INTRODUCTION

Family is the most powerful primary social system or primary social group, to which a person ever
belongs. For example, Birth, childhood, puberty, marriage and death, etc. everything is considered as
family experiences. Family is a source of emotional attachments where an individual experiences all
types of emotions whether it is positive or negative within the family. Every individual within the
family has certain roles and responsibilities; the overriding value in families lies in the relationships
among family members. Family relationships are essential to provide the primary context of human
development. Most family therapists identify the individuals psychiatric problems which are
inseparably related to the family in which he lives. Thus the focus of the therapy is not an individual
client alone, the family or the situational support also takes into consideration.

CONCEPT OF FAMILY THERAPY

The term family therapy coined by the American Psychiatrist Nathan Ackerman in the 1950s. Family
therapy is a method drawn from one or more of a range of, schools, which seeks to help the individual
patient who is the locus of psychopathology - it is at one extreme and at other is a way of thinking
about psychotherapy; the intervention may involve the individual alone, the nuclear family or an
extended family network; however the focus is not so much on the individual but rather than
relationships between people. According to this view psychopathology reflects recurring problematic
international patterns among family members and between the families, midway between these two
positions is one that views the family as acting potentially either as a resource or liabilities for an
identified patient.

Historical Development:

Ackerman (1958) and Murray Bowen (1978) were leaders in family therapy. The family has been
recognized as a fundamental unit of social organization in the human life. Regardless of the specific
pattern of family life, the fundamental narratives, myths, legjpnds and folklore of all cultures
emphasize the power of family relations to mould the character of individual and serve as an exemplar
of the moral and political order of society. Sigmund Freuds writings are interesting and provocative
comments about marital and family relationships and their possible roles in both, individual normal
developmental and psychopathology. Freuds description about unconscious processes like
introspection, projection and identification explained how individual experiences could be transmitted
across the generations in a family.
Definition
A psychotherapeutic approach that focusses on altering interactions between a couple within nuclear
family or its members in extended family or between the family and other interpersonal systems with
the goal of alleviating problems initially presented by individual family

Aims
Changes the relationships through changing the interactions among the people who make up the
family or marital unit.
Family therapist evaluates the complex web of relationships, patterns of transactions that repeat
themselves and the unspoken rules that drives the transactions
Improve group interactions and help each member to function efficiently
Reduce the dysfunctional behaviour and interaction of individual family member
Reduce intra-family relationship conflicts
Mobilize family resources in problem solving
Encourage adaptive family problem-solving or coping behaviour
Improve family communication skills
Meet the emotional needs of family members
Strengthen the familys ability to cope-up with major life stressors
Improve the integration of family system into the societal system
Accept the illness of family members
Understand treatment regimen and extends their cooperation in implementation of treatment and
follow-up services
Assists to locate the community resources
Reduces family stress and anxiety and establishes balance in the family life members, family
subsystems, the family as a whole or other referral sources

INDICATIONS
Relational problems within the family unit
Psychoses
Schizophrenia
Reactive depression
Anxiety disorders
Psychosomatic disorders
Uncontrolled anxiety or hostility
Substance abuse
Childhood psychiatric disorders
Bipolar disorder.
COMPONENTS
Assessment of
- Family structure
- Roles/functions/responsibilities
- Boundaries or limitations
- Communication patterns and skills
- Resources
- Problem-solving skills
Teaching
- Communication skills
- Problem-solving skills
Writing behavioural marital contract
Assignments, e.g. homework, problem- solvation situations.
CLIENT SELECTION
Families may be referred for treatment by
Private Physicians
Welfare agencies, e.g. school, parole officers, judges
Family Physicians
Emergency room psychiatric OPD, e.g. after crisis within the family, drug abuse
After discharging from psychiatric hospital for follow-up services
Marital or sibling conflicts
Situational crisis and maturational crisis, e.g. birth of a child, sudden death of family member

