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Unit 13 Integrated Approach to Family Therapy

1. What do you understand by the integrated approach to family therapy? Illustrate with the help of an example.

An integrated approach to family therapy involves using various schools and theoretical models of family therapy in sessions. The underlying principle is based on an understanding of the family system. This involves considering the family as a whole rather than just focusing on an individual. Family therapists will draw from various models and techniques as they work with a family, rather than rigidly adhering to one specific school of thought.

Example: A therapist might use techniques from structural family therapy, such as joining and boundary making, alongside communication techniques from cognitive behavioural therapy and questions drawn from systemic family therapy. For instance, a family presenting with communication issues might benefit from the therapist first joining with each family member, in the style of structural family therapy. Then, the therapist can help them restructure their interactions by improving communication with active listening and clear expression of needs drawn from a cognitive behavioral model. Finally, the therapist might explore family dynamics using circular questioning from systemic family therapy to help the family gain a better understanding of their family patterns. This illustrates the integration of various approaches to create a treatment plan that fits the needs of the family.

2. What are the phases of family therapy? Explain them with special referrence to Indian families.

Phases of Family Therapy

General structure for family therapy can be broadly divided into three phases:

1. Initial Phase:

   • Referral Intake: This involves reviewing existing information about the family, understanding the family's perception of the problem, their motivation for therapy and the therapist’s assessment of their suitability for family therapy. An informal agreement about therapy modalities and roles is made.
   • Family Assessment: This stage includes 3-4 sessions dedicated to assessing family functioning and interaction patterns. This involves:
     • Genogram: Constructing a three-generation family tree to understand transgenerational patterns.
     • Family Life Cycle: Exploring the family's developmental stages, functions, and roles of members to understand how the family copes with transitions.
     • Problem-Solving: Examining how the family has dealt with stress, using circular questions and enactment techniques to identify patterns.
     • Structural Map: Diagrammatically representing family subsystems, boundaries, power structures and relationships.
   • Family Formulation and Treatment Plan: The therapist formulates a systemic hypothesis regarding the function of the family's symptoms, and discusses a treatment plan and goals with the family.
   • Formal Contract for Therapy: A plan for the therapy, including frequency, intensity and modality, is agreed with the family.

2. Middle Phase:

   • This phase involves the main therapeutic work with the family, the length of which varies depending on the therapy model and the family's needs.
   • Techniques Used:
     • Psychodynamic Therapy: The therapist interprets family dynamics and defences, aiming for emotional insight and new patterns.
     • Structural Family Therapy: Techniques such as unbalancing and boundary making are used to address power imbalances, particularly in families with adolescents.
     • Strategic Family Therapy: The therapist focuses on identifying and changing repetitive patterns by using directives and tasks to help families break out of unproductive cycles.
     • Behavioural Therapy: Utilising techniques such as communication skills training, and problem-solving skills training to develop a more positive and productive family interaction.
   • The therapist selects and integrates approaches to suit the family’s particular needs and context.

3. Termination Phase:

   • The initial goals of therapy are reviewed, and the family reflects on the changes made.
   • The therapist emphasises the importance of sustaining new patterns and provides a positive connotation for the family’s work.
   • The family is cautioned against reverting to old patterns and the importance of all members participating in maintaining new patterns.
   • A follow-up period may be planned to support the changes achieved and ensure a smooth transition.

Special Reference to Indian Families

Several important aspects relevant to family therapy with Indian families:

• Family Structure: Indian families are often functionally joint families, even with a nuclear structure, with multiple generations often involved in therapy.
• Interdependence: Indian families foster interdependence rather than autonomy, a factor that must be considered, especially when dealing with parent-child issues.
• Cultural and Religious Diversity: Therapists must be aware of regional customs, practices, beliefs, and rituals specific to the family's background.
• Therapist Role: Therapists should be cautious of being too directive, as families may place them in an authority position. It's important to adopt a non-directive approach.
• Socioeconomic Factors: Economic constraints can limit access to therapy, with poorer families being more likely to drop out due to other pressing priorities. Distance and a lack of access to transport may also create additional barriers.
• Family-Therapist Fit: A good "family-therapy" fit is crucial for families seeking and staying in therapy.

By considering these cultural factors, therapists can better adapt the general phases of family therapy to the specific needs of Indian families. The integrated model of family therapy allows flexibility and is able to incorporate various therapeutic techniques to better suit the family and their specific needs.

Important Points

• Vidyasagar is credited to be the father of family therapy in India.
• Amritsar Mental Hospital is the place where family therapy started in India.
• Patients and their families may be referred by many different sources including doctors.
• The three generation genogram is constructed diagrammatically listing out the family's information.
• Hypothesis that is based on the function of symptoms of the clients and their family is known as circular hypothesis.