Approaches To Family Therapy

Approaches
to Family Therapy
Ira D. Glick, David R. Kessler, and John F. Clarkin

e-Book 2016 International Psychotherapy Institute
From American Handbook of Psychiatry: Volume 7 edited by Silvano Arieti
Copyright © 1981 by Basic Books
All Rights Reserved
Created in the United States of America

Table of Contents
APPROACHES TO FAMILY THERAPY

Definition
Historical Overview of the Differing Approaches
Evaluation Using Differing Approaches
Differing Approaches to Treatment Elements of Psychotherapy and

Their Relationship to Family Therapy
Conclusion
Bibliography
www.freepsychotherapybooks.org 4
APPROACHES TO FAMILY THERAPY1
Ira D. Glick, David R. Kessler, and John F. Clarkin
Definition
Marital and family treatment can be defined as a professionally

organized attempt to produce beneficial changes in a disturbed marital or
family unit by using essentially interactional, nonpharmacological methods.
Its aim is the establishment of more satisfying ways of living for the entire
family and for individual family members.
Family therapy is distinguished from other psychotherapies by its

conceptual focus on the family system as a whole. Major emphasis is placed on
acknowledging that individual behavior patterns arise from, and inevitably
feed back into, the complicated matrix of the general family system. Beneficial
alterations in the larger marital and family unit will therefore have positive
consequences for the individual members, as well as for the larger systems
themselves. The major emphasis is placed upon understanding and

intervening in the family system’s current patterns of interaction; the origins
and development of these patterns of interaction usually receive only

secondary interest.
In many families, some member or members may be “selected” as
American Handbook of Psychiatry - Volume 7 5

“symptom bearers.” Such individuals will then be described in a variety of
ways that will amount to their being labeled “bad,” “sick,” “stupid,” or “crazy.”
Depending on what sort of label such individuals carry, they, together with
their families, may be treated in any one of several types of helping facility—
for example, psychiatric, correctional, or medical.
But there may not always be an identified patient. Occasionally a marital
or family unit presents itself as being in trouble without singling out any one
member. For example, a couple may realize that their marriage is in trouble
and that the cause of their problems stems from interaction with each other
and not from an individual partner.
The intrapsychic system, the interactional family system, and the
sociocultural system can be viewed as a continuum. However, different
conceptual frameworks are utilized when dealing with each of these systems.
A therapist may choose to emphasize any of the points on this continuum, but
the family therapist is especially sensitive to, and trained in, those aspects
relating specifically to the family system; he is aware of both its individual
characteristics and the larger social matrix.
Family therapy is not necessarily synonymous with conjoint family
therapy (in which the entire family meets together consistently for therapy
sessions). For example, instead of having regular sessions with the entire
family, one of the clinical and theoretical pioneers in the family field has in
recent years been experimenting with the almost exclusive use of the
healthiest member of the family system as the therapeutic agent for change in
the family unit. This therapist has also reported on his use of somewhat
indirect means (for example, provocative letters to family members) as an

imaginative way to conduct family therapy; that is, to bring about change or
movement in a family system.
There are instances in which a family may be seen together while the
therapist’s frame of reference remains limited to that of individual
psychotherapy. Family members in such a setting may be treated as relatively

isolated individual entities. In effect then, such a therapist may be practicing
conventional individual psychotherapy in a family therapy setting.
Family therapy might broadly be thought of as any type of psychosocial

intervention utilizing a conceptual framework that gives primary emphasis to
the family system and that, in its therapeutic strategies, aims for an impact on
the entire family structure. Thus, any psychotherapeutic approach that

attempts to understand or to intervene in an organically viewed family
system might fittingly be called “family therapy.” This is a very broad
definition and admits various points of view, both in theory and in therapy.
Historical Overview of the Differing Approaches

Current approaches have been synthesized from such fields as
psychology, psychiatry, sociology, psychoanalysis, game theory,
communication theory, Gestalt therapy, and the like. How did this state of
affairs come about? The significance attributed to the family’s role in relation
to the psychic and social distress of any of its members has waxed and waned
over the centuries. The important role of the family with regard to individual
problems was mentioned by Confucius in his writings, as well as by the

Greeks in their myths. The early Hawaiians would meet as a family to discuss
solutions to an individual’s problem. For a long time in our own culture,
however, what we now call mental illness and other forms of interpersonal
distress were ascribed to magical, religious, physical, or exclusively

intrapsychic factors. It was not until the turn of this century that individual
psychodynamics were postulated by Freud to be the determinants of human
behavior. Although he stressed the major role of the family in the

development of individual symptoms, he believed that the most effective
technique for dealing with such individual psychopathology was treatment on
a one-to-one basis. At about this same time, others working with the mentally
ill began to suggest that families with a sick member should be seen together,
and that the mentally ill should not be viewed “as individuals removed from
family relationships.” Eventually, psychiatric social workers in child guidance
clinics, who often saw parents individually or together, began to recognize the
importance of dealing with the entire family unit.
In the 1930s a psychoanalyst reported his experience in treating a
marital pair. And in the 1940s, Frieda Fromm-Reichmann postulated that a
pathologic mother (called the “schizophrenogenic mother”) could induce
schizophrenia in a “vulnerable” child. This speculation led other
psychoanalysts to study the role of the father. Their work suggested that the
father also plays an important role in the development of psychopathology. At
the same time, Bela Mittelman began to see a series of marital partners in
simultaneous, but separate, psychoanalyses. This approach was quite
innovative because psychoanalysts had previously believed that this method
of treatment would hinder the therapist from helping his patient, since it was
thought that neither spouse would trust the same therapist and consequently
would withhold important material. Therefore, the other marital partner was
usually referred to a colleague.
Outside the field of psychiatry proper, marital counselors, ministers, and

others have been interviewing spouses together for some time. In the early
1950s the first consistent use of family therapy in modern psychotherapeutic

practice in the United States was reported by several different workers.
Nathan Ackerman began utilizing family interviews in his work with children
and adolescents; and Theodore Lidz and associates, as well as Murray Bowen,
began a more extensive series of investigations of family interactions and
schizophrenia. Gregory Bateson and associates, and Lyman Wynne and

associates then embarked on the more intensive study of family

communication patterns in the families of schizophrenic patients compared to
families in which the patient had another psychiatric disorder.
It was not until the early 1960s, however, that these ideas were
integrated into a general theory of family interrelationships, thereby shaping
the modern field of family therapy. Various schools of thought developed and
journals such as Family Process were established. Many people became
interested in learning about family therapy and in utilizing its techniques. As a
matter of fact, a recent poll taken of California psychologists showed that 90
percent (as expected) practiced individual therapy, but now more than 60
percent also practiced family therapy, while only 30 percent were doing
group therapy. These statistics illustrate the rise in the growth of the family
therapy field in just two decades. During the 1970s the use of family therapy
was expanded to include the application of a “broad range of psychiatric
problems with families differing widely in socioeconomic origin.” The results,
however, remained poor until crisis-oriented and short-term methods were

developed to meet the needs of these families.
Evaluation Using Differing Approaches
There are several points of view regarding the type and quantity of the
evaluative data to be gathered. Some family therapists begin with a specific
and detailed longitudinal history of the family unit and its constituent
members that may perhaps span three or more generations. This procedure
has the advantage of permitting the family and the therapist to go over
together the complex background of the present situation. The therapist will
begin to understand unresolved past and present issues, will usually gain a
sense of rapport and identification with the family and its members, and may
then feel more comfortable in defining problem areas and in planning
strategy. The family, for its part, may benefit by reviewing together the source
and evolution of its current condition—a clarifying, empathy-building process

that was not previously engaged in by its members. The good and the bad are
brought into focus, and the immediate distress is placed in a broader
perspective. Sometimes a family in crisis, however, is too impatient to tolerate

exhaustive history gathering, and in acute situations lengthy data gathering
must be curtailed.
Other therapists do not appear to rely heavily on the longitudinal
approach, attempting instead to delineate the situation that has led the family
to seek treatment and to obtain a cross-sectional view of its present
functioning. This procedure has the advantage of starting with the problems
with which the family is most concerned, and it will not be as potentially time
consuming or as seemingly remote from the present realities as the preceding

method. The therapist, however, may not emerge with as sharp a focus on
important family patterns, and much of the discussion may be negatively
tinged because of the family’s preoccupation with its current difficulty.

