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You can take an individual out of the environment for therapy but you can’t take the environment out of the individual: A case for changing the environment with family therapy

You can take an individual out of the environment for therapy but you can’t take the environment out of the individual: A case for changing the environment with family therapy

Individual therapy has dominated counselling and psychotherapy since the therapy profession began. Individuals are often given a diagnostic label (e.g. depression, anxiety, OCD) and the therapist then works to “cure” that person’s diagnosis or provide tools to manage the symptoms. There is some merit to diagnoses and sometimes it can help an individual feel like they’re not alone in their experience and they understand what’s wrong. However, reducing someone’s experience to a single label ignores not only the individual distress but also the context in which the distress occurs.

None of us are born in a vacuum and we are always a product of our environment (usually the family system) and are especially affected by the relationships we have throughout our lives. While biological factors can play a role in how an individual responds to the environment and how the environment responds to them, it is very rare that distress is just due to individual factors.

Even when a therapist is working with an individual, they very rarely, if ever, encounter a client who does not talk about relationships, or lack of. When you talk to someone with depression, you often hear stories about how they are having difficulties with a boss or work colleagues, how they feel lonely in their relationship with their partner, how they felt ignored as a child, how they experienced early trauma at the hands of someone who was supposed to protect them, how they were bullied and felt that they weren’t good enough…

You hear similar stories for people struggling with anxiety. Anxiety is often a response to an unsafe and uncertain environment and feeling a lack of control over the environment. Individuals who struggle with anxiety may attempt to problem solve their worries and control the environment (e.g. by excessively cleaning, tidying, hoarding, ordering) and people around them. The anxiety often has an impact on other people around the person who is struggling with anxiety and the person often gets triggered by others around them. The anxiety itself often stems from a family environment that didn’t feel safe or was characterised by a high level of anxiety.

If most of our distress is caused by or is a response to others and our environment, why do we expect the individual to get better if the environment doesn’t also change? Sometimes individual therapy can help the client respond better to the environment but family therapy not only helps a client to respond better to the environment but can also help change the environment.

Family therapy became an alternative treatment option to individual therapy in the 1960s and has been helping families recover from a wide range of issues ever since. Many government bodies, therapists and organisations recognise that treating the family may be more beneficial than focusing on the individual alone, especially when the individual client is a child or a teenager and cannot do much to change their environment.

Family therapy can be extremely helpful in a number of situations. For example, it may be that one of the children is acting out, refusing to do chores, feels depressed or does not want to go to school. Family therapy can also be helpful when a family environment changes for example due to separation or divorce, remarriage, death or illness of a family member or loss of a job.

In most families, one or more individuals may experience symptoms and be identified as the person needing help. However, whilst sometimes only one person in the family shows symptoms overtly, usually there is something going on in the whole family that is contributing to the symptoms. And even if not, family members are in the best position to help another family member who is struggling as they will still be there once therapy finishes and can provide ongoing support.

There are also times when families seek family therapy retrospectively after children have left the home as there may be some unresolved issues that are affecting the child(ren)’s quality of life or is getting in the way of the family getting along. Resolving past issues can help all family members feel better and also help them get along.

The focus of family therapy is on the system as a whole rather than on any one individual. It recognises that family members influence each other and one person’s behaviour will affect other members of the family and vice versa. Family therapy aims to resolve family conflict and create closeness and connection as well as a healthy level of separateness between family members.

At our clinic, we primarily use Emotionally-Focused Family Therapy, or EFFT, to treat families. In EFFT, the therapist helps family members create safety and security and reconnect with each other. The change happens through the use of emotions to help understand and change behavioural patterns. These patterns may involve a teenager who is locking themselves up in the room feeling misunderstood and being treated like a child and parents who are trying to help but may end up shouting and imposing additional rules which only end up driving the teenager to withdraw further. Or it may be that a parent is feeling really stressed about family finances and is preoccupied with worries instead of focusing on the child. A child may feel confused and start acting out to get attention from the parent.

EFFT acknowledges that parents generally want to be good parents and want to take care of their children but may be under- or overresponding to the needs of the child for a variety of reasons. Equally, children don’t want to be naughty but may not have an alternative way to regulate their emotions. Instead of feeling able to ask for their needs to be met, children may instead either withdraw or start acting out leading to arguments.

In EFFT, the therapist helps de-escalate the negative conflict pattern, strengthens the parents’ ability to be accessible, responsive and engaged with their children (regardless of age) which creates safety and security for the child to express their needs. When children feel safe in the environment, they are able to cope with challenges and grow into happy and healthy adults. Family therapy can provide a safe space for families to explore their differences and to find ways to break out of the negative conflict pattern into safe and loving connection.

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