THE FUNCTIONS OF FAMILY

Family counselor evaluates the areas of family functions or the activities which are associated with
family life. Healthy families will guide the individuals, how they will function in intimate relationships
in the work place, within their culture and in the society in general.
Management
Use of decision making power for all family activities, rule making, provision of financial and other
support, successful negotiations with extra familial systems with present and future planning.
Boundary Function
Boundaries will maintain a distinction between individuals within the family. Clear boundaries define
the roles of members within the family and allow for differences among members. Diffused boundaries
are blending together the roles, thoughts and feelings of the individual; rigid boundaries prevent family
members from trying out new ideas.
Communication Function
Communication patterns are vital in family life, healthy communication within the family encourages its
members to express their feelings or emotions appropriately. Open expression of feelings is always
essential; whatever it may be either joy or sorrow or conflict or angry; healthy communication will
always help the family members to solve their problems.
Supportive Function
Healthy families are concerned with each others needs, most of the time physical and emotional needs
are met, they feel support from those around and are free to grow and explore new roles and facets of
their personalities.

Socialization Function
Socialization skills are learnt by each individual within the family. They learn how to interact,
negotiate and plan, adopts coping skills. Child learns how to function effectively within their family
and they apply skills in their societies. Parents are primary socializing agents, where the child learns
the pattern of socialization within their families. Each phase of individual life will bring new demands
and requires new approaches to deal with the changes. Healthy families use flexibility to adapt to the
new roles
Biological Function
Replacement of species through the propagation of progeny. Family is a medium where the sex
relations are controlled and regulated.
Psychological Function
Love, belongingness, affection, intimate relationship, sympathy, security, attention, emotional
satisfaction, care of the off springs, sexual relationship, companionship, intimacy, etc. will be attained
through family.
Educational Function
Mother is the first teacher and primary care giver, who will take care of the children. Childs
personality and character formation will be attained through family; it exercises more influence on the
body and mind of the child where his personality will be moulded.
Protective Function
Protects the interests of the child, provides security to cultivate healthy behavior
Recreational Function
Family creates an atmosphere where the childs interests can be fulfilled, the family provides
entertainment for all its members. The love among family members will create positive interest in the
child.
Religious Function
Family develops religious thoughts, kind heartedness and fellow belonging. The child learns moral
values, ethics, codes, honesty, truthfulness, traditions and religious patterns through family.
Cultural Function
Family moulds its members according to its culture. Family serves as an instrument for transmission
and continuity of culture. It transmits ideas, folkways, mores, customs, traditions, beliefs and values
from one generation to other generation.
Social Function
Maintains social status and controls members activities
x

Accumulates and transmits social heritage and contact with all its members
Provides physical shelter, food, clothing which are necessary to the existence of life
It is a primary socializing agency and basic institution
Every member within the family will try to maintain total family health status
Promotes safety and security and lays emphasis on kinship patterns
Elders in the family will teach the behaviour of each individual in an accepted manner and works for
effective performance of the individual within the society

Purpose of Family Therapy

(i) Family Therapist Deals with Family Pain:

When one person in a family (the patient) has pain which shows up in symptoms, all family
members are feelings this pain in same way. Many therapist have found it, useful to call the member
who carries the symptom the identified patient rather than to join the family in causing him the sick
one or the different, this is because family therapist sees identified patients symptoms as serving a
family function as well as an individual function.

(ii) Family Therapist Assists for Family Homeostasis.

Family behaves as a unit. In 1954 Jackson introduced the term Family homeostasis to refer to
this behaviour. According to the concept of family homeostasis the family acts, as to achieve balanced
relationships. Members help to maintain this balance overtly and covertly. Familys repetitions,
circular, predictable communication patterns reveal this balance. When the family homeostasis is pre
carious members exert much effort to maintain it.

