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Family Therapy for Beginners

Professor Richard Layard, one time ‘Happiness Tsar’, wrote, ‘in every study, family relationships, (and our close private life) are more important than any other single factor in affecting our happiness’.

It’s hard to grow and feel safe and content in the world if our family stories are causing us distress and discomfort. This is especially true for children, and young people when their family is their world. When they are struggling with emotional and behavioural problems or maybe unexplained physical ailments a ‘systemic’ approach can be revealing.

Systemic therapy is relational, that means looking at the spaces in between people and their relationships with others, as opposed to looking inside individuals. Systemic therapists are interested in the ‘systems’ that people belong to, such as our families, school, work places, peers and friendships. Exploring the context of tension, distress and unhappiness can help us illuminate the possible causes.

For example we may find stories of divorce and separation, estrangement, sibling rivalry, family illness and disability, bullying, academic struggles, financial problems, loss and bereavement, or drug and alcohol use Family therapy is about having conversations that can be difficult, exposing, controversial, and upsetting.

But also about reconnecting, understanding, sharing and being surprised. Feeling heard, understood, loved and believed. Explaining your side of a story, hearing family stories that help you understand current struggles and appreciating other people’s point of view. Feeling proud and united, relieved and supported and wondering together how you can move on.

Any therapy involves taking a risk; family therapy provides an invitation to be brave and accept that families may be worried, sad or confused about someone they love. Or maybe family relationships are feeling tense and strained, or they are missing someone who played an important role in your lives.

Established, repaired and revisited relationships give families a rich resource for healing.  Family Therapy sessions usually last 90 minutes, and as many family members who are available are welcome.  Work would begin by exploring why it had been decided now was the time for family talking and noting individual and family goals to help focus the work. Some family members may be initially reluctant to attend, its important for them to be aware that just be attending they are showing their support. They do not have to contribute verbally if they do not want to – this could be agreed at the beginning of the session. By just turning up they are able to listen to other expressing their views and will usually join in when they feel comfortable and safe within the process.

A genogram or family tree is usually constructed looking at the current family structure and remembering older generations. This provides a map of the family and a cultural context for the current problems. It generates stories, sometimes forgotten, about how positive and negative patterns and traits may have been inherited by the family in the room. This can be a revealing and emotional, with younger people hearing about relations that may have died before they were born and older ones remembering stories that help build to a clearer understanding of the family’s identity. A time-line constructing a chronology of family births and deaths and other family events is also useful. Again, this begins reveals its own narrative, which can help a family begin to plot the life story of a problem.

Family Therapy is always driven by the goals of the family and continual feedback allows the therapist to ensure that the family are having the conversations they want and need to have. Sometimes it may feel useful for family members to meet individually, in couples or sibling groups as part of the therapy.

It is not necessary to meet weekly; sometimes families find one or two sessions are enough to feel they are able to move forward. In my experience family therapy can be a powerful process with the family leaving more connected with and appreciative of each other.

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

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Emotionally Focused Therapy: For Couples in Distress

Emotionally Focused Therapy (EFT) is a short-term evidence-backed therapy with a high success rate in supporting clients to move through difficulties in their relationship. This includes one or both partners who have experienced early trauma. It is shown to to be an extremely effective way of helping distressed couples strengthen their attachment bond, particularly where one or both partners have experienced early trauma.

As a couple in distress you might feel you’ve reached the end of the line, or you are struggling to get past your partner’s infidelity. Perhaps you can’t seem to get your point across without a descent into conflict.  When this becomes a habitual pattern it becomes destructive, affecting how safe you feel which can erode intimacy, desire and emotional connection.

Emotional, or attachment bonds in our relationships are physiological and therefore potent.  Neuroscience is uncovering how important these attachment bonds are to our sense of safety: distance and separation is perceived as threatening and we go into fight-or-flight mode to get what we need.  This emulates our early life experience when we relied on caregivers to survive.  It might not feel like it but arguments are often a way to draw our partner closer when we feel they are not attuned to us.

Modern couples are subject to different stressors than previous generations. Socio-cultural shifts means we have higher expectations that both partners provide for all our emotional needs  as well as the financial and practical elements. Children may or may not be part of the way we configure our relationship.  Paradoxically we also expect to maintain excitement and passion throughout as we strive to emulate the sexually exciting worlds of the movies.  Yet though we know there’s a dissonance between fantasy and reality, disappointment follows and we may wonder if there’s someone better out there.  EFT considers the wider context that affects relationships, looking at the systems  around the couple that influences their relationship.

How does it work?

Our emotions play a key part in making decisions and in signalling to others our desires, feelings and intentions. Paying attention to our emotions can support us to gauge a situation and act in a way that benefits us and others.

