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Family Therapy and Systemic Practice

INTRODUCTION

This text is a brief overview of basic facts about a therapeutic approach called
family therapy and systemic practice. It is meant for anybody who is interested in this
approach as a professional or a client/patient and also for policy makers, decision
makers in health care delivery and representatives of public and private health
insurance schemes looking to find out what this approach can offer.


WHAT IS FAMILY THERAPY AND SYSTEMIC PRACTICE?

Family therapy addresses the problems people present with in the context of
their relationships with significant people in their lives and their social networks. It is a
well-recognized psychotherapy approach primarily aimed at the family system as a
social unit in contrast to other psychotherapy approaches such as psychodynamic or
cognitive-behavioral therapy which focus on the individual. Family therapy and
systemic practice is a heterogeneous field; there are different schools and models that
share several principles and guiding assumptions. Some of the goals of family therapy
might be for instance: improvement of family functioning on different levels,
enhancement of mutual understanding and emotional support among family members,
development of coping skills and problem-solving strategies in various life dilemmas
and situations and so forth.
Traditionally family therapy has had a primary focus on interactions among
family members, quality of family relationships, various aspects of family development
and functioning and so forth. However, family therapy rest on so called systemic
assumptions or contextual perspective which emphasise the role of wider systems,
such as community, society and the culture to which the family belongs. In recent
years family therapists have started to call themselves `systemic therapists as they
pay more attention to the impact of wider systems and social contexts on peoples
lives.
The systemic perspective which underpins the practice of most family
therapists - views the problems of an individual in relation to the different contexts in
which people live: i.e as a partner in a couple relationship, as a family member, a
person with particular cultural and/or religious allegiances, while also taking into
account socio-economic circumstances and political processes. Systemic practice
regards `context as being of paramount significance for an individuals psychological
development and emotional well-being.
A family therapy session usually lasts between 60-90 minutes; the intervals
between sessions are from one to several weeks depending on the presented
problems, needs of the family members, the stage of the treatment and other
variables. Decisions over these matters are negotiated collaboratively with clients and
any other involved professionals. Although it is hard to estimate and it differs widely,
the average length of family therapy treatment ranges between 6 20 sessions.
Family therapists most often work with more than one family member in the
room but individual sessions or meetings with parents separate from children for
example are also offered when appropriate. Some models of family therapy include
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collaboration with a co-therapist or a team. There are also times when systemic
practitioners will intervene in the professional and/or social networks around families
rather than focus specifically on the nuclear family unit. Both the length and the setting
of family therapy result from a collaboration and a mutual agreement between a
therapist and a family.


WHO CAN BENEFIT FROM FAMILY THERAPY AND/OR SYSTEMIC
PRACTICE?

Family can be both a great source of support for people but also a source of
distress, misunderstanding and pain. Therefore family therapy and systemic practice is
important whenever the aim is to enhance the ability of family members to support
each other. Enabling family members to use their resources more efficiently in a
supportive way can be vital in helping members manage transitional stages of family
development or stressful life events such as a serious illness or a death of a family
member.
Generally speaking, any situation or a problem that affects relationships
between family members and family functioning and its supportive role, can benefit
from systemic family therapy. Similarly any problem of an individual that affects his/her
life in relation to his/her relationships to family and wider contexts will benefit from a
systemic approach. Involving others in an individuals family or social network in the
treatment can help to avoid the pathologizing of that individual and also address the
problem more effectively.
Family therapy can be useful in times of crisis and also with regard to long-
standing problems. It also serves to prevent problems such as a behavioural difficulty,
for example, deteriorating into delinquency or mental health breakdown. Some of the
issues or situations at which a family could benefit from family therapy are listed
bellow.