(iii) Therapist Gives Marital Counseling:
The marital relationship influences the character of family homeostasis. The marital relationship is the
axis around which all other family relationships are formed. The mates are the architects of the family.
A pained marital relationship tends to produce dysfunctional parenting

Approaches to Family Therapy
The family therapy come into existence between 1960s and 1970s, when therapists observed the effects
of social milieu on their clients and interpersonal model is more effective.
1. Double Blind Theory
It describes a situation in which two conflicting messages are given simultaneously on two levels,
verbal and non-verbal. As the messages are conflict people find themselves in a double blind, in which
no acceptable response exists.
2. Strategic Model
By changing any single element in the family system, change can be brought about in the entire system.
This model aims to change the patterns, the rules and the meaning of family interactions.
Family therapists will work with the family to change their rigid pattern of communicating, allowing
children to be present when important decisions are being made. This intervention results in a
systematic change in the family communication

3. Structural Model
It is based on a normative concept of a healthy family, emphasizing the boundaries between family
subsystems and the establishment, maintenance of a clear hierarchy based on parental competence. The
therapist would emphasize the importance of flexibility in the family system that would allow for the
changes inherent to normal growth and development

4. Family Systems Theory
It decreases emotional reactivity and to encourage differentiation among individual family members.
5. Insight Oriented Family Theory
It improves insight into problematic relationships; family is an emotional system, and is responsible for
its own solutions. The therapist uses nurturing and identifies dysfunctional communication pattern.
6. Behavioral Family Therapy
It focuses on organizational patterns, boundary systems and subsystems, it clarifies boundaries,
restructures dysfunctional boundaries, changes repetitive and maladaptive interaction patterns
prescribes rituals; it changes cognition behaviour and helps in skills training. Familys specific values,
norms, traditions, roles and rules have to be conceptualized, familys emotional system are verified,
intergenerational system, various patterns are passed down through the generations. The messages and
legacies of the multigenerational family relate in some way to the clients presenting problem.
Construct multigenerational issues by constructing a genogram. Family therapist will analyze the
genogram patterns and advice the suggestions accordingly

Types of Family Therapy
(i) . Psychodynamic Family Therapy: It helps family members to solve relational problems by
understanding better how emotional process influence the perception, feelings and actions of j those
involved. This therapy concentrate on motivations, conflicts, defenses and the relationships from the |
past that are currently influence the present. Therapeutic change is sought through family members
gaining conscious insight into previously unconscious process that have been generating problem in
family relationships. Psychodynamic family therapist i.e., opening emotional expression clarifying
communication, encouraging family members to speak from the I position and interpretation of
unconscious conflicts. To resolve projective processes, cut-off relationships and difficulties in
modulating closeness and distance in family relationship, in this therapist uses family genogram for as-
sessment.

ii) Structural Family Therapy of Salvador Minchin:
It considers problems involving particular family member linked to the organizational context of
the entire family. It solves problem by changing the familys organization context. It emphasizes an
understanding of family in terms of the family rules and roles that shapes its members actions.
In this therapist observes closely the flow of family structure as family members talk about and
interact together around the presenting problem of the therapy He observes how boundaries, hierarchy,
alliances and coalitions are associated with the presenting symptoms, as well as repetitive behavioral
sequences that involves symptomatic behaviour.
Therapist ameliorates symptoms by shifting family structure. Boundaries can be strengthened or
weakened by behavioral assignment that educate a particular family member from certain moments of
family life or include a particular family member where that person had been absent,
iii) Strategic Family Therapy of Jay Haley, Mitton Erickson:

It is built upon the premise that a therapist is responsible for planning a strategy that solves
successfully the familys presenting problem. The therapist sets clear goals that intervene by changing
relational and communicational process in family (Madanes, 1981).

