Contraindications for family therapy

These are more straightforward than indications. They are self-evident and therefore mentioned only briefly.

1. The family is unavailable because of geographical dispersal or death.

2. There is no shared motivation for change. One or more family members may wish to participate, but their chances of benefiting from a family approach are likely to be less than if committing themselves to individual therapy. (We need to distinguish here between poor motivation and ambivalence; in the latter, the assessor teases out factors that underlie the ambivalence and may encourage the family's engagement.)

3. The level of family disturbance is so severe or long-standing, or both, that a family approach seems prognostically futile. For example, a family that has fought bitterly for years is unlikely to engage in the constructive purpose of exploring their patterns of functioning.

4. Family equilibrium is so precarious that the inevitable turbulence (32) arising from family therapy is likely to lead to decompensation of one or more members; for example, a sexually abused adult may do better in individual therapy than by confronting the abusing relative.

5. The patient is too incapacitated to withstand the demands of family therapy. The person in the midst of a psychotic episode or someone buffeted by severe melancholia is too affected by the illness to engage in family work.

6. An identified patient acknowledges family factors in the evolution of his problem, but seeks the privacy of individual therapy to explore it, at least initially. For example, a university student struggling to achieve a coherent sense of identity may benefit more from her individual pursuit of self-understanding. Such an approach, of course, does not negate an attempt to understand the contribution of family factors to the problem.

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