More experienced (and often more courageous) therapists may severely
curtail past history gathering and may also minimize formalized discussions
of the family’s current situation. They may begin, instead, by dealing from the
onset with the family’s important characteristic patterns of interaction as they
are manifested in the interview setting. They may tend to utilize primarily, or
exclusively, the immediate “here and now” observable family transactions.
The therapist, understanding these transactions to be characteristic of the

family, will clarify and comment on them, and intervene in a variety of ways.
This approach has the advantage of initiating treatment right from the outset,
without the delay of history gathering. There is often a heightened sense of
emotional involvement, and more rapid changes may occur. Sometimes

families are overwhelmed by such an approach, however, feeling threatened
and defensive. Also, when specific information and patterns are allowed to
emerge in this random fashion, the therapist does not always have the same
degree of certainty as to whether the emerging family patterns are indeed
relevant and important.
To a considerable extent these differences in technique may mirror
differences in the therapist’s training, theoretical beliefs, and temperament.
Most therapists, however, probably use combinations of these approaches as

the situation warrants, for there is no evidence of one technique being
superior to the others.
Obviously, there is more than one way to evaluate a family—each way
potentially useful—depending on the situation. The procedure offered in the
evaluation outline depicted in table 20-1 combines, in a somewhat condensed
manner, useful aspects of the first two approaches already discussed. It offers
a practical alternative to gathering an exhaustive history or to plunging into
the middle of the family interaction.
Formulating the Family Problem Areas
When meeting with the family, the therapist experiences its patterns of
interaction and uses the data obtained in order to begin formulating a concept
of the family problem. Data for these formulations may come from historical
material, but just as important will be what the therapist has observed in
personal contact with the family. This will help to form a basis for hypotheses
and therapeutic strategies. The data gathered from the outline provided (see
table 20-1) should permit the family therapist to pinpoint particular areas or
aspects of the family that may require attention. In addition, the data assist in
laying out a priority system, so that the therapist can decide which areas of
the family problem should be dealt with first. The data also clarify therapeutic
strategy and the tactics indicated for the particular phases and goals of
treatment.
Family Patterns of Communicating Thoughts and Feelings

Depending on the approach, some of the areas of communication to be
assessed include: (1) expressions of affection, empathy, and mutual support;
(2) areas of sexual satisfaction and dissatisfaction; (3) daily interaction,
including the sharing of activities; (4) flexibility of roles, rivalry and
competition, and the balance of power; (5) major conflicts in the marital
relationship, including development intensity and means of resolving conflict;
and (6) relationships to family, including children and friends. To what extent
does the family group engage in meaningful and goal-directed negotiations,
rather than being engulfed in incoherent, aimless talk?
Table 20-1 Outline for Family Evaluation2

I. Current Phase of Family Life Cycle
II. Explicit Interview Data
A. What is the current family problem?
B. Why does the family come for treatment at this time?
C. What is the background of the family problem?
1) Composition and characteristics of nuclear and extended family, e.g. age, sex,
occupation, financial status, medical problems, etc.
2) Developmental history and patterns of each family member
3) Developmental history and patterns of the nuclear family unit
4) Current family interactional patterns (internal and external)
D. What is the history of past treatment attempts or other attempts at problem
solving in the family?
E. What are the family’s goals and expectations of the treatment? What are their
motivations and resistances?
III. Formulating the Family Problem Areas
A. Family patterns of communicating thoughts and feelings
B. Family roles and coalitions
C. Operative family myths
D. Family style or typology
IV. Planning and Therapeutic Approach and Establishing the Treatment Contract
Other factors of communication assessment include the general feeling
tone of the family and of individual members, dyads, and triads, together with
appropriateness, degree of variability, intensity, and flexibility. Questions to
be considered might include: To what extent does the family appear to be

emotionally “dead” rather than expressive, empathic, and spontaneous? What
is the level of enjoyment, energy, and humor? To what extent does there
appear to be an emotional divorce between the marital partners? To what

extent is the family system skewed around the particular mood state or
reaction pattern of one of its members?
Family Roles and Coalitions
Differing models of evaluation ask to what extent does the family seem
fragmented and disjointed, as though made up of isolated individuals. Or does

the family appear rather to be one relatively undifferentiated “ego mass”? To
what extent is the marital coalition the most functional and successful one in
the family system? To what extent are there cross-sectional dyadic coalitions
that are stronger than the marital dyad? How successfully are power and
leadership issues resolved? To what extent is this a schismatic family in which

there are two or more alliances seemingly in conflict with one another?
Operative Family Myths
Some individuals in families are “selected” to be “bad,” “sick,” “stupid,”
or “crazy,” and often these roles constitute a kind of self-fulfilling prophecy.
Families as well as individuals function with a set of largely unexamined
fundamental attitudes that have been termed “myths.” These markedly
influence the family’s manner of looking at and coping with itself and the
world.
Family Style or Typology
There is no one way of classifying, or making universally applicable the

complexity of marital and family life styles. Some of the characterizations
presented in table 20-2 may be found helpful, depending on the
circumstances and the therapist’s approach.
After the evaluation data have been gathered and formulated into
hypotheses and goals regarding important problem areas, the therapist is
ready to consider what therapeutic strategies will be appropriate.
Differing Approaches to Treatment Elements of Psychotherapy and Their

Relationship to Family Therapy
1. A good patient-therapist relationship.
2. Release of emotional tension.
3. Cognitive learning.
4. Operant reconditioning of the patient toward more adaptive

behavior patterns by explicit or implicit approval-
disapproval cues and by a corrective emotional relationship
with the therapist.
5. Suggestion and persuasion.
6. Identification with the therapist.
7. Repeated reality testing or practicing of new adaptive techniques in

the context of implicit or explicit emotional therapeutic
support.
Family therapy, too, may use all eight of these elements to improve the
overall functioning of the entire family. The particular mix of the elements will
vary with the specific needs of the family. There is hardly any specific
technique of individual or group therapy that could not in some way or

another be adapted for use in family therapy.
Currently, there are a number of differing approaches for treating
families. Each may emphasize different assumptions and types of

interventions. Some therapists prefer to operate with one strategy in most

cases; others may intermix strategies depending on the type of case and the
phase of treatment.
The type of strategy is sometimes made explicit by the therapist; in
other instances it remains covert; but irrespective of whether a therapist

specializes in one approach or is eclectic, some hypotheses will be formed
about the nature of the family’s difficulty and the preferable approach to
adopt.
Table 20-2 Family Style or Typology

