What Are the Effects of Family Therapy?

The family therapy approach tries to provide an understanding of the context in which a problem or illness has developed. Therapists do not imply that the family is the source of the problem but rather that the enhanced understanding will help the family to mobilise its own resources.

Both large studies and individual reports seem to imply that family dynamics can be transformed for the better, in a number of very different situations, like the following examples.

Schizophrenia

Schizophrenia runs in families. But genetics isn't the only cause or the only factor affecting the condition. There's a lot of evidence that the severity of the illness is hugely affected by how the family relates to the schizophrenic, for example after release from hospital. Studies have shown that when parents are negative following a breakdown, making many critical comments, expressing hostility or trying to be overly controlling, then rates of relapse are far higher than they are when parents are positive. Through family therapy, parents can be trained to be less negative, and the relapse rates of their children falls. Overall, parental reactions have far more effect on relapse rates than whether or not patients keep on taking prescribed drugs.

Coping with Violence

In some situations, family therapists can help people to move forward both within their family and in their relationship to a troubled wider community. In Belfast, therapists were initially intended to treat children with psychological damage as a result of the troubles, but have ended up with an extended role, as it becomes clear that whole families have been badly fractured by violence that has affected the lives of everyone over so many years.

As the political situation appears to be stabilising, many families are breaking prolonged silences that were induced by fear and uncertainty. Sometimes distress has been a general result of the overall situation. In others, a particular incident has impacted on a family. For example, sectarian punishment beatings were sometimes inflicted after a teenager was removed from the family home. This often left the direct victim physically and psychologically injured, while all the rest of the family remained with deep feelings of violation, and other complex emotions, like guilt for being the one to open the door to the perpetrators.

While the fractures and pain may run deep in families like this, family therapists are finding that at least they can help people to start to come to terms with their situation, and explore ways to move forward.

Anorexia

Many doctors have noticed the intensity with which the family is often involved in the anorexic daughter's illness. Psychologists believe that all families strive for stability to some degree, and in the families of anorexics there is often an excess of those aspects of family life that tend towards stability. Without noticing it, everyone gets more and more organised around the self starving girl and interactions become locked in patterns that are hard to change. Families don't cause the illness, but they may play a huge role in either advancing or opposing treatment. Family therapy seems to be able to shift the dynamic in a positive direction. A number of studies have shown this.

The parents are taught a lot about the disease, and about the strategies their daughter may have developed to avoid gaining weight. They are encouraged to support each other and take total control over their daughter's diet in the early stages. At the same time, the therapist should show lots of sympathy and understanding for the patient's terror at the loss of control over her weight. There may be a family picnic meal in the course of a therapy session, where the parents are encouraged to get their daughter to eat one more mouthful than she wants of everything. As she gains weight, control over her own eating is gradually handed back and more general family matters come up for discussion.

There's quite a lot of evidence that this approach works well for some types of patient. For example, in one study that took place in the UK, involving about 60 anorexia patients, half received family therapy after discharge from hospital, and the other half got supportive psychotherapy, a technique where only the patient herself receives counselling. A year later, when the groups were compared, the girls who'd recieved family therapy who'd been ill for less than 3 years were doing much better than the others. More longstanding disease seems to be harder to tackle.

Other Issues

There is a long list of situations similar to those discussed here in which there's good evidence that family therapy can have lasting benefits. It's often not used alone, but in combination with other types of treatments, and it can often prove a godsend in these days when the family unit itself is becoming ever more beleaguered and hard to maintain.