What Does a Family Therapist Do?

Although the history of family therapy is short, it has a long past. For years, to protect the privacy of doctor-patient relationships, healers have opposed the inclusion of patients' families in treatment. The Freudian healers excluded the true family from the treatment and tried to reveal unconscious, projective family characteristics. The Rogers genre also stayed away from the visitor's family, who provided the visitor with unconditional attention. The hospital's psychiatrist also does not encourage family visits because these people may undermine the hospital's good atmosphere. Some concentrated progress in the 1950s and 1950s led to a new view that the family is a vivid system, an organic whole. Observed in psychiatric hospitals, usually when the patient's condition improves, someone in the family will have problems, and changing the family may be an effective way. These observations have promoted the family therapy movement, but the excitement caused by this has blurred the line between researchers' observations and conclusions. The observed result is that the schizophrenic behavior is compatible with the family, and the conclusion is that the family is the cause of schizophrenia. The family is seen as the product of a "system" rather than individual characteristics that share common characteristics as a result of living together. Therefore, the new term of home system came into being. Family therapy has been promoted and developed with the development of hospital psychiatry, group dynamics, interpersonal psychiatry, child-directed sports, and schizophrenia research. John Elderkin Bell, Don Jackson, Nathan Ackerman, and Murray Bowen were the first to start home therapy. In addition, Jay Haley, Virginia Satir, Carl Whitaker, Lyman Wynne, Ivan Boszormenyi-Nagy, and Salvador Minuchin were also important pioneers. . The 1970s and 1980s were the golden age of family therapy. ^[1]

Aixia	(Supervising Psychotherapist)	Department of Clinical Psychology, Beijing Huilongguan Hospital
Guo Chufang	(Attending physician)	Department of Clinical Psychology, Beijing Huilongguan Hospital
Liu Huaqing	(Chief physician)	Department of Clinical Psychology, Beijing Huilongguan Hospital

Family therapy is a group psychotherapy model implemented for families. Its goal is to help families eliminate abnormal and morbid conditions in order to perform healthy family functions. The characteristics of family therapy: instead of focusing on the analysis of the internal psychological structure and status of individual family members, the focus is on the interactions and relationships of family members; explaining individual behaviors and problems from the perspective of family systems; individual changes depend on The whole family changes.

Overview of Family Therapy Development

Home therapy basic concepts

1 Family therapy 1) Interpersonal communication environment

The basic premise of family therapy is that people are a product of their environment. The interaction between an individual and his family members greatly affects his behavior. The therapist attempts to treat the visitor by talking to the client for 50 minutes a week. These 50 minutes of influence will be less than the influence of the people they have contacted for the remaining 167 hours of the week. So often the most effective way to help people solve problems is to meet them and the important people in their lives.

2 Family therapy 2) Complementarity

In any relationship, the behavior of one person is linked to the behavior of others. Most of human action is half of interaction. If one person changes, the relationship changesthe other person will naturally be affected. Family therapists need to consider complementarity when they hear one person complaining about another. For example, husbands often complain about wives. Being considered stingy may mean that no one has listened to her concerns for a long time. Complementarity means mutual influence. Proper complementarity enables couples to divide work and support each other. Rigid complementarity limits individuals' ability to reach their full potential and rigidifies relationships.

3 Home Therapy 3) Cyclic Causality

Actions are interconnected through a series of recursive loops or repeated loops. The theory is that don't analyze and search for who caused what happened with the family without result. The problem is sustained by a series of ongoing actions and feedback. It doesn't matter who initiated it.

4 Family therapy 4) Triangle relationship

Bowen believes that a three-person system is the smallest stable group in human relationships. The two-person system is unstable. When problems arise in the relationship between two people, one or both parties will turn to the sympathy or conflict of the other person to attract a third party. For example, if a couple has a quarrel, sometimes it cannot be resolved, they will catch a child in and involve the child. For example, if the husband is busy at work, the wife will divert happiness and attention to the child. The third person is not passively pulled in, but will run out to help parents maintain a happy family. A person fails to achieve a high degree of self-differentiation because he is in a triangle relationship. The triangular relationship prevents family members from facing the real problems of the family. For a family of three, the son may have listened to the complaints of both husband and wife, and both parties are very good, but the problem of the husband and wife is still not really solved.

