Families in Psychiatry: Therapy in Romania and Lessons for the West

Article excerpt

In the United States, family psychiatrists continue to deal with the fallout from the 1950s and 1960s, when the early family therapists located mental illness within the family and then touted family therapy as the cure. Families felt blamed and shied away from "family therapy"

Yet, research shows that family treatment for many psychiatric and medical illnesses, whether it is family inclusion or psychoeducation, is very effective in reducing morbidity Stigma and fear about family involvement have resulted in family treatment lagging behind other psychotherapies in its acceptance as a valid therapeutic intervention.

As a contrast, it is therefore interesting to look at Romania, a postcommunist country, where all psychotherapies were deemed "unnecessary" under communism. "Psychotherapy and psychoanalysis were known as the studies of the soul during the communist regime and went underground. Secret psychotherapy meetings were held in Sibiu and Timisoara, but after the 1989 revolution, we had access to information from abroad," Dr. Ileana-Mihaela Botezat-Antonescu said during a presentation this year at the World Psychiatric Association meeting in Bucharest, Romania.

"In 1990, freedom occurs, but nobody tells you what to do. You cannot count on anything. It alienated people seeking help. It was a process that took time," said Dr. Botezat-Antonescu, a psychiatrist and psychoanalyst who was trained in the mid-1990s by the Dutch Psychoanalytic Association and serves as chair of the National Center for Mental Health.

Psychotherapists in Romania must somehow address the traumatic environment that lasted a generation. Young people strive to gain their sense of identity and belonging and are challenged with reestablishing a connection between the generations. The sense of intergenerational trauma and loss extends back to grandparents who lost their farms, houses, and social position.

An understanding of the intergenerational transmission of trauma can inform psychotherapists across the globe in their care of young people. Family therapy is a type of psychotherapy that is well suited to address this intergenerational trauma.

Psychological trauma is passed down through the generations in subtle and unspoken ways. It is important for therapists to recognize when this is occurring and work with the whole family. Family therapy that specifically addresses the intergenerational transmission of trauma can help move a family from feelings of helplessness toward resilience.

Development of family therapy

Family therapy developed in Romania through training courses in Cluj, Targu Mures, and Timisoara.

As there were no Romanian trainers, these courses were taught by family therapists from countries such as Ireland, France, and Yugoslavia. Families and trainees spoke Romanian or Hungarian, and during live supervision, simultaneous translation occurred. All courses, readings, and assignments were in English.

Trainees saw families in their own work contexts, for example, psychotherapy centers; psychiatry hospitals; and community centers, such as family planning clinics and domestic violence shelters. Currently, there are 16 family therapy professional organizations (Contemp. Fam. Ther. 2013;35:275-87), including:

* Systemic Family Therapy Association in Cluj

* Association of Family Therapy in Bucharest

* Romanian Association for Family and Systemic Therapy in Timisoara

* Association Crisdu Areopagus in Timisoara

* Pro Familia--Family Therapy Association in Miercurea-Ciuc

* Association for Couple and Family Psychotherapy in Iasi

* Association for Family Counselling and Therapy in Iasi

Dr. Zoltan Konya and Dr. Agnes Konya run the family therapy center in Cluj and have written about the challenges of practicing family therapy in Romania (Context 2007;92:2-4 and Contemporary Family Therapy 2013;35:1). …