These therapies are designed as a counter point to psychodynamic psychotherapy by emphasizing
how people can behave as they do. Therapist commonly view clinical problems as emerging out of
difficult lifestyle transitions, both predictable ones e.g. marriage, childbirth, separating individuating of
an adolescent and unpredictable ones. E.g. loss of job, sudden illness, a death in the family.
The central aim of therapist is to motivate family members to try novel solutions, rather than,
repeating what has been tried in the past. Psycho education, direct behavioral directives. Such as
reframing the symptoms, prescribing the symptoms, restraining the system, positions.

iv)Cognitive Behavior Family Therapy applies principles of learning theory to help family members
solve problems by modifying cognitive distortions and repetitive problem inducing interactions and by
learning new knowledge and skills. CBFT relies heavily upon family psychoeduaction and teaching a
coaching stance of the therapist.
It is based on the influence family members hold by offering positive and negative reinforcement to
other family members. Parents and spouses are trained to eliminate reinforcement contingencies for
undesirable behaviors. Cognitive interventions engage family members as co investigators who study
the ecology of family problems and symptoms and discern new thoughts, feelings and behaviors
interplay. A therapist assists family members in identifying when such cognitive distortions as
catastrophic thinking, overgeneralization or misattribution lead to conflict in relationships. Involves
psycho education, communication training, and problem solving training, operant conditioning
strategies, contingency contracting, thought diaries

v. Post Modern Family Therapies:

These are group of therapies which include narrative, solution focused, collaborative language systems
and feminist family therapies. Innovation introduced by post modem therapies have opened new ways
for families to solve problems by valuing and learning from their own experiences, histories, traditions,
values and identities, instead of seeking answers from mental health experts. The post modem therapies
have sought to empower families by helping them to develop reflective processes for exercising choice
to build supportive communities with other families, and to clarify undesirable ways in which cultural
influences have limited appreciation
and utilization of the familys own practical wisdom.

vi. Family Psycho-Education Therapies

The family psycho-education approaches emerged that sought to put the illness in its place by
helping families to acquire knowledge, skills and resources needed to minimize the loss of time, money
and energy from chronic medical or psychiatric disorder. These approaches avoided promising a cure,
rather the treatment was considered successful when family members accepted presence of the illness
but refused for it to reorganize the life of family. This approach made maximal use of psychotropic
medication to control disruptive symptoms and openly embraced interventions drawn from other
individual, family or social network therapies.
Psycho-education mainly consist discussion about diagnosis, etiology, use of antipsychotic
medication, needs of patient and family members, creation of social contacts and support, problem-
solving with others bearing the burden of the same disorder, countering stigma, cross parenting of
adolescents normalizing family communications and intervening effectively during crisis.
INDIVIDUAL FAMILY THERAPY
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 members are relating to one another and
work out specific issues that have been defined by individual members.
CONJOINT FAMILY THERAPY
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. The
therapist helps the family deal more effectively with problems as they arise and are defined
MULTIPLE FAMILY GROUP THERAPY
In multiple family group therapy, four or five families meet weekly to confront and deal with problems
or issues they have in common. Ability or inability to function well in the home and community, fear
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 groups focus. The multiple family
group becomes the support for all the families. The network also encourages > each person to reach
out and form new relationships outside the group.
MULTIPLE IMPACT THERAPY
In multiple impact therapy, several therapists come together with the families in a community setting.
They live together and deal with pertinent issues for each family member within the context of the
group. 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.
NETWORK THERAPY
Network therapy is conducted in people's homes. All individuals interested or invested in a problem or
crisis that a particular person or persons in a family are experiencing take part. This gathering includes
family, friends, neighbors, professional groups or persons, and anyone in the community who has an
investment in the outcome of the current crisis. People who form the network generally know each
other and interact on a regular basis in each other's lives. Thus a network may include as ma The
rewards are great when all the people involved mobilize energy for management of the problem. The
power is in the network itself. The answers to each problem come from the network and how people in
the network decide to manage each issue as it arises. The therapists serve as a guide to clarify issues,
reinforce the importance of and need for the network towards its members collectively and
individually, and assist in the development and effective management in the evolution of the problem
resolution.ny as 40 to 60 peopleThe rewards are great when all the people involved mobilize energy
for management of the problem. The power is in the network itself. The answers to each problem come
from the network and how people in the network decide to manage each issue as it arises. The
therapists serve as a guide to clarify issues, reinforce the importance of and need for the network
towards its members collectively and individually, and assist in the development and effective
management in the evolution of the problem resolution.


