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Chapter: Essentials of Psychiatry: Family Therapy

Psychodynamic Family Therapy

Psychodynamic psychotherapy helps family members solve rela-tional problems by understanding better how emotional processes influence the perceptions, feelings and actions of those involved.

Psychodynamic Family Therapy


Psychodynamic psychotherapy helps family members solve rela-tional problems by understanding better how emotional processes influence the perceptions, feelings and actions of those involved. The early psychoanalysts noted that intrapsychic processes of an individual powerfully shape his or her interactions with other peo-ple, and most so in emotionally intimate relationships of couples and families. Extending the concepts and language of psychoanal-ysis to family behavior was a logical next step for those who began meeting with parents and children, couples and whole families. In particular, object relations theory provided a bridge from the individual intrapsychic processes to the interpersonal processes of families (Scharff and Scharff, 1987; Framo, 1991; Slipp, 1991).


What to Think About


In order to understand how one family member acts in relation to other family members, psychodynamic family therapy concen- trates upon motivations, conflicts, defenses and relationships from the past that currently influence the present. Family interactions are explained in terms of internal processes within individual family members. Therapeutic change is sought through family members gaining conscious insight into previously unconscious processes that have been generating problems in family relationships.


What to Look For


Psychodynamic family therapy grounds its work in historical in-formation. Extensive individual and family histories are elicited in order to understand family members’ experiential models of the world. These experiential models govern how meanings are attributed to such family patterns as rules for how people should respond and models for being a man or a woman, husband or wife, or mother or father. These models have developed out of each family member’s personal history, the family’s history and mythology, and their cultural history. Some of the diagnostic pat-terns upon which psychodynamic family therapists focus when assessing families include the following:


·  Projective Identification Projective identification is an ego defense to which psychodynamic family therapists have attrib-uted a crucial role in conflictual family relationships. In projec-tive identification, one family member (a parent or couple part-ner) relates to another family member (a particular child or the other couple partner) as if he or she embodied a projected part of self. The projecting family member then interacts with, or relates to, the projected part of self as if that part were an inter-nalized part of himself or herself. The projecting family mem-ber unconsciously prompts the other to conform to the way in which he or she is being perceived, evoking in the other the as-sociated feelings and behaviors as if they were authentic. When viewed from the outside by the therapist, it appears as if the two are in collusion with one another in order to sustain these mu-tual, projected perceptions. Projection of disavowed elements of the self, whether positive or negative, has the effect of charging the relationship with emotion that has been transposed from an intrapsychic sphere into an interpersonal one. Acted out inter-personally, it serves to decrease psychic anxiety at the expense of an increase in tension and impasse in the relationship.


·  Unresolved Grief When a family member, or the family as a whole, has not fully grieved losses, the family can become devel-opmentally frozen. While so preoccupied with the past, it can be difficult to focus enough time and energy on current problems.


·  Clarity of Ego Boundaries and Capacity for Intimacy/ Separateness Conflicted family relationships can represent an alternative method for stabilizing emotional distance when the involved family members lack the emotional maturity to regulate closeness and distance in more differentiated ways. This has been a common model for understanding couples who chronically fight yet never separate.


What to Do


Psychodynamic family therapists employ the fundamental tools of psychodynamic psychotherapy (opening emotional expres-sion, clarifying communications, encouraging family members to speak from the “I” position, and interpretation of unconscious conflicts) to resolve projective processes, cutoff relationships, and difficulties in modulating closeness and distance in fam-ily relationships. Psychodramatic techniques, such as doubling and role reversal, can play useful roles in implementing these interventions (Blatner, 1994). Therapeutic rituals are particularly useful in facilitating grief over losses and in facilitating devel-opmental transitions, such as a young adult leaving home or a couple moving into retirement years (Imber-Black and Roberts, 1992).


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