Classification 1: Based on rules for defining power
1. The symmetrical relationship
In symmetrical relationships, both people exhibit the same types of behavior (which
minimize the differences between them), role definitions are similar, and problems
tend to stem from competition.
2. The complementary relationship
In complementary relationships, the two people exhibit different types of behavior,
and this is found most often in the so-called traditional marriage. This form
maximizes differences and tends to be less competitive and often highly workable.
Unless role definitions are agreed on, however, serious problems can result.
3. The parallel relationship
In parallel relationships, the spouses alternate between symmetrical and
complementary relationships in response to changing situations.
Classification 2: By Parental Stage
The move from the dyadic marital configuration to the larger, more complex one
involving children tends inevitably to bring with it the potential for increased
activities. Possible subcategories under this classification are as follows:
1. Before children
2. Early childhood
3. Latency and adolescent children
4. After the children have left home (empty-nest syndrome)
Classification 3: By Level of Intimacy
1. The conflict-habituated marriage is characterized by severe conflicts, but unpleasant
as it is, the partners are held together by fear of alternatives.
2. The devitalized marriage has less overt expressions of dissatisfaction, with the
marital partners conducting separate lives in many areas. This interaction is
characterized by numbness and apathy and seems to be held together principally by
legal and moral bonds and by the children.
3. The passive-congenial marriage is “pleasant” and there is a sharing of interests
without any great intensity of interaction. The partners’ level of expectation from the
relationship is not very high, and they derive some genuine satisfaction from it.
4. The vital marriage is intensely satisfying to the spouses in at least one major area,
and the partners are able to work together.
5. The total marriage, which is very rare in the investigators’ findings, is characterized
by similarity to the vital marriage except that the former is more intense and
satisfying in the whole range of marital activities.
Classification 4: Personality Style
1. The obsessive-compulsive husband and the hysterical wife. Conflicts of intimacy

often become of major importance.
2. The passive-dependent husband and the dominant wife. Power is the central theme
of this system.
3. The paranoid husband and the depression-prone wife.
4. The depression-prone husband and the paranoid wife.
5. The neurotic wife and the omnipotent husband. Power is the primary conflict area.
The wife’s resentment is expressed through depression and a variety of other
symptoms.
These material styles often work very satisfactorily if the needs of the two partners
are met and if they are not overly inflexible in their application. Problems arise only
when the cost of keeping the system going is too high—when one spouse changes,
thereby upsetting the system, or when one partner indicates the desire to change the
“rules.”
Classification 5: Descriptions of Families in Treatment
No overall concept or model underlies the following six clusters; they are descriptive
in nature. Because they were derived from families referred for treatment, the
clusters imply a generally maladaptive tendency.
1. Constricted. Characterized by excessive restriction of a major aspect of family
emotional life, such as expression of anger, negative affect, or ambivalence. These
emotions become internalized into anxiety, depression, and somatic complaints. The
presenting patient is often a passive, depressed child or young adult.
2. Internalized (“enmeshed”). Characterized by a fearful, pessimistic, hostile,
threatening view of the world, leading to a constant state of vigilance. Such a family

has a well-defined role structure, high family loyalty, and a pseudo-mutual bond
between parents.
3. Object-focused. Characterized by overemphasis on the children (“child centered”),
the outside community, or the self (“narcissistic”). Motivation for treatment depends
on the willingness of the marital couple to form an effective coalition.
4. Impulsive. Characterized by an adolescent or young adult acting out anger toward a
parent onto the community or expressing his or her parents’ difficulties in a socially
unacceptable way.
5. Childlike. Characterized by spouses who have remained dependent on their own
families or on the community, based on either inadequacy or immaturity.
6. Chaotic. Characterized by disintegration. Lack of structure, chronic psychosis and
delinquency, and low commitment to the family unit.
Various schools of family therapy may differ on where they place their
emphasis on the following major treatment dimensions:
1. Past versus present orientation.
2. Verbal interpretations versus action.
3. Growth model versus problem model.
4. General method versus specific plan for each problem.
5. Therapeutic focus on one individual versus focus on two or more

individuals.
6. Equality versus hierarchy in therapeutic relationship.
7. Analogical versus digital thinking (Digital thinking concentrates on

individual “bits” of behavior; the analogical view is more
concerned with multiple levels and contexts of behavior).
Some therapists emphasize reconstruction of past events, whereas
others choose to deal only with current behavior as manifested during the
therapy session. Some therapists favor verbal exploration and interpretation,
whereas others favor utilizing an action or experiential mode of treatment,
either in the session itself or by requiring new behavior outside the interview.
Some therapists think in terms of problems and symptoms and attempt to
decode or understand possible symbolic meanings of symptomatology. Other

therapists may focus on the potentials for growth and differentiation that are
not being fulfilled. Some therapists utilize one or a limited number of methods
in dealing with a whole range of “problems”; others are more eclectic and
attempt to tailor the treatment techniques to what they consider the specific
requirements of the situation.
With the therapeutic focus on one person, the emphasis is often on the
individual’s perceptions, reactions, feelings, and on the equality of status

between the individual and the therapist. When two people constitute the
operative system, attention is directed to interactions and relationships.

Therapists who think in terms of a unit of three people look at coalitions,
structures, and hierarchies of status and power. The number of people
actually involved in the interviews may not be as important as how many

people are involved in the therapist’s way of thinking about the problem.
Three Basic Strategies of Family Therapy

Elsewhere, the authors have singled out three major strategies that are
especially useful for beginners.
1. Those that facilitate communication of thoughts and feelings.
2. Those that shift disturbed, inflexible roles and coalitions.
3. Those that aid family role-assumption, education, and

demythologizing.
These three strategies are not necessarily mutually exclusive and may
overlap. To some extent they represent different frames of reference for
understanding and dealing with the same family phenomena. Nevertheless,
each strategy seems to offer something unique in its concepts and techniques.
In a clinical situation the therapist will be hard put to remain a purist. A
therapist’s efforts to clarify communication may produce shifts in family
coalitions or initiate an exploration of family myths that may lead to a

considerable outpouring of previously concealed affect.
Although some specific therapeutic strategies are listed above, there is
no one magical phrase or technique that will “cure” the family. Instead,
interventions are a series of repetitive maneuvers designed to change
feelings, attitudes, and behavior. If the overall goals and strategy are kept in
mind, specific interventions will suggest themselves and be modified by the

particular circumstances as well as the therapist’s own style.
What is unique in family therapy is not so much the specific approach
but rather the overall focus and strategy that aims to evaluate and produce a
beneficial change in the entire family system.
Models of Family Therapy
The different models of family therapy can be distinguished by their
data base, goals, treatment techniques, selection criteria, explanatory

concepts, and the stance of the therapist. Over time there has evolved a
differentiation of three distinct but overlapping orientations to family
treatment, with each one closely related to a different theoretical orientation.
These are:
1. The insight-awareness approach: Observation, clarification, and

interpretations are used to foster understanding (and
presumably change).
2. The structural-behavioral approach: Manipulations are devised to

alter family structure and conduct.
3. The experiential approach: Emotional experience is designed to

change the way family members see and presumably react to
one another.
Insight-Awareness Model
The insight-awareness orientation has also been known as the