COUPLES THERAPY
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.
Family patterns, interaction and 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 OF FAMILY THERAPY FOR THE INITIAL SESSIONS:

The first family consultation occurs soon after the patients illness is identified and treatment has
begun. In general, the four goals can be identified.
(i) Establishing Empathic / Supportive Connection
Typically, relatives will enter the treatment system after a period of turmoil or crisis. They can be
expected to be demoralized exhausted, and fearful. Often they are also angry, guilt-ridden and
despairing. At the beginning, it is important to allow relatives to ventilate, communicating to them that
their feelings are both expectable and acceptable.
Allow relatives to tell their story in their own way.
Encourage the family to talk about sadness and loss or the sense of isolation and stigma that they
may have experienced or the frustrations.
Demonstrate empathy and support and should look for opportunities to demonstrate trust-
worthiness.
For example do you feel that this conversation has been useful to. you? Is there anything else I
could do that would be helpful to you right now.
Successful management of boundary issues is one of the keys in establishing a supportive
trusting relationship with family members.
Role of the nurse would include taking a history, giving certain information, promoting a certain
kind of behavioral change.

(ii) Evaluating the Familys Current Needs
'
The familys phase of adaptation to the illness will be relevant to relatives needs (Terkelsen 1987,
Harsh, 1992). For family whose ill relative has just suffered an acute, traumatic, first psychotic episode
crisis intervention, respite and basic information about the initial phase of treatment may be all that is
needed. At this point, extended educational intervention would likely be inappropriate.

Skills building interventions are most useful prior to discharge from inpatient services.Emotional
support (Including possibly, supportive psychotherapy) should be extended to relatives when emotional
issues, like grieving surface.


iii) Explore the expectations of relatives
Relatives need help in walking the line between hopelessness and unrealistic hope of complete
cure, which can raise the level of stress
iv) Experiences by all members of the family
Assess the familys skill as well as knowledge, how successful are they at managing symptoms
Assess relatives wishes for involvement in rehabilitative effort in order to plan for the future.
Assess relatives access to outside supports, as well as the nature and extent-of non-illness
related stress.
v) Orienting Relatives to the Current Situation:
Confusion is a major block on the road to mastery. Inadequate orientation is common; it
undermines relatives sense of efficacy and gets the family professional relationship off to a rocky start.
Orientation should be geared to the particular needs of specific families. Some will need a painstaking
and comprehensive orientation to the mental health system as a whole. This may include describing
stages and levels of care.

vi) Developing an Initial Plan for Family Service / Involvement:
The initial phase of family consultation moves towards conclusion when relatives have established
rapport with and trust in the professional. When they understand the current situation, and where the
professionals understand their feelings, strengths, wishes and needs. The end product is a plan that
specifies how and for what purpose relatives will continue to be involved with both the patient and
mental health system.

What clinical or non-clinical services will be provided to the family, and when and how the plan will be
reviewed?

The plan should consider the needs of all family members, even those to whom it is decided that
services wont be directly provided. For example, siblings of a young adult patient may have concerns
that their parents can address. Consultation can help the parents becomes sensitive to, anticipate, and
respond to those concerns more adequately. In addition the person with the illness should be included in
planning for family involvement as his or her wishes for autonomy and privacy may conflict with the
familys desire for involvement and need for information.

GUIDELINES FOR THERAPIST
1. Address the Families Concern to Work Together with Family Therapists: demonstrates that
he/she is sensitive to possible difference and is willing to discuss their views on topic.
2. Orient family to the therapy process through role induction: Nalitzer, Dermen and Connors
(1999) note that role inductions have been found to be useful in improving therapy outcomes and
session dependence particularly for clients with low income and education group. Other advantages of
role induction include more set referencing, more relevant comments and more active participation by
clients (Friedander and Kaul, 1983).

