Family therapy – why I like it, even when I don’t

Subtitle: once you've tried it you can't go back

The reason I decided to study social work was because I thought it would be nice to be a therapist. Not necessarily a private practice therapist, but a therapist. I'd been interested in psychology since before I knew that I was interested in psychology, and I realized that it was much more interesting to talk to someone that to sit in front of a computer. At that time I envisioned being an individual therapst, because I didn't know a thing about family therapy.

After some investigation and indecision, I decided that social work was the quickest route to becoming a therapist, and indeed it was - I was doing therapy about a week into my first year internship. Now, about 2 years later, here I am, a family therapist. As far as I can recall, nowhere along the line did I actually decide to be a family therapist. However, over time, it just seemed like the best thing to do. Here is why.

First of all, there are the practical reasons: Fresh out of grad school with an MSW, you have to work in an agency. Let's say you want to do clinical social work and you are not focused on working with people with severe mental illness. My unscientific, ballpark estimate is that there are about 10x more opportunities for jobs in the child welfare/family services arena than in individual counseling. For reasons I'll discuss below, I never really tried to find a job at an agency providing only individual counseling, but my impression is that it would have been a lot more difficult, and I'd probably still be searching.

On to why I didn't bother trying in the first place. I am, I should note, personally inclined towards individual therapy. I see an individual therapist and value her greatly. I am generally more interested in the interworkings of the mind, the layers of conscious and unconscious material, symbols and structures, archetypes and object relations, and selfobjects. All that stuff has an inherent allure - the "mysteries of the mind".

However, once I got a taste of (doing and reading about) family therapy, I have had trouble letting it go. It just makes so much sense, practically - especially for someone like me who enjoys working with kids (stay tuned for a future post on "Why working with kids alone is the easiest thing for a family worker to do, and that's why you shouldn't do it"). In my opinion it is hard to exagerate the importance of family on development. Kids spend most of their lives with their families except when they are in their school-prisons and asleep); the family atmosphere and structure have a huge impact on how a child develops.

Of course, an individual therapist can make all the difference with a child in spite of their family difficulties. As Clare Winnicott wrote,

my recent experience with young adults has brought home to me
very vividly how much suffering might have been avoided if there had been someone outside the family to whom the boy or girl could have turned for help and understanding when things began to get difficult. (Winnicott, C. "Communicating with Children")

This is true for adults as well (although perhaps not as easy, since over the years we develop shells and defenses that seem so familiar and safe that change can be quite difficult, however many years of therapy we've been in).

A therapist/social worker can help a child individually, but the question still remains: Given the choice of working with the family or in spite of the family, what is best for the child? Then, the answer seems obvious: family therapy.

When we come to adults, the answer is not so obvious. In many cases, life difficulties can be due to problems with partners or children, and individual therapy can be like an escape from that system, rather than addressing the key problems, e.g. a breakdown in communication.

At the same time, many people want personal growth, self-understanding, and self-actualization; whatever all that means, they want it. That is a big reason that I see a therapist. When it comes to actual growth (as opposed to problem solving), I am of the opinion that everyone who feels that impulse could benefit from seeing a (good) individual therapist. Not that everyone needs to or should see a good individual therapist.

So my the verdict is: Family therapy is better than individual therapy for children, especially because children are often blamed simply for reacting to stressful family and social environments. This should be the standard intervention, long before meds are discussed.

For adults, I think good family (or couples) therapy can help with the communication and interpersonal patterns that keep us arguing, feeling judged, or stuck - all the things that take up time that could be spent meditating or writing our novel. However, this is not a replacement for (good, non-stagnant) individual therapy for people who want to dig down into their souls a bit and see what happens.

All that being said: Will I stick with families? I don't know. How am I supposed to make a decision like that? It kind of looks that way... In my idealized future, I develop two specialties: one, in family work of one kind or another (in NYC, Ackerman and Minuchin are the big theorhetical perspectives); and another with an individual, psychodynamic perspective - I lean more towards the object-relations field. Then I'd have all my bases covered and I could really begin raking in the dough.

Alternately, I could split the difference and go into Internal Family Systems. This is a model, developed by Richard Schwartz, that I know very little about, but it sees to apply systems thinking to inner life. That would kill two birds with one stone, as it were: Schwartz claims it can be applied to familes, groups and societies too. I'm sceptical but interested, and one of his books just came in from Amazon, so I'll probably write more about it soon.

A Mature Person according to Virginia Satir

The more I read of from Virginia Satir's Conjoint Family Therapy, the more I appreciate her ideas, to say nothing of her skills in practice. Her focus on communication is right up my alley; and her emphasis on self-esteem sets her apart from other old-school systems and structural theorists, who tend not to look at the intra-psychic.

Her description of functional and dysfunctional communication and relational patterns describes pretty bluntly how we can all get so anxious, angry, and generally muddled up just going through life.

Here a longish tidbit on what maturity is:

"A mature person is one who...is able to make choices and decisions based on accurate perceptions about himself, others, and the context in which he finds himself; who acknowledges these choices and decisions as being his; and who accepts responsibility for their outcomes.

The patterns of behaving that characterize a mature person we call functional because they enable him to deal in a relatively competent and precise way with the world in which he lives. Such a person will:

• manifest himself clearly with others.
• be in touch with signals from his internal self, thus letting himself know openly what he thinks and feels.
• Be able to see and hear what is outside himself as differentiated from himself and as different from anything else.
• Behave toward another person as someone separate from himself and unique.
• Treat the presence of different-ness as an opportunity to learn and explore, rather than as a threat or a signal for conflict.
• Deal with persons and situations in their context, in terms of “how it is” rather than how he wishes it were or expects it to be.
• Accept responsibility for what he feels, thinks, hears and sees, rather than denying it or attributing it to others.
• Have techniques for openly negotiating the giving, receiving and checking of meaning between himself and others.*
  

(*This description of maturity emphasizes social and communication skills rather than the acquisition of knowledge and recognized achievement, which in my view derive from the first two.)

We call an individual dysfunctional when he has not learned to communicate properly."

- Virginia Satir, Conjoint Family Therapy