What is "family therapy," and when is it appropriate?
This YouTube clip
previews what you'll read here:
existed in all ages and cultures because they consistently fill a range of
better than other social groups. For several reasons, some families
"function" better (fill more members' needs more often) than others. When
family structure and dynamics
significantly stress members more than nurture and satisfy them,
therapy is appropriate.
significant family dysfunction are obvious and widespread - e.g. addictions,
abuse, domestic violence, abortions, bankruptcy, divorce, desertion,
suicide, murder, law-breaking, obesity, legal
battles, domestic violence, etc. etc. Usually, symptoms like these indicate
family adults are psychologically
and unaware of key
aims to improve the functioning of a client family by
strategically educating and motivating members
to change things like
attitudes, expectations, behaviors,
beliefs, roles, communications, and
priorities. Sometimes this can best be done by working with
combinations of individual members, several members (like couples
and parent-child combos), and as many family members are willing and able to
meet together at one time.
therapists only work with the whole family, and others are comfortable
meeting with different mixes of members.
A useful way to evaluate potential
family therapists is to ask questions like:
"How long have
you practiced family therapy?" (longer is better)
"What do you
see as the purpose of a family?" (to consistently fill the normal and
special needs of all members)
as an important factor in family functioning?"
For more perspective, see the answer to
below. If you're a stepfamily, see these
questions, and the answers to
through Q30 on the next page. Note that
Lesson 5 in
this nonprofit, ad-free site offers a framework for improving family functioning.
major relationship and family problems well enough by themselves.
Marital counseling or therapy are
similar in goals, and differ in scope and methods. Technically,
marriage (and divorce) mediation (or arbitration) focuses on helping
and reduce one or several specific relationship
barriers. Marital counseling and therapy
focus on helping couples fill a broader range of needs than just effective
communication and problem solving.
effective counseling and
therapy fill each client's current
"well enough" by their own (vs. the provider's) criteria. This
implies that skilled professionals will help each client
early in the work. Then they will respectfully assess
clients are trying to fill their respective needs, and teach them relevant
new attitudes and
to do so.
relationship problems come from barriers like
they usually need the extra training and skills of a marital therapist
rather than a counselor or mediator. Paradoxically, typical troubled couples
can't identify and admit these barriers without skilled feedback, so they're
hindered in choosing an appropriate level of help.
The moral is
- when mates aren't very clear on
what theyeach reallyneed, choose an experienced, licensed
marital therapist for effective outcomes. Ideally, such a
professional will be well aware of how psychological
affect marital choices and communications, and what to
counseling or therapy is best suited to alert courting partners headed
toward major relationship problems before they exchange vows and
cohabit. This is specially true for courting single-parents and new partners
(stepfamily co-parents). See the answer to
Q29 on the
When is counseling or therapy appropriate for a child or teen?
In my experience, many
frustrated parents mistakenly label troubled or defiant kids as "the
Family-systems therapy suggests that many
behavioral or "mental health" problems in kids and adults are symptoms ofsignificant familydysfunction.
Implication - this theory suggests that the first thing concerned
nurturers can do for a "troubled child" is to consult with a veteran
family therapistwith an open mind. That may involve several meetings
of the whole family with the clinician to help her or him diagnose how you
all "work" together (or don't). One or more family adults rejecting or
scorning this idea suggests that they're wounded and
unaware - and that their family is
dysfunctional to some degree.
Forcing a child
into counseling or therapy risks implying "There's something wrong with
you - you're defective, and we're OK." This is the last thing
(wounded) kids need from their adults!
Reality - some kids do
have treatable psychological and physiological problems. I encourage
you to get a competent assessment of your family's
(functionality) first, and then ask for impar-tial professional
guidance on if, when, and what kind of counseling or therapy may be
appropriate for a child you're concerned about.
most lay people (like your parents and grandparents) and many veteran
therapists are unaware of, or reject, the family-systems theory above.
