The idea of solving the whole family’s health problem issues has been a unique aspect of the change in thinking and to bring new discipline in the field of mental health, which is called family therapy. The idea is to drop the focus on individuals and their psyches and to consider the whole relationship system and the contexts in which people live, where problems develop, and where we can find the solution too (Thomas L. Sexton et al, 2003, p.3). Family therapy is an effective approach to guide families in handling psychological problems. Issues like eating disorders, conflict, and trauma are all possible for the trained family therapist to treat (Pauline Kafka, 2008).
Thomas L. Sexton et al (2003) mention that ever since the Civil Rights movement, cultural sensitivity has been propagated as a matter of priority where ethnic groups form the core of diversity in a large country like the USA. As part of the nationwide development of community health services catering to ethnic groups, maximum priority has been given to family therapy which is a solid foundation for the creation of a healthy and well-networked society. The family theory has always expounded behavior within the family to be more in context and very ecological to the growth of a society on the move. Social researchers on the various ethnic groups have been observing the changing dynamics of human behavior that influences family growth and its identity. Thus data on collective identities of different ethnic groups based on gender, language, income levels, education, etc. have been collected to promote the growth and networking of cultures. When it comes to studying multiculturalism it is important to view cultural diversity and a social justice system. Multiculturalism has a deeper connection with the traditional schools of thought i.e., psychology and structural methods of the different social schools of thought. As naturalized citizens from different ethnic backgrounds and from the same community mingle amongst each other, their response system is more or less similar, but it is complex when matched against a race or ethnic background when the two individuals are from different backgrounds altogether. Demographics reveal that since the last 2 or 3 decades a lot of cross-cultural migration has occurred, which has practically uprooted them from their home countries. The separation from their home country as a result of time and acquiring new cultural habits plays a significant role in the diversity and culture of the society. With the passage of time, social values and culture do change as a result of progress in science and technology, which has an indirect impact on citizens and their family behavior. Also, another important feature is the practice of religious rituals, health preservation, and other values and a general outlook towards life, work, and people that contribute to the wellbeing of the individual at a micro-level in the society (Thomas L. Sexton et al, 2003).
There are various models of family therapy like cognitive behavioral model; natural system model; problem focus model; structural model; solution-focused model; strategic model, narrative model; collaborative language system model. Now we will describe the different forms and models of therapy for families individually to analyze each one value:
Structural Family Therapy
Structural family therapy is the most powerful approach for understanding and healing troubled families. In SFT the family’s life history is assessed on the basis of balance between stability and change. The family is considered as one system which has larger social systems and smaller sub social systems. To evaluate the functionality of family patterns family structure, subsystems and boundaries play an important role. To recognize the hierarchy among individuals, subsystems, coalitions and the rules are also very important to understand and help a family (Pauline Kafka, 2008).
Family Patterns: Structural Family Therapy has three basic subsystems (Pauline Kafka, 2008):
- The spouse subsystem where the role of couple relationship and its functions are evaluated.
- The parental subsystem in which role and function of parental relationship is maintained.
- The sibling subsystem where the role and function of children’ relationship is assessed.
Family Boundaries: Understanding a family needs to recognize the processes and boundaries which operate the subsystem in the family. Minuchin has defined three types of interpersonal boundaries which establish the overall ability of the family (Pauline Kafka, 2008):
- Clear boundaries of generic subsystems are good as they are firm as well as flexible.
- Inflexible boundaries bring disengagement between family members and subsystems.
- Diffuse boundaries signify that no one is taking charge and effective guidance during times of change.
Basically SFT defines rules, processes and their interconnections. The main aim of the family therapist is to understand the current structure of the family members and to find out the way they can prevent effective adaptation (Pauline Kafka, 2008).
Natural Systems Theory
Alan S. Gurman (2008) has mentioned that Bowen developed Natural Systems Theory out of some observations and interactions in families where schizophrenic members could be found. During 1954 to 1959 Bowen described dysfunctional cycles of behavior between the patients and psychotic patients. Earlier the clinical researchers just studied the connections between mothers and the patients but Bowen analyzed the important role of the fathers and the quality of the marriage. Bowen’s team investigated fusion and triangulation in families whenever they observed a psychiatric patient’s frequent relapses. Bowen also said if certain types of fusion are also present in a marriage and the family then after modifying these patterns in family therapy the psychotic symptoms can be improved (Alan S. Gurman, 2008).