“historical,” the “psychodynamic,” or the “psychoanalytic school.” In a real
sense, this is the oldest school of family therapy since it grew naturally out of
the psychoanalytic tradition. One of the earliest family therapists was a child
analyst, Nathan Ackerman, who utilized his analytic background to inform
and lend substance to his approach and understanding of families. One has
only to read the transcripts of his sessions to appreciate the influence that
analytic thinking and techniques had upon his work with families and couples.
By changing the transference distortions, correcting the projective
identifications, and infusing insight and new understanding into the arena of
interpersonal turmoil and conflict, this school of family therapy attempts to

change the functioning and interrelationships of the various members of the
family or marital system. The data base is derived from historical material of
the current and past generations, from transference/countertransference
phenomena, unconscious derivatives, and resistances. A basic assumption is

that intrapsychic conflict, interpersonal problem foci, and defensive and
coping mechanisms are modeled and taught within the family system.
Portions of the data base that are of paramount interest to the practitioners of
this model are dream and fantasy material, fantasies and projections about
other family members, and transference distortions about other family
members and the therapist. Understanding the history and mutations over
time of these dynamics is considered crucial to understanding current

dysfunction. A broad use of the terms “transference” and
“countertransference” is used here. Such phenomena can be understood in
terms of transference on at least five levels: (1) man to woman; (2) woman to
man; (3) woman to therapist; (4) man to therapist; (5) couple to therapist.
Just as there are multiple transference reactions, there are multiple

countertransference responses. It is assumed that understanding of
unconscious derivatives and their resistances is usually necessary to effect
change.
The theoretical underpinnings of this model are the familiar ones of
psychoanalytic thinking, including especially topographical concepts of

conscious, preconscious, and unconscious; constructs of the id, ego, and
superego; and concepts that focus on the interaction of individuals, such as
secondary gain, transference, and projective identification. While early

analysts, who opted for a more interactional model (for example, Nathan
Ackerman), criticized this model for its lack of attention to, and language for,
interactional data, more recent authors in the analytic tradition of object

relations (for example, Henry Dicks) have applied these concepts to the
understanding and analytic treatment of these interactional problems.
The major techniques of this model include clarification, interpretation,

exploration of intrapsychic as well as interpersonal dynamics, and
development of insight and empathy. Using such analytic techniques with an

individual in the presence of a spouse or other family member represents a

unique development. At the very least, it is possible that while the therapist is
addressing an interpretation to one individual, the other members of the
family can utilize the interpretative method to explore their own conflicts and
difficulties, as well as to begin to understand the family member more fully

with the input from the therapist.
The goal is to foster understanding and insight in order to effect change

in individuals as well as in the family unit.
Table 20-3. Models of Family Therapy

Model Representative Primarily Data Base Goals Techniques
(Approach Therapists Derived
Or School) From A Model
Of
Learning &/or
Changing
1. Insight- Ackerman; Understanding 1. History Foster 1.

Awareness Nagy & Spark; 2. understanding Observation
(also Paul; Unconscious and insight to 2.
known as Nadelson; derivatives effect change Clarification
Historical, 3. 3.
Psycho- Transference/ Interpretation
dynamic, or counter-
Psychoa- transference
nalytic)
2. Strategic- Palo Alto Observing 1. Sequences Change family 1. Strategies
behavioral Group 2. Commun- structure, desensitize
(also (Jackson, ication communication and/or
known as Bateson, 3. Rules pattern, and condition
Systems, Haley, 4. History roles, patient to
Commun- Satir); 5. Behavior which changes alter family
ications, or Sluzki; perception and structure and
Structural) Bowen; behavior behavior
Minuchin; M. 2. Observe
Erickson; and transform
Palazzoli using
directives
3. Whitaker; Imitation 1. Observed Change ways 1. Therapist
Experiential Bowen; (via the 2. Shared family designs
(also Nagy experience) feelings members and/or
known as and (including the experience participates
Existential) identification therapist’s and with
feelings) presumably family in the
react to each emotional
other experience
2. Empathy
The Strategic-Behavioral Model
This school of family therapy emphasizes understanding sequences,

patterns, and structure, with the emphasis on manipulation as a technique to
effect change. The data base is derived from elements of the structural school,
systems theory, behavioral theory, and communications theory.
The orientation that is unique to the family movement and that has
given it impetus is the systems understanding of family function and
dysfunction. The family systems approach uses the metaphor of

communication theorists such as Gregory Bateson and the computer
metaphors of our modern age, such as feedback loops, communication
exchange, and so forth. These explanatory concepts lead the practitioner to

focus on a data base composed of repetitive interchanges between individuals
in a marriage or family that occur in the here and now (as opposed to the
interest in the history of the relationship in the psychoanalytic model), and
that define, limit, and structure the behavior and experience of the individuals
in the system. While the assumption of the psychoanalytic model is that

individuals in a family group can perceive and distort the working of the
group, the assumption in this model is that the group is greater than the
individuals who compose it, and that the individual is governed and regulated
by this greater entity (the family or the marital dyad). This model works on
the assumption that there is no such thing as non-behavior—even silence is a
means of communication. There is a focus on syntax (ways of
communicating), semantics (the meanings of communicative acts), and
pragmatics (the effects of communication).
The treatment techniques (or strategies) in this model include: (1)
changing family transactional patterns; (2) marking boundaries; (3)

escalating stress; (4) assigning tasks both within and outside of the therapy
session; (5) focusing on, exaggerating, deemphasizing, or relabeling

symptoms; (6) reframing; (7) manipulating mood; (8) clarifying
communication; (9) interrupting repetitive interactional patterns; and (10)
prescribing paradoxical injunctions. In one way or another, the techniques are
intended to interrupt current repetitive interpersonal behaviors and

introduce new interactional patterns that will result in the creation of new
and more mature, or less symptomatic, interactions and inner states.
The behavioral component of the model grows out of the behavioral

orientation that has historically flourished parallel, and in reaction, to the
psychoanalytic tradition. The data base for this orientation is quantifiable,
measurable behavior, whether internal (thoughts) or external (actions).
Explanatory concepts are those of the behavioristic tradition; for example,
stimulus, response, and concepts of learning theory such as classical
conditioning, operant conditioning, schedules of reinforcement, and so forth.

With the behavioral model becoming increasingly applied to interactional
systems such as the family, other concepts have been introduced to expand
the model into the interpersonal sphere. Perhaps the most influential has
been the behavior exchange model of John Thibaut and Harold Kelley, in
which it is postulated that the benefit and cost ratio for each individual is an
exchange situation (for example, marriage) has a major influence on the
course and outcome of that relationship. The goal in this model is to effect
change in discrete, observable, measurable behaviors that are considered
problematic by the individuals seeking assistance. As opposed to the
psychoanalytic model, which often seems to have more ambitious goals of
character change and “insight,” this model tends to focus more on discrete
problem areas defined by clear behavior patterns. Thus, treatment in this
model tends to be briefer and more circumscribed. Emphasis is placed not on

pathology but upon behavioral deficits and excesses that are to be changed. If
undesired behaviors are eliminated (for example, husband hitting wife), it is

not assumed that more social behaviors will necessarily spontaneously
emerge, but rather that the therapist might be required to teach new and
more adaptive behaviors to the spouses or family members.

Techniques include helping family members learn means of effecting the
desired behavior in another member. Some of the major tactics utilized are
behavioral contracting based on good faith or quid pro quo agreements (if you
do this, I will do that), training in communication skills, training in effective
problem solving, and combining positive reinforcement with a decrease in
destructive interchanges.
The stance of the therapist is quite active since he sees his job as a
means to introduce behavior change into the repertoire of the family
members. While in the past behaviorists have written little about how they
handle individual and family resistance to their suggestions, making them
sometimes appear somewhat naive to the experienced clinician, they are
increasingly paying more attention to resistance and at times suggest the use
of paradoxical injunctions more typically enunciated by the systems theorists.
Indeed, it has been suggested that there is a congruence, if not a growing

similarity, between the techniques of the behaviorists and the systems
interventionists.
This school of family therapy avoids the traditional techniques of

individual therapy. It does not concentrate on eliciting historical material, it is
not particularly interested in fostering increased awareness or expression of
buried feelings, and it does not engage in interpreting psychodynamics. It

does not consider understanding and insight to be important or essential in
producing change. Instead, this group of family therapists manipulates
variables such as the participants and rules of therapy by active suggestion
and direction. They may utilize paradoxical commands and clearly attempt to
alter the arrangement and intensity of family coalitions.
The ultimate goal of this technique is not so much to foster
understanding and insight as to change family structures, the communication

