Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 179

Family systems therapy seeks to improve patterns of communication and the quality of interaction among family members (Bitter, 2013). Although there are many types of family therapies, all family therapists view the family as a system—that is, a network of connected individuals who influence and partially direct each other’s behavior. Viewing the family as a system has several implications for therapy. First, no member of the family can be understood in isolation. A family member’s behavior is best understood in the context of all other members of the family. Second, family therapists see the entire family as their “client,” not just the person with the identified problem. Finally, a systems approach to treatment assumes that change in one member of the family will necessarily affect all members of the family. Consequently, family therapists believe that helping one or two family members improve their functioning can lead to symptom reduction in the family member with the identified problem (Kerig, 2016).

The family therapist Salvador Minuchin (1974) developed structural family therapy. Structural family therapists are chiefly concerned with the structure of the relationships between family members and between the family and the outside world. In healthy families, parents form strong social–emotional bonds, or alliances, with each other that are based on mutual respect and open lines of communication. Furthermore, in healthy families, parents form boundaries between themselves and their children. Specifically, parents respect children’s developing autonomy and provide for their social–emotional needs, but they also remain figures of authority.

In unhealthy families, alliances are formed between one parent and the children, leaving the other parent disconnected or estranged from the rest of the family. For example, a mother might encourage her daughter to form an alliance against her father because of the father’s excessive alcohol use. The alliance between the mother and daughter might leave the father feeling alienated from his family, while the mother and daughter might grow to resent the father. This phenomenon is sometimes called triangulation, because an alliance is formed between two family members, leaving a third member feeling isolated or rejected (Sexton & Stanton, 2018).

Furthermore, in unhealthy families, boundaries between parents and children are often overly rigid or excessively diffuse. Disengaged families are characterized by overly rigid boundaries, in which open communication between family members is stifled, and members feel disconnected from one another. In contrast, enmeshed families are characterized by diffuse boundaries where family members lack autonomy and constantly intrude into each other’s lives (Wendel & Gouze, 2015).

Adlerian family therapy is an alternative, contemporary approach to family systems therapy that helps parents manage their children’s behavior problems (Sherman & Dinkmeyer, 2014). An Adlerian family therapist believes that all family members, including children, seek lives based on meaning, effectiveness, and purpose. They view children’s behavior problems as a maladaptive attempt to achieve meaning or purpose in the family. Specifically, misbehavior can occur for four reasons: (1) to gain attention, (2) to assert autonomy from parents, (3) to extract revenge or “to get even,” and (4) to avoid responsibilities and be left alone. The therapist’s task is to identify the purpose of the child’s misbehavior and help parents find a more adaptive role in the family.

Family therapists would insist on seeing Anna and her parents together, for at least part of treatment. The therapist would likely pay attention to alliances and boundaries in Anna’s family and the way Anna’s eating disorder might help to maintain the family system in a maladaptive way. For example, the therapist might discover that Anna’s parents frequently argue with one another and are considering a divorce. The therapist might notice that the onset of Anna’s symptoms coincided with her parents’ marital problems. The therapist might hypothesize that Anna’s eating symptoms serve to maintain the family’s structure by distracting her parents from their marital disputes (Wendel & Gouze, 2015).

A family therapist might also notice that Anna’s parents are overprotective and excessively demanding. The therapist might interpret Anna’s desire to lose weight as a maladaptive attempt to gain the approval of her parents. The therapist might refer Anna’s parents to a marriage counselor to help them improve the quality of their relationship. At the same time, the therapist might work with Anna and her parents to improve communication at home. One goal of therapy might be to help Anna’s parents give her more autonomy over her day-to-day behavior (Bitter, 2013).