Psychodynamic Family Therapy

Psychoanalysis is a therapeutic approach preferred by followers of the Freudian school of thought (circa 1900’s) that sees clients as psychologically ill through unconscious conflict within the mind. Freud based his approach on individual clinical case studies, which fail to be empirically tested due to the impossibility of replication. This means that the treatment of clients is an act of faith based on experience of individual therapists own experience.

The conflict that Freud wrote of was the mind’s ability to protect itself from harm by creating strategies that Freud named defence mechanisms. These mechanisms prevent conscious awareness of traumatic experience from the past in childhood that could cause distress to the client. These defence mechanisms often displayed themselves as maladaptive behaviour and presented themselves in therapy as symptomlogy of biological defects, such as twitching, nervousness and at its worst hysteria (panic attacks).

Freud believed that through the technique of free-association a patient could reinact mentally the past traumas and so through insight could come to terms with the past event. This meant that the client would be free of the syptomolgy and change their behaviour to more suitable strategies for coping with stress.

Freud’s original ideas where based on his theory of child development that led to a model of the mind in which the person’s mental processes where divided into three parts. The first to develop was the “ID”; Freud saw this as the fundamental drive that was innate within all babies. From this stage the baby would explore its world orally to begin with and as it became more dextrous and language developed would move through various exploritry devices such as anal, phallic, latent and genital. More importantly from a therapy point of view each stage represented a maturing of the mind through socialization. This Freud saw as the development of the “Super-Ego” that part of the mind that took on board the beliefs and values of those around us. Parents instilled moral ideals such as right from wrong, consequences, so building up a reaction to guilt. Later teachers would socialize children through what has become known as the hidden-curriculum, the idea being that school taught the value of timekeeping, discipline and the work ethic. Later peer groups would influence and modify this belief system into adult maturity. The final part was that of the “Ego” which Freud saw as testing reality and refereeing between the “Id and the Super Ego” where the two parts of the mind would be in conflict over the Id’s desire for gratification and the Super-ego’s desire for regulation and rule following.

Since Freud’s death in 1939 the neo-Freudians have modified his methods and differing schools of thought have honed and developed psychoanalysis in many different directions. This has meant that modern psychoanalysis may present itself in many forms. Followers of Freud such as Jung, Adler, Horney, Fromm and many others all have contributed particular insights into the therapeutic process. Also since Freud’s time the work of Piaget, Vortgotsky and Klein have shed light into the developing world of the child and given differing aspects of conflict that may arise from early childhood. Later modern research such as conducted by Bowlby, Ruttter and Ainsworth brought into sharp focus the treatment of children by adults and the environment have a vast shaping influence over the child’s eventual behaviour.

It is impossible to explore all the differing types of psychoanalysis in this short essay however on of the most influential and clinically acceptable styles is that of Eric Bern who developed Transactional Analysis. TA was developed on the back of Freudian therapy but was an attempt to demystify the process of analysis by ridding itself of the language problems such as using Latin terms or Greek and Egyptian mythology used by Freudians to explain its concepts. Eric Berne substituted the idea of the ID, EGO & SUPEREGO with the PARENT, ADULT & CHILD, this being more readily understood by the layperson. However unlike Freudian theory TA became much more in-depth and groundbreaking in its insightfulness towards human behaviour.

In all psychoanalytical therapy it is primarily aimed at the individual and the individuals problems of behaviour and ability to cope in the present environment. The success of individual therapy is in debate. Eysenck in the 1960’s published a damning report of the effectiveness of different types of approach to mental health and concluded that there was no supporting evidence that psychotherapy was any more effective than time. Eysenck was effectively saying that you were just as likely to recover with time passing than intervention. He also showed that in-patient statistics supported psychiatry as a more effective treatment for most patients. It has recently come to light that Eysenck exaggerated his figures to prove a point and that in fact the outcomes for psychiatry where not supported by evidence and in most cases people did have better outcomes through a session of psychoanalytical treatments.

From individual therapy came the idea of Group therapy in that clients could benefit from interacting with those that they could identify with as being similar in suffering to themselves. The best group therapy is usually that which brings together people with similar problems areas. Identifying with others helped to stop the belief system of aloneness, isolation and feelings of “am I the only one”. From these beginnings the idea of bringing the family together to help an individual within the unit could be of a therapeutic benefit.

Family therapy is not based on any particular personality theory or school of thought. In itself it is an approach to problems in that the family is viewed as the patient and all are treated together. The idea is that the individual is a product of their environment and that to produce change the environment needs to be altered to benefit all the members of the family.

Unlike individual therapy Family therapy looks initially for the family power structure and improving communications and understanding between the members of the family. Most therapist try to increase individual understanding of each other and the ability for each member of the family to grow and be accepting of differentiation. Most families start of by scapegoating a particular member of the family as the central cause of the upsets and disharmony within the unit. R. D. Laing and Esterson (1964) discovered through their research into the effect of family in producing Schizophrenic children, that the family dynamics where directly responsible for the outcomes experienced by the individual members. In Laing’s eyes the family was responsible for the identification of the scapegoat and then an atmosphere of blaming everything that went wrong on that target member relieved the other family members of responsibility for their own actions.

