The Primary Goal of Family Therapy Is to:

Indian J Psychiatry. 2020 Jan; 62(Suppl 2): S192–S200.

Family Interventions: Basic Principles and Techniques

Mathew Varghese

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India

Vivek Kirpekar

¹N.K.P. Relieve Institute of Medical Sciences, Nagpur, Maharashtra, India

Santosh Loganathan

Section of Psychiatry, National Institute of Mental Wellness and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India

Received 2019 Dec 12; Accepted 2019 Dec 16.

INTRODUCTION

Mental health professionals in India take always involved families in therapy. However, formal interest of families occurred well-nigh one to two decades later this therapeutic modality was started in the Due west past Ackerman.[ane] In India, families form an important part of the social cloth and support system, and equally a effect, they are integral in being part of the treatment and therapeutic process involving an individual with mental illness. Mental illnesses agonize individuals and their families too. When an private is afflicted, the stigma of being mentally sick is not restricted to the individual alone, only to family members/caregivers also. This type of stigma is known equally "Courtesy Stigma" (Goffman). Families are more often than not unaware and lack information about mental illnesses and how to deal with them and in turn, may end up maintaining or perpetuating the illness likewise. Vidyasagar is credited to be the father of Family Therapy in Bharat though he wrote sparingly of his piece of work involving families at the Amritsar Mental Hospital.[2] This affiliate provides salient features of broad principles for providing family interventions for the treating psychiatrist.

TYPES AND GRADES FOR FAMILY INTERVENTIONS

Working with families involves teaching, counseling, and coping skills with families of different psychiatric disorders. Various interventions exist for different disorders such as depression, psychoses, child, and adolescent related bug and alcohol use disorders. Such families require psychoeducation about the illness in question, and in improver, volition crave data about how to deal with the index person with the psychiatric affliction. Psychoeducation involves giving basic information nigh the affliction, its course, causes, handling, and prognosis. These basic informative sessions can last from two to six sessions depending on the time bachelor with clients and their families. Elementary interventions may include dealing with parent-adolescent conflict at dwelling house, where brief counseling to both parties about the expectations of each other and facilitating direct and open advice is required.

Additional family interventions may comprehend specific aspects such as futurity plans, task prospects, medication supervision, marriage and pregnancy (in women), behavioral management, improving communication, and so on. These family interventions offer specific data may too last anywhere between ii and 6 sessions depending on the client's time. For example, explaining the family almost the marriage prospects of an individual with a psychiatric illness tin can be considered a part of psychoeducation too, but specific data about marriage and related concerns crave split up handling. At any given time, families may crave specific focus and feedback about issues such issues.

Family unit therapy is a structured form of psychotherapy that seeks to reduce distress and disharmonize by improving the systems of interactions betwixt family members. It is an ideal counseling method for helping family members suit to an immediate family fellow member struggling with an addiction, medical effect, or mental health diagnosis. Specifically, family therapists are relational therapists: They are generally more interested in what goes on between the individuals rather than inside 1 or more than individuals. Depending on the conflicts at issue and the progress of therapy to appointment, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family unit members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as past pointing out patterns of interaction that the family might non have noticed.

Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to place a unmarried cause. Some families may perceive cause-effect analyses every bit attempts to allocate arraign to 1 or more than individuals, with the effect that for many families, a focus on causation is of little or no clinical utility. It is important to note that a round way of problem evaluation is used, especially in systemic therapies, as opposed to a linear route. Using this method, families can exist helped past finding patterns of behavior, what the causes are, and what can be done to better their situation. Family therapy offers families a way to develop or maintain a good for you and functional family. Patients and families with more difficult and intractable problems such as poor prognosis schizophrenia, conduct and personality disorder, chronic neurotic conditions require family interventions and therapy. The systemic framework approach offers advanced family therapy for such families. This type of advanced therapy requires training that very few centers, such every bit the Family unit Psychiatry Eye at the National Constitute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India offer to trainees and residents. These sessions may last anywhere from eight sessions up to 20 or more on occasions [Table 1].