Relying on them for an expert opinion about helping a "troubled" child risks
(a) shaming the child, (b) creating an unpleasant therapy experience that
can inhibit needed adult counseling later, and (c) leaving significant
family-system problems undiagnosed and amplifying surface problems (unmet
What is pastoral counseling, and when is it appropriate?
Europe, a pastor was a herdsman - someone who provided food and
hides. More recently, pastors accept the role (responsibility) of an advisor
and/or leader in a spiritual or religious com-munity ("flock"). So pastoral
counseling includes special attention to a client's
which other clinicians may not provide.
professionals provide group, marital, and individual pastoral counseling
(spiritual gui-dance). Others have pastoral training and practices but no
formal church roles. Pastoral counselors may use unique interventions for
common client problems that other clinicians don't use - e.g. focused
per-sonal and group prayers and related guided imagery. Devout and pious
clients are often more comfor-table with like-minded clinicians and agencies.
A unique aspect
of some pastoral counseling is the primal belief that clients' problems can
be re-duced or removed through pure faith, penitence, and humble worship
(Divine Grace). This may work for people who's faith (belief system) and
support system is strong enough.
There seems to be
a growing consensus among professional counselors and therapists that
per-sonal and family spirituality and faith (vs. religion) plays an important
part in maintaining
(functionality). What do your family members believe about this?
temporary emotional, spiritual, and social
support in times of special
Each client person brings a unique array of surface and
to the work.
Guideline: if all people affected by the initial ("presenting") problems feel
consistently "better" when counseling ends, it probably "worked." If
some people feel better and others don't, it worked "partially." If
everyone is dissatisfied or frustrated, something about the counseling "didn't
work." Be alert for protective
false selves trying to avoid
guilt, shame, or loss by trying
to give responsibility to a stranger (e.g. a clinician) or someone else.
When is participating in a self-help group appropriate?
The number and
range of self-help groups in most cities and towns testifies to how widely
needed they are. Typical self-help (or mutual-help) groups strive to fill
participants' needs for...
encouragement, and inspiration;
acceptance, socializing, and concern; and...
information and effective suggestions.
Group leadership may be professional, but is often one or more devoted lay
people or couples with enthusiasm, dedication, and commitment, but modest or no training. The most helpful groups offer
a consistent, balanced, flexible format to intentionally meet the needs
They usually meet regularly in a comfortable, accessible setting, are
financially self-supporting or sponsored, and have a clear charter (mission
statement), and a framework of policies and rules (e.g. "start and
stop on time, and no smoking, gossiping, interrupting, or swearing.")
Groups may be local, or affiliated with similar groups in the region or
nation - e.g. any of the "12 step
Anonymous" groups for addicted persons and families, "Compassionate
Friends," for grieving parents, "Parents Without Partners" for single
parents, and Rainbows for members of
divorcing and bereaved families. Some groups are for people with physical problems, and others focus
on emotional, spiritual, or relationship, concerns.
Typical support groups are much less expensive than professional counseling
or therapy. They can help fill some needs effectively, but usually can't
provide the assessments, wisdom, and strategic inter-ventions that trained
and experienced clinicians can. Much advice in typical lay-led groups is "common
sense" suggestions to surface problems, which often don't
acknowledge or satisfy the unfilled
Options: do some preliminary self-assessment to decide specifically what
you need - e.g. "I need to stop exploding at my family members, and
feeling so guilty and frustrated with them and myself." Then ask in your
community if their are groups available that focus on similar needs - e.g.
an "anger manage-ment" group.
If so, (a) ask if people you know have any information about the group
(helpful or not?), and/or (b) go to at least three meetings with an open
mind to get a feel for the people and process. If one group doesn't suit
you, don't write off all similar groups, because each has it's own unique
Most common personal problems have several Internet sites devoted to people
with similar needs. Many offer free "chat rooms" or "chat" - i.e. online support
groups. When there is no physical group to attend (e.g. in a rural
area), this can be a real help - despite lacking the visual communication
and social interaction that "real" groups offer (e.g. group hugs)
If you try out one or more groups and find your needs aren't being met well
enough, then consider individual or group counseling or therapy. After
assessing you, a veteran clinician should be able to advise you on the
usefulness and availability of relevant community and/or Web groups.
