MENTAL HEALTH NURSING - 1

1. FAMILY THERAPY
V. BOOMINATHAN
MSC (N) 1ST YEAR
MTPG & RIHS

2. GENERAL OBJECTIVES
 Explain the introduction of family therapy.
 Discuss the goals of family therapy.
 Enlist the indications & contraindications of
family therapy.
 Describe the functions of the family therapy.
 Explain the types of family therapy.
 Describe the family therapy assessment.

3. INTRODUCTION
Family therapy is the branch of
psychiatry which sees an individual’s
psychiatric symptoms as inseparably
related to the family in which he lives.
Thus the focus of treatment is not on the
individual, but the family.

4. HISTORY
Family therapy is a relatively new
development that came about in the
mid-twentieth century as an adjunct to
individual treatment and refers to the
treatment of the family as whole.

5. “Father of Family
Therapy"
Ackermen (1958) first book of
family therapy was published

6. "Mother of Family
Therapy"
Virginia Satir (26 June 1916 – 10
September 1988) was an
American author and social
worker, known especially for her
approach to family therapy and
her work with family
reconstruction. She is widely
regarded as the "Mother of
Family Therapy"Her most
wellknown books are Conjoint
Family Therapy, 1964

7. CONT/.
Family therapists use a wide variety of
theoretical philosophies and techniques to bring
about change in dysfunctional patterns of
behavior and interaction, some therapists may
focus on the here and now,
Although different therapists may adhere to
different theories and use a wide variety of
methods, the goals of family therapy are basically
the same

8. PURPOSES
 Family therapist deals with Family pain
 Family therapist Assists for family Homeostasis
 Therapist gives marital counseling

9. GOALS
 To reduce dysfunctional behavior of individual
family members.
 To resolve or reduce intrafamily relationship
conflicts.
 To improve family communication skills.
 To heighten awareness and sensitivity to other
family members to meet their needs.

10. CONT/-
 To strengthen the family ability to cope with the
major life stressors and traumatic events
 To improve integration of the family system
into the social system.
 To strengthen the family ability to cope with the
major life stressors and traumatic events.

11. INDICATIONS
 Problems in the relationship within the family(urge
existence of communication or generation gap)
 Interdependence of symptoms(e.g. the wife’s
depression being contingent on the husband’s
alcohol consumption and vice versa)

12. CONT/-
 Development of stress in other family members
when one family member improves (e.g.
development of depression in wife following
husband’s giving up drinking, leading to his
improves participation in family matters)

13. CONT/-
 Symptomatology in one individual reflecting a
dysfunctional family background(e.g. emotional
disorder in a child resulting from conflicting paretal
value system
 Failure of individual therapy (may be because
family tensions have not been handled)

14. CONT/-
Psychiatric illness requiring family
therapy
 Neurosis (anxiety and depression)
 Sexual dysfunctions (other than sexual deviation)
 Adjustment disorders
 conduct and emotional disorders
 Substance abuse

15. 1. FAMILY FACTORS
CONTRAINDICATIONS
 Family in the process of breaking up
 Families in which tense, dysfunctional
equilibrium is present.
 Families staying apart
 No availability of the key family member
Unwillingness to accept the therapy.

16. 2. THERAPIST FACTORS
CONTRAINDICATIONS
 Lack of commitment
 Inflexibility
 Poor psychological mindedness
 Lack of empathy and adequate training
 Therapist having social relationship with the
client.

17. FUNCTIONS OF FAMILY THERAPY
Boundary function
Boundaries will maintain a distinction
between individuals with the family. Rigid
boundaries prevent family members
from trying out new ideas.

18. CONT/-
Communication function:
communication within the family
encourages its members to express their
feelings or emotions appropriately.

19. CONT/-
Supportive function:
supportive function within the family give
freedom to grow and explore new roles
within the family members.

20. CONT/-
Socialization function:
socialization helps to interact, negotiate
and plan adopts coping skills within the
members of the family.

21. CONT/-
Biological function:
family is a medium where the sex
relations are regulated.

22. CONT/-
Psychological function:
love, belongingness, affection, sympathy,
security, attention, emotional
satisfaction, sexual relationship, intimacy
etc. will be attained through family.

23. CONT/-
Educational function:
Mother is the first teacher and primary
care giver who will take care of the
children. Child’s personality and
character formation will be attained
through family.

24. CONT/-
Protective function:
Family protects the interest of the child,
provides security to cultivate healthy
behavior.

