Historically, family therapy grew out of individual therapy as psychologists began to realize that family patterns, interactions, and wounds contribute to both the problem and the solution to emotional and behavioral troubles. There are several schools of thought that drive family therapy, but the overall premise is that families exist as systems, and that “the whole is greater than the sum of its parts.” With younger children, parenting and/or family therapy may be preferred, as parents and siblings have the most direct impact on a child's world. Other components, such as individual play therapy or skill building, can be added to your child's plan of care based on his needs.
Family dynamics is a term used to describe the general pattern and functioning of your family. Family therapists look at patterns of communication, alliances, problem solving, and the assignment of power and resources, among other things, to determine a family's overall style and then assess what about that style is working and what is not. Family therapists also assess a family's adjustment to various transitions, coping, parenting styles, and marital stability to determine which areas might need to be addressed.
In order to fully assess and treat a family, it is generally best for all family members to attend sessions. Children who are very young or older children who may not live full-time with the family may not be included, or included in specific sessions only.
A primary theory in family therapy is the tendency of families to seek to maintain sameness, even in the face of extreme external changes. This is not unlike an automatic piloting system, which is set to maintain a certain course no matter what the weather or currents. An example of homeostasis is a child with anxiety who is learning to be more independent and spend more time away from home, whose parents may miss her company, or be afraid she will not do well, and subtly discourage her progress.
Enmeshment and Disengagement
Enmeshment and disengagement are classic terms used in certain forms of family therapy to describe how close (enmeshed) or distant (disengaged) family members are from one another. The goal in this aspect of family functioning is to seek a balance between these two polarities, and to enhance a family's ability to move, flexibly and adaptively, between the two extremes.
Families who are extremely disengaged may be more likely where there is depression or schizophrenia. An extremely disengaged family system can produce anxiety in children if they feel there is no one to connect with, or to protect them. This can be especially true for children who live in high-crime neighborhoods.
In families in which one or more members have anxiety, the trouble is usually enmeshment, or too little “personal space” between family members. As you saw in Chapter 7, being overprotective can be one form of enmeshment, blocking children from establishing independent, confident selves.
Extended family, such as grandparents, aunts, and uncles may be included in family therapy for a number of reasons. This can be especially important if extended family provides care for your child or if the contact is especially close, so that your child's new skills and the techniques he's learning are supported and reinforced in as many settings as possible. If you have a strong relationship with your family already, and feel they can be team players, you will more than likely be able to enlist their support for your child without the assistance of a therapist.
Parent coaching can be offered individually or in groups, and is often woven into individual therapy when a therapist provides focused time for parents without the child present. It is typical for therapists who specialize in play therapy to offer parent coaching versus family therapy, as they see the child as the “primary patient,” but still want to offer guidance to the parents. Parent coaching can be an essential tool in helping parents to ally with each other, and help their children by reducing anxiety created by mixed messages or approaches.