For more perspective, see this
series of articles on effective support
groups for stepfamily co-par-ents. Much in these articles applies to any
self-help group. Also review the answer to
therapy offers several advantages compared to individual work. Each person
can get nonverbal and probably verbal feedback from several people, not just
one. Hearing other people talk about their situation and coping strategies
can help to...
put your own
situation into perspective ("Ah - I guess I'm not alone with this
resources and options that you wouldn't have thought of alone or with a
counselor. And for many,
to a group (being known, accepted, and valued) can be very satisfying
- specially to socially isolated people.
Professionals running groups can observe each person's way of interacting
directly, rather than relying on clients' subjective descriptions. They
also have some useful intervention options that they can't do in 1-on-1
clinical work - e.g. group role plays. A reality is that some skilled
therapists may not be effective group leaders, and vice versa. A final
consideration: typical group therapy is less expensive, since the
clinician's fee for each meeting is split up among several people.
Three options to choose from are
or group counseling or therapy only,
individual and group counseling concurrently,
individual and group counseling
at separate times.
The best choice
depends on a client's personality, problem/s, past experience, finances,
other supports, and the availability of appropriate professional help.
experience, individual and group therapy in some combination is most
apt to yield long-term satisfaction. Trying a group is guaranteed to
teach you something useful about yourself and the process if you're
Note the difference between a
therapy group (usually led by a professional, and focusing more
deeply on people's issues) and a
self-help group (usually
led by a lay person or couple, and staying more superficial). Each can be
helpful, depending on a participant's mix of
How can I tell if I've been "traumatized" and need professional help?
Let's define a
trauma as "a sudden or expected event that causes someone (a) psychological
upset and/or (b) physical injury that (c) significantly reduces their
ability to function normally. Significantly is a subjective judgment.
For most people,
trauma and traumatized are emotionally provocative ("hand-grenade")
terms like sick, diseased, raped, and "mentally ill." This unpleasant
association causes some people to discount or deny the personal effects of a
traumatic event, and to ignore, avoid, or defer appropriate self-care.
Many people find psychological injuries in themselves and loved ones to be much harder to
assess and admit than physical ones - e.g. admitting a broken arm from
a car crash but denying related depres-sion, guilts, frustrations, and anxieties. Also,
some psychological traumas happen over months or years - e.g. growing up in
environment. These realities can make it hard to answer "Have I (or has someone
I care about) been traumatized?" accurately.
clinical experience with over 1,000 average American adults, I propose that
three more relevant - and measurable - questions are:
do I have
symptoms of "Post Traumatic Stress Disorder (PTSD)?"
do I have
of significant unfinished grief? (because some
can be traumatic)
If you get
anything other than a solid "No" on any of these questions, you may benefit
from hiring a qua-lified professional to check your trauma-assessment and advise you on
appropriate self-care options - including some type of counseling or
therapy. Shop for qualified trauma-recovery and grief clinicians - see the
answers to Q1 and
How can I choose an effective wound-recovery therapist?
I suggest you
five-page article first, to gain useful
perspective for what follows.
presumes that you (a) accept the idea of psychological
and (b) believe such wounds can be
(vs. "cured"). If so, then the first step in getting effective help is to
find an exper-ienced clinician who believes the same thing, and is
professionally devoted to wound-reduction ("reco-very"). The next step is to agree on what
wounds you want to reduce, specifically - e.g. "I want to stop living a
life, and grow my self esteem and self confidence."
I am an
therapist, and am biased about answering this question. My experience and
research since 1979 strongly suggests
that most (all?) common forms of "mental illness"
are symptoms of one cause: false self dominance, or a
disabled true Self.