Tabular array 1

Types and grades of family interventions

Family psychoeducation (basic information)	Family interventions (specific information)	Family therapy (systemic framework)
Low and anxiety	Medication supervision	Schizophrenia with poor prognosis
Schizophrenia and bipolar disorders (psychoses)	Marriage and pregnancy counseling	Conduct and personality disorders
Booze utilize disorders	Job-related counseling	Chronic neurotic conditions
Child and boyish conditions/bug	Hereafter plans- education, stress	Astringent expressed emotions
Organic brain disorders	Coping and stigma	Family discord and major conflicts
Any other affliction	Behavioral management (e.g., contracting)
	Improving advice

Goals of family therapy

Usual goals of family therapy are improving the communication, solving family problems, understanding and treatment special family situations, and creating a better functioning home environment. In add-on, it also involves:

1. Exploring the interactional dynamics of the family and its relationship to psychopathology

2. Mobilizing the family's internal strength and functional resources

3. Restructuring the maladaptive interactional family styles (including improving advice)

4. Strengthening the family's trouble-solving behavior.

Reasons for family interventions

The usual reasons for referral are mentioned beneath. However, it may be possible that sometimes the reasons identified initially may be merely a pointer to many other lurking bug within the family that may go discovered eventually during afterwards assessments.

• Marital problems

• Parent–kid disharmonize

• Bug betwixt siblings

• The effects of illness on the family

• Adjustment problems among family members

• Inconsistency parenting skills

• Psychoeducation for family members nearly an alphabetize patient's affliction

• Handling expresses emotions.

CHALLENGES FACED By THE NOVICE THERAPIST

Whether 1 is a young student, or a seasoned individual therapist, dealing with families can be intimidating at times but too very rewarding if one knows how to deal with them. We take outlined sure challenges that one faces while dealing with families, especially when 1 is beginning.

Beingness overeager to help

This can happen with beginner therapists as they are overeager and keen to assist and offer suggestions direct away. If the therapist starts dominating the interaction past talking, advising, suggesting, commenting, questioning, and interpreting at the start itself, the family falls silent. It is advisable to probe with open-concluded questions initially to sympathise the family.

Poor leadership

Information technology is appropriate for the therapist to have control over the sessions. Sometimes, there may be other individuals/family members who possibly authoritative and take control. Particularly in crisis situations, when the family fails to function equally a unit of measurement, the therapist should accept control of the session and set certain conditions which in his professional person judgment, maximize the chances for success.

Not immersing or engaging/fear or involving

A common problem for the starting time therapist is to go overly involved with the family. However, he may realize this and endeavor to panic and withdraw when he can go distant and cold. Rather, one should gently try to bring together in with the family unit earning their true respect and trust earlier heading to build rapport.

Focusing only on alphabetize patient

Many families believe that their problem is because of the index patient, whereas information technology may seem a tactical fault to focus on this person initially. In doing so, it may essentially agree to the family's hypothesis that their problem is arising out of this person. It is preferable, at the beginning to inform the family that the trouble may lie with the family (especially when referrals are made for family therapies involving multiple members), and not necessarily with whatever one individual.

Not including all members for sessions

Many therapeutic efforts fail considering important family members are non included in the sessions. It is appropriate to find out initially who are the key members involved and who should exist attending the sessions. Sometimes, involving all members initially and then advising them to return to therapy as and when the demand arises is recommended.

Non involving members during sessions

Even though i has involved all members of the family unit in the sessions, not all of them may exist engaged during the sessions. Sometimes, the therapist'south own transference may hold back a member of the family in the sessions. Rather, information technology is recommended that the therapist makes information technology clear that he/she is open to their presence and interactions, either verbally or nonverbally.

Taking sides with any member of the family

It may be easy to fall into the trap of taking one member's side during sessions leaving the other party doubting the fairness and judgment of the therapist. For example, later meeting i marital partner for a few sessions, the therapist, when inbound the couple, discussions may be heavily biased in his views due to his/her prior interaction. Therapists should be aware of this effect and endeavor to be neutral equally possible yet have into confidence each member attending the sessions. Therapist'southward countertransference can hands influence him/her to take sides, especially in families that are overtly blaming from the start, or with one fellow member who may exist ambitious in the sessions, or very submissive during the sessions can influence the therapist's sides; and i needs to exist aware of this early in the sessions.

