FAMILY THERAPY IN

st
21 CENTURY
by Smeyye BALCI

CONTENTS

Family Therapy in 21st Century

Feminist Family Therapy
A Feminist Approach to Illness and Family
Family Violence
Multiculturalism
Race
Poverty and Social Class
Gay and Lesbian Rights
Spirituality
Tailoring Treatment to Populations and Problems
Single-Parent Families
African American Families
Gay and Lesbian Families
Home-Based Services
Medical Family Therapy and Psychoeducation
Relationship Enrichment Programs

Family Therapy in 21st Century

combine models and techniques from various family therapy theories
specific needs of every client
Postmodernism : not knowing the truth for sure. According to Rovelli
(2012), stating that some idea or phenomena is a scientifically proved
is closing the doors to improving that idea/phenomena

Feminist Critique
sharing the responsibility of the problem is
another way of accusing the victim and
continuing with the remaining system
blaming women for causing their own abuse
blaming
women
for
their
children's
psychopathology and even the problem of
family
the father figure who was the hero and saved
the family from dissolution?!

Feminist Family
Therapy
differences between
a feminist family therapist

and a therapist who adopted the principles and

practices of feminism

Feminist therapist is defined as the ones who

composed feminism both into their personal lives
and to their psychotherapy practice
main idea that makes a feminist family therapist
is the sensitivity to gender and a nonsexist
approach towards the clients
those who also put the gender equality in the
center of their therapy practice are should be
considered as feminist therapists

Feminist Family
Therapy
feminist family
therapists one of the main goal

is to extend the assessment to the cultural and

social context in order to rescue men and
women from narrow and unequal roles that
theyve been playing for a long time
powerful political aspect because what this
approach aims to accomplish is to change
patriarchy with a feminist consciousness
a feminist family therapist should have a
feminist sensibility rather than feminist agenda
while challenging patriarchy

Feminist Family
Therapy
major conflict which is encountered

The
by
families is the cultural coding that forces women to
nurture and support men while they are seeking
success even if it decreases womens development
challenge this balance by empowering women to
feel adequate
power refers to having freedom and resources to
accomplish to do things but not domination or
control over someone
Both men and women should be empowered to
free themselves from what taught them to be
acceptable and what is best for them

Feminist Family
Therapy
Therapists are used to working with women as
their clients and in family therapy they tend to
accept the absence of father because of his
work schedule. But in order to resolve the
problems that are result of the sexist
arrangement of family system, family therapist
should insist on having the father come to the
therapy with the rest of the family
members(Nichols, 2013)

A Feminist Approach
to Illness and Family
traditional gender roles are accepted unconsciously
however in case of a chronic illness of a family
member may result the obligatory change in these
roles because of the demands of the illness
in dysfunctional couples, through health habits and
depression, there is an indirect effect on health and
health
outcomes
and
direct
effects
on
cardiovascular, immune and endocrine systems
Spouses contributions to their course of disease
might be helpful or hinder

A Feminist Approach to
Illness and Family
Behavior patterns of being ill is different for
men and women
an illness can challenge gender roles
For example, a woman might need to built
trust first to tell the health psychologist her
illness story; and a man might feel difficulty
talking about his illness story because this is
very much related to exposing vulnerability
which is against to most mens socialization.

Illness, couples and

family life cycle

if a couple with young children

face a chronic illness, while one of
them is mostly focused on
childrearing and the other one on
working, these differences might
cause additional difficulties
because it will devastating
considering the parent roles and
responsibilities
In therapy; how each partner can
make transition into a new role
and what are the possible
obstacles towards these
changes(Silverstein & Goodrich,
2003)

Medical family therapy has a gender sensitivity

to fight with these oppressive experiences
caused by gender roles
aims to help families and increase agency via
psycho-education
encouraging
all
family
members to maintain individual and family
identities, develop flexible roles for caring
illness, and finding resources independent from
gender based socializations
Medical family therapy counters the traditional
medical approach by making sure the patients
voice is heard by the health care professional
and mutual agreement about a treatment to
avoid noncompliance

Family Violence
Judith Myers Avis reported that therapist
who adapt the systemic approach will keep
supporting male power in family and
indirectly leading to danger against women
and children. Systemic approach believed
that family violence was result of a cycle of
mutual provocation

Multiculturalism
It is important to be familiar with our
clients backgrounds and their cultures
because some of their behavior due to
their culture might be different to us but
it is not necessarily wrong

Race
In the US, African American therapists
such as Nancy Boyd-Franklin and Ken
Hardy put families of color into the map
by emphasizing white therapists denial
and ignorance towards them and the
racism they have to live with everyday

Poverty and Social

Class
People who are low on economic status tend to
believe that it was their own fault to become
poor because thats what is believed by
everyone
Therapists should familiarize themselves about
the conditions that poor people live in
A therapist might help the clients see that
being poor is not the result of their own making

Gay and Lesbian

Rights
Therapists should be aware of that a
gay/lesbian client might had to deal with
pressures from society and accepting their own
identity.
When working these clients, it is a therapists
responsibility to get familiarize about the issues
these people face(Nichols, 2013).

