What Is Family Therapy?
Family therapy is a type of treatment designed to help with issues that specifically affect families’ mental health and functioning. It can help individual family members build stronger relationships, improve communication, and manage conflicts within the family system. By improving how family members interact and relate to one another, family therapy can foster change in close relationships.
Some of the primary goals of family therapy are to create a better home environment, solve family issues, and understand the unique issues that a family might face.
Types of Family Therapy
There are several types of family therapy. A few that you might encounter include:
- Family systems therapy: This type is an approach that focuses on helping people utilize the strengths of their relationships to overcome mental health problems.
- Functional family therapy: This is a short-term treatment often utilized for young people experiencing problems with risky behavior, violence, or substance use. It helps teens and families look for solutions while building trust and respect for each individual.
- Narrative family therapy: This type encourages family members to each tell their own story to understand how those experiences shape who they are and how they relate to others. By working with this narrative, the person can start to view problems more objectively than just seeing things through their own narrow lens.
- Psychoeducation: This type of treatment is centered on helping family members better understand mental health conditions. By knowing more about medications, treatment options, and self-help approaches, family members can function as a cohesive support system.
- Supportive family therapy: This type of therapy focuses on creating a safe environment where family members can openly share what they are feeling and get support from their family.
Some therapists may stick with a specific type of family therapy. In contrast, others may take a more eclectic, multimodal approach that incorporates aspects of different types of treatment to suit the needs of the family.
The techniques utilized in family therapy typically depend on factors such as the theoretical orientation of the therapist and the specific needs of the family. Some methods that may be utilized include:
- Behavioral techniques: These methods often focus on skills training and psychoeducation to help family members address specific problems. For example, modeling and role-playing might be used to help family members resolve communication problems.
- Psychodynamic techniques: These methods involve assessing how each family member interprets and responds to the problems they are facing. The therapist works with the family to develop new emotional insights and explore new ways of responding more effectively.
- Structural techniques: These methods focus on helping family members with boundaries and power dynamics within the family. Such techniques can help families create new boundaries and establish routines that improve how the family functions.
Techniques used in family therapy focus on improving emotional awareness, assisting with major changes within a family, helping people accept things they cannot control, and improving communication and collaboration.
Other specific techniques used in family therapy may include learning to practice empathy, emotional validation, reflective listening, and cognitive reframing.
What Family Therapy Can Help With
Family therapy can help people with many different issues. Some of these include:
- Behavioral problems in children or teens
- Changes within the family
- Communication problems
- Death of loved one
- Divorce, separation, or marital problems
- Parent-child conflicts
- Problems between siblings
- Parenting issues
- Stressful events or major life transitions
This type of therapy can also address individual mental health problems that can affect the entire family, such as anxiety, chronic illness, depression, and substance use.
Benefits of Family Therapy
Because this form of treatment addresses communication, family members can learn how to better share their thoughts and needs and resolve conflicts in a way that is less likely to damage relationships.
This type of therapy also focuses on how family members can address an individual family member’s difficulties. For example, if one family member has a mental health condition, family therapy can help alter some conditions that sometimes contribute to the problem.
When individuals are affected by mental illness, family members may sometimes lack awareness of how to help. As a result, they may engage in behaviors that maintain or even worsen aspects of the illness. Family therapy can help members of the family learn more about what they can do to support their family member who has a mental disorder while preserving their own mental well-being.
Research suggests that family therapy can be effective for a range of purposes. Some supporting evidence includes:
- A 2018 review found that family therapy could be useful in treating adult-focused problems, including relationship distress, intimate partner violence, mood disorders, anxiety disorders, psychosis, alcohol issues, and adjustment to chronic physical illness.
- A 2019 study found that family therapy helped improve different areas of family functioning to help teens who were experiencing mental health problems.
- One 2019 review found that family therapy demonstrated effectiveness in treating conduct problems, emotional problems, eating disorders, somatic problems, and recovery from abuse or neglect. The study also found that it was useful either when utilized independently or as part of a multimodal treatment program.
Further research is needed to better understand how family therapy may be most effective and how it compares to other forms of treatment.
Things to Consider
Because family therapy involves talking about emotional problems and conflicts, it can be difficult and upsetting. In some cases, people may initially feel worse before they begin to improve. It is important to remember that a professional therapist is there to help members of the family work through these conflicts and handle the intense emotions that people may experience.
While family therapy can be useful for various issues, that doesn’t mean it is right for everyone or every situation. Some other types of treatment that may also be useful include cognitive-behavioral therapy (CBT) or child psychotherapy.
How to Get Started
Family therapy is often short-term, but it may also take place for a year or longer, depending on the situation and needs of the family. While it frequently involves all family unit members, it may also focus on those who are willing or able to participate in treatment.
During therapy sessions, the therapist will ask questions to learn more about the problems that have brought the family to therapy. They will also look at other factors contributing to issues, such as underlying mental health conditions and environmental stress.
This type of therapy is often provided by licensed marriage and family therapists (LMFT), but it can also be practiced by other mental health professionals including licensed professional counselors, psychologists, and social workers.
If you are interested in trying family therapy, it can be helpful to ask your doctor for a referral or look for professionals in your area who specialize in this type of therapy. You can also search the online directory at the American Association for Marriage and Family Therapy website.
What is factitious disorder?
