Outcome research in family therapy

The term family therapy can be misleading. ‘Family’ is open to many interpretations, if not attacks, because it is frequently read as implying a twoparent, heterosexual couple with two children, with the woman primarily the ‘homemaker’ and the man the ‘breadwinner’, with occasional backup from the grandparents. Such a picture would seem to marginalise or exclude other family forms, such as childless couples, single parents with children, gay or lesbian couples and unattached elderly persons. However, the reality is that family therapists treat many different forms of committed relationships and friendships. As to the term therapy, it tends to imply the presence of illness or dysfunction, located in the family rather than one of its individual members, and may thus be quite unacceptable to families who often believe that it is the patient and not them whom requires help. Being at the receiving end of family therapy can have strong connotations of blame. Practitioners therefore increasingly use the term systemic therapy, which is also more informative because some of the work often involves the wider system. The systemic approach is essentially a contextual approach – seeing and treating people in context. The first systematic work carried out with families dates back to the 1950s when Bateson and his team studied the patterns of schizophrenic transaction and communication. It was then postulated that the family of the patient with schizophrenia was shaping his/her thought processes through the often bizarre communication requirements imposed (Bateson et al, 1956). The team also observed that if the ‘identified patient’ improved, the family could become destabilised, seemingly resisting or blocking the clinical improvement of the patient – as if they needed the patient to remain unwell. The family was seen as a system with homeostatic tendencies and a variety of properties, such as hierarchies, boundaries, overt and covert conflicts between specific members, and coalitions. The various parts of the system, the family members, were seen as behaving according to a set of explicit and implicit rules that govern interpersonal behaviours and communications (Watzlawick et al, 1967). Family systems therapy was invented to challenge and disrupt unhelpful interaction patterns and dysfunctional communications, allowing new ways of relating to emerge. Over the past five decades a whole range of systemic approaches have been developed.