Spirituality
a debate about whether therapists
should explore the spirituality of the
family or not
peoples
answers
about
their
spirituality also tell a lot about their
well-being(Nichols, 2013)

Integrating Spirituality
in Family Therapy
In therapy, most families wanted to gain deep
meaning about their lives and contribute to their
spirituality
examples of effective faith based health care
programs which combines spirituality aspects through
clergy with communication skill for a premarital
program for couples
it is important for therapists to familiarize about their
own spirituality and religious view and related biases
It is important to acknowledge the clients spirituality,
religious views and beliefs rather than avoiding it

in Eastern cultures, to treat an illness,

they use mind, body and spirit
interactions
In Chinese medicine, trying to find ways
to increase energy for internal resilience
and resistance to disease
In future, new approach to family, a more
holistic approach such as biopsychosocial
and spiritual way to approach clients

Spirituality and Health

our faiths, rituals and prayers provide positive
effects on our health and physical well being by
triggering emotions that influence physiological
systems
elderly who have strong religious beliefs tend
to be happier with their lives and to have a
lower blood pressure(Walsh, 2009)

There are two ways that therapist could utilize

the spirituality of their clients in the sessions;
first, is the spirituality of the client contribute to
distress of the family;
secondly is the spirituality of the family can
contribute to solving the problems in the family
When families face a conflict, a crisis; they use
their strengths and bounds between members
and resilience which all these are enhanced by
sharing spiritual values and and practices to
support one another(Walsh, 2009)

Tailoring Treatment to
Populations and
Problems
Books about family therapy cover families with
specific problems such as drug abuse, single
parent families, stepparent families, divorcing
families, blended families and families who are
in a transmission
A family therapist might face some difficulties
when treating single-parent families, families of
minorities and gay and lesbian families(Nichols,
2013)

Single-Parent Families
Single parent families have
a very similar problem with
two parent families: an
overburdened mother, who
is enmeshed with her
children and disconnect
from relationships with
other adults
the goal of therapy is to
empower the mothers
position in the family and in
her relationships with her
children and provide her
some resources to make
her life more fulfilling

the therapist should support the parent with

already existed resources and empower her to
acquire more effective role in her children
providing for the children with one pay-check is
very hard and sometimes force people to put
up with very difficult conditions in workplace
just to provide their families
Financial difficulties may led to depression and
low self-esteem

In therapy, therapist should account for financial state of

his/her client and arrange sessions according to the parents
work schedule. Further in therapy, single-parent can be
presented with options that suggest a more financially stable
life such as going back to school
Supporting the single-parent can be started with
empowering already existing bounds with his/her parents
and close friends
A very important challenge that a single mother might face
is to integrate the father of her children to their lives. Usually
the father seems like an outsider and even an enemy
however the therapist should understand these negatives
feelings of the mother towards the father and help her to
involve the father (emergence of two subsystems after
divorce)

Ambiguities after
divorce
ex-spouses have
different constructs about each

other and these constructs are mostly determined

by the reason led them to get a divorce

If these complicated views about ex spouses

toward each other may lead to feelings of anger
and blaming one side; the therapist should help
the ex spouses to reconstruct new images about
each other so that they can believe the other one
will offer something to their children in the
future(Barnes, 2004)
In children, sadness, failure at school, violence; in
parents, increasing hostility towards one another

African American
Families
African American families
are characterized with
their extended families
and kinship networks
which provide support
and strength to them
Usually an African
American family came to
therapy when they lost
connections of their
extended family and
kinships

In therapy, therapist should focus on connecting the

family again with those extended family members and
kinships to provide them support to cope with
conflicts. These extended family members and kinship
networks might be call to the therapy sessions as well
in the assessment process.
Religion plays an important role as a source of
strength in an African American family, so it is useful
to state whether the family is practicing any religion.
particular complications in African American families
caused by absence of men (fathers: death or in jail),
presence of grandparents in the household and so on

Gay and Lesbian

Families

In gay community, the term

family refers to an
important reconstruction of
a traditional arrangement
that was causing difficulties
and abusive for LGBT
individuals(Silverstein
&Goodrich, 2003)

specific problems same sex

couples face such as
homophobia in their
families and in society,
boundaries, gender related
behaviors and developing
social support

In working with same sex couples, therapist should

pay attention to use a language free from homophobic
expressions and biases as much as possible
Gender roles in heterosexual couples, are controversial
in same sex couples and led some problems for the
same sex couple
Monogamy is an issue to discuss in therapy with same
sex couples to clarify the boundaries of commitment
Because there is not a model of family in same sex
couples, the issues of couples needed to be handle
more cautiously by the therapist