Factitious disorder is a serious mental health disorder in which a person appears sick or produces physical or mental illness. People with factitious disorder deliberately produce symptoms of an illness for the purpose of receiving care and attention in a medical setting. The symptoms aren’t intended to get them practical benefits — the gain is believed to be mainly psychological.
Factitious disorder is considered a mental illness. It’s associated with severe emotional difficulties and patients’ likelihood of harming themselves by continuing to produce more symptoms, resulting in getting themselves unnecessary procedures and surgeries.
What are the types of factitious disorder?
Factitious disorders are of two types:
- Factitious disorder imposed on self: This type includes the falsifying of psychological or physical signs or symptoms. An example of a psychological factitious disorder is mimicking behavior that is typical of a mental illness, such as schizophrenia. The person may appear confused, make absurd statements, and report hallucinations (the experience of sensing things that are not there; for example, hearing voices).
- Factitious disorder imposed on another: People with this disorder produce or fabricate symptoms of illness in others under their care: children, elderly adults, disabled persons or pets. It most often occurs in mothers (although it can occur in fathers) who intentionally harm their children in order to receive attention. The diagnosis is not given to the victim, but rather to the perpetrator.
What are the warning signs of factitious disorder?
Possible warning signs of factitious disorder include:
- Dramatic but inconsistent medical history.
- Unclear symptoms that aren’t controllable, become more severe or change once treatment has begun.
- Unpredictable relapses following improvement in the condition.
- Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illness.
- Presence of many surgical scars.
- Appearance of new or additional symptoms following negative test results.
- Presence of symptoms only when the patient is alone or not being observed.
- Willingness or eagerness to have medical tests, operations or other procedures.
- History of seeking treatment at many hospitals, clinics and doctors’ offices, possibly even in different cities.
- Reluctance by the patient to allow healthcare professionals to meet with or talk to family members, friends and prior healthcare providers.
- Refusal of psychiatric or psychological evaluation.
- Forecasting negative medical outcomes despite no evidence.
- The patient sabotaging discharge plans or suddenly becoming more ill as they’re about to be discharged from the hospital setting.
How common is factitious disorder?
No reliable statistics are available regarding the number of people in the United States who suffer from factitious disorder. Getting accurate statistics is difficult because patients don’t typically acknowledge their disorder. People with factitious disorders also tend to seek treatment at many different healthcare facilities, resulting in statistics that are misleading. It’s estimated that about 1% of those admitted to hospitals are believed to have factitious disorder, but this is likely under-reported.
Symptoms and Causes
What causes factitious disorder?
The exact cause of factitious disorder is not known, but researchers believe both biological and psychological factors play a role. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses in themselves or family members that required hospitalization, may be factors in the development of the disorder.
Most patients with factitious disorder have histories of abuse, trauma, family dysfunction, social isolation, early chronic medical illness or professional experience in healthcare (training in nursing, health aid work, etc.).
What are the symptoms of factitious disorder?
People with factitious disorder may:
- Lie about or mimic symptoms.
- Hurt themselves to bring on symptoms.
- Alter diagnostic tests (such as contaminating a urine sample or tampering with a wound to prevent healing).
- Be willing to undergo painful or risky tests and operations in order to obtain the sympathy and special attention given to people who are truly medically ill.
Most people with this condition do not believe they have factitious disorder. They may not be entirely aware of why they are inducing their own illness. Many people with factitious disorder may also suffer from other mental disorders, particularly personality or identity disorders.
Diagnosis and Tests
How is factitious disorder diagnosed?
Due to the deceptive behaviors involved, diagnosing factitious disorder is difficult. Doctors must also rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering a diagnosis of factitious disorder.
If the healthcare provider finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist (mental health professionals who are specially trained to diagnose and treat mental illnesses). Psychiatrists and psychologists use thorough history, physical examinations, laboratory tests, imagery, and psychological testing to evaluate a person for physical and mental conditions.
The doctor bases a diagnosis on the exclusion of actual physical or mental illness, and observation of the patient’s attitude and behavior.
Management and Treatment
How is factitious disorder treated?
The first goal of treatment is to change the person’s behavior and reduce their misuse of medical resources. In the case of factitious disorder imposed on another, the main goal is to ensure the safety and protection of any real or potential victims.
Once the first goal is met, treatment aims to resolve any underlying psychological issues that may be causing the behavior.
The primary treatment for factitious disorder is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). Family therapy also may help in teaching family members not to reward or reinforce the behavior of the person with the disorder.
There are no medications to actually treat factitious disorder. Medication may be used, however, to treat any related disorder, such as depression or anxiety.
What are the complications of factitious disorder?
People with factitious disorder are at risk for health problems associated with hurting themselves by causing symptoms. In addition, they may suffer health problems related to multiple tests, procedures, and treatments, and are at high risk for substance abuse and suicide attempts. A complication of factitious disorder imposed on another is the abuse and potential death of the victims.
Can factitious disorder be prevented?
There is no known way to prevent factitious disorder. It may be helpful to start treatment in people as soon as they begin to have symptoms.
Outlook / Prognosis
What is the prognosis (outlook) for people with factitious disorder?
Some people with factitious disorder suffer one or two brief episodes of symptoms. In most cases, however, factitious disorder is a chronic, or long-term, condition that can be very difficult to treat. And unfortunately, due to their low self-awareness, many people with factitious disorder will not seek or follow treatment.