacommunication and paradoxical double-bind messages.
Reframing, prescribing the symptom, relabeling, restraining (going slow), Bellac Ploy Narrative therapy Michael White, David Epston People use stories to make sense of their experience and to establish their identity as a social and political constructs based on local knowledge. Narrative therapists avoid marginalizing their clients by positioning themselves as a co-editor of their reality with the idea that "the person is not the problem, but the problem is the problem.
" Deconstruction, externalizing problems, mapping, asking permission Object relations therapy Hazan & Shaver, David Scharff & Jill Scharff, James Framo, Individuals choose relationships that attempt to heal insecure attachments from childhood. Negative patterns established by their parents (object) are projected onto their partners. Detriangulation, co-therapy, psychoanalysis, holding environment Psychoanalytic family therapy Nathan Ackerman By applying the strategies of Freudian psychoanalysis to the family system therapists can gain insight into the interlocking psychopathologies of the family members and seek to improve complementarity Psychoanalysis, authenticity, joining, confrontation Solution focused therapy Kim Insoo Berg, Steve de Shazer, William O'Hanlon, Michelle Weiner-Davis, Paul Watzlawick The inevitable onset of constant change leads to negative interpretations of the past and language that shapes the meaning of an individual's situation, diminishing their hope and causing them to overlook their own strengths and resources.
Future focus, beginner's mind, miracle question, goal setting, scaling Strategic therapy Jay Haley, Cloe Madanes Symptoms of dysfunction are purposeful in maintaining homeostasis in the family hierarchy as it transitions through various stages in the family life cycle. Directives, paradoxical injunctions, positioning, metaphoric tasks, restraining (going slow) Structural family therapy Salvador Minuchin, Harry Aponte, Charles Fishman, Braulio Montalvo Family problems arise from maladaptive boundaries and subsystems that are created within the overall family system of rules and rituals that governs their interactions.
Joining, family mapping, hypothesizing, reenactments, reframing, unbalancing Journals Contemporary Family Therapy Family Process Family Relations Family Relations, Interdisciplinary Journal of Applied Family Studies, ISSN 0197-6664 Journal of Family Therapy Marriage Fitness Journal of Marital and Family Therapy Families, Systems, & Health See also Alternative dispute resolution Acceptance and commitment therapy CAMFT Child abuse Conflict resolution Cognitive behavioral therapy Deinstitutionalisation Domestic violence Dysfunctional family Emotionally focused therapy ENRICH Family Environment Scale Family Life Education Family Life Space Identified patient Internal Family Systems Model Interpersonal psychotherapy Interpersonal relationship Mediation Mindfulness-based cognitive therapy Multisystemic Therapy (MST) Positive psychology Relationship education Relationships Australia Strategic Family Therapy Footnotes ^ a b c Broderick, C.
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34 (5): 875–884. doi:10.1111/j.1939-0025.1964.tb02243.x. ^ Hare-Mustin, Rachel T. (1978). "A Feminist Approach to Family Therapy". Family Process. 17 (2): 181–94. doi:10.1111/j.1545-5300.1978.00181.x. PMID 678351. ^ Gottlieb, M.C. (1995). Developing Your Ethical Position in Family Therapy: Special Issues. Paper presented at the Annual Meeting of the American Psychological Association (103rd, New York, NY, August 11–15, 1995).
^ Melito, Richard (2003). "Values in the Role of the Family Therapist: Self Determination and Justice". Journal of Marital and Family Therapy. 29 (1): 3–11. doi:10.1111/j.1752-0606.2003.tb00378.x. PMID 12616794. ^ Fowers, B. J.; Richardson, F. C. (1996). "Individualism, Family Ideology and Family Therapy". Theory & Psychology. 6: 121–151. doi:10.1177/0959354396061009. ^ USA Today 6/21/2005 Hearts divide over marital therapy.
^ "Code of Ethics," American Association of Marriage and Family Therapy, July 1, 2012. ^ "When Every Session Mattered". Psychotherapy Networker Magazine. 38 (4): 42. July–August 2014. ^ Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family therapists: Integrating theory and practice. Pacific Grove, CA: Brooks/Cole/Thomson. ^ Goldenberg, I., & Goldenberg, H.
(2008). Family therapy: An overview. Belmont, CA: Thomson Brooks/Cole. ^ Gurman, A. S. (2008). Clinical handbook of couple therapy. New York: Guilford Press. ^ Sexton, T. L., Weeks, G. R., & Robbins, M. S. (2003). Handbook of family therapy: The science and practice of working with families and couples. New York: Brunner-Routledge. Further reading Deborah Weinstein, The Pathological Family: Postwar America and the Rise of Family Therapy.
