Family Therapy

Concepts, Process and Practice

Alan Carr

• Publisher: Wiley-Blackwell
• Year: 2012
• Print ISBN: 9781119954651, 9781119954644
• eBook ISBN: 9781118384275
• Edition: 3
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Now in its third edition, this highly regarded and well-established textbook includes up-to-date coverage of recent advances in family therapy practice and reviews of latest research, whilst retaining the popular structure and chapter features of previous editions.

• Presents a unique, integrative approach to the theory and practice of family therapy
• Distinctive style addresses family behaviour patterns, family belief systems and narratives, and broader contextual factors in problem formation and resolution
• Shows how the model can be applied to address issues of childhood and adolescence (e.g. conduct problems, drug abuse) and of adulthood (e.g. marital distress, anxiety, depression)
• Student-friendly features: chapters begin with a chapter plan and conclude with a summary of key points; theoretical chapters include a glossary of new terms; case studies and further reading suggestions are included throughout

Part One

CENTRAL CONCEPTS IN FAMILY THERAPY

Chapter 1

GOALS OF FAMILY THERAPY ACROSS THE LIFECYCLE

Family therapy is a broad term for a range of methods for working with families with various biopsychosocial difficulties. Within the broad ­cathedral of family therapy there is a wide variety of views on what types of problems are appropriately addressed by family therapy; who defines these problems; what constitutes family therapy practices; what type of theoretical rationale underpins these practices; and what type of research supports the validity of these practices.

Some family therapists argue that all human problems are essentially relational and so family therapy is appropriate in all instances. Others argue that marital and family therapy are appropriate for specific relationship problems or as an adjunct to pharmacological treatment of particular conditions such as schizophrenia.

Some family therapists argue that problems addressed in therapy are defined by clients. That is, parents, children or marital partners seeking help. Others argue that problems are best defined by professionals in terms of psychiatric diagnoses or statutory status, such as being a family in which child abuse has occurred and which is on an at-risk register, or being a person with an alcohol problem on probation.

With respect to practices, some family therapists invite all family ­members to all therapy sessions. Others conduct family therapy with individuals, by empowering them to manage their relationships with family members in more satisfactory ways. Still others have broadened family therapy so that it includes members of the wider professional and social network around the family; they may refer to this approach as systemic practice.

There are many theories of family therapy. Some focus on the role of the family in predisposing people to developing problems or in precipitating their difficulties. Others focus on the role of the family in problem maintenance. But all family therapists highlight the role of the family in problem resolution. There is also considerable variability in the degree to which theories privilege the role of family patterns of interaction, family belief systems and narratives, and historical contextual and constitutional ­factors in the aetiology and maintenance of problems.

With respect to research, some family therapists argue that case studies or descriptive qualitative research provide adequate support for the ­efficacy of family therapy. On the other hand, some family therapists ­highlight the importance of quantitative results from controlled research trials in supporting the degree to which family therapy is effective in ­treating specific problems.

Within this volume an integrative and developmental approach will be taken to family therapy, and where better to start than with a consideration of family problems across the lifecycle?

Family problems occur across all stages of the lifecycle. Here are some examples:

• A 6-year-old whose parents cannot control him and who pushes his sister down the stairs.
• A 13-year-old girl who worries her parents because she will not eat and has lost a lot of weight.
• A 19-year-old boy who believes he is being poisoned and refuses to take prescribed antipsychotic medication.
• A couple in their mid-thirties who consistently argue and fight with each other.
• A blended family in which the parents have both previously been married and have difficulties managing their children’s unpredictable and confusing behaviour.
• A family in which a parent has died prematurely and in which the 13-year-old has run away from home.
• A family in which a child is terminally ill and will not follow medical advice.
• A family with traditional values in which a teenager ‘comes out’ and declares that he is gay.
• A family in which both parents are unemployed and have difficulty managing their children without getting into violent rows.
• A black family living in a predominantly white community, where the 16-year-old boy is involved in drug abuse in a delinquent peer group.