patterns, and roles—changes that will presumably change perception of the
individuals in the family unit and ultimately change behavior.
Experiential-Existential Model
This school believes that it is vital for the therapist to be aware of and
take into account not only the experience of each member of the family, but
also the therapist’s experience as an outsider entering the family. Empathy is
the key here—that is, the ability of the therapist to experience what a
particular family member feels at any given moment in the context of the
family. The data base is not only what the therapist sees, but what he and/or
the family feel.
The data base is derived from situations that the therapist designs,
permitting him to participate with the family in an emotional experience. If a
subject cannot be discussed, the therapist brings it up. His use of empathy
enables him not only to understand what an individual family might be feeling

but allows him sometimes to serve as a model for identification. He may be a
role model for a family or an advocate and help the family achieve something.
If a family is starving, the family therapist helps change the family by going
with them to get food stamps.
Thus, in this form of therapy the therapist offers himself as a real person
in order to minimize the distance between himself and the family. He is
always on the side of the family, but his behavior is different from any other
family member and is designed to promote more functional behavior.
The goal is to change the way family members experience and

presumably react to each other. A secondary goal is growth and
differentiation of family members.
Relationship of Theory to Therapy
It is important and interesting to note that there is often not a one-to-
one match between a practitioner’s theoretical position and his therapeutic
techniques and performance. This is true, of course, for all fields of therapy
and not just family therapy. However, the field of family therapy has been
noted for its vigor rather than rigor, as well as for its energetic deployment in
all kinds of human problems. There has been less attention to the
development of a theoretical understanding of family functioning and family

pathology. It follows, then, that while we can isolate three theoretical schools
of family therapy, the practitioners and what they do in a family session can
be classified from points of view other than that of their theoretical
metaphors or concepts. For example, in one of the earliest and still useful
classifications of family therapists, Chris Beels and Andrew Ferber talk of
conductors (therapists who take charge and direct the family sessions) and
reactors (therapists who wait for stimuli to arise from the family interaction
before beginning to shape those interactions with subtle and increasingly
direct intervention. In this schema, Nathan Ackerman, Norman Paul, and

Murray Bowen can be seen as conductors, while Carl Whitaker and Ivan Nagy
are reactors, and Jay Haley and Don Jackson are described as reactors who are
also systems purists, a reference once again to the theoretical stance. Both
points of view —the theoretical stance of the practitioner and a more

descriptive term relating to his style while working with families—are useful
in the conceptualization and teaching of this field.
Other Approaches
Certain approaches are associated with innovative therapists. Don

Jackson and others of the Palo Alto group focused much of their attention on
pathologic communication. Together with Gregory Bateson and others,
Jackson wrote about the “double bind” as playing a prominent part in family
difficulties. Jay Haley, originally a member of the same group, has recently
become more interested in the paradoxical intervention approach of Milton

Erickson. Virginia Satir, long interested in the communication frame of
reference, has recently moved into the area of family growth enhancement. A
current member of the Palo Alto group, Paul Watzlawick, believes that
“illogical,” unreasonable action can produce the desired change. He borrows

from the concepts of communications, double bind, and action-oriented
techniques of problem resolution.
Murray Bowen, a family therapy pioneer, concerned himself on one
hand with ideas about the lack of differentiation of various family subsystems
and, on the other hand, with the extreme disengagement of many individuals
in families—individuals who hardly seem to participate meaningfully in the
family. He has used a variety of techniques over the years, including seeing in
therapy only the healthiest family member and using that person as the agent,
or model, of family change. He has used letters written from one family
member to another as an indirect method for stirring up change in family
systems.
Carl Whitaker believes in the technique of paradoxical intention and
manipulates the family members into believing the therapist has to
overpower them, as if they are all engaged in a battle. He believes that the
therapist has to deprogram himself and advance his own growing edge in
order to conduct effective family therapy. In many ways Carl Whitaker

appears to see family sessions in experiential terms with a good deal of
emphasis on “feeling states” during the session and during immediate
feedback.
Jerry Lewis, Robert Beavers, and their coworkers have found that well-
functioning families may have particular attributes that are lacking in
dysfunctional families. A family therapist can apply this knowledge in his
work as follows:
1. The therapist works as collaborator, implying respect for the

other’s subjective world view. He demonstrates with the
treatment family an affiliative rather than an oppositional
attitude, and a commitment to negotiation as the basis for
treatment.
2. The therapist conveys a belief in complex motivations, especially

with respect to the reciprocal nature of human interactions,
paying special attention to (and including himself as being
involved in) the interactions that occur in the family-
treatment setting.
3. The therapist needs to be a model of clarity, spontaneity, non-

intrusiveness, and permissiveness with respect to the
expression of all types of affects, frequently expressing
empathic comments, acknowledging other people’s views,
and demonstrating a caring attitude.
An authoritarian style of treatment, in which the therapist sets himself

up as the all-knowing and all-powerful manipulator of the family’s

interactions and goals, may at times prove to be helpful, even though it
contradicts the model just outlined. People in some sociocultural settings are
accustomed to a directive style and may be left confused or unconvinced by
an invitation to share authority and responsibility. This directive style may be
needed at times with the most dysfunctional families, aiding them in
becoming less chaotic and enabling them to move to an intermediate
“adequate” stage.
We believe it is wisest to employ a pluralistic approach; that is, tailoring
the approach to the problem, rather than using a single approach in all
situations.
Specific Techniques
Many specific techniques (in addition to the basic three that have
already been described) can be employed during the course of treatment.
Family Tasks
Family therapy focuses on behavioral change. Accordingly, many family
therapists routinely prescribe various tasks for the family to perform during
the session and, more commonly, between sessions. The rationale for this is to
have the family work out and repeat behavior patterns outside the session.
The therapist (rather than the family) takes control of the symptom or
problem and helps realign coalitions. For example, family members that have
not had any recreational activity together in several years may be asked to
take a vacation together, or a husband and wife may be instructed to discuss a
family secret.
Special techniques have been devised for helping lower socioeconomic
class families, ghetto families, and highly disorganized families. The work of
Salvador Minuchin and others indicate that it is both necessary and possible
to help these families deal with some of their basic needs by using indigenous
populations as family advocates when dealing with social agencies; by
mobilizing the most constructive forces in the family system; and by

providing training in basic task performance. Such tasks might involve getting
the family registered with a housing agency. This serves to train and
strengthen the family unit’s ability to handle its problems in concrete terms; it
also helps to solidify the often shaky and inadequate manner in which the
family provides for its elemental needs. In this way the family can gain the
experience of accomplishing something meaningful for itself during its daily
struggle for existence and stability. These methods may be more useful than
the more symbolic, attitudinal, psychological techniques appropriate for
middle- and upper-class families.
Prescribing the Symptoms3

Don Jackson, John Weakland, and Jay Haley have written about a
therapeutic technique in which the therapist “prescribes the symptoms.” After
the therapist “orders” the family members (or individual) to intensify effect
and the frequency of the symptoms, the symptoms begin to lose their
autonomy, mystery, and power. Whereas they previously seemed to have
been out of control, they now appear to come under the therapist’s control.
The participants in the behavior become more conscious of them, and often
the disruptive behavior lessens or disappears. A marital couple that has
engaged in nonproductive arguing may be told to continue fighting and even
to increase it; for example, the couple may be ordered to fight about the menu
before dinner, so that they can enjoy the food. This injunction jars the
continuing process, and they may rebel against the outsider’s orders (which is
often a necessary step to change).
The therapist is obligated to follow through to make sure that the

directions have been followed in the way that was intended. The therapist
does this by seeing the family in his office on an ongoing basis, by asking more
than one family member what changes have taken place, or by visiting the
family at home.
Some therapists write a family prescription after the initial session,
telling the members they will receive a message about what the therapist
thinks is wrong with the family and what needs to change. This gives the
therapist time that is not available in the heat of the session and creates an
opportunity for a more accurate formulation of the family’s problems. The
prescription is a typewritten letter sent separately to each family member. It
may describe what is happening in the family and ask each member to
continue his course of action. For example, the therapist agrees with Joe (the
identified patient) that he should not move out of the house at present. His
parents, however, are told that they should continue to vacillate by alternately
supporting his moving out and undermining it. This prescription was sent to a
family with a thirty-two-year-old son who kept “messing up” each time he left
home, so that he was always forced to return to the family. The prescription
had the effect of making Joe angry, of shifting him out of the house, and of
identifying what his parents were doing. For some families there is something
quite powerful about a well-thought-out message that is “official” and to the
point.
Family Reconstruction
An in-depth exploration of family background is believed to improve the
therapeutic outcome. All family participants explore their own life histories,
learning about themselves and one another in the process. Such techniques as
role playing and psychodrama can be used to bring out significant past events
in the lives of families. A “family map” or genogram is used to diagram the

family of origin.