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Distinct Crucial Art Principles have advanced extensive different eras, with the transforming artists' perceptions of processing, analyzing, and responding to numerous artwork sorts. Their inventive expressions have been explored by their development, functionality, and participation in arts. Every single historical period has provided novel contribution of historic and cultural contexts for establishing the key Arts Fundamentals on the related period. Visual Arts enable artists assimilate the crucial element Arts Concepts of Symmetry, Coloration, Pattern, Distinction as well as discrepancies amongst one or maybe more components while in the composition. The key Artwork Principles of Visual Arts assistance recognize and distinguish in between the size such as, Symmetry & Asymmetry, Positive & Negative Space, Light & Dark, Solid & Transparent, and Large & Small.See Also: Van Wezel Performing Arts Hall Seating Chart
Artwork plays a vibrant role from the personal life on the individual as well as within the social and economic development of the nation. The study of Visible arts encourages personal development and the awareness of both our cultural heritage as well as role of artwork during the society. The learner acquires personal knowledge, skills and competencies through activities in Visual arts. When one studies Visible arts, he/she would come to appreciate or fully grasp that artwork is an integral part of everyday life.
Family therapy is a well-established and evidence-based approach alongside other psychotherapeutic modalities. However, its development and availability varies among European countries. While in some countries family therapy maintains a strong position and plays an important role in both public health care and private practices, in others therapists still strive for family therapy to become more recognized and widespread.
The following concise text was created to help family therapists in achieving this aim. This text provides essential information about family therapy and systemic practice, including references pertaining to scientific evidence. The text was developed specifically to contribute to a negotiation process with authorities who can influence the role of family therapy in various contexts. Such people are health care policy makers, social service workers, and heads of departments, insurance companies and so forth.
Family Therapy and Systemic Practice Introduction This text is a brief overview of basic facts about the therapeutic approach ‘Family Therapy and Systemic Practice’. It is meant for all who are interested in this approach as professionals, as clients/patients and also as policy and decision makers in health care delivery and representatives of public and private health insurance schemes seeking to comprehend what this approach can offer.
What is Family Therapy and Systemic Practice? Family therapy addresses the problems people present within the context of their relationships with significant persons in their lives and their social networks. It is a well-recognized psychotherapeutic approach, primarily concerned with the family system as a social unit, in contrast to other psychotherapy approaches such as psychodynamic or cognitive-behavioral therapy, which focus on the individual.
Family therapy and systemic practice is a heterogeneous field; there are different schools and models that share several principles and guiding assumptions. Some of the commonly shared goals of family therapy might be for example: improvement of family functioning on different levels, enhancement of mutual understanding and emotional support among family members, development of coping skills and problem-solving strategies in various life dilemmas and situations.
Traditionally family therapy has had a primary focus on interactions among family members, quality of family relationships, various aspects of family development and functioning. However, family therapy rests on ‘systemic assumptions’ or ‘a contextual perspective’ which emphasise the role of wider systems, such as the community, the society and the culture to which the family belongs. In recent years, family therapists have started to call themselves `systemic therapists’ as they pay more attention to the impact of wider systems and social contexts on people’s lives.
The systemic perspective – which underpins the practice of most family therapists – views the problems of an individual in relation to the different contexts in which this individual lives: i.e as a partner in a couple relationship, as a family member, a person with particular cultural and/or religious allegiances, while also taking into account socio-economic circumstances and political processes.
Systemic practice considers `context’ as being of paramount significance for an individual’s psychological development and emotional well-being. A family therapy session usually lasts between 60-90 minutes; the intervals between sessions are from one to several weeks depending on the presented problems, the needs of the family members, the stage of the treatment and other variables. Decisions over these matters are negotiated collaboratively with clients and any other involved professionals.
Although it is hard to estimate, and it differs widely, the average length of family therapy treatment ranges between 6 – 20 sessions. Family therapists most often work with more than one family member in the room but individual sessions, or meetings with parents separate from children for example, are also offered when appropriate. Some models of family therapy include collaboration with a co-therapist or a team.
There are also times when systemic practitioners will intervene in the professional and/or social networks around families rather than focus specifically on the nuclear family unit. Both the length and the setting of family therapy result from a collaboration and a mutual agreement between a therapist and a family. Who can benefit from Family Therapy and/or Systemic Practice? The family can be both a great source of support for people but also a source of distress, misunderstanding and pain.
Therefore family therapy and systemic practice is important whenever the aim is to enhance the ability of family members to support each other. Enabling family members to use their resources more efficiently in a supportive way can be vital in helping members manage transitional stages of family development or stressful life events such as a serious illness or a death of a family member. Generally speaking, any situation or a problem that affects relationships among family members and family functioning and its supportive role, can benefit from systemic family therapy.
Similarly any problem of an individual that affects his/her life in relation to his/her relationships to family and wider contexts will benefit from a systemic approach. Involving others in of an individual’s family or social network in the treatment can help to avoid the pathologizing of that individual and can also help address the problem more effectively. Family therapy can be useful in times of crisis and with long-standing problems as well.