3. Do not Assume Familiarity with Clients in the First Session: Therapist should ask family
members how they would like to be addressed and not call clients by their first names, as this can be
disrespectful (Ho, 1927; Paniagua, 1998) it is important not to assume familiarity prematurely,
especially with older family members because the misuse of given names and disregard for paper titles
such as Mr. and Ms.

4. Join with the Family Before Gathering Sensitive Information: Families that come in for therapy
are sometimes weighted down by secrets and have difficult time discussing sensitive topics such as
paternity, absent family members and legal or substance, abuse problems (Boyd-Franklin, 1989). For
this reason it is recommended that therapist work to join with the family while being considerate of their
need for privacy. Boyd-Franklin (1989) observed that the family secrets that are silent to treatment will
be revealed over time as the therapist and family continue to work together to find solution to family
problems.By helping families understand that they have a say in the therapy process (role induction) and
not by assuming familiarity prematurely, families can begin to feel comfortable.

5. Maintain a Broad Definition of Family when Assessing Family Structure and Roles: In gathering
information about who lives in the home and who fulfills family roles, it is important to assess for the
involvement of extended family and non blood kin (Paniaqua, 1998). Presences of these ties to the
extended family have been shown to be related to better psychological functioning in men and women
(Ellison, 1990).

6. Assess and Intervene Multisystemmatically: When addressing the needs of family system,
therapists are encouraged to view the family in relation to their school, church, neighborhood and or
community. This multisystem or ecostructural perspective allows for more contextually sensitive
assessment of the familys situation and how that is related to societal problems (Aponte, 1976). In
addition, it allows therapist the chance to join with the family around real life problems such as housing,
food, clothing, financial help and medical care (Boyd Franklin, 1989).

7. Report to Family Members who are Unable or Unwilling to Attend : Consistent with the
multisystem emphasis, therapist should be prepared to use phone calls or letters to contact family
members that are unable or unwilling to attend as their non-attendance can be representative of their
true status or power in the family. Decision regarding contact with absent family members should be
made by those involved in treatment, with attention in treatment, with attention to clients
confidentiality.

8. Do Home Visits: Home based therapy has been a central part of the treatment of families for some
time. Home, visits can aid in the process and progress of therapy because they have an opportunity to
meet and engage family member that are hesitant to come to therapy; they allow therapist to engage the
family in their environment; and they permit more clear assessment of the contextual factors that play a
role in the lives of the family. Before making home visit, therapist should explain the rationale for the
home therapy sessions. This can help address any concerns about the purpose of the visit and clarify
that it is not for the purpose of checking upon them or evaluating household management or financial
need.

9. Use a Problem Solving Focus in Treatment: It is often advantageous to approach family therapy
with a focus on problem resolution and/or symptom alleviation. When families are able to address their
biggest concern, and if they experience an immediate benefit to therapy, they are more likely to trust the
therapy process.

10. Use Scriptural Reference / Metaphors: Religious writing and/or metaphors from Bible,Kuran or
other resources can be used to join with clients, foster family cohesion, challenge rigidity and punctuate
important realization.

11. Be Creative and Flexible when Involving Male Family Member in Therapy: Involvement of
both parents has both effective and instrumental roles that are crucial to role development, functioning
and positive child well-being outcomes.

12. Acknowledge Strengths, Resources and Success: It is often difficult for families to see their
abilities and resources when they are overwhelmed with a problem or feeling ashamed for having it.
These feelings of embarrassment can be prevented from being able to appreciate their individual success
and/ or their ethnic heritage of strength and survival specifically. Therapist are encouraged to use
cultural resources such as strong kinship bonds, role flexibility, strong religious orientation, and strong
education/ work ethnic while working with families. E.g. therapy can draw on role flexibility in helping
the family to make role substitutions or adjustments when family members are unable to fulfill their
usual responsibilities due to prolonged illness.

