Family Therapy in 21st century

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Family Therapy in the 21st century

Submitted by: TEHMINA JABEEN (University of Karachi)

Family therapy practice has expanded in its viewpoint on how to practice family therapy. Family therapy is no longer viewed as only conjoint work between family members.  Therapists practice family therapy with individuals alone, as well as various combinations of people from family groups and other significant people who may be involved with individuals who need help.  For example, a family therapist might work with an individual client, a live-in couple, a foster family, a social services agency representative, or a teacher.  Family therapists work with anyone who is in a relationship with the person who has the presenting problem and is either participating in the problem or could be a resource to a solution.  The idea of “problem- determined system” is sometimes used to describe this process of helping.  The system that the therapist works with is determined by who is defining and participating in the client’s life around the problem issues.

Family therapists currently utilize a more ecological systems perspective and expand their relationship emphasis beyond the nuclear and extended family to include other societal systems and cultural issues that impact individuals and families.  For example, a family’s relationship with a social service delivery system, race, gender, and socioeconomic status have become important issues to consider when formulating therapeutic strategies.

  • Increase in popularity of family approaches

.  Postmodern approaches, narrative therapy, and solution-focused brief therapy have become popular alternatives for the practice of family therapy. These newer approaches developed in reaction to traditional systems models and each model disavows allegiance to the family systems theory.

There is less allegiance to the practice of one type of family therapy model. Practising therapists use a combination of techniques when working with families.  Integrationism and technical eclecticism are the preferred ways to practice family therapy (Lebow, 1997).   Multi-component treatment programs, which emphasize more than one approach being delivered at the same time, are the preferred way to work with various client populations.  Family researchers are combining strategies across models to design empirically-based treatments for hard-to-serve clients such as serious juvenile offenders and substance-abusing youths (Henggeler, 1999).

Feminist, postmodern, and multicultural perspectives are at the forefront of discussions about family models and have redefined our understanding of family systems.

  1. Feminist viewpoints emphasize the unequal power relations between men and women and how these larger societal issues impact family life and problem-solving. Postmodern viewpoints emphasize the constructed nature of reality and the need for collaborative relationships between client and therapist.
  2. Postmodern family therapists examine sociocultural issues such as how client problems and beliefs become socially constructed, the need for empowerment of marginalized clients, the political nature of therapy, and a need for social justice.
  1. Multicultural perspectives emphasize race and culture and why these variables are important to therapeutic work. Multicultural, postmodern, and solution-focused practices also emphasize non-pathological approaches to clients. These perspectives have helped therapists learn to respect diversity and see strengths in the families they serve.  All practising therapists trained in family therapy are challenged to become the culture and gender-sensitive and to practice therapy recognizing the importance of the strengths of their clients. Each therapist is also expected to develop responsive interventions that take into account social justice issues.
  • In recent years, however, family therapists are emphasizing the importance of working with attachment processes and emotional states. The use of acceptance strategies is one of the major means of helping families resolve their differences.  Therapies that use emotion-focused techniques have offered effective results for distressed couples  (Jacobson & Christensen, 1996; Johnson, Hunsley, Greenberg, & Schindler, 1999).  Research has also shown that a positive ratio of positive to negative emotions is important to marital satisfaction and the health of family relationships.  Research has repeatedly shown that couples who are defensive, criticize, show contempt, and stonewall their partners are the most distressed couples and the ones who are most likely to divorce (Gottman, 1998).

Narrative Family Therapy                      


Social constructionist conceptualization of how people develop and create ‘storied’ meanings in their lives.

Narrative therapy

A postmodern approach to counselling that is based on counsellor characteristics that create an encouraging climate where clients see their stories from different perspectives. The philosophical framework assists clients in finding new meanings and possibilities in their lives.

Alternative story

A story that develops in therapy in contradiction to the dominant story that the problem is embedded in.


A joint process where client and therapist share responsibility for developing alternative stories.


