Family Therapy

Family therapy, also known as couples therapy or marital therapy, is part of psychotherapy aimed to identify and solve psychological and other problems arising from interaction between partners and spouses. Family therapy has its roots in the social work movements of the 19th century in Britain and the United States. However, as a branch of psychotherapy, marital therapy evolved from the marriage counseling movements of the 20th century. Its growth as a distinct profession can be traced back to the 1942 establishment of the American Association of Marriage Counselors, later renamed American Association of Marriage and Family Therapy (AAMFT), and the work of independent clinicians who gathered family members for therapy sessions. The field is largely influenced by psychoanalysis, social learning and behavior theories. Despite their variety, most marital therapy models view the family or the couple as a whole entity of interrelated members rather than as a mere sum of individuals.

Behavioral couples therapy (BCT) is believed to have the widest research base, drawing heavily on social exchange and social learning theories. Therapists using this approach focus on raising the positive and reducing the negative interactions in distressed couples, teaching them communication behaviors and conflict-solving techniques to address problems when they arise. For instance, partners are guided by the therapist to make and enact lists of positive actions they could do for each other, focusing on problem areas. Thus, couples facing difficulties over parenting are encouraged to share parental duties to handle the problem. The communication and problem-solving skills include clearly outlining the problem, giving solutions, picking solutions that suit both partners, applying the solution and assessing its effect.

The integrated behavioral couples therapy (IBCT) is a modification of the traditional behavioral couples theory. While BCT focuses on change, the IBCT is seeking balance between change and acceptance. The IBCT is also helping reduce withdrawal/escape behavior or at least raise tolerance to such behavior indirectly reinforcing emotional links between partners. Cognitive behavioral couples therapy (CBCT) is developed from the BCT but additionally includes cognitions, their assessment and their change to achieve greater accuracy. Cognitions that are studied and included in the therapy are assumptions about the partner, attributions to past behavior and expectations on partners' behavior.

The emotionally focused theory (EFT) sees problems of couples arising from underdeveloped or disrupted attachment ties, which alienate partners emotionally and reduce relationship satisfaction. The family systems approach views couples problems in the multilevel setting of the wider society and culture.

Couples go to therapists for up to 20 sessions to discuss, solve or at least accept difficulties in their relationships. They largely seek help to solve sex and communication problems, cope with divorce or separation, infidelity and domestic violence, and address parenting difficulties. Problems in the parent-child dyad may include difficulties with a particular child, disagreements about parental roles and duties and the more conflict-ridden relations with stepchildren.

Dissatisfaction with sex life may arise from different expectations of partners on when, where and how they would have sex, or in more complex cases, from the different emotional implications each partner attach to sex with some using sex as a means of reconciliation and others needing to reconcile first and then make sex.

A key issue in addressing infidelity problems is whether the couple would dissolve or stay together, while regarding home violence problems therapists are split on whether it is appropriate to treat the couple together. Family therapists also try to solve problems of ageing, same-sex, intercultural and interracial couples. These specific groups bring to therapy both the problems of traditional couples and additional issues including homophobia, the stigma of living without marriage, the learning to cope with illness or death of a spouse, the ways to deal with prejudice and racism and the problems arising from interaction of different cultures.

Couples therapy also seeks solutions of individual problems such as depression, anxiety disorders (agoraphobia) and substance abuse (mostly alcoholism). Therapy interventions are primarily focused on relationship patterns and family therapists are often referred to as relational therapists. In general, family therapists are more interested in solving problems than in finding a cause.

Selected full-text books and articles on this topic

Handbook of Family Therapy: The Science and Practice of Working with Families and Couples
Thomas L. Sexton; Gerald R. Weeks; Michael S. Robbins.
Brunner-Routledge, 2003
An Introduction to Family Therapy: Systemic Theory and Practice
Rudi Dallos; Ros Draper.
Open University Press, 2005 (2nd edition)
Research Methods in Family Therapy
Douglas H. Sprenkle; Fred P. Piercy.
Guilford Press, 2005
Global Perspectives in Family Therapy: Development, Practice, and Trends
Kit S.Ng.
Brunner-Routledge, 2003
Culturally Competent Family Therapy: A General Model
Shlomo Ariel.
Praeger Publishers, 1999
Family Therapy beyond Postmodernism: Practice Challenges Theory
Carmel Flaskas.
Routledge, 2002
Creating An Ethical Position in Family Therapy
Ivan B. Inger; Jeri Inger.
Karnac Books, 1994
Family Therapy: First Steps towards a Systemic Approach
John B. Burnham.
Routledge, 1988
Foundations of Family Therapy: A Conceptual Framework for Systems Change
Lynn Hoffman.
Basic Books, 1981
Exchanging Voices: A Collaborative Approach to Family Therapy
Lynn Hoffman.
Karnac Books, 1993
Family Therapy as An Alternative to Medication: An Appraisal of Pharmland
Phoebe S. Prosky; David V. Keith.
Brunner Routledge, 2003
Clinical Competencies Specific to Family-Based Therapy
Stinchfield, Tracy Anne.
Counselor Education and Supervision, Vol. 43, No. 4, June 2004
Milan Systemic Family Therapy: Conversations in Theory and Practice
Luigi Boscolo; Gianfranco Cecching; Lynn Hoffman; Peggy Penn.
Basic Books, 1987
Second Thoughts on the Theory and Practice of the Milan Approach to Family Therapy
David Campbell; Ros Draper; Clare Huffington.
Karnac Books, 1991
The Integrative Family Therapy Supervisor: A Primer
Robert E. Lee; Craig A. Everett.
Brunner-Routledge, 2004
Family Therapy Review: Preparing for Comprehensive and Licensing Examinations
Robert H. Coombs.
Lawrence Erlbaum Associates, 2005
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