These are all complex cases which involve or affect all family members to a greater or lesser degree. A number of these cases also involve or affect members of the community in which the family lives. In some of the cases listed, other agencies including schools, hospitals, social services, law enforcement, juvenile justice or probation may be involved. Family ­therapy is a broad psychotherapeutic movement which offers conceptual frameworks for making sense of complex cases such as those listed here and entails approaches to clinical practice for helping families resolve complex problems.

The lifecycle is a particularly useful framework within which to conceptualise problems that may be referred for family therapy. In this chapter, normative models of the family and individual lifecycles will be described. Gender development, lifecycle issues unique to lesbian and gay people and issues of culture and class will also be discussed. The aim of the ­chapter is to sketch out some of the problem areas which may be addressed by family therapy across the lifecycle.

THE FAMILY LIFECYCLE

Families are unique social systems insofar as membership is based on combinations of biological, legal, affectional, geographic and historical ties. In contrast to other social systems, entry into family systems is through birth, adoption, fostering or marriage and members can leave only by death. Severing all family connections is never possible. Furthermore, while family members fulfil certain roles which entail ­specific definable tasks such as the provision of food and shelter, it is the relationships within families which are primary and irreplaceable.

With single-parenthood, divorce, separation and remarriage as common events, a narrow and traditional definition of the family is no longer useful (Walsh, 2012). It is more expedient to think of a person’s family as a network of people in their immediate psychosocial field. This may include household members and others who, while not members of the household, play a significant role in the person’s life. For example: a ­separated parent and spouse living elsewhere with whom a child has regular ­contact; foster parents who provide relief care periodically; a grandmother who provides informal day-care; and so forth. In clinical practice the primary concern is the extent to which this network meets the individual’s needs.

Leaving Home

Having noted the limitations of a traditional model of family structure, paradoxically the most useful available models of the family lifecycle are based upon the norm of the traditional nuclear family, with other family forms being conceptualised as deviations from this norm (McGoldrick et al., 2011). One such model is presented in Table 1.1. This model delineates the main developmental tasks to be completed by the family at each stage of family development. In the first stage, the principal concerns are with differentiating from the family of origin by completing school, developing relationships outside the family, completing one’s education and beginning a career. Problems in developing emotional autonomy from the family of origin may occur at this stage and may find expression in many ways, including depression, drug abuse and eating disorders such as ­anorexia and bulimia. Problems in developing economic independence may also occur where young adults have not completed their education or where limited career options are available. In these circumstances some young adults become involved in crime.

Table 1.1 Stages of the family lifecycle

Adapted from McGoldrick, M., Carter, B. & Garcia-Preto, N. (2011). The expanded family lifecycle. Individual, family and social perspectives (Fourth Edition). Boston: Allyn & Bacon. (p. 16–17).

Stage	Emotional transition processes	Tasks essential for developmental progression
Leaving Home	Accepting emotional and financial responsibility for the self	Differentiating self from family of origin and developing adult-to-adult relationship with parents Developing intimate peer relationships Beginning a career and moving towards financial independence Establishing self in a community and society
Forming a Couple	Committing to a new system	Selecting a partner and deciding to form a long-term relationship Developing a way to live together based on reality rather than mutual projection Realigning couple’s relationships with families of origin and peers to include partners
Families with Young Children	Accepting new members into the system	Adjusting couple system to make space for children Arranging child-rearing, financial and housekeeping responsibilities within the couple Realigning relationships with families of origin to include parenting and grandparenting roles Realigning family relationships with community and society to accommodate new family structure
Families with Adolescents	Increasing the flexibility of family boundaries to accommodate adolescents’ growing independence and grandparents’ increasing constraints	Adjusting parent–child relationships to allow adolescents more autonomy Adjusting family relationships as couple takes on responsibility of caring for ageing parents Realigning family relationships with community and society to accommodate adolescents’ increasing autonomy and grandparents’ increasing constraints
Launching Children and Moving into Midlife	Accepting many exits from and entries into the family system	Adjusting to living as a couple again Addressing couple’s midlife issues and possibilities of new interests and projects Parents and grown children negotiating adult-to-adult relationships Adjusting to include in-laws and grandchildren within the family circle Dealing with disabilities and death of couple’s ageing parents Realigning family relationships with community and society to accommodate new family structure and relationships
Families with Parents in Late Middle Age	Accepting new generational roles	Maintaining couple’s functioning and interests, and exploring new family and social roles while coping with physiological decline Adjusting to children taking a more central role in family maintenance Making room for the wisdom and experience of the ageing couple Supporting the older generation to live as independently as possible within the constraints of ageing Realigning family relationships with community and society to accommodate new family structure and relationships
Families with Parents Nearing the End of Life	Accepting the constraints of ageing and the reality of death, and the completion of one cycle of life	Dealing with loss of partner, siblings and peers Preparing for death through life review and integration Adjusting to reversal of roles, where children care for parents Realigning family relationships with community and society to accommodate changing family relationships