5 Family therapy 5) Family structure

It refers to the functional structure in the family that can affect the interaction between family members. The family is composed of sub-systems, which can be divided by generations, behaviors, common interests, and functions, and separated by interpersonal boundaries. Boundaries protect the independence and autonomy of families and their sub-systems. For example, the rule that you are not allowed to call during dinner is a line that protects families from interference. Subsystems that are not adequately protected by boundaries can limit the development of interpersonal skills. If the child is allowed to interrupt the parent's conversation casually, the boundaries between generations will be attacked, and the relationship between husband and wife will be destroyed by the role of parents. If parents are always involved in disputes between children, children cannot learn how to win their own battles. Rigid boundaries can foster autonomy. The downside is the lack of warmth and affection. Entangled parents provide a sense of intimacy to their children, but excessive intimacy can weaken initiative.

6 Home treatment 6) Significance of symptoms

The patient's symptoms have a stabilizing effect on the family, and the effect of this inherent balance is called symptom function. In an article called "Children with emotional disorders are scapegoats for families", it is pointed out that children with emotional disorders are involved in parental tensions without exception, and parental conflicts are transferred to one of their children so that they Will be able to maintain a stable relationship. The idea that symptoms serve function has been widely questioned, but in some cases it is worth considering this possibility. For example, a mother's depression or a child's refusal to go to school may prove to be a function of protecting the family.

7 Family therapy 7) Family life cycle

It refers to the different stages of family life, from separation from their parents to marriage, having children, getting older, retiring, and eventually dying. Including single young people leaving home, loved ones forming a family through marriage, the arrival of the first child, adolescent children at home, children living independently from home, and family life at the end of life. The life cycle is like a calibrated clock. At the end of the time, the family's internal functions and development tasks must be adjusted accordingly, otherwise problems will easily occur. For example, single young people who leave their homes need to be economically and emotionally differentiated from their original families. They need to establish close peer relationships and gradually become mature people who can live independently. At this time, it is necessary for the native family and the young people to be able to make some adjustments. The family can give the child a modest space and give some encouragement and support to the child's development outside the family. ^[1]

Main schools of home therapy

1 Family therapy 1) Bowen family system therapy

First proposed by Bowen, it is also known as Bowen theory. He tends to understand the family as a systems theory rather than a method of intervention. Six important concepts were put forward in his theory: self-differentiation, triangular relationship, nuclear family emotional processes, intergenerational transmission, emotional isolation, and social emotional processes. Among them, "self-differentiation" is Bowen's core theory. Its function is the individual's ability to deal with stress. People with poor autonomy and independence often struggle with their families too much, which can easily cause dysfunction. "Triangular relationship" is another important concept proposed by Bowen. He believes that the main factor leading to the emotional triangle is anxiety. The increase in anxiety will make people more emotionally close to each other. The problem between individuals in the coming year is that the feeling of the victim will prompt the individual to seek the sympathy of others, or pull the third party into conflict. Third-party involvement can ease anxiety by dispersing anxiety in a triangular relationship. Bowen's theory is an important contribution to family therapy, and it has also become an enlightening concept of family therapy. Among the pioneers of family therapy, the family therapist at Bowen expanded on the principles of psychoanalysis and provided a broader perspective on the study of human behavior and problems in family therapy.

2 Family therapy 2) Structural family therapy

Minuchin began his family therapy career in the early 1960s. At that time, he found that there were two models of problematic families: some families were tangled, in chaos and closely connected to each other; another family was separated, isolated and seemingly unrelated. Both types of families lack a clear line of rights, and overly entangled parents are too involved in their children, thereby losing parental leadership and control. Structural family therapy provides such a blueprint and provides the foundation for tissue strategy therapy. Structural family therapy has three basic components: structure, sub-system, and boundary. The techniques of structural family therapy include two general strategies. First, the therapist must adapt to the family to truly 'join' the family. Challenging the family's preferred relationship model often triggers family resistance. Conversely, families are more likely to receive treatment if they begin to understand and accept the family. Once the goal of initially joining the family was achieved, structuralists began using reorganization strategies.