Exploring meaning by taking apart/unpacking the taken-for-granted categories and assumptions underlying social practices that are guised as truths.

Dominant story

Understanding a situation that is accepted within a culture that appears to represent reality. Dominant stories are developed through conversations in social and cultural contexts and these stories shape how people construct and constitute what they can see, feel, and do. For the most part, dominant stories are foundational to cultures.

Externalizing conversation

A way of speaking about a problem as if it is an entity that is separate from the client. This approach is useful because it moves the location of the problem from an internalized characteristic of the client. The therapeutic conversation moves towards talking about the problem as an external barrier.

Mapping-the-influence questions

A series of questions asked about a problem that clients have internalized as a means of understanding the relationship between client and problem.

Problem-saturated story

When clients are overwhelmed and fused to problems. NT assist clients to understand they do not have to reduce their identity by totalizing descriptions.


It is a process in narrative therapy in which clients and therapists jointly create an alternative, preferred, life story.

Unique outcome

lived experiences are outside the realm of dominant stories OR lived experiences are contradiction to the problem story.

Integrative Model

As with all theories and models of therapy, even family therapy has started to evolve. While noteworthy differences continue to exist in the theoretical assumptions according to each of the separate schools of thought, present within the umbrella of Family therapy, on what makes the nature and origin of psychological dysfunction, what precisely they look for in understanding family patterns, and in their strategies for therapeutic intervention. However with all the recent developments in family therapy, one of the more modern approaches and most seen these days in general practice is the integrative model and eclecticism. In order to understand the Integrative model we need to know what both models represent.

Eclecticism refers to the selection of concepts or intervention techniques from a variety of theoretical sources, usually based on the experiences of a clinician that a specific approach works with a certain set of presenting problems. Thus it can be said that eclecticism is usually pragmatic and case based as compared to the Integrative model.

The Integrative model can be defined as or understood as an extensive combining of different and discrete parts of different theories and treatment processes into a single higher-level theory that crosses the theoretical boundaries of each of these separate theories and uses intervention techniques in a unified manner. This integrative model is being adopted in practice, as mentioned before, by therapists across the various psychotherapies which also include Family Psychotherapy.

There is no one integrative theory. There have been several but none have yet to be defined as the major or predominant integrative therapy. A number of efforts have appeared, such as Dattilio’s (1998) endeavor to combine systemic and cognitive perspectives, Pinsof’s (1995) attempt to synthesize family, individual, and biological therapies, and Wachtel’s (1997) bid to integrate psychoanalysis, behavior therapy, and the relational world of family therapy.

Integrative couple’s therapy by Jacobson & Christensen (1996) represents a successful combination of a humanistic outlook and communication training, added to the problem-solving techniques of behavioral therapy. It delineates various procedures designed to help couples see certain differences between them as inevitable, helping to foster tolerance rather than resignation concerning perceived negative behaviors in a partner, and acceptance of those behaviors especially resistant to change.

By acknowledging each other’s emotional vulnerabilities and personality differences, Christensen and Jacobson contend that couples take a large step toward active acceptance of each other’s feelings and actions, and as a consequence have moved away from blaming and towards reconcilable differences. Two key themes in this therapeutic approach involve promoting acceptance and promoting change

The reason why integrative model and even eclecticism is becoming the norm in family therapy is that there is a lack in the belief in the endless possibilities of a single model or theory and how it could be universally applicable to all client problems and appropriate for all families regardless of cultural background or family type. This is due to the prevalence of a wide variety of family configurations (single parents, gay couples, remarried families) and culturally diverse groups which reinforces the idea that no single theory or set of interventions is likely to fit all equally well.


  • Goldenberg, H. and Goldenburg, I. (2008) Family Therapy: An Overview. 7th Edition.
  • file:///C:/Users/hp/Downloads/09a-Family_Systems-21stCENTURY.pdf


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