It also serves to prevent problems such as a behavioural difficulty, for example, deteriorating into delinquency or mental health breakdown. Some of the issues or situations a family could benefit from through family therapy are listed below. Health problems, particularly chronic physical illnesses Psychosomatic problems Child and adolescent mental health Adult mental health Psychosexual difficulties Alcohol and other substance abuse Marital problems including separation and divorce issues Foster care, adoption and related issues Issues involving the Family’s life cycle and transitional stages of life Promoting parenting skills and family functioning School-related problems Work-related problems Traumatic experiences, loss and bereavement Disruption of family life due to social, political and religious conflicts It should be noted that socially and economically disadvantaged families may in particular benefit from family therapy and systemic practice.
In a number of European countries, such as Finland and the United Kingdom, these approaches are available and well established within public services. Current evidence base Family therapy (also known as systemic therapy) enables family members to express and explore difficult thoughts and emotions safely, to understand each other’s experiences and views, to appreciate each other’s needs, to build on family strengths and make useful changes in their relationships and their lives.
However, are these statements supported by evidence according to current mainstream scientific standards? Since the 1990´s there has been a steady increase in studies providing a strong evidence base for family therapy in different situations. At present, research of different design and methodology provides substantial evidence for both the efficacy and the effectiveness of diverse family interventions.
Several reviews also suggest that family therapy is not more costly, and sometimes even significantly less expensive than other treatments that do not usually include the family. It is the proven cost-effectiveness of family therapy in some settings that will be of interest to people responsible for public services organization or treatment program development in health care institutions. Some of the research findings show that including a family therapy in treatment significantly reduces costs of provided health care and the cost of pharmacological treatment.
There are a great deal of studies that demonstrate the effectiveness of family therapy, systemic intervention or family work in the treatment of eating disorders, conduct problems, depression, addictions, schizophrenia and other problems in childhood or adolescence. Although the level of efficacy and effectiveness of family therapy and family-based interventions differs according to the research design and studied conditions, family therapy is currently established as an evidence-based psychotherapy approach.
Some recent papers with this supportive evidence are listed at the end of this text among the references. Given the current state of the art in the family therapy field, it is no surprise, that in some European countries, family therapy is recognised as an evidence-based approach by official scientific bodies, for example in the United Kingdom, Germany and Finland. Summary Family therapy based on systemic perspective is a distinctive psychotherapy approach with a primary focus on family and other relationships of an individual.
It is a well-researched approach with strong evidence of efficacy and effectiveness in a wide range of specific conditions. Provision of family therapy should be offered for the following reasons: Family-focused work is an important means of preventing various problems that may become a serious burden for society in general. Family therapy is considered a highly effective approach in the prevention and treatment of various emotional and behavioral problems in childhood and adolescence.
Family therapy can help family members to use their own resources in providing support to each other in various stressful situations, including mental and physical illness. Properly trained family therapists and systemic consultants may use their skills in diverse contexts such as organizations and institutions, where they can foster team work and problem-solving. They can also participate in conflict resolution and negotiation processes in social and political crises.
A systemic perspective in its broadest sense can contribute to strengthening solidarity, tolerance, trust and collaboration, the cornerstones of a healthy society. References Parker, J. Current Practice, Future Responsibilities. AFT 2007, www.aft.org.uk Stratton, P. Report on the evidence base of systemic family therapy. AFT 2005, www.aft.org.uk Asen, E. Outcome research in family therapy. Advances in Psychiatric Treatment.
2002, 8: 230–238 Sexton, T.L., Alexander, J.L., Mease, A.L. Levels of Evidence for the Models and Mechanisms of Therapeutic Change in Family and Couple Therapy. In Lambert, M. Garfield´s and Bergin´s Handbook of Psychotherapy and Behavioral Change, Wiley&Sons, 2004, ISBN: 978-0-471-37755-9 Carr. A. The effectiveness of family therapy and systemic interventions for child-focused problems.
Journal of Family Therapy, 2009, 31, 3-45. Carr, A. The effectiveness of family therapy and systemic interventions for adult-focused problems. Journal of Family Therapy, 2009, 31, 45-74. Russel Crane, D. Effectiveness Research on the Cost of Family Therapy. Psychotherapeutenjopurnal, 2007, 23: 20-24 Russel Crane, D. The cost-effectiveness of family therapy: a summary and progress report. Journal of Family Therapy, 2008, 30:399-410 Russell Crane, D.
Individual and Family Therapy in Managed Care: Comparing the Costs of Treatments by the Mental Health Professions. Journal of Marital and Family Therapy. (In press) www.europeanfamilytherapy.eu http://en.wikipedia.org/wiki/Family_therapy http://www.mayoclinic.com/health/family-therapy/HQ00662 7th June 2009David SkorunkaOn behalf of the working group of the EFTA-NFTO Chamber Download Family Therapy and Systemic Practice: The Essentials
Title: Family Art Therapy Interventions