I. What is family therapy and how is it different from individual counselling?
Family therapy is based on family systems theory which arose from the fields of biology and cybernetics in the 1940s and 1950s. The first influence was Von Bertalanffy, an Austrian biologist, who attempted to integrate systems thinking and biology in a universal theory of living systems. Von Bertalanffy postulated that families are open systems that interact with their environment and that a system is larger than sum of its parts. The latter means that family therapists work both with the ‘parts’ or ‘individual members’ and the interactions or relationship among family members (the ‘larger than sum of the parts’ bit).
By applying von Bertalanffy’s ideas to family systems, early family therapists focussed on the interactional patterns between family members. They developed some central conceptual lenses to understand family interactions. The concept of equifinality refers to the ability of the family to reach a given final goal in many different ways. Morphostasis refers to the forces that stabilise the family over time and morphogenesis refers to forces that support the family’s ability to change and grow. These concepts are commonly held by family therapists from all backgrounds.
The second major influence of family systems theory was cybernetics, the study of feedback mechanisms in self-regulating systems. The idea of positive and negative feedback loops was applied to explain how families use information and communication to maintain a sense of stability over time and to develop mechanisms to adapt to changes in their environment. Note that early family therapists had a mechanistic view of family interactions.
The 1970s and 1980s saw society change from modern to postmodern thinking. Family therapy was similarly transformed by postmodernism, which is the concept of rejecting the idea of the self as a processor of the “truth” and accepting a plurality of voices; of replacing one reality with multiple realities. It is a philosophical position suggesting that reality is constructed within belief systems and that the observer is an integral part in what is observed.
In addition to exploring how family members make adaptive interactions, the discourse expanded to attend to how individual members’ beliefs shape their interaction and more broadly, how cultural forces shape these beliefs. Constructivist theories posit that nothing is perceived directly, that perceptions are filtered through the mind of the observer which draws family therapy into the area of meaning and human beings as meaning-making beings. Constructivists suggest that the meaning that family members derive in mutual interactions influences their interactions in significant ways. Thus, the use of language became a crucial part when working with families.
II. Family therapy vs individual therapy and Medicare
The primary difference between the two approaches is where and how it locates psychopathology. The individual approach derives from a medical perspective whereby pathology is located in the individual intrapsychic space. A family systems perspective regards an individual’s functioning to be determined less by intrapsychic factors and more by his or her experiences of the pushes and pulls of the family system, including competing emotional demands, role definitions and expectations, boundary and hierarchy issues, coalitions and collusions, loyalty conflicts, family and institutional culture and belief systems, double binds, projective identifications, and systemic anxiety. On the other hand, equally relevant are self-correcting and self-reinforcing feedback loops that can either facilitate or hinder pathology or health, breakdown or resilience.
Today, the dilemma is played out in the Better Access funding model of mental health provision under the medical discourse of diagnosis and pathology in a person, in other words, focussing on intrapsychic factors and not on interpersonal factors such as couple or relationship counselling. Family therapy does not fit within the medical discourse of Better Access which has a diagnostic approach which is at odds with a relational construction of problems. Balancing therapeutic fidelity and one’s duty to meet the terms of service provision under the Better Access program is not always possible.
Couples counselling as a subsystem of family therapy shares family therapy’s relational approach and is also disallowed for Better Access funding even when the person’s depression is obviously deeply rooted in the marital discord. The Australian Psychological Professional Advisory Service pronounced that “the provision of relationship counselling does not constitute the valid use of a Better Access item, Relationship counselling does not fulfill Medicare requirements even when a mental disorder is present in both parties, because having two clients in the same consultation would not meet the requirements of the Better Access item descriptor”.
Roles, routines and rituals are the ways a family manifest itself. These roles, routine and rituals need to be executed with sufficient flexibility, responsiveness and cohesion to enhance family experience. On the other hand, some interactional patterns that disrupt family harmony are demand/withdraw, dominance/submission and pursuit/distance.
The family therapist’s standpoint is that the family is doing the best it can, even if the behaviours seem to be unhelpful. The target for therapy is to identify the processes that promote or prevent change and to guide the family unit into more adaptive processes.
The practice of family therapy does not always require the attendance of all family members. The therapist may work with the couple or the parents and a child or any subset of the family group. However, couple counselling is a specialised part of family therapy and in recent times, has been influenced by attachment theory.
