What’s the hardest thing about family therapy? Myths and challenges

Family therapy can truly become either a saving grace or a boxing ring. For many of my clients, it’s a boxing ring full of traps, snakes, confusion, and drama. No matter how much I attempt to encourage my young client’s to give it a try and be courageous, the session drama becomes a living, breathing soap opera. Have you ever  been in family therapy or wondered what it would be like to attend a family session? This article will address some questions about family therapy and explore some common myths.

Photo by james.thompson

Family therapy is not as simple as it may appear. There are tons of techniques, approaches, and “schools” of thought that influence the flow of a single session. A therapist’s style will also influence the flow of family therapy. What most people struggle to realize is that family therapy is not just an opportunity to attend therapy together as a family, but rather a chance to challenge each other, discuss very uncomfortable subjects that affect the family unit, and make real changes. Unfortunately, families believe that family therapy involves discussing why the family does not get along and waiting on the therapist to offer tools or techniques to help. While some of this is true, the real point of family therapy is to “work through” challenges which might result in intense rage, very upsetting discussions or sessions, and abrupt endings after someone walks out. Family therapy is not pretty. Sometimes sessions go as planned and sometimes they do not.

It’s important to also keep in mind that a family therapist can either make or break a session. Depending on the personality, style, and training of your family therapist, a session can be civil and helpful or uncivil and violent. For many people, family therapy is something they would rather avoid. The reasons for this are very clear. For those individuals who absolutely hate family therapy, you will love the fact that I have observed there are 6 ways (maybe more) in which family therapy can be harmful:

1. Incompetent family therapist: Believe it or not, a therapist who is skilled at what they do and has had experience with family drama would know exactly what to do if family sessions become too confrontational. A therapist who is afraid to “jump in between” two family members yelling and screaming at each other, would not offer much support to the family. A therapist must truly have courage and confidence to play the middle man, especially when family tension is high.
2. No rules or boundaries: Family therapy can truly escalate from 0-10 in a matter of seconds depending on the topic, the emotions involved, and the people involved. I’ve had my fair share of family sessions in which a teenager became so escalated that back up staff had to be called into the session. A therapist who does not start family sessions with rules and boundaries, are looking for trouble. If a therapist highlights how a healthy family session should be conducted, the participants will be more mindful of their responses and behaviors.
3. No goals or direction: In my experience with families, it is important to have some goal or direction for the family session before it begins. Sessions can truly take on a nature of their own and with so many emotions and thoughts being shared in a family session, lack of goals or direction can result in a waste of time. It’s very easy for a therapist to sit back and watch a family fight or argue. Family therapy should not be a boxing ring but a process by which each family member works through their problems and toward an ultimate goal. This is easier said than done in many cases.
4. Lack of family motivation to change: Most family therapists are passionate about their jobs and the privilege they have to work with really difficult families and cases. But a family therapist can only do but so much if the family does not see a reason to change, is actively working on changing, or is willing to try to change. There is nothing that family therapy can offer if the family itself refuses to identify their needs and change.
5. Too much animosity: Sometimes family therapy is simply unhealthy. Family therapy is not for everyone. A family who is struggling with some very intense circumstances such as a violent death or murder, rape or incest, racism or prejudice, jealousy or strong resentment, or even divorce may not benefit from family therapy. Sometimes therapy is useful if the individuals of the family seek their own therapy. Individual therapy is useful in helping the individual identify their feelings, thoughts, and challenges. After individual therapy is completed, pursuing family therapy could be useful. In other words, it might be best for individuals to seek their own treatment before coming together for family therapy.
6. “Identified patient” not being treated: Family therapy can truly be difficult if there is an individual member of the family who is struggling with their own mental health challenges. For example, a mother who is struggling with PTSD (post traumatic stress disorder) and does not have her own therapist or is being treated with medication, might find it difficult to be cognitively and emotionally present in family therapy. It might also be difficult for this mother to fully engage in treatment if her own psychological health is poor.

Sadly, most families believe that family therapy is long and tedious. But that’s not always the case. There are 3 common myths of family therapy that many of my clients come to therapy with:

1. Family therapy is a chess match: Some family therapy sessions feel like a chess match between the family members and the therapist. Multiple questions are asked, hidden feelings are prodded, and statements made in session are challenged. But the point of family therapy is not to embarrass you or make you feel overwhelmed, it is to encourage you to explore the issues that brought you into therapy in the first place. This isn’t always pretty.
2. Family therapists are detached: Every therapist has a different style, attitude, and life perspective. One family therapist might sit quietly as you and your family argue everything, while another therapist might provide “homework assignments” to complete as a family outside of therapy such as going to the mall together, cooking together, or completing a worksheet. Some family therapists sit close to the family and might even attempt to become a piece of the family, temporarily.
3. Family therapy is long-term: Family therapy is not always a long term investment. In fact, it can be as short as 28 days, a month, or 3 months. Children who are in residential treatment facilities engage in family therapy for 3-11 months. Some adults can also attend family therapy short-term. Therapy has truly changed over the years due to managed health care and insurance. Managed health care often seeks evidence based therapy that is short-term. More and more agencies and therapists are offering short-term family therapy that provides well-proven approaches to common challenges such as divorce or custody issues.

Can you identify some challenges of family therapy? Perhaps the thought of “family therapy” is taboo in your family. For many of my clients, family therapy is something they truly struggle with. Some of the reasons for this include: poor boundaries within the family, resentment toward specific family members, fear of being targeted or resented, embarrassment, or feeling like a family therapist cannot help them “fix” their problems. While my intent is not to discourage you from family therapy, but to encourage honest discussion, I will admit that I would also struggle with family therapy. It is not a comfortable experience and often challenges you on many levels.

As always, I’d love to hear your thoughts about this.

All the best