Humor and Banter
With the technique of humor and banter, the therapist intentionally
makes humorous comments in order to ease a tense moment or to highlight a

problem area in the family. The therapist exaggerates aspects of an
individual’s or a family’s behavior. Prerequisites include, but are not limited
to, the family and the therapist having a sense of humor and being able to
maintain a good rapport.
Including the Family of Origin
James Framo believes that involvement of the family of origin is one of
the most effective techniques in family therapy. It is based on the accepted

rationale that current family problems are grounded in part on reenactments
of previous problems that the husband and wife have had with their own
families of origin. The therapist routinely has at least one session with each
marriage partner, together with that partner’s own family of origin. The
individual’s spouse and children are not present in order to minimize
emotionalism. This enables the therapist to discuss the here-and-now

“corrections” with the aim of increasing present relatedness to the spouse’s
current family. There is usually a great deal of resistance to this technique.
Coaching
With the coaching technique, the therapist acts like a coach in helping
the family member make changes. For example, the therapist may explain
concepts and theories, give examples, draw diagrams, ask questions, make
predictions, or suggest alternatives. The therapist can get up from a chair and
stand behind family members whispering instructions or a supervisor can
phone instructions into a specially equipped room.
Mourning and Empathy
With the technique of mourning and empathy, the therapist elicits
unresolved grief for a parent, child, or relative in order to effect change. This
technique is borrowed in part from Gestalt therapy, in which there is an
attempt to release long-hidden feelings, expectations, and emotions.
Visits
With the voyages technique (modeled on the home-visit techniques) the
therapist travels wherever necessary to bring leverage to the family problem.

For instance, he may go to schools, homes, housing projects, churches, clinics,
bars, hospitals, and so forth. He meets with individuals or agencies that
influence the family (for example, the principal of a school).
Self-Disclosure

In individual psychotherapy the therapist usually does not reveal much
information about himself. The therapy is focused on the patient’s problems,
feelings, and behavior rather than on those of the therapist’s. Some family
therapists prefer, however, to use themselves as a major instrument in
changing the family by revealing material about themselves, their nuclear and
extended families, job philosophy, conflicts, goals, and plans.
This technique has not been accepted for most training programs
because of the belief that it may create more problems than it solves.
Guided Fantasy
With the technique of guided fantasy, the therapist helps the individual
share his internal system of fantasies and thoughts with other family
members. The rationale is that “daydreaming” can provide people with a

powerful tool for their growth and problem solving. It is important to have
each member share his or her inner thoughts with the rest of the family, so
that they can be empathic in helping the individual grow.
Family Sculpture
Family sculpture is a technique in which the therapist asks one or all of
the members of the family to create at a given moment a physical

representation of their relationships by arranging their bodies in space.
Alliances and estrangement can be concretized by such an exercise. The
technique can be used as part of the diagnostic workup to generate
hypotheses or to represent a concept being worked on concretely during the
course of therapy. Both the content of “the sculpture” and the way “the
sculptor” (that is, family member) uses mass and form are examined. It is an
excellent technique for nonverbal families.
Multiple-Family Group Therapy
The technique of multiple-group therapy brings together several family
units into a group just as traditional group therapy brings together

individuals. These groups may meet on a regular basis. The size of such
groups may vary from three to eight families at any one time. Groups can
include infants and those old enough to be living independently, as well as

significant others such as grandparents, in-laws, and fiancés. The duration of
the treatment on an outpatient basis can be from three months to one year,
whereas on an inpatient basis the family might participate in treatment
usually only as long as the identified patient remains hospitalized.
This technique seems to work best when there is a good balance
between the families who have been in the group previously (that is, more
experienced families) and those that have not. A balance between interfamily
and intra-family interaction is also desirable.

As part of the process, there is a great deal of mutual disclosure and
sharing, as well as peer review and evaluation of what has gone on. Socializing
between these families outside of the group formal sessions has been used
but with uncertain results.
Gould has summarized the process of such groups as follows:
1. They are sharing and interactional rather than analytical.
2. They are fast moving, experiential, often hectic, and very much in
the here-and-now.
3. There is a great deal of crucial interfamily contact that makes it

possible for families to learn from one another.
It has been claimed that multiple-family therapy groups, in contrast to

individual family treatment sessions, have very few dropouts. They are
thought to be especially useful when the family expresses a great deal of
denial.
Network Therapy
Ross Speck and his associates have described a novel approach to help
the identified patient. Members of the kinship system, friends of the family,
and all significant others who bear on the problem, are brought together to
work on the problem. This adds healthier voices to the mix. These groups
meet for three to six biweekly sessions lasting about four hours. The meetings
are held usually in the identified patient’s home, and thirty to forty-five
people can be involved.
Psychodrama and Role Playing
Psychodrama and role playing techniques have also been used to help
families enact family problems and work out new patterns. They are
especially useful in nonverbal families. In role playing or reverse role playing,
one partner either plays himself in a hypothetical situation or takes on the
role of his partner, often switching roles back and forth and commenting on
the observations, feelings, and behavior elicited. Role reversal is believed to

be useful for developing empathy in family members.
Gestalt Therapy
In adapting Gestalt therapy to family problems, the therapist stresses

that the only real time is the present, and he does not rehash the past. He
stresses that each individual is responsible for his or her own behavior
(countering the familiar resistance, “I did it only because he or she made me
do it”). He stresses that symptoms and conflicts are the here-and-now

expressions of unresolved situations of childhood that can be finished in
treatment. Significant attention is paid to nonverbal behavior.