Guarded families

Some families put on a guarded façade and turn down to claiming each other in the session. Past being neutral and nonjudgmental, sometimes, the therapist tin can perpetuate this guarded façade put forth past families. Hence, therapists must exist able to read this and try to challenge them, listen to microchallenges inside the family, must be ready to move in and out from ane family fellow member to another, without fixing to one member.

Communicating with the therapist outside sessions

Many families try to reduce tension past communicating with therapist exterior the session, and offset therapist are peculiarly susceptible for such ploys. The family or a member/s may want to meet the therapist outside the sessions past trying to influence the therapist to their views and opinions. Therapists must refrain from such encounters and suggest discussing these issues openly during the sessions. Of grade, rarely, at that place may be sensitive or very personal information that one may want to talk over in person that may exist permissible.

Ignoring previous work done by other therapists

It is easy for family therapists to ignore previous therapists. The family therapist'southward ignorance of the furnishings of previous therapy tin serious hamper the work. By discussing the previous therapist helps the new therapist to understand the problem hands and could salve time also.

Getting sucked to the family's melancholia land/mood

If transference involves the therapist in family structure, the therapist'south dependency can overinvolved him in the family'due south style and tone of interaction. A depressed family unit causes both: Therapist to relate seriously and sadly. A hostile family may cause the therapist to relate in an attacking manner. The most serious problem tin can occur when a family unit is in a state of anxiety, induces the therapist to become anxious and brand his/her comments to seem accusatory and blaming. It is very difficult for the beginning therapist to "experience" where the family is affectively, to be empathic, still to exist able to relate at times on a different affective level-to answer co-ordinate to situations. Information technology is of import to be enlightened of the affective state/mood of the family unit just slips in and out of that state [Tabular array 2].

Table 2

Guidelines for conducting interventions with families

Timings for appointments to be followed for smooth conduct of sessions

Arriving belatedly may reduce actual session time past the same margin

Any counterfoil or postponement of sessions to be informed in advance by both parties

Session location would be intimated in advance

An approximate full number of expected family sessions to exist informed in the beginning; including frequency of the sessions

Inform clients near the reason why the family is being seen together

Advise clients that changes may occur gradually after assessments and immediate solutions may non exist provided equally far as possible

The duration of the sessions would be informed in the first itself (45 min to an 60 minutes)

Whatsoever other matters arising, in the end, can brought up during subsequent sessions

During sessions, clients to refrain from interrupting when someone else is talking

Family members to look for turns to talk equally everyone would be given the opportunity

Clients to avoid verbal arguments or fights during the sessions

Inform clients about the confidentiality of the contents of the sessions and record-keeping practices

Clients to avoid any discussions outside of therapy sessions with the therapist

Clients to hash out relevant matters as far equally possible in the sessions even though some matters may be conflicting in nature

Make a formal contract with the family unit nigh roles of therapist and the family members

In families with violence, a no-violence contract is preferable during the entire process of family therapy

FUNCTIONS OF A Family unit THERAPIST

1. The family unit therapist establishes a useful rapport: Empathy and communication among the family members and between them and himself

2. The therapist uses the rapport to evoke the expression of major conflicts and ways of coping.

   • The therapist clarifies conflict by dissolving barriers, confusions, and misunderstandings

   • Gradually, the therapist attempts to bring to the family to a mutual and more authentic agreement of what is wrong

   • This he achieves through a serial of partial interventions, which include.

     • Counteracting inappropriate denials, conflicts

     • Lifting hidden intrapersonal conflict to the level of interpersonal interaction.

3. The therapist fulfills in office the role of truthful parent figure, a controller of danger, and a source of emotional support and satisfaction-supplying elements that the family needs but lacks. He introduces more advisable attitudes, emotions, and images of family unit relations than the family has e'er had

4. The therapist works toward penetrating (entering into) and undermining resistances and reducing the intensity of shared currents of conflict, guilt, and fear. He accomplishes these aims mainly using confrontation and estimation

5. The therapist serves as a personal instrument of reality testing for the family.

In carrying out these functions, the family therapist plays a wide range of roles, as:

• An activator

• Challenger

• Supporter

• Interpreter

• Re-integrator

• Educator.

