Family therapy

Sidney Bloch and Edwin Harari Historicaldeyelopments

Proliferation, of'schools' therapy


Systems^-orientedjherapy,:, furtheLde.velopments Postmodern developments

Criticism,,, oLs.ystems „approaches

Indications fo.Lfam.ily,, therapy Contraindications.,, for ,fa.mily,,therapy Assessment History,, from „the, „patient

Tihepres,e,nti,ng,, proMemand,,, changes, i,n,,t.h„e., ,fa.mi!y Ihewid,e,Lfa,mily, .context

Making, ,a,, Pr0yisi0na!l,,f0,rmu!atl0n How, doe,slh,e,famNy, function,?

Are,,fami!y,, ,fac,tors,.i.n.volyed,,,in„ ths,,patient,is,,problemis? Interview,, w,it,h,,,,ke,y,,l,n,fo,r,m,a,nts ThefamJly, Mintervlew

Revised formulation

The, course of, therapy Role,,of, the,, family therapist TheMnMilan,,approach Problems,,encountered,in,, therapy,, famil,y,th.erapy


Chapter, References

The term 'family therapy', coined by the American psychiatrist Nathan Ackerman in the 1950s, covers a variety of approaches. At one extreme, family therapy is a method drawn from one or more of a range of schools which seeks to help the individual patient who is the locus of psychopathology. At the other extreme, family therapy is a way of thinking about psychotherapy; the intervention may involve the individual alone, the nuclear family, or an extended network; however, the focus is not so much on the individual but rather the relationships between people. According to this view psychopathology reflects recurring, problematic interactional patterns among family members and between the family and, possibly, other social institutions, including doctors and helping agencies. Midway between these two positions is one that views the family as acting potentially either as a resource or a liability for an identified patient. Different interventions are thus needed to enhance the positive effects of family relationships compared with those that seek to minimize or negate their noxious effects.

As will be elaborated below, such a range of interventions makes it difficult to define and research family therapy. Historical developments

The family has long been recognized as a fundamental unit of social organization in the lives of humans. Regardless of the specific pattern of family life, the foundational narratives, myths, legends, and folklore of all cultures emphasize the power of family relations to mould the character of the individual and serve as an exemplar of the moral and political order of society.

In the past 150 years new academic disciplines, among them anthropology, sociology, and social history, have devoted considerable attention to the various forms of family structure found in different cultures at different historical periods. Constrained perhaps by Western medicine's focus on the individual patient, psychiatry has been slow to develop an interest in the family other than as a source of genetically transmitted diseases.

Scattered through the writings of Sigmund Freud are interesting and provocative comments about marital and family relationships and their possible roles in both individual normal development and psychopathology.(l) Freud's description of unconscious processes like introjection, projection, and identification explained how individual experiences could be transmitted across the generations in a family. Freud's successors elaborated and modified his formulations; for instance, in 1921, J.C. Flugel published the first detailed psychoanalytical account of family relationships. (2)

Strongly influenced by the work in the United Kingdom of Anna Freud, Melanie Klein, and Donald Winnicott, the child guidance movement developed a model of one therapist working with the disturbed child and another with the parents, most often the mother on her own. The two clinicians collaborated in order to recognize how the mother's anxieties distorted her perception and handling of her child, which added to the child's own developmental anxieties. This work, however, was conducted by psychiatric social workers and only a minority of psychiatrists.

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