Weekend Family Marathons
Weekend family marathons have been reported in which one or several
entire family units get together for extended periods (anywhere from eight to
twelve hours or longer) with leaders (“facilitators”) for a variety of intensive
types of encounters, usually including affect catharsis and nonverbal
experience.
Behavioral Approaches
Behavioral approaches deal with the means by which certain behaviors
can be learned, reinforced, or extinguished, irrespective of the original causes
for such behavior. Even relatively minor changes in the behavior of one family
member, or in a dyad, may bring about a significant alteration in the behavior
and feelings of other family members. External behavioral change may
precede internal attitudinal change.
Techniques of behavioral therapy include assertiveness training,

operant conditioning, relaxation and desensitization, contingency
reinforcement, and cognitive behavior modifications. Family members can be
utilized as co-therapists in various behavior modification exercises that are
rehearsed initially in the therapist’s office and are assigned for practice at
home.
Videotape
Therapists often find it beneficial to review their sessions and to have a
record of an entire course of therapy. Immediate playback of a videotape

helps families attain some psychological distance, makes them increasingly
self-aware, helps to correct distortions or conflicts about communication, and
is invaluable in revealing the important nonverbal aspects of interactions that

might otherwise be lost. Families often comment constructively while viewing
their own videotaped interactions and see things that they might deny when a
therapist points them out.
Audiotape
Audiotape has also been used as an adjunct to family therapy. A tape of a
session can be made and the family can take it home and listen to it, or a tape
can be made at home and then played at the session.
One-Way Mirror
The family meets in a room equipped with a one-way mirror. The
therapist can leave the family alone and observe its members through the
one-way mirror or have one or more selected members, including an
estranged member, observe the interactions. The family member comes out of
the “heat of battle” and is presumably then able both to distance himself from

what is going on and to change the unwanted behavior in the family system.
Some co-therapists find it useful for one therapist of the team to be in
the room with the family while the other therapist observes (alone or with
selected family members). The therapy can be interrupted at any time, so that
the co-therapists can confer and plan. The therapist who functions primarily
as an observer can be very objective, and this will facilitate treatment.
Conclusion
Family therapy is an approach rather than a single technique. It is a
group of therapeutic interventions, all focusing on the family, but directed
toward a variety of specific therapeutic goals. Therefore the relative
importance of a particular guideline depends in large part on the extent to
which the therapist uses the family model. For instance, if the therapist treats
all problems with family therapy, then guidelines are not important.
Conversely, when different problems are treated in different ways, then
guidelines become crucial.
Until about ten years ago, indications and contraindications for family
therapy had been based on ingenious hunches regarding treatment efficacy in

a specific situation and on clinical experience (a term once defined as “making
the same mistake for thirty years”). More recently there have been some
controlled outcome data that define situations in which family or marital
therapy might be the treatment of choice. These situations include:
1. Marital therapy for a marital problem.
2. Marital therapy for sexual dysfunction.
3. Family therapy for certain childhood and adolescent behavior

problems.
4. Family therapy for the “chronic patient” (i.e., those in need of long-
term continuing care and rehabilitation).
Any final authoritative pronouncement as to when and which family
therapy approach should be used must be withheld until more controlled data
are available comparing family therapy with other types of treatment.
Bibliography
Ackerman, N. W. Treating the Troubled Family. New York: Basic Books, 1966.
Bach, G. R., and Wyden, P. Intimate Enemy: How to Fight Fair in Love and Marriage. New York:
William Morrow, 1969.
Bateson, G., et al. “Towards a Theory of Schizophrenia,” Behavioral Science, (1956) 1:251-264.
Beels, C., and Ferber, A. “What Family Therapists Do,” in Ferber, A., Mendelsohn, M., and Napier,
A., eds, The Book of Family Therapy. Boston: Houghton Mifflin, 1973, pp. 176-194.
Bell, J. E. Family Group Therapy. Public Health Monograph No. 64. Washington, D.C.: Department
of Health, Education and Welfare, Public Health Service, 1961.

Berman, E. M. and Lief, H. I. “Marital Therapy from a Psychiatric Perspective: An Overview,”
American Journal of Psychiatry, 132 (1975): 583-592.
Blinder, M., et al. “MCFT: Simultaneous Treatment of Several Families,” American Journal of
Psychotherapy, 19 (1965): 559.
Bowen, M. “A Family Concept of Schizophrenia,” in Jackson, D. D., ed., The Etiology of

Schizophrenia. New York: Basic Books, i960, pp. 346-372.
----. Family Therapy in Clinical Practice. New York: Jason Aronson, 1978.
Camp, H. “Structured Family Therapy: An Outsider’s Perspective,” Family Process, 12 (1973): 269-
277.
Chazan, R. “A Group Family Therapy Approach to Schizophrenia,” The Israel Annals of Psychiatry
and Related Disciplines, 12 (1974): 177-193.
Curry, A. “Therapeutic Management of a Multiple Family Group,” International Journal of Group

Psychotherapy 15 (1965): 90-96.
David, A. “Using Audiotape as an Adjunct to Family Therapy: Three Case Reports,” Psychotherapy,
7 (1970): 28-32.
Dicks H. V. Marital Tensions. New York: Basic Books, 1967.
Framo, J. L. Towards the differentiation of a self in one’s own family. Family Interaction: A
Dialogue between Family Researchers and Family Therapists. New York: Springer
Pub., 1972, pp. 111-166.
----. “Personal Reflections of a Family Therapist,” Journal Marriage & Family Counsel, 1 (1975): 15-
28.
Friedman, P. H. “Outline (alphabet) of 26 Techniques of Family and Marital Therapy: A through Z,”
Psychotherapy: Theory, Research and Practice, 11 (1974): 259-264.
Fromm-Reichmann, F. “Notes on the Development of Schizophrenia by Psychoanalytic
Psychotherapy,” Psychiatry, 11 (1948): 267-277.
Glick, I. D., and Kessler, D. R. Marital and Family Therapy, 2nd ed. New York: Grune & Stratton,
1980.
Gould, E. “Self-Help Aspects of Multi-Family Group Therapy.” Unpublished paper, p. 2.
Grunebaum, H., and Chasin, R., “Thinking Like a Family Therapist.” Paper presented at the
Downstate Medical Center’s Symposium on Family Therapy, Training of Child
Psychiatrists, New York, December, 1978.
Gurman, A. S., and Kniskern, D. P. “Research on Marital and Family Therapy: Progress, Perspective
and Prospect,” in Garfield, S. L., and Bergin, A. E., ed., Handbook of Psychotherapy
and Behavior Change: An Empirical Analysis, 2nd ed. New York: Wiley, 1978. pp.
817-901.
Haley, J. Strategies of Psychotherapy. New York: Grune & Stratton, 1963.
----. Uncommon Therapy: The Psychiatric Techniques of Milton H. Erickson, M.D. New York: Norton,
1973.
Haley, J., and Hoffman, L. Techniques of Family Therapy. New York: Basic Books, 1967.
Harris, L. “Analysis of a Paradoxical Logic: A Case Study,” Family Process, 19 (1980): 19-33.
Jackson, D., and Weakland, J. “Conjoint Family Therapy: Some Considerations on Theory,
Technique and Results,” in Haley, J., ed., Changing Families. New York: Grune and
Stratton, 1971, pp. 13-35.
Landes J., and Winter, W. “A New Strategy for Treating Disintegrating Families,” Family Process, 5
(1966): 1-20.
Laqueur, H. P., Wells, C., and Agresti, M. “Multiple-family Therapy in a State Hospital,” Hospital &
Community Psychiatry, 20 (1969): 13-20.
Laqueur, H. P. “Multiple Family Therapy and General Systems Theory,” in Ackerman, N. W., ed.,

Family Therapy in Transition. Boston: Little, Brown & Co., 1970, pp. 82-93.
Leveton, A. “Elizabeth is Frightened,” Voices, 8 (1972): 4-13.
Leveton, E. Psychodrama for the Timid Clinician. New York: Springer Pub., 1977.
Lewis, J. M., et al. No Single Thread: Psychological Health in Family Systems. New York: Brunner
Mazel, 1976.
Lidz, R., and Lidz, T. “The Family Environment of Schizophrenic Patients,” American Journal of
Psychiatry, 106 (1949): 322-345.
Lidz, T., et al. “Intrafamilial Environment of the Schizophrenic Patient. VI. The Transmission of
Irrationality Archives of Neurology and Psychiatry, 79 (1958): 305-316.
McKinney, J. “Adapting Family Therapy to Multi-deficit Families,” Social Casework, 51 (1970):