Cognitive Behavior Therapy
In the sixties, cognitive behavioral therapy was used to treat individuals (especially children), in the treatment of anxiety and depression, but over the years, cognitive behavior therapy was improvised by devising ways to improve communication and bring in a problem solving approach to be used for treating the complex problems arising from intimate family relationships. Cognitive behavioral couple and family therapy (Dattilio & Epstein) stresses the significant role played by cognition in marital problems that are manifested in disillusionment and unrealistic expectations that exist between a couple. Although family therapies did exist long before, it was discovered that using cognitive factors was as important as combining with patterns of behavioral interaction. As societies began to progress with the advancement in lifestyles and standard of living, it became increasingly important to employ cognitive factors while researching into marital solutions and the wide array of research papers written and published in gazettes and other forms of medical literature. They were used to deal and address problems jointly with couples having strained relations, and also at an individual partner level where skills could be evaluated and enhanced for modifying problem areas when making use of own cognition skills and problem solving approach. Post the seventies, several researchers and many psycho-analysts have contributed to the improvement in the use of cognitive factors to make the therapy more effective when dealing with couples and families that were affected by dysfunctional relationships. The decade from 1980-90, saw a surge in wide research and contribution to literature that was focused on cognitive behavioral couple and family therapy. The year 1989 is particularly significant, because researchers viz., Baucom and Epstein happened to lend form to the various kinds of cognitions that address distress spots in relationships. However there could be lacunae to the use of the vast amount of available information when treating difficult relationships as there could be a possibility of wrong inferences and assumptions amongst couples. Hence inaccurate predictions could hamper relationships further (Thomas L. Sexton et al, 2003).
When we see a relationship between a child and the problem, we see the importance of playfulness. In narrative therapy playful approaches are direct and do not much focus on the child as a problem rather they perceive child problem relationship in a way which is significant for adults as well (Narrative Therapy with Children and their families, Para 5).
“The problem is the problem, the person is not the problem” is an oft quoted maxim of narrative therapy. The linguistic practice of externalization, (White, 1988/9; White & Epston, 1990a) which separates persons from problems, is a playful way to motivate children to face and diminish difficulties (Narrative Therapy with Children and their families, Para 6).
When the problem is taken as integral part of character or nature of the persons’ relationships, it’s very difficult for them to change. If the problem is separated from the person, it relieves the pressure of blames and defensiveness. After establishing some distance from the problem, family members can think about the effects of the problems on their lives and can find out the or own resources to have relationship with it. This practice creates a lighter atmosphere for the children who can handle their own problem rather than facing, blame, guilt and shame (Narrative Therapy with Children and their families, Para 7).
Communication Model: Mental Research Institute (MRI)
The Mental Research Institute handles minor difficulties, small problems and daily hassles. MRI therapy focuses on distress not behavior. It makes efforts to reduce distress in which the client has to behave differently when he faces the problem (W.A. Griffin et al, 1999).
- When a smaller problem is not handled properly then the next problem occurs and this mishandling creates distress.
- When a problem occurs, the solutions to rectify the problem vary
Therapy: The aim of therapy is to reduce distress which is linked with the current problem. Distress can be reduced by changing behaviors’ linked with the current problem and to present the problem in that way which reduces the distress (W.A. Griffin et al, 1999).
Solution Focused Therapy
Solution Focused Therapy (SFT) is linked to solving problem(s) at a root cause level, and hence it is associated with Brief Therapy, Problem Focused Therapy and Possibility Therapy, all of which have a commonality of purpose. The focus is on the language of thought e.g., language of perceiving the problem versus language of perceiving the solution (Solution Focused Therapy).
A study of the basic theory approach reveals the procedural methodology that has helped couples resolve issues in marital communication, by looking into the role and standpoint of the SFT therapist and the client (Solution Focused Therapy).
The interaction between an SFT therapist and a client works in different ways with different people. Salient features of the SFT program (Solution Focused Therapy):
- It is insight oriented and future focused
- Does not get too deep into member’s pathology
It is very important to identify the kinds of couple who come in for SFT treatment, and they are generally of 3 types : visitor, complainant, and customer. These kinds of couple seek treatment from a certain point of view e.g., ‘visitor’ denies that he has no problem, which is indicative of the fact that he is insensitive and lacks a sense of responsibility, ‘complainant’ admits that they have a problem but need a third party to fix it for them, ‘customer’ does admit that they have a problem and own up to resolve issues (Solution Focused Therapy).
Although SFT is quite effective when followed correctly, however research findings reveal that SFT has a skewed success ratio because of certain design flaws in the way it is administered.
SFT has a certain methodology to be followed and has the following stages as a procedure:
Pre-Session – Session [Stage-1: Socializing and joining, Stage-2: Problem description, Stage-3: Goaling, Stage:4 Break, Stage:5 Ending ]
Kafka, P (2008) Structural Family Therapy. Web.
Griffin, W. A. (1999) Models of Family Therapy: the essential guide, Brunner/ Mazel, Philadelphia, p.155
Gurman S A (2008) Clinical Handbook of Couple Therapy, The Guildford Press, New York, p.736
Narrative Therapy with Children and their Families. Web.
Sexton, L T et al (2003), Handbook of Family Therapy: the Science and practice of working with, Brunner Routledge, New York, p.489