About Family Therapy
What is Family Therapy?
“Family and systemic psychotherapy – also known as family therapy – can help those in close relationships to better understand and support each other. It enables family members to express and explore difficult thoughts and emotions safely, understand each other’s experiences and views, appreciate each other’s needs, build on family strengths, and work together to make useful changes in their relationships and their lives.” AFT’s leaflet What is Family Therapy
It is about thinking of families as a resource and part of the solution rather than to blame for the person’s problems.
Family therapists can see couples as well as children and adults on their own, or with other family members or other significant people in the person’s life. Sometimes they offer a mixture of individual and family appointments, if they think that will be useful.
For more information on Family Therapy please refer to the Association of Family Therapy & Systemic Practice website.
Systemic Approaches and Practice
A systemic approach considers that individuals cannot be understood in isolation from the contexts in which they are part of. As such, the approach pays particular attention to significant relationships, culture and the belief systems that give meaning to a person’s actions. It is a thought-provoking approach and has a focus on building strengths to facilitate helpful changes. Above all, it is a respectful, nurturing and appreciative approach.
Systemic approaches draw from communication and relational theories to develop an understanding of patterns of interactions and how systems work. A system can be any group of people that are interconnected such as families, working teams, members of a community, school, etc. Professionals trained as family and systemic psychotherapists are able to work in many different contexts. They often work in therapy services but are also skilled in working with groups, teams and with management structures in organisations.
Who can benefit from undertaking Family and Systemic Psychotherapy?
Everyone, at some point in life, has difficulties in their relationships; they may struggle to lead their lives according to their values and goals or they may get stuck in unhelpful or unhealthy patterns of behaviour.
Family and Systemic psychotherapists can help these individuals, couples and families to reflect on their patterns of behaviour and relationships, to improve communication; to realign themselves with their goals and values in life; and to develop strategies and coping skills to help move their lives in the direction that is most meaningful to them.
There is evidence that Family and Systemic Psychotherapy can be effective with a number of emotional and mental health issues as described in the Research and Evidence-Based Practice section.
Research and Evidence-Based Practice
Due to the very complex nature of mental health problems, it is not always possible to know accurately what the best treatment for each condition is. Psychological approaches that are not systematically structured are less suitable to be evidenced through empirical research. Despite these constraints, the field of systemic and family therapy continuously reviews and contributes to Evidence-Based Practice (EBP). EBP[i] refers to the process of clinical decision-making that integrates three main areas:
(1) The best available research on the most effective treatment for each condition;
(2) Clinical expertise (judgment and experience of the clinician to consider each client/patient’s particular health state and needs) and
(3) The client/patient’s preferences and values.
In the UK, there is a Non-Departmental Public Body responsible for providing national guidance and advice to improve health and social care across the public sector based on research and EBP; it is known as The National Institute for Health and Care Excellence – NICE.
Systemic Family Therapy is recommended in NICE guidelines for the treatment of several child-focused, adult-focused and couple related problems[ii].
“Reviews of research list the following circumstances in which family therapy has been proven to be effective for children, adolescents and the important people in their lives:
• Problems in infancy; sleep, feeding and attachment
• Child abuse and neglect
• Child and adolescent conduct problems such as behavioural difficulties, attention deficit hyperactivity disorder (ADHD), and delinquency
• Emotional problems including anxiety, depression, grief, bipolar disorder, self harm and suicidality
• Body-related problems including enuresis, encopresis, recurrent abdominal pain, medically unexplained symptoms and poorly controlled asthma and diabetes
• Drug abuse
• Eating disorders including anorexia, bulimia and obesity
• First episode psychosis
Reviews of research show effectiveness of family therapy for adults and families affected by:
• Relationship difficulties and distress
• Psychosexual problems
• Intimate partner violence
• Anxiety disorders
• Mood disorders and depression
• Alcohol and drug problems
• Adjustment to chronic physical illness”
It is not, however, only people experiencing serious mental health problems that can benefit from professional support as described in the Who can benefit from systemic and family therapy section.
Training to become a Family Therapist
“Family Therapist” is currently not a protected title in the UK.As a result, some therapists may provide family sessions and call themselves family therapist, even though they do not have full training and experience in theories related to family therapy and the associated professional registration.
