Basics of Family Therapy

Despite which technique or theory you use, typically the beginnings of family therapy will look the same. Usually, family therapy includes everyone who lives in the household, and sometimes extended family members. The therapist begins by establishing report with all the members. Greet the contact person first, and greet everyone, including children, individually. After everyone has settled, summarize the initial contact conversation and ask for input. Listen and reflect every point of view. When someone does not offer input in the initial conversation, ask for it directly. Establish a bond with every family member to reduce anxiety. You want to convey the message that you are not going to scapegoat anyone or jump to conclusions. Develop a hypothesis about the family; are there triangles? How do they benefit from the presenting problem? What is the cycle of the presenting problem? Is there a scapegoat? What are the boundaries like?

To minimize yelling, establish a rule that only one person may speak at a time. If emotions are becoming too volatile too early, change directions. Exploring strengths is always a good idea. Imagine a couple who entered therapy as a last resort to avoiding divorce. The wife is counting off a list of complaints about the husband, saying he's emotionally distant, ignores her, etc etc. The husband is becoming tense and annoyed hearing a reiteration of his failings. When the wife slows down, the therapist could say, 'I can see how that would be frustrating. I'm just curious; what do you think his strengths are in this family?' The wife switches directions and begins to talk about how good of a father he is, how he responds to his children's needs. First, the husband has probably heard his list of failures many times, but probably not heard his wife praise his parenting skills recently. The tension between the two deescalates. The strengths question and answer here could also be taken down the solution focused path and search for exceptions. But I'll come back to the solution focused technique in a later entry.

Adapted from:
Nichols, M. (2009). The essentials of family therapy (4th ed.) Boston: Pearson.