Psychotherapy for the family: Many hands make light work

I absolutely love working with families. This is a new aspect of my work as a therapist, and I have been working with families for about 2 years now. I value working with individuals as a thoroughgoing and intensive therapeutic approach. Sometimes, however, the best way to address a struggle is to acknowledge that it exists at the level of the family. When all the key players are in the room, as seems obvious, the difficulties which people experience in relation their families can emerge strongly in the moment, as opposed to in individual therapy, where these difficulties are spoken about outside of the time of their occurrence. At times, especially in the beginning of family therapy, there is a strong feeling of nervousness, because, often for the first time, families are sitting together with the purpose of talking in a real way about their shared struggles. Most often the families I work with have reached a time in their life cycle in which the children are either in their mid-teens or older. I wouldn’t generally conduct family with young children, as it would be over-inclusive and potentially overwhelming for young children.

My approach when working with families is relatively flexible, but typically begins in the same kind of way from case to case. I would typically have the first session with all members of the family in the room. Following on from this I would meet each sibling separately, and the parental couple together. Once the therapy has begun, I wouldn’t necessarily insist on working with all members of the family at the same time. Once having gathered a sense of the family as a whole, I would have tried in the beginning to identify the problematic two-person relationships, the areas of conflict between the parental couple and any particular sibling, and the healthy alliances. On the basis on this I would probably suggest that I spend some time with the people involved in the problematic relationship. Once I get to know a feeling, and once a feeling of trust and safety has developed, the work can become exciting and fascinating, as the family begins to relate in a more natural and spontaneous manner, almost as if I were not in the room. Some families are more adept at managing their own struggles, and so with such families I might play more of a witnessing role, doing relatively little to manage the conflict. I would, instead, entrust the management of conflict to the family itself. This would open up the possibility for the family to work through its own difficulties in a manner which is not directed by me, but which fits in with the family’s own established strategies for coping with struggle.

However, with families who present with a more disrupted communication pattern I would be active and at times strongly directive. There are times when the reality of our relationships is that we feel utterly helpless to manage the difficulties which are threatening to break the connection. Conflict becomes volatile and hugely anxiety arousing. Instead of feeling safe enough to move towards one another in an open-hearted manner, ready to engage with our shared pain, we either move away into a self-preservative retreat, or resist the other in actively or passively aggressive ways. In these times, when the emotions being expressed simply cannot be digested, the work of family therapy is to provide a space to actively think about what is happening in the moment of its occurrence. I, as a member of this family, need to think about what is happening in my mind. I need to explore my assumptions about what is happening in the mind of my brother, sister or parent, and need to non-defensively invite them to share their thoughts and feelings with me. Far easier said than done. The activity of coming to understand my mind and the mind of another, and helping the other to understand the contents of my mind, is the primary work of family therapy. As such, the work aims to interrupt the patterns of compulsively expressing feelings. This kind of compulsive expression of feeling, in which we act our feelings out rather than communicating them, usually leads to the breakdown of connection, and failure in our ability to empathise. Family therapy aims to slow things down, and quieten things, so that we can just think about what we’re doing. We need to come to understand how the various members of the family understand the reasons for the family’s problems. Who is blaming, and who feels blamed? Who feels supported, and who feels neglected? Who feels resentful and why? If the children are being raised by two parents, are both parents on the same page, or are there important differences in their attitudes towards family life and their roles as parents? Is one person feeling scapegoated within the family system? These and countless more questions need to be thought about with an attitude of interest, curiosity and deep care for the family’s emotional life. This can be a very rich experience, although often quite taxing emotionally. The fact is though, that once a family takes the brave step of entering the therapy space together, they have demonstrated a commitment to trying, which often goes a long way to helping.

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