Family therapy developed from the work of Ludwig von Bertalanffy (1956) from his theory of General Systems. This sees man as autonomous, creative organism living in an open system i.e. the family. Behaviour is regulated by the family and is seen in Gestalt terms as being part of a whole system of which the individual is but a part. Each individual then must contribute to the whole family in order for it to function successfully. Bertalanffy stressed communication between members as the fundamental system to improving relationships and to stop the system of scapegoating. The purpose of the family therapy is to help the individuals emerge from the whole by becoming separate persons moving from an undifferentiated wholeness to a differentiated individual.

Unlike psychoanalysis, family therapy often involves two therapists. One acts as mediator between the members and initiates subject discussion and guidance, while the other acts as an observer. It is very difficult to note everything that is going on in body language and asides when four or more family members are all speaking and trying to communicate their scenario of what is going wrong within the family unit. The second therapist can look objectively at both what the family members are contributing and also how their colleague is influencing and interacting within the group. Through this technique over many sessions the family dynamics emerge and conflicts and resolutions can be obtained to the satisfaction of all the members of the family in crisis.

One particular theory of family therapy was proposed by George Kelly (1955) called “Personal Construct Theory.” Kelly believed that a people are constantly changing and developing and that to understand someone we have to try and find out how that person makes sense of the world. Kelly believed that people act as scientists constantly evaluating the world and applying attributions to explain and understand the actions of others. Kelly’s contribution to family therapy was that by individual psychoanalysis with members of a family you could ask each one their impression of how the others think and relate to them and what the other family members think of each other. From this approach the family create model of their world and construct relationships based on this fundamental postulate that individual members anticipate what the other members will do in any situation and therefore act accordingly towards them. It was Kelly’s hypothesis that by understanding the individual analysis that family constructs and so interaction could be better understood. In therapeutic terms this meant a more in-depth insight into relationships and how others perceived the family environment.

From Kelly’s and others work it is possible in both psychoanalysis and family therapy to see alliances, dyads and triads within the family system. Alliances explain conflict when for example father and mother allow the son to stay out late but not the daughter. A dyad exists between the father and mother against the daughter and a triad if the son also agrees with the parents. However these dynamics can change. Mother may sympathise with the daughter’s plights and may have an alliance between the daughter against the Father’s wishes. The son may align himself to the daughter against the father and mother and so form two dyads in conflict. This system helps us to understand the problems and interaction within the family unit on a therapeutic level.

The effect of both psychoanalysis and family therapy are not diametrically opposed but act as complimentary to each other as a form of support depending on the needs of the client and their presenting problems. The therapist in both situations needs to be aware of their limitations in the work to be achieved and the goals set by both the individual and family members. Both methods require a high level of theoretical understanding and the ability to be flexible in the approach taken. Critically the therapist should always remember to clearly define the aims and objectives of their chosen therapy and the reasons and acceptability of the clients to that particular approach.

A relationship of trust has to be achieved in therapy and this is doubly hard to do when confronted by hostile family members who may feel intimidated by being in therapy in the first place. Being able to integrate with one person through empathy is a skill needed by the therapist and in family therapy this means of course trying to empathise with four or more people without appearing bias to one member over another. The danger of transference exists at a more complex level in the family therapy. The therapist may be seen as a threat to parental dominance by becoming the new parent. The main aim of either therapy is to bring the client or clients to a conflict free environment and not to create new conflicts along the way.

Much modern therapy is of course short-term in duration and in itself creates problems. Economically all therapy can be expensive and therapist should be aware of the economic conflicts involved, even to the point of the family blaming one member for the expense of therapy. By its very nature therapy can in many instances only guide the individual or family on to the path of resolution and so should concentrate on those skills needed by the clients to achieve this goal as early as possible during therapy. This will enable the clients to continue therapy on their own by following laid down strategies for dealing with future conflict. Teaching Eric Berne’s “Game Theory” can help clients to recognise for themselves when what they say or do is not what they really mean but a psychological game based in childhood as a way of resolving problems that is no longer affective in adulthood.

“What ever method the therapist uses or the client responds too both psychoanalysis, in its many forms and family therapy can help to resolve conscious and unconscious conflict.

References:

Berne, E (1964) Games People Play, Pgs. 1/37

Berne, E (1970) Sex in Human Loving, Pgs93/96

Kennedy, E (1973) On Becoming a Counsellor Pg 221

Bion, W.R. (1961) Experiences in Groups Pg 11

Fromm, E. (1973) The Anatomy of Human Destructiveness Pg 291

Rycroft, C (1985) Psychoanalysis and Behaviour Pgs 58, 128, 147.

Mitchell, J (1986) The Selected Melanie Klein Pgs57, 84.

Laing, RD & Esterson, A (1964) Sanity, Madness and the Family Pgs 1/15

Christensen/Wagner/Halliday (2001) Instant Notes Psychology Pgs.236

REA’s Problem Solver in Psychology Pgs600/601

Thompson. B (1984) Unit 8 Social Psychology D307 Open University Pgs9-19

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