One of the strengths of EFT is that it places emphasis on the negative cycle of conflict couples get pulled into rather than apportioning blame to either person.  The therapist works in collaboration with both partners to identify this dance of ‘pursue-withdraw’ or ‘criticise-defend’ as the couple interact in the room. This here and now focus illustrates the triggers, escalation points and underlying feelings that erode attachment bonds but often remain unspoken.

The therapist supports the couple to listen effectively, witness and ultimately validate the other person’s underlying feelings, emotions and desires.  Partners learn to express feelings from a place of vulnerability and ask for what they want and need from each other.

The ultimate aim of EFT is to reduce conflict and  restore a sense of safety, connection and  intimacy.  Whatever the outcome you will learn new skills of communication, increase compassion for each other and re-establish trust and safety.  It isn’t always an easy journey but you will learn a lot about each other and yourself in the process that will help you make clear decisions about your relationship.

If you would like to try out EFT please get in touch.

 

Suzanne Worrica is an experienced psychotherapist who works with individuals and couples. She is available at our Lewes Practice.

 

Resources –

Susan M. Johnson (2019) Attachment in action — changing the face of 21st century couple therapy  www.Sciencedirect.com

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Existential Therapies

“A rich tapestry of intersecting therapeutic practices, all of which orientate themselves around shard concern: human lived experience” (1)

What is existential therapy? I’m asked this a lot. I even ask myself from time to time. In some ways it could be described as an attitude held by the therapist. It is certainly, in my experience, a continually unfolding enterprise due in part to its emphasis on relationship, non-directive stance, non-structured framework and an openness to wonder and mystery rather than reduction and categorisation.

In this blog, and future blogs I will begin to reflect on some understandings within existential therapy.

It is perhaps safe to start with reiterating what many have said before: there are as many ways to be an existential therapist as there are existential therapists (2) (and clients may I add). I am aware how vague that sounds, however, I believe it is actually what makes existential therapy so valuable. Its variety and openness invites connections and relationships to be developed in an authentic and unique way with each client. It also challenges some illusions regarding life (and therapy) including that it is and can be objective, manualisable and unambiguous.

Existential therapy is framed around a variety of existential thinkers, and other philosophers. Many have been influential in its development. At times the diversity of understandings about human existence reveals contrasting understandings which can be confusing. However, this is also the very ingredient that permits the aforementioned subjectivity, diversity and disagreement.

Existential therapy recognises the significance that each individual interprets from their particular context, therefore rejecting the notion that one size fits all. It invites every individual to recognise and bring forth their unique potential. Its very nature permits consideration of life in all its complexity and nuance, and recognises how uncertainty is intricately connected with living life.

What underpins existential therapy is the starting point: May (1958) (3) described existential therapy as an exploration that seeks to understand individuals as being. It invites a person to experience and have awareness of their own being, their own existence, their own aliveness, their own relation to one’s self and one’s world as a precondition for unraveling and working through their difficulties. Its focus is on the existence of each individual being sitting with the therapist, and what occurs between them. It does not disparage investigations about behaviour patterns or dynamisms but it recognises these elements are only really understood in the context of each individual’s structured existence. It is existence, or as May (1958) described the ‘I am’ experience, that underpins everything else.

So what does this mean in practical terms? Typically, existential therapy does not employ diagnostic frameworks to label or categorise personal characteristics or experiences. Abstract knowledge about a person, an assessment report or a theoretical understanding about a certain type of experience or behaviour is less important than the reality and experience that emerges between two people (client and therapist for instance) encountering each other in a room.

How else does this show up in an existential therapeutic session? In other ways, and always depending on the client’s needs, clients may be encouraged to understand their relationship to, and come to terms with, the ‘four ultimate concerns’ of existence as understood by Irvin Yalom (1980). Yalom described these as death, freedom, isolation and meaninglessness.

Additionally, clients may be invited to consider how they are being and relating to four basic existential dimensions (4). This may take the shape of exploring their relationship to personal, spiritual, physical and social aspects of their existence.

As mentioned in other blogs what has been written above and before is not a blueprint for what to expect in existential therapy. It is also not an exhaustive discussion of ideas within existential therapy. However, if you are interested in reading about other significant ideas in existential therapies, as I understand them, please read my other blogs.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice and Lewes Practice.

 

Further reading by Susanna Petitpierre –

Being embodied in Therapy: Feeling and listening to your body

 

References

(1) Cooper, M. (2003) Existential Therapies. London: Sage. (p. 1)

(2) Cohn, H. (2002) Heidegger and the roots of Existential Therapy. London: Continuum

(3) May, R., (1958) Origins of the existential movement. in Existence. (Eds: Rollo May, Ernest Angel & Henri, F Ellenberg) USA: Rowman and Littlefield Publishers, (p. 31).