Forming a Couple

In the second stage of the family lifecycle model, the principal tasks are those associated with selecting a partner and deciding to marry or cohabit. In the following discussion, the term ‘marriage’ is used to cover both traditional marriage and the more modern arrangement of long-term cohabitation. Adams (1995) views mate selection as a ­complex process that involves four stages. In the first phase, partners are selected from among those available for interaction. At this stage, people select mates who are physically attractive and similar to themselves in interests, intelligence, personality and other valued behaviours and attributes. In the second phase there is a comparison of values following revelation of identities through self-disclosing conversations. If this leads to a deepening of the original attraction then the relationship will persist. In the third phase there is an exploration of role compatibility and the degree to which mutual empathy is possible. Once interlocking roles and mutual empathy have developed, the costs of separation begin to outweigh the difficulties and tensions associated with staying together. If the attraction has deepened sufficiently and the barriers to separation are strong enough, consolidation of the relationship occurs. In the fourth and final phase, a decision is made about long-term ­compatibility and commitment. If a positive decision is reached about both of these issues then marriage or long-term cohabitation may occur. When partners come together, they are effectively bringing two family traditions together, and setting the stage for the integration of these ­traditions, with their norms, values, rules, roles and routines, into a new tradition. Decision-making about this process is not always easy, and couples may come to a marital and family therapist to address this complex issue.

Childless couples must develop routines for living together which are based on a realistic appraisal of the other’s strengths, weaknesses and ­idiosyncrasies, rather than on the idealised views (or mutual projections) which formed the basis of their relationship during the initial period of infatuation. Coming to terms with the dissolution of the mutual projective system which characterises the infatuation so common in the early stages of intimate relationships is a particularly stressful task for many couples and may lead to a referral for marital or family therapy (Savage-Scharff & Scharff, 2008).

Contextual Factors Associated with Marital Satisfaction

The following demographic factors are associated with marital satisfaction (Conger et al., 2010; Fincham & Beach, 2010; Gottman & Notarius, 2002; Newman & Newman, 2011):

• high level of education;
• high socioeconomic status;
• similarity of spouses’ interests, intelligence and personalities;
• early or late stage of family lifecycle;
• sexual compatibility;
• for women, later marriage.

The precise mechanisms lin...

Table of contents

• Cover
• Praise for the third edition
• Series page
• Title page
• Copyright page
• ABOUT THE AUTHOR
• FOREWORD TO THE THIRD EDITION
• PREFACE
• ACKNOWLEDGEMENTS
• Part One: CENTRAL CONCEPTS IN FAMILY THERAPY
• Part Two: PROCESSES IN FAMILY THERAPY
• Part Three: FAMILY THERAPY PRACTICE WITH CHILD- AND ADOLESCENT-FOCUSED PROBLEMS
• Part Four: FAMILY THERAPY PRACTICE WITH ADULT-FOCUSED PROBLEMS
• Part Five: RESEARCH AND RESOURCES
• REFERENCES
• INDEX