Family Therapy (Family-Focused Therapy): How It Works & Effectiveness of FFT

What does family have to do with mental health?

On average, we meet around 80,000 people in our lifetime. Out of these, in most cases, the only ones who truly know us are our family members and friends. The support that they lend helps us develop a crucial relationship with the outside world. 

However, family dynamics is a vast concept. You have parents, siblings, grandparents, spouses, children, cousins, aunts, uncles, friends, etc. Our family or friends are indeed our biggest supporters. But these relationships also play a big role in our mental well-being.

For example, Children having single parents or growing up in unstable and unloving family environments have higher chances of developing mental health problems. 

This is exactly what FFT (family-focused therapy) focuses on. Family-focused therapy focuses on improving family relationships and behaviours.  In many cases, this therapy is also used for people who have a family member who is suffering from a mental health illness. 

What is Family-Focused Therapy?

Family-focused therapy is a type of psychotherapy that helps to improve relationships within the family and deal with a wide range of problems. The This therapy aims of this therapy is to find constructive ways to help each other in the family. 

But how does this happen?

You might have heard the saying - “The quality of your relationships determines the quality of your life. 

This is what stays at the core of the family-focused therapy. Developed by David J. Miklowitz and Chung, FFT works to restore family dynamics to improve the quality of life. The therapists work with the family members to educate them on the issues faced and enhance their communication and problem-solving skills. 

The techniques used in solution-focused family therapy help with:

1. Improving the functioning of a family as a unit.
2. Improve the interpersonal relationships within the family.
3. Help a person suffering from mental health illnesses receive correct support from the family. 

Family-focused therapy is a very simple form of therapy. It has been used in a lot of clinical settings for the treatment of various mental health disorders like bipolar disorder, schizophrenia, etc. 

Importance of Family Dynamics in Mental Health Treatment

In the simplest terms, family dynamics are the pattern of interactions among the family members and the relationship we share with them. Because we rely on physical, emotional, and economic support from our family, it becomes a primary source of security and stress. 

Studies have shown that unhealthy family dynamics can cause children to experience stress and trauma. This includes emotional, sexual, or physical abuse, parental divorce, criminal behaviour or mental illness, or substance abuse in the family unit. Therapies like attachment-focused family therapy have helped to rebuild secure relationships between adolescents and their parents. 

On the contrary, having a healthy relationship with your family in your adult life also helps to cope with life stresses. Studies have also shown that people with good family dynamics recover better from major surgeries than those without. 

This shows how even a little support from the family or loved ones can contribute to the therapy. 

How Family-Focused Therapy Works

Let us take the example of Rishi, who is suffering from depression. His family has never encountered any such problems and hence are unable to understand what he is going through. Rishi tried to explain but his parents were unable to understand why he was depressed. 

In such cases, family-focused therapy might come to the rescue. FFT (Family-focused therapy) helps the family build stronger relationships, communicate effectively and help the person suffering from mental illness.

By doing this, the treatment ensures that the home has a positive and supportive environment, which is necessary for a person to thrive. Therapists do this by adopting various family-focused therapy techniques like:

Psychoeducation: 

It is natural for a family to feel frightened when a family member is struggling with their mental health. Psychoeducation ensures that the problems faced by the person are known by the family. In simple terms, the therapists will educate the family on the struggles encountered and ways in which they can help the person struggling. 

Here, the therapist will also provide coping skills and help to create a plan to prevent relapse. 

Communication training: 

When you communicate clearly, there are less of chances of misunderstandings. This is what family-focused therapy fixates on. The family also learns to change the maladaptive behaviours to avoid conflict. 

Problem-solving skills:

Once the family learns about the maladaptive behaviours or the illness of a person, they can use the skills advised by therapists to resolve the conflicts effectively. This includes viewing things in a positive light, defining the problem, finding alternative solutions, and then implementing them step by step. Problem-solving has a great impact when the family collaborates to find solutions to the problem.