BASIC STEPS FOR FAMILY INTERVENTIONS

The initial phase of therapy

1. The referral intake

2. Family assessment

3. Family unit formulation and handling programme

4. Formal contract.

The referral intake

Patients and their families are normally referred to equally some family problem has been identified. The therapist may be accepted to the usual 1-on-1 therapeutic situation involving a patient merely may be puzzled in his approach past the presence of many family members and with a lot of information. A few guidelines are similar to the approaches followed while conducting individual therapy. The guidelines for conducting family interventions are given in Table 2. At the time of the intake, the therapist reviews all the available information in the family from the case file and the referring clinicians. This intake session lasts for 20–30 min and is held with all the available family unit members. The aim of the intake session is to briefly understand the family unit'due south perception of their problem, their motivation and need to undergo family intervention and the therapist assessments of suitability for family unit therapy. In one case this is determined the nature and modality of the therapy is explained to the family unit and an informal contract is made about modalities and roles of therapist and the family members. The exercise'southward and don'ts of the family interventions are laid down to the family at the outset of the process of the interventions.

The family unit cess and hypothesis

The cess of different aspects of family unit functioning and interactions must typically take virtually 3–v sessions with the whole family, each session must last approximately 45 min to an hour. Different therapists may want to take assessments in dissimilar ways depending on their mode. Mentioned below are a few tasks which are recommended for the therapist to perform. Unremarkably, it is recommended that the naïve therapist starts with a iii-generation genogram so follows-up with the different life cycle stages and family unit functions every bit outlined below.

1. The three-generation genogram is constructed diagrammatically listing out the index patient's generation and 2 more related generations, for example, patients and grandparents in an adolescent customer or parents and children in a middle-aged client. The ages and composition of the members are recorded, and the transgenerational family patterns and interactions are looked at to understand the family from a longitudinal and epigenetic perspective. The therapist also familiarizes himself with whatsoever family unit dynamics prior to consultation. This gives a wide background to understand the state of affairs the family is dealing with now

2. The life cycle of the alphabetize family unit is explored next. The functions of the family and specific roles of different members are delineated in each of the stages of the family life cycle.[3] The alphabetize family is seen from a developmental perspective, and the therapist gets a longitudinal and temporal perspective of the family unit. Care is taken to see how the family has coped with problems and the process of transition from one stage to another. If children are also part of the family unit, their field of study and parenting styles are explored (eastward.g., whether there is inconsistent parenting)

3. Trouble Solving: Many therapists look at this aspect of the family to see how cohesive or adjustable the family has been. Usually, the family unit members are asked to describe some stress that the family has faced, i.eastward., some life events, environmental stressors, or illness in a family unit fellow member. The therapist then gain to get a clarification of how the family coped with this problem. Here, "circular questions" are employed and therapist focuses on ancestor events. The crisis and the consequent events are examined closely to look for patterns that emerge. The family function (or dysfunction) is heightened when at that place is a crisis state of affairs and the therapist look at patterns rather than the content described. Thus, the therapist gets an "as if I was there" view of the family unit. The same inquiry is possible using the technique of enactment[4]

4. The Structural Map: One time the inquiry is over, the therapist draws the structural map, which is a diagrammatic representation of the family unit organization, showing the different subsystems, its boundaries, ability structure and relationships betwixt people. Diagrammatic notions used in structural therapy or Bowenian therapy are used to denote relationships (normal, conflictual, or afar) and subsystem boundaries, in different triadic relationships. This tin as well be done on a timeline to show changes in relationships in different life wheel stages and influences from different life events

5. The Circular Hypothesis: A systemic family hypothesis is now postulated by looking at the function of symptoms for both the client and his family. Answers to the following questions provide the circular hypothesis:

   1. What the client is trying to convey through his/her symptoms?

   2. What is the part of the family unit in maintaining these symptoms?

   3. Why has the family come up now?

   This round hypothesis tin can be confirmed on further inquiry with the family unit to see how the "dysfunctional equilibrium" is maintained. At this stage, we advise that a family conception is generated, hypothesized and analyzed. This leads to a comprehensive systemic formulation involving three generations. This formulation will make up one's mind which family members we need to see in a therapy, what interventional techniques we should use and what changes in relationships nosotros should effect. The squad will also discuss the minimum, most effective treatment plan which emerges because the almost feasible changes the family can make

