Family therapy, also referred to as couple and family therapy and family systems therapy, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health.
What the different schools of family therapy have in common is a belief that, regardless of the origin of the problem, and regardless of whether the clients consider it an "individual" or "family" issue, involving families in solutions is often beneficial. This involvement of families is commonly accomplished by their direct participation in the therapy session. The skills of the family therapist thus include the ability to influence conversations in a way that catalyzes the strengths, wisdom, and support of the wider system.
In the field's early years, many clinicians defined the family in a narrow, traditional manner usually including parents and children. As the field has evolved, the concept of the family is more commonly defined in terms of strongly supportive, long-term roles and relationships between people who may or may not be related by blood.
Family therapy has been used effectively in the full range of human dilemmas; there is no category of relationship or psychological problem that has not been addressed with this approach.
The basic theory of classical systemic family therapy was derived mainly from systems theory and cybernetics. As the field evolved, it was then influenced by behavioral therapy and cognitive psychotherapy, although most of the founders of the field had psychoanalytic backgrounds. More recent developments have come from feminist, postmodernist, narrative, psychodynamic and attachment theories.
Important schools of family therapy include structural family therapy, strategic family therapy, a range of cognitive and behavioral approaches, constructivist (eg, Milan systems, post-systems/collaborative/conversational, reflective), solution-focused therapy, psychodynamic, object relations, intergenerational (Bowen systems theory, Contextual therapy), Emotionally Focused Therapy, experiential therapy, and narrative therapy. Multicultural, intercultural, and integrative approaches are being developed. Most practitioners claim to be "eclectic", using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s).
The number of sessions depends on the situation, but the average is 5-20 sessions. A family therapist usually meets several members of the family at the same time; (conjoint family therapy is used in the approach of Virginia Satir and others.) This has the advantage of making differences between the ways family members perceive mutual relations as well as interaction patterns in the session apparent both for the therapist and the family. These patterns frequently mirror habitual interaction patterns at home, even though the therapist is now incorporated into the family system. Therapy interventions usually focus on relationship patterns rather than on analyzing impulses of the unconscious mind or early childhood trauma of individuals as a Freudian therapist would do - although some schools of family therapy, for example psychodynamic and intergenerational, do consider such individual and historical factors, and they may use instruments such as the genogram to help to elucidate the patterns of relationship across generations.
Family therapy is really a way of thinking, an epistemology rather than about how many people sit in the room with the therapist. Family therapists are relational therapists; they are generally more interested in what goes between people rather than in people. Depending on circumstances, a therapist may point out to the family interaction patterns that the family might have not noticed; or suggest different ways of responding to other family members. These changes in the way of responding may then trigger repercussions in the whole system, leading to a more satisfactory systemic state; it should be noted though, that some family therapists - in particular those that identify as psychodynamic, object relations, intergenerational, EFT, or experiential family therapists - tend to be as interested in individuals as in systems.
Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. A causal focus can be experienced as blaming by some families and is with many issues of questionable clinical utility. Media and the Family has been emerging as an important area since the introduction of the topic by Bernard Luskin at the spring 2008 CAMFT Conference. The effect of media on behavior has become so pervasive now that those studying family therapy are now studying the subject.
A novel development in the field of couples therapy in particular, has involved the introduction of insights gained from affective neuroscience and psychopharmacology into clinical practice. There has been interest in use of the so-called love hormone – oxytocin – during therapy sessions, although this is still largely experimental and somewhat controversial.
Family therapy journals include: Family Process, Journal of Systemic Therapies, Journal of Marital and Family Therapy, Journal of Family Therapy, The Australian & New Zealand Journal of Family Therapy, The Psychotherapy Networker, The Journal of Sex and Marital Therapy, The Australian Journal of Family Therapy, The International Journal of Narrative Therapy and Community Work
Family therapy practitioners come from a range of professional backgrounds, and some are specifically qualified or licensed/registered in family therapy (licensing is not required in some jurisdictions and requirements vary from place to place). In the UK and the US, family therapists are usually psychologists, nurses, psychotherapists, social workers, or counselors who have done further training in family therapy, either a diploma or an M.Sc.; however, in the U.S., there is a specific degree and license as a Marriage and Family therapist.
Prior to 1999 in California, counselors who specialized in this area were called Marriage, Family and Child Counselors. Today, they are known as Marriage and Family Therapists (MFT), and work variously in private practice, in clinical settings such as hospitals, institutions, or counseling organizations.
A master's degree is required to work as an MFT in some states. Most commonly, MFTs will first earn a M.S. or M.A. degree in psychology, family studies, or social work and then spend 2 to 3 years completing a program in specific areas of psychology relevant to marriage and family therapy. After graduation, prospective MFTs work as interns under the supervision of a licensed professional, and are referred to as MFTi's.
Requirements vary, but in most states about 3000 hours of supervised work as an intern are needed to sit for a licensing exam. MFTs must be licensed by the state to practice. Only after completing their education and internship and passing the state licensing exam can they call themselves MFTs and work unsupervised.
License restrictions can vary considerably from state to state. In Ohio, for example, Marriage and Family Therapists are not allowed to diagnose and treat mental and emotional disorders, practice independently, or bill insurance.
There have been concerns raised within the profession about the fact that specialist training in couples therapy – as distinct from family therapy in general - is not required to gain a license as an MFT or membership of the main professional body, the AAMFT.
Since issues of interpersonal conflict, values, and ethics are often more pronounced in relationship therapy than in individual therapy, there has been debate within the profession about the different values that are implicit in the various theoretical models of therapy and the role of the therapist’s own values in the therapeutic process, and how prospective clients should best go about finding a therapist whose values and objectives are most consistent with their own. Specific issues that have emerged have included an increasing questioning of the longstanding notion of therapeutic neutrality, a concern with questions of justice and self-determination, connectedness and independence, "functioning" versus "authenticity, and questions about the degree of the therapist’s "pro-marriage/family" versus "pro-individual" commitment.