 Who Can Participate in FFT?

There are a lot of people who can benefit from family-focused therapy. It can be parents, spouses, siblings, grandparents, relatives, etc. It can be for a variety of issues like marital problems, substance abuse, misunderstandings, etc. 

However, FFT is not only for resolving issues in the family. It is also used to help people who are suffering from mental health disorders like bipolar disorder, schizophrenia, depression, eating disorders and other psychiatric conditions. 

In cases of mental health illnesses, the therapists might also use alternative therapies. For example, in the cases of bipolar disorder. A therapist might advise family-focused therapy to help the person cope better in their personal life. It also provides the family with skills to deal with the person’s illnesses. However, the therapist might also advise taking up interpersonal and social rhythm therapy. This therapy will help the person restore the disrupted routine, which is common in cases of bipolar disorder. It also focuses on improving interpersonal relationships that are usually affected because of the illness. When this is combined with family-focused therapy, interpersonal relationships strengthen and the family can function better as a unit. 

Frequency and Duration of FFT Sessions

The frequency and duration of the FFT sessions vary since every family has unique problems. A typical FFT schedule comprises 21 sessions over 9 months. These sessions are usually 50 minutes to 1 hour long and the therapist might conduct two sessions per week. 

Seeking family therapy means that the members have to keep a non-judgmental approach. In the initial sessions, the therapist will get to know about each family member’s concerns. They might ask about the concerns, challenges and hopes of the therapy. The therapist will encourage everyone to listen to what a member is saying. 

Once this is done, the therapist will help the members understand the impact of words and behaviours. The therapist might also suggest strategies to manage it better.  If a person in the family is struggling with their mental health, the therapist will educate the members on the illness and also advise them on finding ways to cope with the situation and provide solutions for effectively managing it. 

In the end, the family-focused therapy techniques are implemented. These techniques might encourage to use of problem-solving skills like reacting to a situation mindfully, communicating clearly and coping with an illness optimistically. 

Conditions Treated by Family-Focused Therapy

Family-focused therapy has helped in treating many adolescent and adult conditions. There is ample evidence suggesting that the following psychiatric conditions have been managed effectively with the help of FFT:

1. Bipolar disorder:

Family therapy is used in combination with medications to treat bipolar disorder. Most of the family therapy for bipolar disorder consists of psychoeducation along with teaching skills to promote better communication. This also includes the family learning warning signs of relapse and creating a safety plan to stabilise the patient. 

Research suggests that family therapy helps in the improvement of symptoms. The patient gains control over the episodes, reduced frequency of recurrences and a reduction of severity of symptoms is seen. When combined with pharmacotherapy, the disorder can be managed effectively. 

However, more research needs to be carried out to test the accurate efficacy of the therapy on the disorder. 

2. Schizophrenia

Family members of the person suffering from schizophrenia - usually the caregivers are under immense stress since they do not know how to handle the person suffering from the disorder.

Using family therapy helps the family understand how schizophrenia affects a person.  Family-focused therapy for schizophrenia usually consists of:

• Psychoeducation
• Stress reduction
• Emotional processing
• Structured problem-solving 
• Communication improvement

A lot of research has been done to test the efficacy of family interventions for schizophrenia. Findings suggest that family therapy has a positive impact on the patient’s recovery and there is a lesser chance of readmission and relapses. Another benefit of using family therapy is that the burden on the caregivers is significantly reduced because of the techniques taught by the therapists, giving them a chance to live a better quality of life. 

3. Mood disorders

Family therapy is often used in treating depression. Numerous types of family therapies are used for patients suffering from postpartum depression, major depressive disorder, seasonal affective disorder, etc. It becomes useful for family members to cope with the illness effectively. Studies show that family therapy is especially helpful for adolescents who are going through depression. 

A study conducted for adolescents showed that two-thirds of the patients recovered quickly with the help of family therapy. 

