Family Therapy

In today’s society, earning a healthy income takes up a great deal of time and energy. One of the principles that Freud developed with which I agree has to do with his belief that every individual has a finite amount of mental energy available for investment in the different aspects of his/her life. For example, if an individual has, say, a total mental energy amount of one gallon, and three quarts of that gallon are invested into work, not much is left for family, hobbies, church, etc. That is why one of the major problems that successful people face has to do with the appropriate allocation of their mental resources.

The typical family that I treat has a problem child, an over-involved mother, and a father who is more withdrawn from meaningful contact with other family members. His work is very demanding, both in terms of time and energy. Since he is financially supporting the family, often quite well, his wife is in a very difficult position in which it appears unreasonable for her to complain about his lack of involvement with her and the children. This emotional abandonment of her and the rest of the family usually has occurred very gradually, over much time. She may not realize why, but usually the wife feels chronically unhappy and may even be consciously aware of some of the anger that she has towards her husband.

Since Mom is in a double-bind position where she feels “guilty” and “stupid” for demanding more from her husband, the children step in with unconscious efforts to emotionally reunite their parents as a functioning team. Unfortunately, the way people operate, outstanding good behavior is acknowledged, then quickly forgotten. Thus, the best way for a child to reestablish communication between his/her parents is to have problems. The two most common problems I see are either connected with school or with substance abuse. Problems in either of these two areas are usually considered important enough to merit the attention of both parents.

The usual scenario is Mom tries to handle the problem on her own, as she has learned though the years to handle other minor difficulties with the children. But this time, the problem is just too large. The child is older and the magnitude of his/her misbehavior is outside her competency level. She communicates this to her husband, with an implicitly or explicitly stated desire for his help. Depending on how distant the relationship is between the couple at this point, the request for help may be an emphatic but friendly one, or filled with hostile recriminations. Father will step in, but if he acts without cooperating with Mother, usually the intervention will be to little avail. The child senses the transient nature of the father’s involvement. While for some children any attention from Dad will cause change in their behavior in a positive direction, many teen-agers and “hard-core” younger children will continue to mess up.

This is usually about the time I come into the picture. My rules for family therapy include that the whole family must be present. The whole family is defined as everyone living in the household and/or everyone who has some influence over the child’s behavior. This may include grandparents, aunts, occasionally even neighbors or friends of the parents. I have sent home countless families from the waiting room because the father was too busy or too tired to come to the sessions. He seems to feel, after all, that since he is footing the bill for the sessions, what more need he do?

Prognosis for families depends upon the rigidity of the personalities involved and the duration of the problems in the family. Obviously, the more unwilling the father is to recommence functioning as his wife’s emotional partner, the poorer the prognosis for a successful resolution to the family’s problems. Similarly, if the wife and children have years of intense anger stored up, they are difficult to work with in therapy.

Families have all sorts of implicit rules governing the behaviors of their members that they bring into the therapy room. For example, “We never talk about grandma’s drinking problem,” or “I won’t talk about your affair if you won’t talk about mine.” The rules also cover day-to-day behaviors. For example, the children know without verbalizing it that if they want to do some activity, they ask Mom, not Dad. One common rule that impedes progress in therapy is “Family problems are not to be discussed outside the family.” This rule prevents many families from seeking treatment and encourages denial even among the family members that a problem exists. I believe that many times a bad family situation has already begun to improve when a parent picks up the phone and schedules the first therapy appointment. At that point, someone in the family is acknowledging the fact that old solutions are not working. I will often remind the family of this fact in encouraging them to follow my suggestions.

I will not go into detail about the sorts of suggestions I make to families with problems, not because of a reluctance to reveal “trade secrets”, but because therapy has to be tailored to fit the individual family. Moreover, the presence of an unbiased authority figure who has no investment in taking one “side” over another is a crucial ingredient in successfully changing families. It is impossible to do successful family therapy with your own family or with the families of friends. The dual role conflict dilutes one’s effectiveness. Family therapy can be a long, drawn-out process and success often depends on how much the involved parties are willing to invest, energy-wise and time-wise.