The Specifics of Family Therapy Techniques and How It Impacted Me

The family of M.H. came to me concerned about her bizarre behaviour and her mental health. She is a 17 year old girl that escaped several times from her home, and having emotional relationships with some men that she makes acquaintance with while on the run. They also said most of these men take advantage of her trying to get physical contact, and that she sometimes agree to go for it. She steals money from her parents, always lies and they just couldn’t deal with her anymore. Her parents claim that this all started two years ago after she had a major operation on her brain, while the doctors assured her MRI and all her x-rays are sound.

I talked with the parents for some time to know more about their family and the family dynamics. Their family consists of the mother and father with one son and two daughters where M.H. is the middle child. The difference in age between the parents is 17 years, and the way they handled the conversation through the session showed that the problem was way beyond M.H. and her siblings. The way they are seated revealed the distance between them, they sure can’t communicate in a healthy way or get along in a normal conversation. So we agreed on meeting them all together as a family for a couple of sessions, - which took me some social skills and time to convince the father- and see how the therapy goes.

After a couple of sessions I could conceptualize the dilemma of this family. The parents have a lot of marital problems; they lack direct communication and have major difficulties in functioning as parents in coherent family. They seem they are backing away from change and reluctant to be involved in therapy or to see themselves as a part of the family dynamic that lead to M.H’s problems. The father is so abusive he hits the mother and calls her names. He does this to his kids as well. The brother is given more authorities in the family under the title of (the man of the family); leading the women in the family to suffer systemic injustice because of their sex as perceived by the feminists (Pilalis & Anderson, 1986).

They also seem to be disengaged, not responding to emotional cues and failing to connect to each other. This showed a low level of cohesion and individuation which is a natural result after understanding the family’s cultural context and the family dynamics (Doherty & McDaniel, 2010). As for M.H., the narrative inside her head describing her family and herself is distorted. She sees herself, her life and her body in a shameful way, and always thinks people sees her in the same way she sees herself. She is embarrassed from her body, feels inferior because of how her brother treats her and has a lot of bad thoughts and emotions towards her parents because of the hitting and the way they look at her and call her names. They even sometime say to her directly that they don’t want her and that she is a shame to the family.

This made her live anger and resentment from her own self and her family. Running away from her house is a compulsive behaviour. Whitfield (2006) said this compulsive behaviour gets the client a “temporary relief from tension, suffering and numbness, even though we might have some shame about it” (p. 79). The thing is her family interpreted her running away as revenge or hatred and handled it with a more supressing way, which never stopped the cycle of their interpersonal patterns.

The parents of this family never put into consideration their children’s inner experiences. They fear emotional intimacy and they even are uncomfortable with their own emotional needs. This leads to the physical and verbal abuse; which eliminates the children’s instinctive urge to ask for proper communication with emotional contact, and let the children think they are rejected by their parents hence live with conflicts and low self-esteem and more emotional loneliness (Gibson,2015).

After this conceptualization, I think that I need to work with this family with systemic and narrative family therapy techniques. The system theory or system thinking is the theory were the therapist concentrates on the family and identifies its systems, subsystems and suprasystems. It helps seeing the boundaries in each system, interpersonal patterns of behaviour leading to family problems, and makes it easier for the family to set the goals for the therapy (Barker & Chang, 2013). We will start the therapy by exploring the systems of the family, the family rules and try setting goals for the therapy. Enactment, circular questions and family sculpting are very useful techniques that will help the family through the therapy. Enactment lets the family witness their problems and how it affects them, circular questions makes them think about the problems in a different way and the family sculpting lets the family members see how they would like to function in the future (Doherty & McDaniel, 2010). This can help each member see others and the problem in a whole new way that is so helpful for the therapy.

Integrating narrative family therapy with the systemic family therapy is useful for changing the narrative of each member of the family about oneself and about others in each system identified by the family. Narrating new stories with new possibilities for the family and its systems helps reaching the therapy goals and setting new boundaries that can make a huge difference in the family dynamics. Also this will help change the family members expectations from themselves and others, and replace reactivity with observation and more mature awareness which helps in stepping away from their old interpersonal patterns (Gibson,2015).