4. Eating disorders

Family-focused therapy has emerged as an effective intervention for treating eating disorders like anorexia nervosa and bulimia nervosa. The therapy focuses on restoring the health of the patient. The first step is to inform the family that due to the nature of the disorder, it might be difficult for the patient to make decisions for themselves. Parents/ family are given the responsibility of what the patient eats, and how much they eat and monitor their daily activities. The second step is to organize a family meal where the patient is encouraged to eat healthy portions of meals along with the family. The final step consists of tracking the progress of the patient and navigating the challenges to avoid relapse.

A study conducted at the Maudsley Hospital in London used Family therapy as a treatment option alongside their ongoing treatment. 90% of the patients from ages 14 to 55 showed improvement in their symptoms. 

5. Drug abuse

Family therapy uses the family’s strengths to help a person fight the addiction. It addresses family characteristics, behaviours, and attitudes that can influence adolescent substance use. It also includes the implementation of positive family and social activities that can lead to a reduction in substance abuse. Activities like adult supervision and support, family-rule setting, and spending family time together reinforce positive behaviours through parental guidance.

In fact, studies suggest that people going through family therapy are more likely to stick through their treatment, stop misusing drugs and remain sober. 

6. Relationship conflicts

Every person is different and so it is natural to have differences in opinion. However, it is difficult when people living under the same roof have issues communicating freely with each other. By working with a therapist, a family can work towards adopting efficient communication skills and working harmoniously. 

Therapists also use different therapies to help couples manage conflicts effectively. This might include understanding and changing negative behavioural patterns and rebuilding relationships.

Studies show that 70-80% of the families found improvement in their relations and individual mental health and 91% of people were able to deal with their routine problems in a better way.  

How FFT is Used in Treatment Plans

As stated above, many family-focused therapy techniques are combined with other therapies to ensure maximum recovery. In most cases, when a person is struggling with their mental health, therapists first start by educating the family about the illness. On the other hand, the patient starts with their therapy. More than often, the patient starts with CBT (Cognitive Behavioural Therapy). FFT is also used alongside the administration of medications. 

This is done especially in the case of mental health illnesses like bipolar disorder or schizophrenia. While there is still a lot of research required for family-focused therapy for schizophrenia, trials have been conducted that tested the efficacy of FFT for bipolar disorder when combined with pharmacotherapy. 

In a study conducted over two years on adolescents suffering from bipolar disorder I and II were administered medications along with 21 sessions of FFT for 9 months. Results revealed that participants in family-focused treatment had less severe manic symptoms during year 2 than did those who were not.

Benefits of Family-Focused Therapy

Family-focused therapy has been useful in treating multiple mental health conditions like depression, anxiety, OCD, schizophrenia and bipolar disorder.  It stresses the fact that family plays an instrumental role in the recovery of patients. All in all, family-focused therapy has these benefits:

1. Improved family communication:

Some families perceive differences as a way of blaming one or more people within the family. With the help of FFT, the people in the family learn how to communicate better and work on their negative behaviours. In cases of an immediate family member experiencing difficulties with their mental health, transparent communication leads to a better understanding of their problems.

2. Enhanced problem-solving abilities:

The most important component of family therapy is the problem-solving ability among the family members. For example, a person is suffering from bipolar disorder. With the help of FFT, the family members get more equipped to deal with the challenges that come along with bipolar disorder. Challenges like getting through the manic episodes, preventing relapse, maintaining a healthy environment at home, etc. 

3. Reduction in relapse rates for mental health conditions

FFT has shown a great reduction in the relapse rates for various mental health conditions. For depression, FFT was effective in preventing relapse after 9 months of therapy. It was also beneficial in improving social contact with people suffering from depression. For conditions like bipolar disorder, the relapse rate was 11% as compared to patients who received standard care. 

4. Greater understanding of mental health by the entire family

FFT is beneficial in promoting understanding of mental health by the entire family. All the members of the family are educated on the concepts of mental health and how it affects an individual. Therapists teach family members skills to trace their behaviours and learn to react mindfully in every situation. 