These positive strategies have achieved the goal of breaking down dysfunctional structures by strengthening loose boundaries and relaxing rigid boundaries. In 1981, Minuchin moved to New York and established the now-famous Minuchin Family Therapy Center. In addition, there are some simple and practical techniques for structural family therapy that are worth introducing: imitation refers to the process of participating in the family by imitating behavior, style, emotional range or communication content. The therapist may talk about personal experience. These practices are sometimes spontaneous and sometimes designed; however, they usually have measures to increase the therapist's connection to the family. Action initiation refers to the therapist bringing external family conflicts into the treatment session so that family members can demonstrate their treatment, the therapist can also observe the process, and begin to find ways to correct their interactions and cause structural changes. The therapist uses this technique to actively create scenarios where family members exhibit poor communication during treatment time.

3 Family therapy 3) Strategic family therapy

The most profound impact of decades of tactical therapy came from Milton Erickson, although the impact did not occur until his death. From the mid-1970s to the mid-1980s, the strategic approach attracted many family therapists. One of the reasons is that it will focus on practice and problem-solving as the center, which not only becomes a fascination for tactics, but also a confusing place. Erickson's talent has been widely praised and imitated, but it is very regrettable that many healers have not mastered the principles of predictable treatment. Instead, they just imitate Erickson's 'unusual technology'. However, tactical therapy shows strong control over the visitor, and it shows distinctive creativity and operability from the perspective of unique thinking. At the same time, the emergence of strategies can mask resistance and stimulate family change. The predominant treatments of the 1990s raised the status of cognition. Bring cognitive status beyond behavior and encourage the therapist to collaborate with the visitor instead of manipulating the visitor. Such a change is the gradual withdrawal of tactical therapy.

4 Family therapy 4) Experienced family therapy

Empirical family therapy originates from the humanistic trend of thought in psychology. It is inspired by expressive therapy and emphasizes the role of timely and current experience here and now. In the early stages of home therapy, some techniques were borrowed from individual and group therapy, when empirical home therapy was very popular. It borrows arousal techniques such as role-playing and emotional confrontation from Gestalt therapy and understanding groups, while other expressive therapies such as sculpting and family painting have a profound impact on art and psychodrama. In the genre of empirical family therapy, two great masters appeared: Carl Whitaker and Virginia Satir. Whitaker advocates a free, intuitive approach to breaking down camouflage, liberating self, and returning each family member to the true self. He first applied psychotherapy to the family, and although he was once considered independent, he became one of the most prominent therapists in the field. Breaking the old habit, though considered tolerable at the time, Whitaker was still respected for his achievements in family therapy. Virginia Satir is one of the key figures in the development of family therapy. She believes that a healthy family life includes being open and sharing feelings, feelings and love together. She is also famous for describing family roles, such as "savior" and "pacifier". She believes that the function of family roles is to restrain the relationships in the family. Empirical family therapy is based on the premise that the causes and effects of family problems make emotional stress. Systematic family therapists look at the roots of symptomatic behavior from the perspective of family interaction patterns, which are seen as the result of the shadows of the family members' respective defense projections. From this perspective, if family members can first understand how they really feel-fear and anxiety, and hope and desire, then trying some positive changes in the family will be more successful. Therefore, empirical family therapy starts from the inside, helping individuals to express their sincere emotions, and creating more real family bonds.

5 Family therapy 5) Psychoanalytic family therapy

Clinicians trained in psychoanalysis were the earliest to engage in family therapy, but when they began to face the family, they mostly applied deep psychological perspectives in systems theory. In the mid-1980s, there was a return to the interest of family therapists in psychodynamics, mainly in object relationship theory and self-psychology. The key purpose of psychoanalytic therapy is to help people understand their basic motivations and resolve conflicts by expressing these aspirations in a healthy way. Freud's theory emphasizes sexual drive and aggressive impulses, self-psychology focuses on the desire to be appreciated, and object relationship therapists focus on the need for secure attachment relationships. But they have a common belief that if individuals in the family understand and begin to resolve their own personal conflicts, they can help spouses and family members get along better. Psychoanalytic family therapists pay less attention to groups and their modes of communication, and more to individuals and their feelings. Psychoanalytic theories aimed at exploring these feelings help clinicians understand the basic issues behind people's struggles.