25. CONT/-
Recreational function:
Family creates an atmosphere where
the child’s interest can be fulfilled. The
love among family members will create
positive interest in the child.

26. CONT/-
Religious function:
Family develops religious thoughts, kind
heartedness and fellow belonging. The
child learns more moral values, ethics,
codes, honesty, truthfulness, traditions
and religious patterns.

27. CONT/-
Social function:
maintain social status and controls
member’s activities.
Promotes safety and security and lays
emphasis on kinship patterns -
provides physical shelter, food, clothing
which are necessary to the existence of
life.

28. MODELS OF FAMILY THERAPY
Many models of family therapy exists, none of which
is superior to other. The particular models used
depend upon the training received the context in
which therapy occurs and the personality of the
therapist

29. 1. PSYCHO-DYNAMIC
EXPERIMENTAL MODEL
It emphasizes individual maturation in the context of the
family system and is free from unconscious patterns of
anxiety and projections rooted in the past. In this models the
therapist seek to establish an intimate bond with each
family members and session alternate between the therapist
exchanges with the member and member exchanges with
one on others. Towards the end, family member may be
encourages to changes their seats, to touch each other and
make direct eye contact

30. 2. BOWEMEN MODEL
Murray bowen called this model family systems but
in the family therapy field it rightfully carries the
names of its originator. The hallmark of the Bowen
models is persons differentiation from their family of
origin their ability to be their true selves in the face
of the familial or other pressures that threaten the
loss of love of social position.

31. 3. STRUCTURAL MODEL
In this families are viewed as single, interrelated
system assessed in terms of significant alliances and
splits among family members hierarchy of power,
clarity and firmness of boundaries between the
generation , and family tolerance for each other. The
structural model uses concurrent individual and
family therapy

32. 4. GENERAL SYSTEM MODEL
It holds that facilities are system and that every action in
a family produces reaction in one or more of these
members. Every member is presumed to play a role
which relatively stable. Some families try to scape goat
one member by blaming him or her for the family
problems. If the identified patient improves, another
family member may become the scape goat. This
models overlaps with some of the other models
presented, particularly bowen and structural model.

33. In individual family therapy, each
family member has a single
therapist. The whole family may
meet occasionally with one or
two of the therapists to see how
the member’s are relating to one
another and work out specific
issues that have been defined by
the individual members
GOALS
1. Individual family
therapy=
TYPES OF FAMILY THERAPY

34. The most common type of family
therapy is the single-family
group, or conjoint family therapy.
The nuclear family is seen, and
the issues and problems raised
by the family are the ones
addressed by the therapist. The
way in which the family interacts
is observed and becomes the
focus of therapy.
GOALS
2. Conjoint famil
therapy=
TYPES OF FAMILY THERAPY

35. Couples are often seen by the
therapist together. The couple
may be experiencing difficulties
in their marriage, and in therapy,
they are helped to work together
to seek a resolution for their
problems.
3. Couples therapy=
TYPES OF FAMILY THERAPY

36. Family patterns, interaction and
the communication styles, and
each partner’s goals, hopes and
expectations are examined in
therapy. This examination
enables the couple to find a
common ground for resolving
conflicts by recognizing and
respecting each other’s
similarities and differences.
GOALS
3. Couples therapy
CONT/-=
TYPES OF FAMILY THERAPY

37. In multiple family group therapy,
four or five families meet weekly
to confront and deal with the
problems or issues they have in
common. The multiple family
group become the support for all
the families. The network also
encourages each person to
reach out form new relationships
outside the group.
GOALS
4. Multiple family
group Therapy=
TYPES OF FAMILY THERAPY

38. Ability or inability to function well
in the home and community
fearing of talking to or relating to
others, abuse, anger, neglect, the
development of social skills, and
responsibility for oneself are
some of the issues on which
these group focus
GOALS
CONT/-=
TYPES OF FAMILY THERAPY

39. In multiple impact therapy,
several therapists come together
with families in a community
setting. They live together and
deal with pertinent issues for
each family member within the
context of the group.
5. Multiple Impact
Therapy=
TYPES OF FAMILY THERAPY

40. Multiple impact therapy is similar
to multiple family group therapy
except that it is more intense and
time limited. Like multiple family
group therapy, it focuses on
developing skills or working
together as a family and with
other families
GOALS
CONT/-=
TYPES OF FAMILY THERAPY

41. Network therapy is conducted in
people’s homes. All individuals
interested or invested in a
problem or crisis that particular
person or persons in a family are
experiencing take part. People
who form the network generally
know each other and interact on
a regular basis in each other’s
lives.
GOALS
6. NETWORK
THERAPY=
TYPES OF FAMILY THERAPY