The therapy will take from 12 to 15 sessions depending on the flow of the sessions and the resistance of the family to therapy. And this is one of the main issues that might arise in therapy. The father resisted going through the therapy in the first place. Trying to let him take responsibility in the system and change the interpersonal patterns will take some effort, emotional intelligence and some time from my part; and hopefully this will have a positive effect on the therapy of the family. Also the hidden conflicts between the parents or what’s inside the minds of each member of the family as individuals might be an issue during the therapy; and may lead to the importance of personal therapy to some of them.

Changing dysfunctional patterns is not an easy thing and may take some time depending on the therapy dynamics and the interpersonal connection in the family that allow for both emotional bonding and individual autonomy. Putting the goal of therapy in front of us makes every slight change useful and helps for more flexibility (Doherty & McDaniel, 2010).

Also using family sculpting and setting new rules and boundaries will help in therapy progress and reaching for the new goals they set at the beginning of the therapy. Setting clear boundaries between the parents, the siblings and the parents with their children will protect the integrity of these subsystems and allow for a more cohesive family with more mature awareness and balanced interpersonal pattern (Doherty & McDaniel, 2010). This may help M.H. see her role in the family differently, making her accept her family and her own self which will help her change her behaviour after letting go of the anger and resentment she used to have towards her family and her life. Also setting boundaries that distinguish subsystems from each other will make family members work better on their interpersonal patterns and determine how they communicate verbally and non-verbally (Barker & Chang, 2013).

Working with this family in the context of family therapy raised some ethical issues that reflect the way of their interpersonal pattern. The mother tried to manipulate me to take her point of view and her side. She tried to come to me individually telling secrets that she doesn’t want to reveal in the session with the rest of the family members. Not only the secrets were irrelevant to the therapy, but also not helping in the system functioning that I needed to work with them on. I psycho-educated her and refused that pattern she wanted me to get involved in and it took her two tries to understand how the therapy is supposed to work for their own benefit.

In order for this family to get the most out of the family therapy away from the traditional therapy, I should formulate a system of ethics based on the multilevel aspect of systems in this particular family. Wendorf (1985) stated that it is “the therapist responsibility, confidentiality, patient privilege, informed consent and the right to refuse treatment, therapist values, sex roles, and training and supervision” (p.445), that makes an ethical therapy and more comprehensive treatment. This may take some time, some awareness and being firm in not slipping into the emotional abuse they used to communicate with in their systemic patterns.

Working with M.H.’s family before encountering family therapy would have made the therapy go into a totally different direction. It would have led to personal therapy with her ignoring the dynamics of the family; and after couple of forecasted relapses she would probably be hospitalised as her parents wanted in the first place. Working with a person who grew up in a troubled environment that led to distorted self-image and troubled thoughts about the environment and the culture context that one lived for a long time needs different approach and trying to work with the family as one unit (Whitfield, 2006). Seeing the family exploring and experiencing new interpersonal patterns together, sharing their feelings and expressing their emotions to each other in a healthy way made me realize the importance of the family dynamics and its effect on the different family’s systems.

Studying family therapy really affected me as a therapist. Learning that there is no such thing as ‘normal family’, but instead we define the family as a healthy family or a well-functioning family that can come in many forms, and that the most important thing in families is how the family provides the different needs of each individual. These needs are “material, emotional and spiritual” (p. 19) as stated by Barker & Chang (2013). This had a huge impact on me as a therapist working in a mental hospital; seeing different families every day and trying to get the best out of them. It let me change my perspective seeing clients and their symptoms as a part of a bigger picture. This helped me integrate some new techniques in individual therapy; seeing that most of the symptoms of the clients are connected to the system, and trying to raise their awareness to their needs, their interpersonal patterns and how to accept their families as they are.

Studying family therapy also affected me personally. It really helped me in accepting my family and the way I grew up; stopping the blame game that will never get us anywhere. I came to understand the different systems in my family, the cultural context I was raised in and how I adapted with my unmet through my life. I also learned that it is impossible not to communicate, and that sitting alone with no relation with other family members is in itself communication. That made me understand my relation with my own father and how his silent way of communication had a huge impact on my personality and how I grew up with a certain interpersonal pattern. It is all about accepting your own challenges that makes the best out of you.

The current reality nowadays is that families no longer develop in healthy predictable ways, and that members of the family live with unmet needs that affect them and how they see themselves and others (Barker & Chang, 2013).