6 Family therapy 6) Cognitive behavior family therapy

Family symptoms are seen as the result of learned responses, unconscious acquisitions, and reinforcements. Treatment is usually time-limited and symptomatic. The behavioral methods applied to the family are based on social learning theory. Behaviors are learned and maintained because of their results, and they can be changed by changing their results. One must add to the theory of social learning is that Thibaut and Kelley's theory of social exchange believes that people are committed to maximizing the "reward" of interpersonal relationships while minimizing the "cost". Behavior therapists focus on the consequences of changing problem behavior, which is both an advantage and a disadvantage of the method. By thinking about the problems that arise, behaviorists are enough to develop a range of effective techniques. On the other hand, behavior is only part of the individual, and the person showing the problem is only part of the family.

If the unresolved conflict still confuses them, it is not enough to just make them change. Behaviorists rarely treat entire families. They only pay attention to the subsystem where the target behavior is located. Unfortunately, not including or considering the entire family in treatment may have adverse consequences. And, if change does not involve the entire family, new behavior cannot be strengthened and sustained. Despite these shortcomings, behavioral family therapy provides effective techniques for child problems and problematic marriages. The biggest advantage of behavioral therapy is to observe and measure changes. The second improvement is from the reduction or enhancement of specific sign behaviors to the teaching of general problem-solving, cognitive and communication skills. The third advance is to have standardized interventions to address the specific and changing needs of individuals and families. ^[1]

Applied Research on Family Therapy

Research on family problems in China has found that the family environment is related to children's learning disabilities, self-awareness, problem behaviors, and personality, and parenting styles have an impact on children's academic achievement. Children's behavioral problems, such as aggression and resistance, violations of discipline, anxiety and depression, loneliness and withdrawal, and various physical discomforts, can predict various problems in adolescence and adulthood. Studies have also shown that poor family psychosocial factors increase the risk of neurosis. Poor parenting practices, such as rejection, preference, and over-protection, can easily cause children to suffer from neurosis. Foreign studies have shown that family therapy has a good effect on patients with various mental illnesses, which helps families adapt to various difficulties in their development process, restore normal family structure, and improve the quality of life of various mental illnesses. For example, a study of the management styles of parents of schizophrenics in their verbal and nonverbal behaviors shows that more parents need to skillfully manage patients with schizophrenia, which is good for schizophrenia patients. Supportive role. In addition, some studies have found that the use of antipsychotic drugs in the family to treat schizophrenia is better than antipsychotic drugs alone, and can correct some morbid personality of patients. ^[2-3]

Systematic family therapy was first introduced into China. When the family therapist talked with a neurotic family, he felt a strong power from his father (mother). His (her) values became a powerful force in the family, and often Consistent with the positive values of society at that time. This kind of power is the family s strong concern about their own destiny from the positive side, and a overpriced concept imposed on the family from the negative side. The conflicts and pressures that pervade the family are exactly the reason for the child to sick What drives family pressure. Once symptoms appear, the conflict can be weakened by the parents' deliberate control. ^[4]

In addition, there are many therapists who have other mental illnesses, such as bipolar disorder, marital problems, personality disorders, physical disorders caused by psychological factors (feeding disorders, psychogenic vomiting), childhood mental disorders (including learning skills Disorders, tics disorders, conduct disorders, etc.) have been treated at home, which shows that the treatment is suitable for China and has good results.

Family therapist advice

1) Family therapy is mostly used for adolescent behavior problems, such as learning problems, dating problems and neurotic problems, eating disorders and psychosomatic diseases, and conflicts between young couples.

2) When there is conflict between family members, other conflicts that are ineffective through other treatments (individual treatment), or personal conflicts that cannot be handled in individual treatments, or the family has hindered the treatment, family treatment can be sought.

3) Although the symptoms reflect on someone, they reflect a problem in the family system, the family is too neglected or overly anxious for the treatment of the affected member, the family member requests to participate in the treatment of a patient, and the family has a recurrent mental illness When there is a problem with the patient, someone in the family and others, it is necessary to consider home treatment.

4) In patients with severe mental illness, paranoid personality disorder, sexual abuse and other diseases, family treatment is not the first choice. If there are other positive psychopathological problems, such as mood disorders, schizophrenia, etc., family therapy can be used as an aid.