To qualify as a Family and Systemic Psychotherapist, it is necessary for an individual to undertake a four-year training in Foundation, Intermediate and Qualifying Masters level. “The four-year training is designed to qualify students to work with families, couples, individuals, other systems and relationship networks and includes training relevant to work with children and adolescents.”[iii] It is a requirement that students entering this training already have a qualification in a relevant profession e.g. social work, nursing, clinical psychology or psychiatry.
Upon completion of the intermediate level of this training, professionals can call themselves “systemic practitioners” and they can apply systemic concepts into their existing professional practice. It is only after qualification in the Masters level that professionals can call themselves a “Family and Systemic Psychotherapist”, become an accredited member of the AFT (Association for Family Therapy and Systemic Practice in the UK) and register with the UKCP (UK Council for Psychotherapy). There are a wide range of competencies expected from a qualified Family and Systemic Psychotherapist. For a summary of Competency Benchmarks, please refer to this topic on the Frequently Asked Questions Section (FAQ).
To become a certified Systemic Supervisor, Systemic and Family Psychotherapists have to complete a further one-year training at Masters Level. The course combines teaching in advanced systemic family therapy and supervision theories, alongside the practice of retrospective individual and live group supervisions. The course covers aspects related to the training and evaluation of Systemic Family Psychotherapists, as well as consultation to teams and organisations.
Family and Systemic Psychotherapists and Supervisors adhere to standards and ethical guidelines devised by the UKCP and AFT, including a requirement to comply with Continuing Professional Development (CPD) in order to renew their annual memberships.
For more information on training, the profession and registration please refer to the Association of Family Therapy & Systemic Practice website.
The Competency Benchmark for Family and Systemic Psychotherapists
The National Occupational Standards for Psychological Therapies (NOS) describes what is expected of someone working in their occupation. The minimum competencies of a Systemic and Family Psychotherapist are summarised as following[iii]:
• "To undertake an assessment for Family and Systemic Psychotherapy as a therapeutic activity. This requires taking sensitive account of the client’s needs as information is gathered enabling the client’s wider perspective.
• To promote constructive patterns in relationships within and across systems. Through the promotion of open communication and the engagement of relevant people in the therapeutic alliance clients are assisted to focus on their actions, resources and the impact on their own lives and the wider system.
• To be able to use the resources of a team in Family and Systemic Psychotherapy. This requires collaboratively reflecting the team’s contributions and adjusting the direction of the therapeutic work.
• To be able to explain the rationale for systemic approaches explaining to the individual, the family and the significant system how one change in the system leads to another.
• To be able to intervene in patterns within and across systems.
• To be able to explore differences across and within cultures in family and systemic therapy. The therapist will recognise when extra consultation is required to support client well-being and that it involves respectfully challenging beliefs, behaviours and practice within the logic of the cultural system.
• To promote change through tasks between Family and Systemic Psychotherapy sessions. This will include developing effective tasks, eliciting feedback helpful to the clients and adjusting the pace and direction of therapy in response to the tasks.
• To be able to develop a formulation in Family and Systemic Psychotherapy, which includes themselves and, the professional systems of which they are member. This involves sharing multiple narratives, contexts and perspectives with the family recognising that it evolves during the progress of therapy.
• Being able to work across different languages in Family and Systemic Psychotherapy. Interpreters have an important role in the system and the therapist demonstrates to the client their desire to achieve a shared conceptual agreement.
• To be able to monitor and review progress in Family and Systemic Psychotherapy. This requires that the therapist and client together highlight progress or when direction may need to change. The therapist works self and relational reflexively.
• To be able to engage significant members of the client’s system.
• To be able to promote the engagement of children and adolescent in Family and Systemic Psychotherapy.
• To be able to manage the ending of Family and Systemic Psychotherapy."
The Profession's Code of Ethics and Practice
The Association for Family Therapy and Systemic Practice in the UK has three relevant documents related to the profession’s Code of Ethics and Practice. They are:
[i] Sackett, D. et al (1996) Evidence-based medicine: what it is and what it isn’t. British Medical Journal, 312, 71-72
[ii] Journal of Family Therapy (2014) Vol 36 (2)
[iii] The Blue Book. Training Standards and Course Accreditation (2015) 4th edition, AFT