I have seen
(in-ner-family therapy) succeed at reducing psychological wounds often enough
to recommend it as the therapy of choice. Other
types of therapy can also be effective. To see if there is a "parts work"
therapist near you, see
Since the advent
of family-systems therapy (Q7) in the 1950s, there is
increasing agreement that growing up in a "dysfunctional"
family promotes most psychological and relationship "problems." There is much
less agreement on the nature of such problems (called "wounds" here) and
how to reduce them effectively. If you can't find an acceptable
parts-work therapist, I recommend investigating clinicians experienced with
these types of therapy:
- this healing technique has special appeal to lay and clinical people with a
strong Christian faith; and...
EMDR (Eye Movement Desensitization and Reprocessing)
- augments and/or replaces traditional "talk therapies" to help
many survivors permanently reduce psychological wounds from major life
Other therapists promote various ways to "heal from toxic
parents," nurture your "Inner Child," (singular), and "Let Go of the Past." Each
has unique benefits and limitations that depend on the clinician's
person-ality, style, wisdom, and wholistic health, as well as the brand of
counseling or therapy they offer.
grief is a natural
process which allows eventually accepting major life
(any broken bond, not just deaths) and resuming normal life activities. Many
people bearing significant
from childhood and/or who were not raised in a
family are hindered or blocked in healthy mourning. For some, this is
because they're unable to form healthy
bonds with other people.
produces common behavioral
and can promote significant psycholog-ical, relationship, and medical
problems. So the answer is: "Grief counseling is appropriate when you
(or someone) have too many of these symptoms that interfere with productive
I suspect that
what is often labeled as "clinical depression" is really a combination of
psychological wounds and blocked grief. Implication - if you or
another person is "too depressed too often," explore the possibility that
effective grief counseling is more useful than anti-depression medication.
Such medica-tions may reduce the symptoms, but not the underlying
Some counselors and therapists
specialize in assessing for
incomplete grief and freeing it up. For better perspective on hiring such a
helper, first study this article.
I suggest you learn the ideas in this quiz before
starting to shop for professional help. Searching the Web for "grief
counselors" will bring you many useful choices.
My experience is
that three factors can hinder healthy grieving: (a) psychological
and (c) living in a family and/or working in a social environment that
normal mourning. This suggests that a competent grief clinician will assess
all three factors and offer appropriate interventions.
perspective and options on healthy grieving, see self-improvement
true addictions are reflexive (vs. intentional) attempts to numb
inner pain. For perspective
please read this series of articles and return.
answer to this question is "Addiction counseling is appropriate when you feel you have - or may
have - a compulsion that degrades your health and life." A wiser answer is
"When someone in your family may have - or has - any of the
of addiction." This is a better response because
true addictions are not a
they're a symptom of (a) a
family, and (b) adult
Some substance addictions do have physiological component - e.g. bodily
"cravings" for nicotine, heroine, and fatty "comfort" foods.
From this view,
the best way to answer this question in your unique situation is to (a)
learn addic-tion basics, and then (b) hire
a professional addictions counselor to evaluate whether individual and/or
family therapy (Q7) is warranted.
Note that forcing an addict to get counseling usually won't change
anything. The desire to "get sober" must come from within, and usually
When is "anger management" therapy appropriate?
on the answer, read this
article first and then return. I propose
that "anger outbursts," "road rage," and "rageaholism" are all surface
symptoms of an underlying primary problem: a disabled
true Self, probably
formed in a
low-nurturance childhood. This is the real meaning of the common
diagnosis "lack of impulse control."
I propose that
personal, marital, and family "anger problems" probably won't permanently
recede unless individual or group therapy focuses on (a) personal-wound
reduction + (b) possible healthy-grieving
+ (c) the person's current family
With this opinion
in mind, I suggest that "anger management" counseling, classes, and/or
therapy are only appropriate with a professional provider who
includes all three of these elements in his or her work. Family-law judges
who order attendance in an anger-management class or program are usually
unaware of this, and aren't trained to evaluate the effectiveness of the provider's