Family Psychiatry


A senior founding clinician famously stated: "When families come to me for help, I assume they have problems not because there is something inherently wrong with them, but because they've gotten stuck -- stuck with a structure whose time has passed, and stuck with a story that doesn't work." Systemic therapy can be used both on its own as well as in combination with other treatments. Family Systems Therapy is the treatment of choice for relationship difficulties, intergenerational conflict, and other problems endemic to the family life cycle. The Family Institute of Westchester web site provides numerous examples of predictable difficulties omnipresent in the life cycle for which a systemic perspective is ideally suited: “couples desperate to make some meaning out of their relationship, to learn how to raise children, impart values and feel less anxious in a terrifying world; families attempting to regain their equilibrium after a company downsizing; minority couples assailed by everyday racism; single women coming to grips with living in a married world; and families coping with a parent’s chronic illness or contemplating a future after the death of a loved one.” Intervention proceeds based on “the facts of functioning”, the existing patterns in real relationships. The treatment focus is on direct assessment and change of the relationships between individuals. The practice of family systems therapy is distinguished by how the clinician attends to the relationship system in diagnostic evaluation, problem formulation, and treatment planning. Family systems theory connects individual and relationship problems to the multiple triangles that surround and entangle them. It is not a method, but an all-encompassing theoretical orientation that views the family as a social system, with assessment and treatment of the problems of an individual member in the context of the family as an interactive unit. A systems viewpoint can be utilized regardless of how many people are physically present in the consulting room. Family Systems Therapy has a positive view of both the individual and the family. An approach that incorporates “the normative crises of the family life cycle” provides numerous opportunities for preventative mental health care. The brief long-term family therapy model proposes that the psychiatrist be available to each family and its various constellations or sub-systems in an ongoing fashion so as to avoid emotional cut-off and loss. There is a completion of each stage but no termination. Coming back for further treatment at another point in the development of the family is not seen as a failure, but a success in working through another stage of life cycle development. The goal is to solve problems in current relationships so as not to leave a damaging legacy for future generations.

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