What Family Therapists Should Know and Consider About Their Approach.
Family therapy, or “systemic therapy,” as it is better described, is a holistic process that espouses to resolve problems through relational healing, but is it practiced that way? It is hard to imagine how our family of origin, with its ever-evolving interactive contexts is not the primary source of our strengths and dysfunctions. This framework of therapy is successful because, if practiced correctly, it is not about the individual or family system, rather it is what is interactively occurring in the system from multiple perspectives. Solutions to problems are resolved in the present. This creates liminality, those transitional moments that lead to, as Bateson (1972) would also say, “a difference that makes a difference.” From a systemic perspective, in relationships we each create different views that, like quantum physics, can all be correct.
It is important, especially in today’s rapidly changing world, that clinicians who say that they do family therapy are transparent with prospective patients who are enlightened enough to seek it. This entails agreeing on what it is to be systemic and how the therapy will proceed. What do I mean by this? I have been a practicing systemic family therapist, Approved Supervisor, and adjunct professor at the graduate level for the past 40 years. My training is in family cultural studies (anthropology and psychology) which has taught me the gift of being a systems thinker that creates a unique segue to learning about the interactive complexity of our lives. It is important for both a family therapist, and those seeking help, to mutually explore presenting relationship issues that are simultaneously connected to wider societal contexts. A kind of a zooming in and out process.
Is this occurring in family therapy settings, with the many astonishing things that are affecting families today? This includes varying manifestations of cultural norms, historical views, ethnicity, gender, class, racial recognition, and diversity to mention a few. All this is within a wider socioeconomic context where, in America, the official poverty rate is approximately 13% based on a family of four making $25,000 (Poverty USA, 2018). However, if the poverty income level for a family of four were arbitrarily proclaimed to be just twice that income amount, the poverty rate would be closer to 50%. This startling and near impossible survival exists within one of the richest countries in the world. Even more so regarding the horrific disproportionate everyday existence for people of color that is interwoven and part of the root causes of today’s needed antiracist protest movement.
Systemic family therapy is an ecological process, where the whole family (and community) is more than the sum of its parts (Palazzoli, Boscolo, Ceccin, & Prata, 1978). It may not be able to resolve all socio-economic problems, yet it certainly can help with the emotional outcomes of post pandemic, racial unrest, extreme financial issues, and power policy changes. Our “individuality” is defined by the context of our relationships. This further underscores the need for the involvement, recruitment and systemic training of multicultural and non-white clinicians in the collective quest of strengthening our interdependency.
Ironically, family therapy is recognized by the federal government as an official mental health discipline, however it isn’t covered under Medicare. Nor is it on equal footing with other forms of therapy in relation to insurance companies. The last time I checked, seniors are still part of families/communities and now, more than ever, in great need of systemic assistance.
Inherent in a systemic framework, like nature, where there are no labels, opposites or dichotomies, all is interrelated. Solutions to problems can be attained through different avenues, weathering inevitable paradoxes, by using improvisation and resolving double binds. The emphasis is on the “how” of the interactions that are occurring. This is supported by research (AAMFT, 2020). It works! So why is family therapy still struggling to find out if it is a discipline, technique, or even useful? Family therapy is no longer as it was; the new kid on the block. In 1960, there were only 237 members of the American Association for Marriage and Family Therapy. Today, there are close to 60,000 family therapists in the U.S. (AAMFT, 2020). Ninety-two percent are white and still struggle with that cultural lens of privilege. This contrasts with approximately 680,000 social workers, 106,000 clinical psychologists and 113,000 mental health counselors (Counseling Career Guide, 2020). A revealing statistic for those latter disciplines is the enormous gap between the number of traditional one-on-one therapy clients and working with more than one person in the therapy room (or currently on the virtual screen).
The American Psychological Association (2015) cites that approximately 2% of their members do family therapy. For clinical social workers, approximately 12% are employed working with families, while mental health counselors report 16% involved with families (Careers in Psychology, n.d.). Even more astonishing is family therapists admitting to working mostly with individuals rather than families from an AAMFT survey of its members during the early days of the 21st century (Northey, 2005). Little has changed in that regard as AAMFT currently states that about half of the treatment provided by its members is one-on-one with the other half using a combination of treatments (AAMFT, 2020). This still indicates a need for family therapists to reclaim their epistemological basis, one where the complexity of the family or context in question is the therapeutic process.
With that said, don’t get me wrong; there are obviously many excellent therapists who specialize in individual psychotherapy and there are also real family therapists out there, but obviously far and few. Why is this so? Is it the predominance of allopathic medicine, where fragmentation and dependency on medications that help address symptoms is the norm? Or is it a cultural pattern of discrimination that discourages and fosters unequal distribution of wealth and living standards? Could it be the mindset of therapists themselves, or insurance companies who force a structure, diagnosis and coverage that follows a medical model and outdated cultural /racial assumptions at the expense of working within the whole system that may be in need of a difference?
Systemic family therapy can address current societal pressures in a way that supports diversity and developmental stages in a holistic manner, one that integrates wider contexts based on relationships, and social dynamics. An approach that encourages new perspectives, given these trying times, and finds novel forms of interdependency and make use of all segments of our culture (i.e., education, politics, media, agencies that serve and protect, etc.) and most of all, strengthening and celebrating multicultural backgrounds.
So, what to do? I suggest that we call ourselves systemic family therapists and advocate an approach that creates a forum allowing those who seek our assistance to learn about themselves via their relationships. Make it clear that you practice systemically and encourage meeting with family members or other significant people at the same time, while respecting different points of view. Most of all, become a recovering family therapist and revisit what it means to be a systemic thinker and change agent.
It takes two to know one.
—Gregory Bateson
Kenneth Silvestri, EdD, LMFT, is a Clinical Fellow of AAMFT and an Approved Supervisor. He holds a doctoral degree from Columbia University in Family Cultural Studies. Silvestri serves as a clinical professor for Daybreak University’s graduate Counseling program and is a clinical assistant professor of Family and Community Medicine at the New York Medical College. www.Drkennethsilvestri.com
REFERENCES
AAMFT. (2020). About marriage and family therapists. Retrieved from https://www.aamft.org/About_AAMFT/About_Marriage_and_Family_Therapists.aspx
American Psychological Association. (2015). 2015 APA survey of psychology health service providers. Retrieved from https://www.apa.org/workforce/publications/15-health-service-providers/#
Bateson, G. (1972). Steps to an ecology of mind. San Francisco: Chandler Publishing Company.
Careers in Psychology. (n.d.). Employment outlook & career guidance for family social workers. Retrieved from https://careersinpsychology.org/employment-outlook-guidance-family-social-workers/
Counseling Career Guide. (2020). Careers in counseling. Retrieved from https://www.counselingdegreeguide.org/careers
Northey, W. (2005). Studying marriage and family therapists in the 21st century. Journal of Marital and Family Therapy, 31(1), 99-105.
Palazzoli, S., Boscolo, L., Cecchin, G., & Prata, G. (1978). Paradox and counter paradox. New York: Aronson.
Poverty USA. (2018). The population of poverty USA. Retrieved from https://www.povertyusa.org/facts
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