1The worldview
Interaction, structure, meaning: three things family therapy looks at
Family therapy (also called systemic family therapy; in Hong Kong you will also see marriage and family therapy and family counselling) treats a family, or the most important relationships around one person, as a whole. It doesn't ask which person has the problem; it asks what the problem is doing in this family and how it is kept going, back and forth. "Systemic" names this way of seeing; it doesn't require the whole family to attend. In the research, systemic therapy has also been done with some members, with couples, in groups, and even with one person.[35,39]
The shared starting point is circular causality: a person's behaviour is both a response to the last move and the cause of the next, so a problem isn't caused from one side but by a pattern of interaction. A mother pushes harder, her son pulls back; he pulls back, she pushes harder. Who pursues and who withdraws is often not personality but who wants the change: a study observing 31 married couples found both partners demanded more when discussing a change they wanted, and withdrew more when discussing a change the other wanted. Moving the problem from "one person" to "between people" is the most basic move in family therapy.[1,18]
Family therapy is a field, not one school. The 1970s and 80s produced four influential traditions: Bowen's family systems theory, Minuchin's structural approach, Haley and Madanes's strategic approach, and the Milan team's systemic approach. From the late 1980s a postmodern turn (narrative, solution-focused, collaborative dialogue) moved the weight from the family's structure to how family members talk about the problem. Many of the family therapies with research behind them today are manualised programmes built for one kind of problem, and don't belong to any one classic school. Below: the worldview they share first, then each in turn.[2,5,8,11,14,39]
The schools differ in emphasis, but family therapy usually looks at three things at once: the back-and-forth sequence of what family members do, the family's structure (who is close to whom, who is in charge, who gets pulled in), and how each person explains the problem and one another. Each moves the others: structure decides who responds from which position, interaction replays the structure every day, and meaning makes it seem natural. Each school below comes in through one or two of these layers.