6. Formal Contract: A cursory understanding of the family homeostasis is presented to the family. Sometimes, the full hypothesis may be fed to the family in a noncritical and positive way ("Positive Connotation"), appreciating the way in which the system is performance the therapist presents the handling plat to the family unit and negotiates with the members the program and action they would like to have upward at the present time. The time frame and modality of therapy is contracted with the family, and the therapy is put into force. The frequency and intensity of sessions are adamant by the degree of distress felt by the family unit and the geographical distance from the therapy eye, i.e., families may exist seen as inpatients at the center if they are in crunch or if they live far abroad.

The Family Psychiatry Center at The NIMHANS, Bengaluru, Karnataka, India, is one of the centers where formal preparation in therapy is regularly conducted. An outline of the Family Cess Proforma[5] used at this middle is given in Figure 1. Several other structured family cess instruments are available [Effigy 1].

Family assessment proforma (Obtained with permission from the Family unit Psychiatry Center, National Found of Mental Health and Neurosciences, Bengaluru, Karnataka, India)

Middle phase of therapy

This stage of therapy forms the major work that is carried out with the family. Depending on the school of therapy, that is used, these sessions may number from a few (strategic) to many sessions lasting many months (psychodynamic). The techniques employed depend on the understanding of the family during the assessment as much as the family unit – therapist fit. For example, the caste of psychological sophistication of the clients will make up one's mind the apply of psychodynamic and behavioral techniques. Similarly, a therapist who is comfy with structural/strategic methods would put these therapies to maximum use. The nature of the disorder and the degree of pathology may likewise determine the pick of therapy, i.e., behavioral techniques may be used more in chronic psychotic conditions while the more difficult or resistant families may become brief strategic therapies. We will now describe some of the important techniques used with different kinds of problems.

Psychodynamic therapy

This school was one of the kickoff to exist described by people like Ackerman and Bowen.[1,six] This method has been made more contextual and briefer by therapists like Boszormenyi-Nasgy and Framo.[7,eight] Essentially, the therapist understands the dynamics employed by unlike members of the family and the interrelationships of these members. These family unit ego defenses are interpreted to the members and the goal of therapy is to effects emotional insight and working through of new defense force patterns. Family unit transferences may become axiomatic and may demand estimation. Therapy ordinarily lasts from 15 to thirty sessions and this method may be employed in persons who are psychologically sophisticated, and able to empathize dynamics and interpretations. Sustained and high motivation is necessary for such a therapy. This method is found useful in couples with marital discord from upper heart-class backgrounds. Fourth dimension required is a major constraint.

Behavioral methods

Behavioral techniques find use in many types of therapies and conditions. It has been extensively used in chronic psychotic illnesses past workers such as Fallon et al., (1986) and Anderson et al.[ix,10] Psychoeducation and skills preparation in advice and problem-solving are found very useful among families which do not have very serious dysfunction. Techniques such as modeling or function-plays are useful in improving advice styles and to teach parenting skills with disturbed children. Obviously, motivation for therapy is a major requisite and hence techniques such as contracting, homework assignments are used in couples with marital discord. Behavioral techniques used in sexual dysfunction are as well possible when adapted co-ordinate to clients' needs.

Structural family unit therapy

Described by Minuchin; Fishman and Unbarger[4,11,12] has become quite pop over the past few years among therapists in India. This is possibly considering of many reasons. Our families are bachelor with their manifold subsystems of parents, children, grandparents and structure is easily discerned and changed. In improver, in recent years most clients nowadays with conduct and personality disorders in adolescence and early adulthood. Hence, techniques similar unbalancing, purlieus-making are quite useful equally the common bug involve adolescents who are wielding power with poor marital adjustments between parents. These techniques are useful for many of our clients.

Strategic technique

We take constitute that these cursory techniques tin be very powerfully used with families which are difficult and highly resistant to change. We unremarkably utilize them when other methods have failed, and we need to take a U-turn in therapy. Techniques employed by the Milan school[13,14] reframing, positive connotation, paradoxical (symptom) prescription have been used effectively. And so also have techniques like prescription in brief methods advocated by Erikson, Watzlawick et al.,[15,16] been useful. Familiarity and competence with these techniques is a must and therapy is usually brief and speedily terminated with prescriptions [Table iii].