Sex and Internet

Internet, is rather a
recent technology, is
helping people connect
with others and not
connect with others while
keeping them online
socializing and having
them socialize in a non
traditional but a
technological way

In the US, many family therapists are facing with the problems
in family caused by cybersex incidents
excessive consumption of internet pornography and infidelity
issues are very common
The dangers to internet use for children may involve
cyberbullying, cyberharassment and inappropriate sexual
contact with people in real world
For teenagers, parental control over their behavior might let to
rebellion which may not be so obvious if the subject is shame
sensitive such as sexuality
Pornography might seem rather harmless for adult audience
however there are still risks that it can turn into compulsions
and their secret nature might cause harm to trust and intimacy
of the couples relationship
People who are suffering from compulsive sexual behavior seek
help through recovery programs

Home-based Services
home-based services aims to provide the
family as a major recipient of mental health
care
Home-based services has four elements:
family
support
services,
therapeutic
intervention, case management and crisis
intervention

Family support service involves respite care and

assisting the family to provide food, shelter, and
clothing.
Therapeutic intervention involves individual, couples or
family therapy. The main goal here is to empower family
to find their own strengths to solve their problems by
themselves.
Case management include finding connections in the
resources that community provide such as medical care,
education and job trainings.
Crisis intervention refers providing 24 hours available
emergency services by contacting home-based agency
or an outside mental health emergency service

For a therapist, visiting the family at their

home is a great way to understand their family
history, their identities and religious beliefs. For
example looking through photo albums may be
a good way to the therapist to join the family
Studies have found that in home based
therapies, the most important thing is
therapeutic relationship between the family
and the therapist. Therapists warm attitude
may contribute to the relationship

Medical Family
Therapy &
Psychoeducation
medical family therapy which emphasizing
helping families who are dealing with chronic
illnesses such as diabetics, cancer and
psychoeducational family therapy which
had its roots from working with families who
have a schizophrenic family member.

Psychoeducation and
Schizophrenia
Some studies
showed that the course

of
schizophrenia is affected by the amount of stress that
the patients experience after coming back to their
homes
it is important for schizophrenic patients to have
rather a peaceful environment at their houses in
order to prevent relapses
Psychoeducation aims to help families of
schizophrenic patient get enough knowledge to
understand the disease and have a sense of mastery,
reduce the guilt and shame and conflict
Main goal for the family is to help them learn coping
strategies while living with a schizophrenic patient
and preventing relapse and rehospitalization

Medical Family
Therapy
Medical family therapy aims to help
families while coping with a chronic
disease. It involves not just the family of
the patient but their physician and nurses
who take care of them; aimed to provide
communication and support between the
family and their health care provider
team

Relationship Enrichment
Programs
developed by Bernard Guerney, Jr. in 1977 to help
couples clarify their conflicts, be open about their
feelings and acknowledge each others feelings
and work through problems and finally become
satisfied with being emotional partners
three core skills: Expressive(owning) skill
which refers to an awareness towards ones own
feelings and taking responsibility about these
feelings while not projecting them to others;
Emphatic Responding (Receptive) skill refers
to listen others feelings; Conversive(DiscussionNegotiation/Engagement)
skill
refers
to
learning to acknowledge what was heard.

PREPARE: Premarital Personal and Relationship Inventory

is developed by David Olson and his colleagues to assess
the couples history and expectations, communication, and
the areas where they might face a conflict in the future
and promoting discussions about these possible problems.
http://www.youtube.com/watch?v=QRCMOtYGTgk
Marriage Encounter Weekend: first organized by a
church in Barcelona to provide support and enrichment for
Catholic couples. In these events, couples get to work on
their communication and problem-solving skills, sexual
intimacy and spiritual issues.
PREP: Prevention and Relationship Enhancement Program
developed by Floyd, Markham, Kelly, Blumberg and
Stanley in 1995 which aims to teach communication and
conflict resolution skills and explore expectations and
attitudes about marriage and avoid couples to develop
unhealthy defensive patterns in their relationships

References
Barnes, G. G. (2004). Family Therapy in Changing Times. New York: NY:
Palgrave Macmillan.
Dallos, R. & Draper, R. (2010) An Introduction to Family Therapy: Systemic
Theory and
Practice. Berkshire, England: Open University Press.
Nichols, M. P. (2013). Family Therapy: Concepts and Methods. Upper
Saddle River: New
Jersey: Pearson Education Inc.
Rovelli, C. (2012). This will make you smarter. J. Brockman (Ed.). New
York, NY:
HarperCollins.
Silverstein, L. B. & Goodrich, T. J. (Eds.). (2003). Feminist Family Therapy:
Empowerment in
Social Context. Washington, DC: American
Psychological Association.
Walsh, F. (Eds.). (2009). Spiritual Resources in Family Therapy. New York,
NY: The Guilford
Press.

Type a quote here.

Johnny Appleseed