NOTE: THIS WAS ORIGINALLY PUBLISHED IN BINAH MAGAZINE'S BI-WEEKLY COLUMN THERAPY: A SNEAK PEEK INSIDE
So just when you thought you knew everything you needed to know about therapy for individuals, I am going to give the rug underneath you a little jerk, and topple you over with another model of therapy called family therapy. Yep, you heard right. Family therapy is when the family comes into the therapy room.
Yeah, I know.
Just imagining yourself in therapy was a major step. Now the idea of your parents, your husband, your kids, your sister-in-law or son-in-law in therapy is enough to send you to a psychiatrist for some medication or sleeping pill that will put you out of commission for a coupla years.
I happen to looove doing family therapy. And I will tell you why.
Here's what happens:
Parents drag their kid into therapy and say, “Fix him!”
Or, schools mandate a child into therapy and command, “Get this girl functioning again.”
Sometimes, the script changes and a guy sends his wife to therapy or the wife sends her guy. Or, everyone points a finger at the father, accusing him of being the problem; or at the new daughter-in-law who has upset the family somehow or another.
These individuals are called the identified patient. It's easy to see why this or that individual has been identified as a culprit, wreaking havoc in the family. She is sulking in her room, barking at her siblings; he is waking up late for Shacharis, refusing to attend morning seder at yeshiva. She is yelling at the children; he is withholding money from his wife. And the new daughter-in-law refuses to join the family for Shabbosim, holding her husband hostage in her home.
Right?
Wrong.
Often, when these individuals come for therapy, a clearer picture emerges in which a family system of dysfunction is revealed. The child is socially awkward or shy, but there is a family history of social maladaptations in which the mother has suffered socially all her life, but the effects were muted by her life of privilege that compensated. The sister-in-law is behaving badly, but then stories of the father's inappropriate behavior at the Shabbos table is revealed. And sometimes, the family's dysfunction is much more subtle and harder to identify.
As a mentor years ago for Project YES, which helps families at risk, my supervisor called these identified patients the weak link in the family. He compared it to a chain, made up of links. Put a weight onto the chain, he explained, and eventually, one link will snap. The weight is felt by everyone, but one link will bear the burden of the weight. That is our identified patient. The kid or mother or sister-in-law that finally snaps under the family's burden.
While in our community, we deal mostly with the identified patient, often with success—because when one wheel begins to move, the interconnecting parts begin to move as well (the other family members)—it is extremely gratifying to work with a family as a whole.
And in family therapy, the therapist's client is not the identified patient, but the family itself.
Each family has its own structure and rules; and self-regulating mechanisms to keep the family's status quo—its homeostasis.
Structure would define how the family organizes itself; who is the boss in the house (or boss-driver!), the breadwinner, halachic authority, disciplinarian, and other various roles and religious doctrine. Rules would define who needs to do what and why. For example, rules would include religious and educational expectations, who needs to help and how, and other ways in which a family operates.
A functional family's rules, even those that are covert or unspoken, benefits the members of the family. Rules like, “We all have jobs for Shabbos,” or “Totty is responsible for the parnassah,”; but in a dysfunctional family, rules can be givens like, “It's safer to stay in your room when Mommy is angry.” Or, “Girls have to help but boys can get away with doing chores.”
A family can be a functional family but then becomes disorganized because of a challenge such as a death, divorce, loss of job, or illness.
Often, when an identified patient is brought into therapy, it's because she challenges the homeostasis. She upsets the family balance and how it has organized itself to function.
A child is acting out at school, stealing money and bullying. She is upsetting the family's rules in which children are expected to behave and not bring attentions to themselves. This rule is important to the family because then the father can cow the children into submission with his anger and threats of withholding.
According to the family, the child needs therapy to stop her behavior and return the family's status quo. But therapy can cause more problems because the child is not necessarily the problem, although she is the identified patient! And when therapy helps the child act functionally, and refuse to accept rules that are detrimental to her well being, such as “We don't tell anyone that Totty and Mommy fight and say hurtful words to each other,” can definitely cause more chaos to a family when the child does tell.
If a therapist is successful with the child, then the family might find itself totally disorganized, because this child is now healthy and will not abide by the family's dysfunctional rules and structure. And that's when the kid is usually yanked out of therapy!
But bring the whole family into the therapy room, and a therapist can work with the family unit to effect change to the family that will restore a family's functioning, or enable it to find—for the first time—functional ways of achieving its equilibrium.
Therapists view the family through different lenses, depending on their orientation, and sometimes work with a few lenses. There's understanding how a family functions according to inter—generational patterns (the grandmother had anxiety, the mother has anxiety, the kid has anxiety), or perhaps through the family's transactional patterns in which we observe the hierarchical and subsystems of the family (is Totty and Mommy a strong dyad, or has the family restructured so that the oldest daughter and Mommy are aligned, leaving Totty powerless on the outside?).
Family therapists use a variety of techniques and interventions to restore a family's equilibrium. One of my favorite is observing how family members seat themselves, revealing how they align themselves in the family. One child sits alone, another sits sandwiched between both parents. Two sisters sit together, a third sits furthest away from the family. A father sits near his daughter, the mother near her son. Chairs are angled away or towards each other. And then sometimes, a therapist can simply move members nearer or further from each other to foster sibling or parent dyads, new alignments and support systems that change the family's structure and brings it closer to healthy functioning.
The challenge of family therapy is channeling the dynamite to make it dynamic!
YOU CAN CHECK OUT MY PROFILE AT https://www.linkedin.com/in/mindy-blumenfeld-a8067583
My book, Therapy, Shmerapy, can be found in bookstores or online