Functions of Family Therapist:
(i) Establishes a rapport, empathy and communication among family members
(ii) Evolves the major conflicts and ways of coping clarifies by dissolving barriers, confusions and
misunderstandings. Helps to bring more mutual and accurate understanding.
(iii) Extends emotional support. Plays a role of a true parent-figure-a controller of danger.
(iv) Serves as a personal instrument of reality testing for the family.
(v) Serves as an educator and a personifier of useful models of family health.
Education to the Family
i) Families need to understand that hospitals are not the proper places for long-term treatment. The
crisis care that hospitals provide is not recovery oriented. Stabilization is not a recovery.
ii) Rehabilitation and recovery can start in treatment facility but such settings can never support the
full recovery potential of any individual.
iii) Rehabilitation and effective treatment are more likely to occur in community settings, under the
most normalized condition possible.
iv) The current developments of enhanced supports for community living are allowing the patient
to live more normal lives and experience full rehabilitation.
v) Education will help our families understand how to resolve their conflicts over accepting a
more detached role.
vi) Dependency cripples the functioning of both families and consumers.
vii) Families need tf) wofk closely with mental health professionals.
viii) Help the patient relearn how to live again. Recovery from mental illness involves the relearning
of many skills and is essentially development of a new life.
ix) Help the patient to relearn how to do things.
x) A regressed patient has great difficulty in relating to other people and in meeting adult needs for
safety, security, and continuity in living.
(xi) Families need to learn that relapse and regression are normal parts of the recovery and not
evidence of failure.
(xii) Families need to learn to accept risks and changes. Risks may lead temporarily to relapse and re
hospitalization, but a static environment is deadly to recovery.
(xiii)Sickness is static. Recovery is change. Families need to accept the lifelong challenges of
impairment and change.
(xiv) Family education focus on a change in perspective. Person with mental illness needs to be seen
with new eyes. Instead of dysfunction, incompetency, and disease, one needs to see a 5 person
who can function, competent and have ability and potential.
(xv) The families need to make the patient experience that families are their support system, lifelines
in the years of struggles, hardship and pain.
NURSES ROLE IN FAMILY WORK:
1. To co-ordinate treatment- everyone is working towards same goals in a collaborative
supportive way.
2. To pay attention to the social and clinical needs of patient and family.
3. To provide optimum medication management.
4. To listen to families and treat them as equal partners.
5. To explore family expectations.
6. To assess familys strengths, problems and goals.
7. To provide initial intensive education program me followed by continuing education target at
needs.
8. To provide explicit crisis plan and professional response,
9. To promote clear communication and active listening.
10. To provide training in structured problem solving technique.
11. To help resolve family conflict and sensitive response to emotions.
12. To help family come in-terms with feelings of loss.
13. To encourage family to expand social support networks.
14. To encourage the family to adjust their expectations.
15. To be flexible in meeting the needs of the family.
16. To provide follow up contacts for future access to support if work with family ceases

CONCLUSION
In family therapy and marital therapy (also called as couples therapy), the focus of intervention is not on
the individual but is instead on the family as a unit or the marital unit. There are several varieties of
family and marital therapies, such as those based on psycho dynamic, behavioral or systemic principles.
Whenever there are relational problems within a family or marital unit (either primarily or secondary to
a psychiatric disorder), family and/or marital therapy is indicated. For example, in a behavioral marital
therapy, components of therapy may include problem solving, training in communication skills, writing
a behavioral marital contract, and home-work assignments.

BIBLOGRAPHY

1. K.Lalitha, Mental Health and Psychiatric Nursing, an Indian perspective,VMG publications

2. Niraj ,Ahuja, A Short text book of Psychiarty,5
th
edition,Jaypee Brothers publisher

3. Mary C Townsend; Psychiatric Mental Health Nursing; 5
th
edition;Jaypee Brothers Medical
Publishers;(2007

A
SEMINAR ON
FAMILY THERAPY






SUBMITTED TO SUBMITTED BY
Mrs.MILY THOMAS SANU R
ASST.PROFESSOR I year M.Sc Nursing
KIMS CON KIMS CON




SUBMITTED ON:25/08/2014