(4) Van Deurzen, E. (2012) Existential Counselling & Psychotherapy in Practice. London: Sage

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The language of love: how couples communicate

When working with couples I am often struck by how much they love each other!

This may sound surprising – by definition the couples I see in my practice have come to me because their relationship is in trouble.  However I rarely see couples who say they no longer love each other. In my experience the problem isn’t that love is no longer there, rather it is that the individuals no longer feel loved by each other.  

By the time couples come to see me one or both of them have been feeling unloved for quite some time.  This comes across in many different ways but often the individuals are hurt and angry. This is easy to understand.  One of our basic human emotional needs is to feel loved. As human beings when we are deprived of a primary emotional need we feel psychological pain which leads to feelings of anger and sadness. 

The emphasis here is on the word feel.  It is not enough to know that our partner loves us, we need to feel that love.  The difficulty is that what makes one person feel loved is often different to what makes their partner feel loved.  If couples are to develop and maintain long lasting intimate relationships they need to know what they need in order to feel loved and also what the desires and needs of their partners are so that they are communicating their feelings in a way their partner can understand on a deep emotional level.

According to Gary Chapman we communicate our love in 5 Love Languages.  They are:

  • Words of Affirmation
  • Quality Time
  • Receiving Gifts
  • Acts of Service 
  • Physical Touch (including sex)

However, we do not understand all 5 Love Languages in the same way.  For example an individual in couples therapy ‘A’ might express frustration that they are being accused of being unloving even though they are always telling their partner ‘B’ how much they love them – Words of Affirmation. The problem is that ‘B’s love language is Quality Time so although she is hearing the words they are not translating into the feeling of being loved.  The chances are that B in turn is using the ‘wrong’ language to express their love for A.

The situation is further complicated by the fact that very often individuals don’t actually know what makes them feel loved.  They might assume that they feel loved when their partner does nice things for them (Acts of Service) but what can emerge in therapy is that actually what makes them feel loved is being physically touched.  

Once couples have discovered what makes their partner feel loved they can then make the choice to actively love their partner in the language their partner understands emotionally.  This is necessarily an oversimplification but once individuals are giving and receiving more of what they need to feel loved by each other some of the feelings of hurt and anger dissipate leaving a healthier emotional climate in which to work on other aspects of their relationship.

In my next blog I will consider family dynamics and how they unconsciously impact on our ways of relating to our partners.

Anna Reynolds is a UKCP registered Psychoanalytic Psychotherapist qualified to work with a broad range of psychological issues as well as more complex mental health conditions in adults.  Anna works with individuals and couples.  Anna is available at our Lewes Practice.

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The Therapeutic Relationship and the Unconscious

Therapy is often referred to in terms of it being relational, or as a relationship, albeit a particular type of relationship, one that has very specific parameters, particularly around money, time, touch, and about whose inner life is there to be explored.

Despite this, in some ways, very one-way relationship, an awful lot of what goes on is a kind of relating. The therapist will encourage the client to speak as freely as possible and through a careful listening to the client’s words and to what is evoked in themselves, through this listening, they will try and relate as closely as possible to the clients experience and will feed this understanding back via their own comments, or interpretations.

What makes this different from other listening conversations, is that the therapists understanding and feedback will be influenced by the therapists training, specifically their own therapy and their learning of theories, which provide maps of mental structures and types of human experience and distress.

The therapist as well as listening to the stories, will also listen for patterns, for words, they will try and be attuned to what is going on emotionally for the client and also pay attention to the actions of therapy, to the how the client goes about relating to the therapist. When the therapist feels something useful has been understood, they will share this.

Sometimes this may not have been consciously known by the client, and this is why it can be useful. However, it can also be unnerving, as we like to believe we are the masters of our own houses, independent and not in need of the help of another.

Freud said there have been three great blows to man’s ego, the Copernican discovery that the solar system didn’t revolve around the earth, Darwin’s discovery that we are descended from animals, and share an essentially mammalian brain structure and Freuds own discovery that we have a dynamic unconscious, that the rational beings we like to believe ourselves to be is only one part of the story.

Part of this unconscious is the repressed unconscious, the place where we store the things we don’t want to know about ourselves, however these things are known at some level and we can expound a great deal of energy trying not to know them.

Getting to know and understand these parts of ourselves although often frightening to begin with, can actually be a huge relief as we come to know and accept these parts of ourselves, parts of ourselves that may seem like monsters under the bed and cast scary shadows but are usually essentially human characteristics.

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

A Nation Divided

Adolescence: the trials and tribulations

Does the male mid-life crisis exist?

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