The Role of the Therapist

The family therapist is in charge of the structure of treatment (Whitaker & Bumberry, 1988). This means that the therapist will organize the timing of the sessions, where and how they will occur, and who should come. He or she may suggest homework assignments to diagnose the problem and test the family’s willingness to change.

The family therapist is also in charge of the communication in therapy. With more than one person, and sometimes many people, in the room, the therapist has many relationships to develop and manage. He or she becomes a kind of traffic cop—teaching family members to communicate without blame, listen respectfully to each other, acknowledge they heard what was said, and learn to deal with conflict, difference, and emotional intensity. The therapist wants to hear the individual and family stories, to understand their belief systems, and, like an applied anthropologist, to help the family find the solutions to their pain and their problems from within their culture and value systems.

The therapist may also be something of a teacher, educating or showing patients how their behavior affects each other. A common example of this is when a depressed patient is demanding and difficult when he feels badly so that his spouse distances from him, which only leads the patient to feel more depressed and be more difficult. Uncovering these cycles, or cycles related to violence or child misbehavior or psychosomatic illness, all can be foci of family therapy, helping the family to recognize the effect of each individual’s behavior on the other.

The Role of the Patient and Family

While the therapist is in charge of the treatment, the family is in charge of the initiative for change (Whitaker, 1988). It is critical that the therapist not become more invested and motivated in change than the family. Otherwise, a pursuer–distancer dynamic occurs with the therapist as pursuer, often resulting in the family backing away from change (Fogarty, 1976). The skill of the therapist is in increasing the patient and family’s motivation for change.

Sandra and Molly came to therapy because of some mild partner violence (Sandra had slapped Molly on the arm once); both said they wanted to stop this destructive way of relating before it got worse. When the therapist tried to schedule an intake session, neither member of the couple could agree on when to come in. Finally, both said that Wednesday at 8 p.m. would work, though the therapist had stated that she only saw patients until 7 p.m. The therapist was tempted to bend the commitment to herself and her own family out of concern for this couple’s problem. However, recognizing a potentially unhelpful pattern at the beginning of therapy, she said she would work hard to schedule them, but it had to be some time during her regular office hours before 7 p.m. Whitaker & Bumberry (1988) called this the “battle for structure,” and insisted the therapist must win this battle for treatment to succeed.

The therapist also asked Sandra and Molly each to take notes any time either of them began to feel angry and bring the notes into therapy, thereby working to increase their motivation for change. Whitaker called this the “battle for initiative,” and insisted that the family must win this battle for treatment to succeed.

BRIEF AND LONG-TERM STRATEGIES AND TECHNIQUES

The techniques and strategies of family therapy operationalize systems thinking and can be used in single-session therapy or long-term work. Goal setting, in the beginning, allows the family and the therapist to stay focused and measure the progress and outcome of therapy. The use of tools such as the genogram, time lines, and sculpting organize complex family information so that it is useful to the family and the therapist. Techniques such as positive connotation and listing family strengths help to broaden the assessment of the presenting problem. Circular questions, enactment, and externalizing the problem are techniques that put the presenting complaint in context.