A family system tries to remain in homeostasis. Any family, like most complex systems, wants to remain in balance and resists any change that may challenge its present functioning and its chance to survive.
Let’s say a couple is experiencing strains in their relationship that threaten the continuity of their marriage. Suddenly, for whatever reason, a child becomes sick, or alternatively, there is a child in the family who has been sick for years. Now that the family system is threatened by the possibility of the parents’ separation, the child gains a new motivation for staying sick (secondary gains). It serves a purpose for the continued existence of the family. If the child remains sick the parents might stay together out of concern for their child. The child gets sacrificed for the benefit of the larger system. None of this occurs intentionally. The family and the child are not aware that this dynamic is influencing their behavior. It happens automatically outside of everyone’s awareness.
When the therapist makes the family and the child aware of this dynamic, they are shocked. The parents may feel guilty that their child has been sacrificing themselves for the benefit of the family. The child may suddenly become aware of a motivation for staying sick that they did not know they had. Now they need to make a conscious decision whether they want to continue staying sick for the family’s benefit. This awareness offers them freedom of choice which, like all choices, implies responsibility and which the child may welcome and dislike at the same time.
Family therapy is a type of systems theory. It looks at a patient as part of a greater whole and not primarily as an individual, like traditional psychotherapy. Family therapy sees every person in the family as a cog in a wheel who can be understood as part and parcel of their system, their family. The psychological functioning of each family member is tied up in the psychological functioning of the entire organism. In nature, organisms have natural tendencies that ensure their survival. The family organism is no different.
Family therapists felt they could work most effectively by bringing in the entire family together to help the identified patient (IP). A lot can be learned this way. One can tell from where people sit whom they are aligned with emotionally, who makes them feel safe and who threatens them. There are political alignments within every family, unspoken concessions, unspoken negotiations, conscious and unconscious manipulations, agreements that are not spoken but understood. Public and private behavior, public and private declarations, shared secrets, positions taken in accord with or against the family’s values, all communicate people’s feelings vis-a-vis external and internal family issues. Everyone has alliances, everyone takes a stand.
If a father is cheating in a family, a son, who has always been used by the mother as a substitute companion, may become stuck in that role because it is the only role he knows and has always made him feel useful and needed. A narcissistic mother may encourage her son’s behavior if it suits her needs. A daughter may react differently. She may be disappointed with her father and as a woman may be jealous of the attention her father gives to his paramour. The daughter may become promiscuous as a way of directing her energy outside of the family, much as the father has done. Through her behavior she may be saying to her father, “If it’s good for you it’s good for me.”
The therapist may meet with the daughter separately to understand what the daughter is trying to communicate. By helping the daughter change her behavioral communication into verbal communication she can be more effective with her father and family. She can only do this if she becomes aware of what she is trying to communicate and helping her translate this behavior into language is one of the therapist’s roles.
As in individual therapy, a family therapist must maintain impartiality and objectivity. The therapist cannot be effective if he “feels bad” for the identified patient more or less than anyone else in the family. The client is not the identified patient, rather, it is the family.
Therapists who are trained in traditional individual therapy may have difficulty focusing on an entire family at once. Family therapy requires special training. However, a therapist practicing individual therapy can think in systems theory terms and use this to help the patient.
When treating adult survivors of childhood abuse or industry whistleblowers, one of the issues that is often discussed is why the system failed the individual. (Think of the “Me Too” movement and Harvey Weinstein.) There are many reasons. One reason is that disclosure of the wrongdoing might threaten the continued existence of the family or system. Since people form systems to increase benefits for group members, if an individual must be sacrificed on behalf of the group, so be it. We try to protect against this natural tendency with laws that protect individual rights. But the rule of law and the rules of nature are different. It wasn’t until 1920 that women obtained the right to vote. This legal protection required mass social protest because the homeostasis of American society was being threatened. The natural response of an organism, whether a society or a family, that is threatened by an external force, is to spit out that force like a virus.
This is a hard pill for many survivors to swallow. Since group affiliation is often a source of self-esteem, the therapist must help patients reestablish their self-esteem as people, apart from their membership in any prior system. This is especially challenging when dealing with threats to the Jewish family, where family cohesion and unity are central values.
Jonathan Bellin, LCSW studied with Salvador Minuchin, MD, a creator of family therapy. Jonathan combines family therapy with individual therapy and is accepting new patients into his tele-therapy practice. He treats anxiety, mood disorders, and personal and professional relationship issues. Please contact him at [email protected]