Tabular array three

Summaries of the different schools of therapies

School of therapy	Central elements	Remarks
Psychodynamic therapy	Based on psychoanalysis; accent on conscious and unconscious processes; the past bug are even so dynamic in the current setting; early on life experiences are significant; intrapersonal and interpersonal processes are entangled	Alter is steady; requires long-term investment (twenty-forty sessions); psychological mindedness of client required
Behavioral methods	Maladaptive behaviors, not underlying causes, should be the targets of modify; non required to treat the unabridged family; the therapist is the skilful, instructor, collaborator, and double-decker	Parent-skills preparation and behavioral handling of sexual dysfunctions are examples; treatment is short term
Structural family therapy	Symptoms are understood in terms of family unit interaction patterns, family organization must change earlier symptom reduction; emphasis on the whole family and its subunits; therapist joins, maps out, and helps transform family	Especially useful with juvenile delinquents, alcohol apply and anorexia, low SES families, and cross-cultural populations
Strategic technique	Not helpful to tell families what they are doing wrong; behavior change must precede other changes; directives from therapist are instructions given to family unit, necessary to make changes inside the showtime three sessions	Short-term treatment; techniques are very innovative; useful in eating disorders and substance employ

FAMILY INTERVENTIONS IN SPECIFIC DISORDERS

Techniques to promote family adaptation to illness

• Heighten awareness of shifting family roles – pragmatic and emotional

• Facilitate major family unit lifestyle changes

• Increase advice within and outside the family unit regarding the disease

• Assistance family to take what they cannot control, focus energies on what they can

• Find pregnant in the illness. Help families movement beyond "Why us?"

• Facilitate them grieving inevitable losses–of function, of dreams, of life

• Increase productive collaboration amidst patients, families, and the wellness-intendance team

• Trace prior family experience with the disease through constructing a genogram

• Gear up individual and family unit goals related to disease and to nonillness developmental events.

Schizophrenia

Family EE and advice deviance (or lack of clarity and structure in communication) are well-established risk factors for the onset of schizophrenia.

Psychoeducational interventions aim to increase family members' understanding of the disorder and their power to manage the positive and negative symptoms of psychosis.

Simple strategies would include reduction of adverse family atmosphere by reducing stress and burden on relatives, reduction of expressions of anger and guilt by the family unit, helping relatives to anticipate and solve bug, maintenance of reasonable expectations for patient performance, to set up advisable limits whilst maintaining some caste of separation when needed; and changing relatives' beliefs and conventionalities systems.

Programs emphasize family resilience. Address families' need for educational activity, crisis intervention, skills training, and emotional support.

Bipolar mood disorder

To recognize the early signs and symptoms of bipolar disorder.

Develop strategies for intervening early with new episodes and assure consistency with medication regimens.

Manage moodiness and swings of the patient, acrimony direction, feelings of frustration.

Depression

Family conflict and rejection, low family unit support, ineffective communication, poor expression of affect, abuse, and insecure attachment bonds are main focus of family therapy associated with low cognitive-behavioral and interpersonal interventions for depression.

Anxiety

Family unit-based handling for anxiety combines family therapy with cognitive-behavioral interventions.

Targets the characteristics of the family environment that back up anxiogenic beliefs and avoidant behaviors.

The goal is to disrupt the interactional patterns that reinforce the disorder.

To assist family members in using exposure, reward, relaxation, and response prevention techniques to reduce the patients' anxieties.

Eating disorders

Target the dysfunctional family processes, namely, enmeshment and overprotectiveness.

To assist parents build effective and developmentally appropriate strategies for promoting and monitoring their child's eating behaviors.

Childhood disorders

The chief focus is the development of constructive parenting and contingency direction strategies that will disrupt the problematic family interactions associated with ADHD and ODD.

Family-based interventions for autism spectrum disorder

Parents taught to employ advice and social training tools that are adjusted to the needs of their children and apply these techniques to their family unit interactions at home.

