What it is: Family therapists think of people’s lives as intertwined and interdependent: each family member affects and influences the rest. “An individual’s life is not just an internal process—we are all shaped and influenced and conditioned by our relationships,” says Margaret Dunlevy, L.C.S.W., a family therapist who teaches at Montefiore Medical Center in New York. “So we are not individuals in a vacuum: we are always in systems, we are always in relationships.”
The family systems therapist works from the outside—the family unit—inward. “If you can change the structure of the family, if you can change the interactions in the family, you can really make tremendous change in the individuals in that family,” Dunlevy says.
There are several different types of family systems therapy. Structural therapists try to show families the ways in which they’re conditioning each other to behave in certain ways. By chipping away at the family’s status quo, you can change the way they relate. Bowenian family therapy looks at whether family members are “enmeshed,” meaning excessively close and dependent on each other, or cut off from each other and tries to help them find balance. But all family systems therapists look at the individual as a part of a larger group of people.
Clients learn how their families are functioning and why. Dunlevy notes that people don’t take the time or have the wherewithal to understand their family dynamics, but “once people get those concepts, it just takes them to a whole other level of consciousness,” she says. “Once you get to that level, you never go back.”
How it works: Therapy starts with an intake session, in which the therapist gets the family’s history, as well as those of both parents’ families. Children complete diagnostic drawings, expressing themselves through art and play. Therapists also talk to children’s teachers to see how they’re doing in school. “You’re always going to engage and join with the family, search for strengths right from the beginning and gather a lot of information about the situation before you can make any connections,” Dunlevy says.
Sessions are meant to draw out aspects of patients’ past that are influencing the way they’re relating in the present, and open clients’ eyes to how they’re behaving and treating one another. The therapist encourages family members to talk to one another naturally in session. “You want the family to be how they are in front of you, and begin to talk just like they do at home,” Dunlevy says. The therapist points out ways in which family members could more effectively and healthily communicate with each other, and they’re expected to practice at home.
Who it fits: Any families looking to improve their relationships. “Even the most highly-functional families may still have pieces of this that they can be helped with,” Dunlevy says. “If you really feel that you overreact, if you feel that your child doesn’t listen to you, if you feel like your child doesn’t respect you, if you feel like an ineffective parent and you don’t know what to do”—in any of these cases, family systems therapy might be a good fit for you.
Shown to treat: Runs the gamut from discipline problems to moodiness to abuse. Any issue that one or more members of a family is struggling with can be addressed through family therapy.
Duration: Anywhere from 12 sessions to several years. “Twelve sessions is a good amount to get to know people, to diagnose the issues and begin to do some interventions and send them on their way,” Dunlevy says. But for people with severe issues, it could take many years to get to the root of the problem.
Where to find a family therapist: If you have insurance, call your provider and ask for family systems therapists. Or call the psychiatry department of a major hospital near you for a referral.
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