Psychodynamic Therapy vs. Family-Focused Therapy

Both psychodynamic therapy and family-focused therapy are highly used therapies in clinical settings. Though both therapies focus on helping people become more aware of their emotions, there are subtle differences in the therapy. While Family-focused therapy focuses on the emotions of the entire family, psychodynamic therapy focuses on the emotions and subconscious thoughts of a person. 

Psychodynamic therapy:

Psychodynamic therapy encourages the client to become more aware of their emotions and process their unresolved feelings. For example, a client whose relationship with his father is deeply conflicted may find himself reacting to the therapist as if he were the client's father. The therapist will assess the underlying emotions of the client and use these techniques to find out more:

1. Free association:

By talking to the client, the therapist will encourage the client to identify patterns and reflect on their feelings. This helps the clients explore their thoughts and emotions.

2. Projective tests:

The therapist will use tests like word association or inkblot tests to identify subconscious thoughts and feelings. For example, the Rorschach tests are a common psychodynamic therapy. 

3. Dream analysis: 

The therapist will help the client unlock their unconscious thoughts through their dreams. They will help to understand the hidden messages and fear. 

Psychodynamic therapy is used for treating various mental health conditions like depression, anxiety, relationship issues and even family dynamics. However, Family-focused therapy is more effective when it comes to addressing mental health challenges faced by a member or conflicts in the family.

Family-focused therapy:

On the contrary, family-focused therapy places its emphasis on family dynamics. All the members of the family are assessed by the therapist. They attempt to reduce the friction caused by the differences in opinion. 

However, in most cases, FFT is used to support a family member who is struggling with their mental health. It can be for a variety of psychiatric conditions like mood disorders, bipolar disorders, and eating disorders.  

As seen above, FFT uses psychoeducation, to enhance communication skills and focus more on problem-solving skills. Therapists take all the feelings of the family members into consideration and provide them with skills to handle the person struggling with their mental health. 

Limitations of Family-Focused Therapy

While it is highly preferable in many cases, there are some limitations of Family-focused therapy. They are:

1. Unwillingness to participate:

Not all family members are willing to participate in the therapy. It can be because they are uncomfortable sharing private information with a therapist.

2. Financial costs:

There is ample evidence stating that FFT can act as an important tool for taking care of the mental health of family members. As much as it is helpful, financial hardships can prevent the family from accessing help for mental health. 

3. Differences in value:

The therapist may have different values than the family or a family member. This can create emotional strain and become a possible reason for conflict during therapy.

4. Power imbalance:

Since it is family-focused therapy, a family member can be more overpowering than others. This creates an imbalance in the power dynamics in the family. This usually happens when there is an elder in the family. Although therapy is a safe and open space for all the members to speak freely, some might withhold certain information to avoid facing them. 

Whatever the situation may be, FFT can only become successful if the family members are willing to be more open and ready to accept that mental health is an important resource for everybody. The entire family has to consider each other’s point of view and work together as a unit.

At Mave Health, we believe that FFT reaffirms the importance of family as a critical support system in our lives. Mave’s therapy club focuses on helping families navigate these challenges and work towards healing in the best way possible.

Conclusion

Family-focused therapy highlights the impact of family dynamics on the family. May it be your parents, siblings, cousins or some other relatives, the bond that we share with them has a lasting impact on the quality of our life. Enhancing communication and emotional support can help to strengthen family bonds and empower family members to play a pivotal role in facing mental health challenges.  FFT has demonstrated its effectiveness in managing many mental health conditions like schizophrenia, bipolar disorder, depression and even substance abuse. FFT has shown great improvement in the management of the disorders. Studies have reported the benefits of family-focused therapy include reduced relapse rates, improved interpersonal relationships and a deeper understanding of mental health. However, it ultimately depends upon the willingness of the family members to face these challenges.

References:

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