Substance misuse

Enhance the coping ability of family members and reduce the negative consequences of alcohol and drug abuse on concerned relatives; eliminate the family factors that constitute barriers to treatment; use family unit support to engage and retain the drug and/or booze user in therapy; change the characteristics of the family environment that contribute to relapse Al-Anon, AL-teen.

Termination phase

This terminal phase of therapy is finished in a couple of sessions. The initial goals of therapy are reviewed with the family unit. The family unit and the therapist review together the goals which were achieved, and the therapist reminds the family the new patterns/changes which have emerged. The need to continue these new patterns is emphasized. At the aforementioned time, the family is cautioned that these new patterns will occur when all members make a concerted endeavor to meet this happen. Family members are reminded that it is easy to autumn back to the one-time patterns of functioning which had produced the unstable equilibrium necessitating consultation.

At termination, the therapist commonly negotiates new goals, new tasks or new interactions with the family that they will carry out for the next few months in the follow up catamenia. The family is told that they demand to review these new patterns after a couple of months and then as to determine how things take gone and how conflicts take been addressed by the family. This fashion the family has a improve chance of sustaining the change created. Sometimes booster sessions are besides brash after half-dozen–12 months peculiarly for outstation families who cannot come up regularly for follow-ups. These booster sessions will review the progress and negotiate farther changes with the family over a couple of sessions. This follow-upward flow, afterwards therapy is terminated is crucial for working through process and ensures that the customer-therapist bond is not severed likewise quickly. It is like shooting fish in a barrel to deal with the clients' and therapist' anxieties if this transition phase is smooth.

SPECIAL SOCIOCULTURAL ISSUES IN THERAPY SPECIFIC TO India

Nearly Indian families are functionally joint families though they may have a nuclear family unit structure. Furthermore, unlike the Western world more than two generations readily come for therapy. Hence, it becomes necessary to deal with 2 to three generations in therapy and also with transgenerational problems. Our families as well foster dependency and interdependency rather than autonomy. This issue must likewise be kept in mind when dealing with parent–child issues. Indians take a varied cultural and religious multifariousness depending on the region from which the family unit comes. The therapist has to be familiar with the regional customs, practices, beliefs, and rituals. The Indian family therapist has to also be wary of being besides directive in therapy equally our families may give the mantle of omnipotence to the therapist and it may be more difficult for u.s.a. to adopt at 1-down or nondirective arroyo. Hence, while systemic family therapy is eminently possible in Republic of india i must keep in mind these sociocultural factors then as to get a good "family unit-therapist fit."

Constraint factors in therapy

The economic backwardness of nigh out families makes therapy feasible and affordable, in terms of time and coin spent, only to the eye and upper classes of our guild. The poorer families usually drop out of therapy equally they take other more than pressing priorities. The lack of tertiary social support and welfare or social security makes it less possible to network with other systems. Nosotros are likewise woefully inadequate in terms of trained family unit therapists to cater to our large population. In our country, distances seem rather daunting and modes of transport and advice are poor for families to readily seek out a therapist. We work with these constraint factors and and then the "family-therapy" fit is an important cistron for families that are seeking and staying in family therapy.17

CONCLUSIONS

Over the last few years, a systemic model has evolved for service and for training. The model uses a predominantly systematic framework for agreement families and the techniques for therapy are drawn from unlike schools namely the structural, strategic, and behavioral psychodynamic therapies.

Appendix: Glossary of terms

Structure

The repetitive patterns of interaction that organize the way in which family unit members relate and interact with each other.

Boundaries

Boundaries are the rules defining who participates in the arrangement and how, i.eastward., the degree of admission outsiders have to the system.

Subsystem

It may comprise of a single person, or several persons joined together by common membership criteria, for example, age, gender, or shared purpose.

Coalition

When alignments stand up in opposition to another role of the organization (i.e., when several family unit members are against another member/southward.

Alliance

The joining together of two or more members. It popularly designates appositive affinity between two units of a system.

Channels of communication are a mechanism that defines "who speaks to whom." When channels of communication are blocked, needs cannot be fulfilled, problems cannot exist solved, and goals cannot be achieved.

Enmeshed families

In which, there is extreme sensitivity among the individual members to each other and their master subsystem.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001353/#:~:text=Usual%20goals%20of%20family%20therapy,and%20its%20relationship%20to%20psychopathology

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