Intuitively, this made sense as we live our lives in and through relationships and when they go wrong, there is almost always drastic emotional and psychological distress. Family therapy shifted the focus of treatment from the individual to the patterns of behaviours which promote and sustain symptoms and problems. These symptoms block the family’s ability to draw on its inherent strengths.
The family-informed therapist views the individual client as a single point within a network of influences, past and present, conscious and unconscious. The family therapist of today has a binocular foci on the interpersonal space and the intrapsychic places of the family members.
Providing family therapy is arguably more challenging than individual intervention. While still unregulated, post-graduate training is desirable to be an effective family therapist.
More recently, family therapy has languished for several reasons. There are fewer clinicians willing to train to see families and families scare clinicians. Few clinicians seek to straddle the areas of individual and group dynamics, intrapsychic and interpersonal, the life stages along the family life cycle, simultaneously in a juggling act. It requires a willingness to be nimble, stubbornly respectful and kindly impartial.
Another important factor is the emergence of Family Psychology as a subspecialty of contemporary psychology and how it has defined itself vis-à-vis family therapy.
III. Family Psychology
Systems theory has become commonplace today and family systems viewpoints have gained wide acceptance in psychology over the past 40 years. While many psychologists have been interested in family, marriage, systems theory and contextualism, it was not until the founding of the Division of Family Psychology (IFP) in 1985 and 2 years later, in 1987, its journal, the Journal of Family Psychology that the family psychology specialty achieved a well-defined and differentiated identity within mainstream psychology. The division became a home for interests relevant to psychologists who wished to practice from a family therapy or systems perspective. The founding of JFP (first a divisional journal and now an APA journal) is an endorsement of the specialty’s centrality in contemporary psychology. Family psychology is usually taught within a clinical or child psychology speciality.
The first issue of the Journal of Family Psychology defined Family Psychology as follows:
“Family psychology, using a systemic perspective, broadens psychology’s traditional emphasis on the individual. and, while it retains a primary emphasis on marriage and the family, it uses the systemic view to focus on the nature and role of individuals in primary relationship structures, as well as, more broadly, the social ecology of the family-those networks in which the family interacts and resides. (Liddle, 1987a, p. 9)”
Family psychology has added other significant perspectives to family therapy’s systems theory. Family psychology uses a broad, developmental perspective to understand health and illness or problems and thus, family therapy can rightly be regarded as a subcategory of family psychology.
The American Society for Couple & Family Psychology (https://www.apadivisions.org/division-43/about/specialty) declared Family Psychology as a Specialty:
Family Psychology is a Specialty
The specialty of Family Psychology is unique because of the perspective from which family psychologists are trained to consider the biopsychosocial problems of their clients. Family Psychology is an approach to understanding human functioning and treating problems that is based on general systems theory. The systems perspective assumes that the emotional functioning of individuals within a group is interdependent so that the feelings and behavior of one person can only be understood within the context of other group members.
The distinctiveness of Family Psychology cannot be defined based on the populations with whom family psychologists work because of its broad application. Nor can Family Psychology be defined by the number of people in the consulting room. Rather, it is defined by its systems perspective from which problems and developmental issues are addressed.
It is not so much that family psychologists treat different populations than other professional psychologists. Nor is it even that a family psychologist’s clients present with vastly different problems. Rather, the epistemology of the family psychologist differentiates him or her from the more traditionally trained professional psychologist. The family psychologist is trained to approach client issues from systemic and multisystemic perspectives. This perspective provides a vastly different conceptual model from which to view the complex presenting issues of families and their constituent members. Whether the client is a family, a couple, or a single member of a family, to the extent that the client’s presenting issue intersects with family or systemic functioning, a specialized conceptual model and related interventions are required. Consequently, a specialization in family psychology provides a unique perspective and approach to working with many of the same populations and problems treated by psychologists from other specialties.
In sum, the family relationship clinician operates with a binocular vision of the intrapsychic (within person psychopathology-health) and the interpersonal (relationship or between persons psychopathology-health) juggling both in an equitable manner which fits the contemporary speciality of couples counselling approaches by Gottman, Sue Johnson’s Emotion-Focussed Therapy and Schema Therapy for Couples.