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Family therapy

A form of psychotherapy that is based on the idea that the behaviours of individuals and families is influenced and maintained by the way other individuals and systems interact with them both within and outside of the family. When a member of the family has a problem that is persistent it can often dominate family life and impact significant on family function, interaction and communication. The aim of family therapy is to help family members recognise and understand how they function as a family and in particular how their patterns of interaction may have become organised around the symptoms or problems of one of their members. Where these patterns of interaction have become unhelpful and perhaps contribute to the maintenances of the problem, the family is helped to develop more functional patterns of organising and interacting within the family. Families are generally seen together but may at times be seen by the family therapists individually or with only some members of the family. Family therapy draws on a number of theoretical principles/approaches that may be used singularly or together in therapy. In the treatment of OCD various forms of family therapy are used, these include systemic, strategic, cognitive behavioural, and narrative family therapy although in practice these approaches tend to overlap:

  • Systemic family therapy tends to focus on the meaning of OCD symptoms within the family unit. The therapy tends to see OCD symptoms as a sign that the family unit is stressed, leading to difficult, unspoken emotions between family members. A systemic treatment might involve the therapists exploring ‘OCD stories’ within a family, thus changing the way that the family members have co-created the meaning of OCD. This is aimed at improving relationships within the family and in turn, changing the meaning of the individual's symptoms to allow for changes in their behaviour.
  • Strategic family therapy tends to focus on power issues within the family, which in turn may well impact on both family members' understanding and response to OCD, and the OCD symptoms themselves. The rationale is that a more flexible, creative family structure may reduce stress, and challenge the ‘power’ of the OCD symptoms.
  • Cognitive behavioural family therapy (CBFT) as a treatment for OCD is based on the recognition that families of people with OCD become involved in trying to help manage the distress and the interference caused by the compulsions. The OCD thus disrupts family relationships. The focus of the treatment is to help the family understand how their well-intentioned involvement can inadvertently maintain the disorder and then help them withdraw from the compulsions. In some cases, especially with children, family members may act as co-therapists to help with ERP. Although the aim is to improve family relationships, the focus is more on reducing a particular individual's obsessive-compulsive symptoms in which other family members have become involved.
  • Narrative family therapy proposes that individuals and families acquire certain stories about themselves which have the effect of filtering their experiences and thereby selecting what information gets focused on how it is understood and how this determines how individual problems within the family are perceived and addressed. Narrative family therapy is concerned with finding ways for families to develop new stories or expressions through which to enable them to change their lives.