327-333.
Madanes, C., and Haley, J. “Dimensions of Family Therapy," Journal of Nervous & Mental Disease
165 (1977): 88-98.
Mandelbaum, A. “Diagnosis in Family Treatment,” Bulletin of the Menninger Clinic, 40 (1976): 497-
504.
Marmor, J. “Marmor Lecture,” Psychiatric News, 5 November 1975, p. 1.
Minuchin, S. Families and Family Therapy. Cambridge, Mass.: Harvard University Press, 1974.
----., et al. Families of the Slums: An Exploration of Their Structure and Treatment. New York: Basic
Books, 1967.
Mittelman, B. “The Concurrent Analysis of Married Couples,” Psychoanalytic Quarterly, 17 (1948):

182-197.
Nadelson, C. C. “Marital Therapy from a Psychoanalytic Perspective,” in Paolino, T. J., and

McCrady, B. S., ed., Marriage and Marital Therapy. New York: Brunner Mazel, 1978,
p. 123.
Napier, A. Y., and Whitaker, C. A. The Family Crucible. New York: Harper & Row, 1978.
Oberndorf, C. P. “Folie a deaux,” International Journal of Psychoanalysis, 15 (1934): 14-24.
Paolino, T. J., and McCrady, B. S., eds. Marriage and Marital Therapy. New York: Brunner Mazel,
1978.
Paul, N. L. “The Role of Mourning and Empathy in Conjoint Marital Therapy,” in Zuk, G. H., and
Boszormenyi-Nagy, I., eds., Family Therapy and Disturbed Families. Palo Alto, Ca:
Science and Behavior Books, 1967, pp. 186-205.
Sager, C., Brayboy, T., and Waxenberg, B. Black Ghetto Family in Therapy: A Laboratory Experience.
New York: Grove Press, 1970.
Sander, F. M. “Marriage and the Family in Freud’s Writing,” Journal of the American Academy of
Psychoanalysis, 6 (1978): 157-174.
Satir, V. M. Conjoint Family Therapy: A Guide to Theory and Technique. Palo Alto, Ca.: Science and
Behavior Books, 1964.
----. People-making. Cupertino, Ca.: Science and Behavior Books, 1972.
Selvini, P. M., et al. Paradox and Counter-paradox. A New Model in the Therapy of the Family
Schizophrenic Transaction. New York: Jason Aronson, 1978.
Silk, S. “The Use of Videotape in Brief Joint Marital Therapy,” American Journal of Psychotherapy,
26 (1972): 417-424.
Simon, R. “Sculpting the Family,” Family Process, 11 (1972): 49-58.
Sluzki, C. E. “Marital Therapy from a Systems Theory Perspective in New York,” in Paolino, T. J.,
and McCrady, B. S., ed., Marriage and Marital Therapy. New York: Brunner Mazel,
1978, pp. 366-394.

Smith, Z. E. Discussion on Charity Organizations. Proceedings of the National Conference on
Charities and Correction, 1890, p. 377.
Speck, R. V., and Attneave, C. L. “Network Therapy,” in Haley, J., ed., Changing Families. New York:
Grune & Stratton, 1971 pp. 312-332.
----. Family Networks. New York: Pantheon Books, 1973.
Speck, R. V., and Rueveni, U. “Network Therapy: A Developing Concept,” Family Process, 8 (1969):
182-191.
Thibaut, J. W., and Kelly, H. H. The Social Psychology of Groups. New York: John Wiley, 1959.
Watzlawick, P. J., Beavin, H., and Jackson, D. D. Pragmatics of Human Communication. A Study of
Interactional Patterns, Pathologies, and Paradoxes. New York: Norton, 1967.
Wynne, L., et al. “Pseudo-Mutuality in the Family Relations of Schizophrenics,” Psychiatry, 21

(1958): 205-220.
Zimet, C. N. “NIMH Backs up on its Forward Plan and the National Register Survey of
Licensed/Certified Psychologists,” Psychotherapy Bulletin, 10 (1977): 1-3.
Zuk, G. H. “Editor’s Introduction: The Three Crises in Family Therapy,” International Journal of
Family Therapy, 1 (1979): 3-8-
Notes
1 Parts of this chapter were abstracted from: Glick, I.D., and Kessler, D. R. Marital and Family Therapy,
2nd ed. New York: Grune & Stratton, 1980, with the permission of the publisher.
2 Sources: M. Gill, R. Newman, and F. Redlich. The Initial Interviews in Psychiatric Practice. New York:
International Universities Press, 1954; and Group for the Advancement of Psychiatry.
The Case History Method in the Study of Family Process. Report no. 76. New York: Group
for the Advancement of Psychiatry, 1970.
3 Also called “paradoxical prescription [or] intention,” “symptom scheduling,” “negative practice,” or
“reverse psychology.”

Approaches To Family Therapy

Uploaded by

Copyright:

Available Formats

Approaches To Family Therapy

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Approaches To Family Therapy

Uploaded by

Copyright:

Available Formats

Approaches

Ira D. Glick, David R. Kessler, and John F. Clarkin

From American Handbook of Psychiatry: Volume 7 edited by Silvano Arieti

Copyright © 1981 by Basic Books

All Rights Reserved

Created in the United States of America

APPROACHES TO FAMILY THERAPY

Historical Overview of the Differing Approaches

Evaluation Using Differing Approaches

Differing Approaches to Treatment Elements of Psychotherapy and

Marital and family treatment can be defined as a professionally

family unit by using essentially interactional, nonpharmacological methods.

family and for individual family members.

Family therapy is distinguished from other psychotherapies by its

acknowledging that individual behavior patterns arise from, and inevitably

themselves. The major emphasis is placed upon understanding and

and development of these patterns of interaction usually receive only

In many families, some member or members may be “selected” as

American Handbook of Psychiatry - Volume 7 5

for example, psychiatric, correctional, or medical.

But there may not always be an identified patient. Occasionally a marital

and not from an individual partner.

The intrapsychic system, the interactional family system, and the

sociocultural system can be viewed as a continuum. However, different

relating specifically to the family system; he is aware of both its individual

characteristics and the larger social matrix.

Family therapy is not necessarily synonymous with conjoint family

indirect means (for example, provocative letters to family members) as an

movement in a family system.

therapist’s frame of reference remains limited to that of individual

psychotherapy. Family members in such a setting may be treated as relatively

conventional individual psychotherapy in a family therapy setting.

Family therapy might broadly be thought of as any type of psychosocial

the entire family structure. Thus, any psychotherapeutic approach that

system might fittingly be called “family therapy.” This is a very broad

Historical Overview of the Differing Approaches

American Handbook of Psychiatry - Volume 7 7

psychology, psychiatry, sociology, psychoanalysis, game theory,

problems was mentioned by Confucius in his writings, as well as by the

solutions to an individual’s problem. For a long time in our own culture,

distress were ascribed to magical, religious, physical, or exclusively

psychodynamics were postulated by Freud to be the determinants of human

behavior. Although he stressed the major role of the family in the

technique for dealing with such individual psychopathology was treatment on

family relationships.” Eventually, psychiatric social workers in child guidance

marital pair. And in the 1940s, Frieda Fromm-Reichmann postulated that a

pathologic mother (called the “schizophrenogenic mother”) could induce

schizophrenia in a “vulnerable” child. This speculation led other

father also plays an important role in the development of psychopathology. At

innovative because psychoanalysts had previously believed that this method

usually referred to a colleague.

Outside the field of psychiatry proper, marital counselors, ministers, and

1950s the first consistent use of family therapy in modern psychotherapeutic

schizophrenia. Gregory Bateson and associates, and Lyman Wynne and

American Handbook of Psychiatry - Volume 7 9

families in which the patient had another psychiatric disorder.

integrated into a general theory of family interrelationships, thereby shaping

interested in learning about family therapy and in utilizing its techniques. As a

matter of fact, a recent poll taken of California psychologists showed that 90