Health problems, particularly chronic physical illnesses
Psychosomatic problems
Child and adolescent mental health
Adult mental health
Psychosexual difficulties
Alcohol and other substance abuse
Marital problems including separation and divorce issues
Foster care, adoption and related issues
Family life cycle and transitional stages of life issues
Promoting parenting skills and family functioning
School-related problems
Work-related problems
Traumatic experiences, loss and bereavement
Disruption of family life due to social, political and religious conflicts

It should be noted that socially and economically disadvantaged families may in
particular benefit from family therapy and systemic practice. Thus it is desirable those
approaches are available within public services like in some European countries such
as Finland or the Great Britain.
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CURRENT EVIDENCE BASE

It was just mentioned in the previous lines that family therapy based on
systemic perspective pose effective help for people with a wide range of problems and
difficulties. It also can be considered as a way of prevention against various problems
that may affect family or persons other relationships later in life. However, are those
statements supported with any evidence according to current mainstream scientific
standards?
Since the 1990s there has been a steady increase in studies providing strong
evidence base for family therapy in different indications. At present, research of
different design and methodology provides substantial evidence for both the efficacy
and the effectiveness of diverse family interventions. Several reviews also suggest
that family therapy is not more costly, and sometimes even significantly less expensive
than other treatments that do not usually include the family. It is the proven cost-
effectiveness of family in some conditions that will be of interest to people responsible
for public services organization or treatment programs development in health care
institutions. Some of the research findings show that including a family therapy in
treatment significantly reduces costs of provided health care and cost of
pharmacological treatment. There is a great deal of studies that demonstrate the
effectiveness of family therapy, systemic intervention or family work in treatment of
eating disorders, conduct problems, depression, addictions, schizophrenia and other
problems in childhood or adolescence.
Although the level of efficacy and effectiveness of family therapy and family-
based interventions differ according to research design and studied conditions, family
therapy is currently established as an evidence-based psychotherapy approach. Some
of recent papers with this supportive evidence are listed at the end of this text among
the references. Given the current state of the art in family therapy field, it is no surprise
that in some European countries is family therapy recognised as an evidence-based
approach by scientific bodies, for instance in the Great Britain, Germany, Finland etc.


SUMMARY

Family therapy based on systemic perspective is a distinctive psychotherapy
approach with primary focus on family and other relationships of an individual. It is a
well-researched approach with strong evidence of efficacy and effectiveness in a wide
range of specific conditions. Bellow there are mentioned some of the reasons why
provision of family therapy should be ensured and expanded.

Family-focused work is important in prevention of various problems that may
become a serious burden for a society in general.
Family therapy is considered an essential approach in childhood and
adolescence as both prevention and treatment of various emotional and
behavioral problems.
Family therapy can help family members to both use their own resources in
providing support each other in various stressful situations including mental and
physical illness.
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Properly trained family therapists and systemic consultants may use their skills
in diverse contexts such as organizations and institutions, where they can foster
team work and problem-solving. They can also participate in conflict resolutions
and negotiation processes in social and political crises.
A systemic perspective in its broadest sense can contribute to strengthening
solidarity, tolerance, trust and collaboration, the cornerstones of a healthy
society.



REFERENCES

Parker, J. Current Practice, Future Responsibilities. AFT 2007, [Link]

Stratton, P. Report on the evidence base of systemic family therapy. AFT 2005,
[Link]

Asen, E. Outcome research in family therapy. Advances in Psychiatric Treatment.
2002, 8: 230238

Sexton, T.L., Alexander, J.L., Mease, A.L. Levels of Evidence for the Models and
Mechanisms of Therapeutic Change in Family and Couple Therapy. In Lambert, M.
Garfields and Bergins Handbook of Psychotherapy and Behavioral Change,
Wiley&Sons, 2004, ISBN: 978-0-471-37755-9

Carr, A. The effectiveness of family therapy and systemic intervention for child-focused
problems. (in press, due for publication in Journal of Family Therapy in 2009)

Carr. A. The effectiveness of family therapy and systemic intervention for adult-focused
problems. (in press, due for publication in Journal of Family Therapy in 2009)

Russel Crane, D. Effectiveness Research on the Cost of Family Therapy.
Psychotherapeutenjopurnal, 2007, 23: 20-24

Russel Crane, D. The cost-effectiveness of family therapy: a summary and progress
report. Journal of Family Therapy, 2008, 30:399-410

Russell Crane, D. Individual and Family Therapy in Managed Care: Comparing the
Costs of Treatments by the Mental Health Professions. Journal of Marital and Family
Therapy. (In press)

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As a collaborative project, the preceding text was created by a working group of family
therapists members of the NFTO Chamber of European Family Therapy Association
(EFTA), the main professional body for family therapists in Europe.