Haven and Hope

Why family therapy? Because it deals with family pain.

Virginia Satir, internationally renowned family and couple’s therapist

When a young person is experiencing emotional, behavioral, or social challenges, typically multiple interventions directed at the individual person are initiated. While individually focused intervention is often very helpful, it does not go far enough. To fully intervene and positively impact the well-being of a young person, the family needs to be included in the intervention efforts as well. For children, family is the most important and influential part of their lives and an essential component to their growth and development. Family relationships are intended to provide the necessary emotional support and socialization skills that children need to become happy, productive, and self-sufficient young adults. Family is where young people learn how to manage their feelings and behavior, how to have relationships with other people, and how to define who they are as individuals while being a part of groups and society. Family therapy goes beyond individual interventions by directly ensuring families are functioning at their best and that everyone is benefiting from their relationships and interactions with one another.

Family therapy strengthens the successes achieved through individual interventions and helps ensure that individual intervention successes are generalized and sustained in all areas of one’s life for years to come. Family therapy reinforces the notions that no one person is alone in their struggles, there is greater strength in numbers, and most challenges are multidetermined thus rarely the fault of just one person. Family therapy focuses on how each family member perceives and reacts in relationship to other family members. Everyone in the family is seen as having a hand in how healthy and adaptive the family can become. In families where there is mental illness or a family member has been diagnosed with a developmental disorder such as autism, the family must adjust to heightened levels of stress and accommodation on a daily basis. Because these circumstances require a greater allocation of family resources, in every way possible, the family system can become unbalanced and strained to the point where the family is not able to operate at its optimal capacity. The Mayo Clinic states, “Family therapy doesn’t automatically solve family conflicts or make an unpleasant situation go away. But it can help you and your family members understand one another better, and it can provide skills to cope with challenging situations in a more effective way. It may also help the family achieve a sense of togetherness.” (Mayo Clinic, 2017)

Mental health symptoms or emotional and social challenges do not develop or occur in a vacuum. A family therapist acknowledges and works with how each individual family member influences the others, and thus the family, and how the family unit impacts each individual family member. For example, a suicidal teenager who requires around-the-clock support and supervision to prevent self-harm alters how other family members lead their lives. Family members change their habits to become more available to help protect the suicidal family member from themselves. The safety and well-being of one becomes the central organizing factor of how the family and its members function. This resulting alteration of other family members’ lives can bear out as emotional exhaustion, resentment, and maladjustment that negatively impacts how family members get along and work together. According to the principles of family therapy, an alternative explanation would be that the suicidal ideation of the teenager is caused by or is the result of unexpressed family conflict or dysfunction, which is pushing the family apart and creating emotional distance among family members. The presence of suicidal ideation, even though it is distressing and disturbing, can bring the family closer together, and keep it together, until the existing family conflict has been identified and rectified. Ultimately, the family therapist wants to help families develop an awareness of how their relationships to one another impact them as individuals and as a family unit helping them to intentionally interact with each other in a way that supports everyone’s positive growth and development. According to Forum staff (2019):

“The goal of family therapy is to help family members improve communication, solve family problems, understand and handle special family situations and create a better functioning home environment. For families with one member who has a serious physical or mental illness, family therapy can educate families about the illness and work out problems associated with care of the family member. For children and adolescents, family therapy most often is used when the child or adolescent has a personality, anxiety, or mood disorder that impairs their family and social functioning, and when a stepfamily is formed or begins having difficulties adjusting to the new family life. Families with members from a mixture of racial, cultural, and religious backgrounds, as well as families made up of same-sex couples who are raising children, may also benefit from family therapy.”

There are numerous family therapy approaches, with each focusing on a different aspect of family functioning. While some family therapists use an approach and adhere to those principles for all the families they work with, it has become increasingly common for a family therapist to determine which approach would be most beneficial given a family’s unique circumstances and challenges. Broadly, approaches differ in the way they conceptualize how conflicts arise within families and what fosters symptoms and dysfunction. Depending on which approach is being used, the family therapist will focus on: (1) how a family is organized in terms of roles and responsibilities, as well as the hierarchal structure in terms of communication, decision making, and authority; (2) communication patterns between family members when there are unintentional or implied messages resulting in dysfunctional or maladaptive behaviors; (3) intergenerational transmission of behavioral responses as a result of genetics and family rituals and traditions; (4) socially constructed values and meanings regarding behavior that either support or impede positive attitudes and narratives about one’s self and one’s family; (5) mindset regarding the family members’ problem-solving skills becoming overly negative to the point of believing there is no solution to the problem when in fact there is; and (6) the availability of resources, connections, and affirming messages throughout broadening spheres of influence starting at the individual, moving to the community, and then to society.

Without question, the young person suffering from mental health challenges or the impact of being on the autism spectrum bears the burden of his or her symptoms and difficulties. However, it is equally true that other family members are affected by the situation as well. Most commonly, parents are recognized for how children having special needs add to their obligations and stress and require them to learn new and different parenting habits better suited to the needs of the child. These adaptations can interfere with other family relationships and derail parents’ professional work performance; siblings can also experience direct and vicarious exposure to upsetting and traumatic episodes by and/or related to their sibling’s unique needs. Siblings may also struggle with feelings of resentment toward their sibling for needing so much more and having to adjust to and accommodate those needs over their own. Siblings who see their parents being overwhelmed and burdened can try to become “perfect” or suppress their needs in an effort to help decrease demands on their parents or to gain attention for being such a “good child.” Family therapy provides a time and place to safely explore and talk about these types of experiences with an attentive and caring objective person who can guide the discussion. It is also a place where ideas and feelings can be aired and heard and where people’s vulnerabilities are protected.

Including family therapy in the treatment plan for young people ensures they benefit from the loving care and support they so desperately need from family members. Individually, it helps make sure the family grows as the child grows. As the individual changes, it is imperative that the family dynamic changes as well. If the family is not growing and changing alongside the person receiving individual services, the likelihood that these new capacities and skills will persist after treatment has ended is greatly reduced. In fact, without family intervention, it is likely that whatever symptoms or challenges brought the young person into individual treatment will reappear again in some form at each new developmental life stage. Family therapy is essential when aiding and addressing the cognitive, emotional, behavioral, and social concerns of young people; it is not enough to just help the child. Family therapy is a tool that helps not only the child, siblings, and parents but also generations of family members to come.

During my 30-plus years of professional experience helping children, adolescents, and emerging young adults with significant mental health challenges and/or high functioning autism at the Sonia Shankman Orthogenic School (O-School) and Brooke Whitted Center (BWC), I believe that as I have emphasized family systems approaches more and more, my impact has become stronger and deeper in the lives of the people with whom I have worked. It has been my privilege and honor to be privy to a family’s interactions, so that I can really get to know the family and see how each member interacts with the others and how family members function as a team, while having them trust me enough to really let their family dynamics out. It is when I am able to help families see or hear something that they were previously unaware of, despite it clearly disrupting their interactions, that I am doing my best for the family. Family therapy has made it possible to help people faster, make change last longer, and foster family development so that families are ready for all of life’s transitions and daily challenges, no matter what they are. Family therapy and family engagement are key components of the successful work done at both the O-School and BWC.

Author Pete Myers currently serves as the Co-Executive Director for the O-School and the BWC. To learn more about the O-School’s residential and day programs, please visit our website. If you have a child or loved one who you believe may benefit from the O-School’s or BWC’s services, please visit our contact page or call our Director of Admissions, Kristin Friesen, at 773-420-2891.