42. This gathering includes family,
friends, neighbours, professional
groups or persons, and anyone
in the community who has an
investment in the outcome of the
current crisis.
Thus a network may include as
many as 40 to 60 people.
GOALS
CONT/-=
TYPES OF FAMILY THERAPY

43. FAMILY THERAPY ASSESSMENT
Boyer and Jeffrey (1984) describe six elements on
which families are assessed to be either functional or
dysfunctional. The six element of assessment include:
1. Communication
2. Self-concept reinforcement
3. Family member expectations.
4. Handling differences.
5. Family interactional patterns.
6. Family climate

44. 1.COMMUNICATION
Functional communication patterns are those in
which verbal and non-verbal messages are clear,
direct, and congruent between sender and intended
receiver. Family member are encouraged to express
honest feelings and opinions, and all members
participate in decisions that affect the family
system. Each member is an active listener to other
members of the family.

45. CONT/-
Making assumption:
In this, one assumes that others will know what is
meant by an action or an expression For e.g., a
father says to his teenage son “you should have
gone to market to bring some provisions for home
during my absence at home”.

46. CONT/-
Be letting the Feelings:
This behaviour involves ignoring or minimizing another’s
feelings, when they are expressed. This encourage the
individual to withhold honest feelings to avoid being hurt by
the negative response. For e.g. elder brother scolding his
sister (young one) and she is angry with him. Then the
mother consoles girl that “oh don’t be angry, he does not
mean anything”

47. CONT/-
Failing to Listen:
In this, one does not hear what the other individual is
saying. This can mean , not hearing the words by
‘turning out’ what is being said, or It can be selective
listening, in which a person hears only selective part
of the message or interprets in a selective manner.

48. CONT/-
Communicating Indirectly:
It usually means that an individual does not
cannot present a message to receiver directly, so
he or she seeks to communicate through a third
person.

49. CONT/-
Presenting double – blind messages:
In this, family-member may respond to a direct
request by another family member only to be
rebuked when the request is fulfilled.

50. 2.SELF CONCEPT REENFORCEMENT
Functional families strive to reinforce and strengthen
each member’s self-concept, with the positive results
being that family members feel loved and valued.in
this, the manner in which children see and value
themselves is influenced most significantly by the
messages they receive concerning their value to
other members of the family.

51. 3.FAMILY MEMBER’S
EXPECTATION
Every individual have some expectations about
the outcomes of the life situations they
experience. The expectations are related to and
significantly influenced by earlier life experiences.
Each family member is different, with different
strength’s and limitations. Each member must be
valued independently

52. 4. HANDLING DIFFERENCES
It is difficult to conceive of two or more individuals living
together who agree on everything all of the time.
Serious problems in a family functioning appear when
differences becomes equated with “badness” is seen
not caring. Member are willing to hear the other
person’s position, respect the other person’s right and
work to modify the expectations on both sides of the
issue to negotiate a workable solution..

53. 5. FAMILY INTERACTION PATTERNS
All families develop recurring, predictable patterns of
interactions over time. These are often thought of as
“family rules”. Interactions may have to do with
communication expressing expectations and handling
differences. Family rules are functional when they are
workable and constructive and promote the needs of
all family members

54. 6. FAMILY CLIMATE
The atmosphere or climate of a family is composed
of a blend of the feelings and experiences that are
the result of the family member’s verbal and non-
verbal sharing and interacting. It has been suggested
that a positive family climate is founded on trust and
is reflected in openness. A dysfunctional family
climate is evidenced by tensions, pain, physical
disabilities, frustrations or guilt

55. EDUCATION TO FAMILY
● Families need to understand
that hospitals are not the
proper places for long-term
treatment
● Families need to work closely
with the mental health
professionals
● Help the patient to relearn
how to do things
● Families needs to learn that
relapse and regression are
normal parts of the recovery
and not evidence of failure
● Family education focus on a
change in perspective
● Families needs to learn to
accept risks and changes

56. Nurses role in family therapy

• To pay attention to the social
and clinical needs of pateint
and family
• To provide optimum
medication management
• To listen to families and treat
them as equal partes
• To explore family
expectations
• To assess familly’s strengths,
problems and goals
• To provide explicit crisis plan
and professional response
• To provide training in structured
problem solving technique
• To help resolve family conflict
and sensitive response to
emotions
• To be flexible in meeting the
needs of the family
• To provide follow up contacts
for future access to support if
work with family ceases

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