Family Therapy: Insights and Applications

DB 5.1: General Concepts of Family Therapy

Family therapy provides a framework for understanding individuals within their relational context, emphasizing the family as a system. Four key general systems concepts central to family therapy are homeostasis, feedback loops, hierarchy, roles, rules, subsystems, boundaries, and wholeness. These concepts are pivotal in addressing systemic family dysfunction and promoting healthier interactions: Family Therapy: Insights and Applications.

Homeostasis

Homeostasis describes the tendency of the family system to maintain stability, even if the patterns sustaining that stability are maladaptive. For instance, in families where there is a substance abuser, other members may unwittingly enable the behavior to avoid conflict. Treatment disrupts this pattern and encourages healthier dynamics by urging the family to adapt to new roles and responsibilities. The therapist may step in to interrupt these behaviors and reinstate functional stability (Jabbari et al., 2023).

Feedback Loops

These processes reinforce or dampen behaviors within the family system, respectively. For example, a parent overly criticizing a child may encourage the child to act out more, reinforcing the critical behavior of the parent as part of a positive feedback loop. In that vein, therapeutic interventions, such as positive reinforcement for desired behaviors, can create a negative feedback loop, which decreases the problem behaviors and hence stabilizes the family dynamic.

Hierarchy, Roles, Rules, Subsystems, and Boundaries

This refers to the structure through which family interactions are governed. Dysfunction results when boundaries become rigid or diffuse or even when the roles and rules become unclear (Saathoff, 2008). For instance, if a child is made to assume a parental role due to issues like a substance use problem in a caretaker, there can be role confusion due to stress. Therapy aims at reaffirming appropriate boundaries and roles, ensuring that family members interact within a healthy structure.

Wholeness

Wholeness connotes that the family system is more than the sum of its parts. A change in one member impacts the entire system (Center for Substance Abuse Treatment, 2010). For example, a teenager going into substance use recovery may prompt changes in family routines and dynamics, like better communication and lower tension. Therapy helps the members understand the connectedness of their relationships and encourages the collaboration of the family in recovery.

These concepts empower the therapist to address systemic issues in families, allowing adaptation, growth, and healing of the system. The focus of the therapist shifts from isolated behavior to systemic interactions, thereby promoting long-term functional changes in the family system.

References

Centre for Substance Abuse Treatment. (2010). Chapter 1 Substance Abuse Treatment and Family Therapy. Nih.gov; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK64269/

Saathoff, A. (2008, November 11). Family Therapy [Video]. YouTube. https://youtu.be/mPW0UZd9gQ4?si=-isdis8JBSObQFBu

Jabbari, B., Rouster, A. S., & Schoo, C. (2023, September 16). Family Dynamics. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560487/

DB 5.2: Family Therapy Modalities

Two widely applied family therapy modalities in addiction treatment are the Family Disease Model and Multidimensional Family Therapy (MDFT). These approaches address systemic dysfunctions and recovery comprehensively, offering tailored strategies for families impacted by substance use.

The Family Disease Model views addiction as a family illness, recognizing that substance use impacts all members, not just the individual. This model focuses on breaking the cycles of codependency and enabling behaviors, and it encourages recovery for all involved. Therapy taught families about the dynamics of addiction and how to have healthier relationships with each other. For example, a mother who allowed her son to make use of illicit substances could sit down with a counselor and set limits, thus helping the son accept responsibilities in case of relapse.

Closer to the role of service organizations like Al-Anon, these are important in this model of treatment to ensure that members achieve long-term sobriety and strong coping mechanisms to withstand the stress of familial and social pressure (Saathoff, 2008). The strategy complies with the principles of the systemic family therapy to which Minuchin referred, asserting the interdependency of the family systems.

            MDFT targets adolescents with substance use disorders, addressing influences at individual, familial, and systemic levels. It integrates solution-focused techniques to enhance family communication and collaboration. For instance, a teenager taking substances because of pressure from peers will benefit from parental interferences that encourage surveillance and care.

MDFT focuses on how culture can influence the applicability of the intervention and is, therefore, perfect for many families and their unique values. This adaptability is essential for addressing external influences like school challenges and peer dynamics (Gikandi et al., 2021). It also emphasizes that MDFT centers on role realignment and strengthens family relationships.

Both modalities emphasize systemic change, highlighting how family dynamics perpetuate or disrupt addiction patterns. While the Family Disease Model excels in addressing enabling behaviors and codependency, MDFT is particularly effective in supporting adolescents by strengthening family bonds and addressing external stressors.

These modalities provide a venue for sustainable recovery via education, collaboration, and consideration of culture. For further information, refer to NIDA’s facts on family therapy and SAMHSA’s TIP 39. Indeed, these resources have evidence-based strategies for the provision of effective family therapy practices.

Link 1: https://archives.nida.nih.gov/sites/default/files/manual5.pdf

Link 2: https://store.samhsa.gov/product/tip-39-substance-abuse-treatment-and-family-therapy/pep20-02-02-012

References

Gikandi, A. W., Egunjobi, J. P., & Muriithi, J. K. (2021). Influence of Family Cohesion on Substance Use Disorders among the Youth in Selected Rehabilitation Centres in Nairobi County, Kenya. International Journal of Research and Innovation in Social Science, 05(08), 241–246. https://doi.org/10.47772/ijriss.2021.5816

Saathoff, A. (2008, November 11). Family Therapy [Video]. YouTube. https://youtu.be/mPW0UZd9gQ4?si=-isdis8JBSObQFBu

DB 5.3: Case Analysis for Joe’s Family

Joe’s case highlights the intersection of addiction and family dynamics. His substance use, escalating after his father’s death, has strained his 40-year marriage and relationships with his children. Addressing Joe’s situation requires a Structural Family Therapy (SFT) approach, focusing on boundaries, roles, and systemic dynamics (Information et al., 2020).

SFT places Joe’s drinking into the larger family dysfunction. Indeed, his wife’s attempts to control his drinking-such as taking away beer and issuing ultimatums-actually create unhealthy family interactions. Treatment can help the family define ways to set clear boundaries, such as allowing Joe to take responsibility for the behavior yet be emotionally supportive of the family. Furthermore, therapeutic factors such as enactments are paramount.

It is in such enactments of normal quarrels-like the issue of Joe’s drinking-that the therapist can observe the patterns and help guide healthier interactions. Psycho-education also prepares the family to understand the systemic consequences of addiction and collaboratively builds a recovery process.

Joe is presumably in the contemplation stage of change because he is motivated enough by the possible divorce yet unwilling to commit fully to the recovery process. His family, making proactive efforts to remedy the situation, is in action. These stages must be matched through therapy to work collectively.

Addressing possible dual diagnoses, such as grief-related depression, is important. Joe’s drinking might be masking unresolved feelings regarding his father’s death, and he might need mental health treatment in addition to addiction (Smail, 2023). A psychiatric evaluation for possible medication might be a good referral. Referrals are also critical for systemic support.

Joe may benefit from individual addiction counseling or membership in Alcoholics Anonymous. His family may join Al-Anon to build resilience and learn helpful ways to support Joe. Professional legal counseling may assist him through the complexities of a possibly pending divorce. Therapies that address systemic issues, emotional health, and communication will better enable Joe and his family to work through relationships for long-term recovery.

References

Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & USA, 20894. (2020). Chapter 2—Influence of Substance Misuse on Families. In www.ncbi.nlm.nih.gov. Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK571087/

Smail, K. (2023, April 13). The Impact of Substance Abuse on Couple and Family Relationships. Decide to Commit. https://decidetocommit.com/the-impact-of-substance-abuse-on-couple-and-family-relationships/

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