By Dr. Udena Attygalle “We worry about what a child will be tomorrow, yet we forget he is someone today.” – Stacia Tauscher In working with children and their families, it is not an uncommon experience to come across situations where you cannot neatly categorise a problem that a family faces into a mental health [...]

The Sunday Times Sri Lanka

Family therapy; a way to help children and adolescents


By Dr. Udena Attygalle

“We worry about what a child will be tomorrow, yet we forget he is someone today.” – Stacia Tauscher
In working with children and their families, it is not an uncommon experience to come across situations where you cannot neatly categorise a problem that a family faces into a mental health disorder or condition. Nevertheless, these problems are genuine issues that people are struggling with. The stressed working parents who struggle to spend more time with their child and find that when they do, it always ends up in a fight, and the single father with a teenager daughter whom he no longer understands, all have real issues. While these problems are to a certain extent, a result of temperaments and genetic predispositions, they are mostly interactional and relationship issues. In short, most of the sorrows as well as joys of mankind appear in the context of relationships.

Graphic illustrating Bronfenbrenner’s ecological systems theory

While we are relating to others, others are relating to us, and within this process of relating we are both influencing and being influenced. Thus this bi- directional pattern of being related to goes on and on. Family therapy is based on the idea that there is an opportunity for change within this process, and the hope that this will lead to a better outcome. Thus family therapy is not just about a “family” in a traditional sense, it could be an issue with a spouse, a child, a friend or even an organisational issue.

This process becomes even more important when working with children. After all, the child’s world is greatly influenced by the two main domains of family and school. As Donald Winnicot, the child psychiatrist and paediatrician famously said, “there is no such thing as a baby, there is a baby and someone else”. Developmental psychologist Bronfenbrenner meanwhile further emphasised the many different levels of societal influence on a child’s development (illustrated here).

There are many ways and models of working with families. However, most family therapists use an eclectic approach, using helpful methods from many models. While a therapist with a “structural” perspective may look at the family structure and alliances as causes and solutions to issues, a “strategic” therapist may give the family certain strategic tasks aimed at giving the family an experience so that they find the solutions to the issues themselves.

Meanwhile “narratively” focused therapists believe that we are affected by the narratives or stories we build about ourselves and will help the family find a different narrative. Thus “the parent who always gets angry” maybe a narrative about ourselves that has got built along the years and one that we want to change.

While the goals of working with a family are usually decided together with the family, e.g. “having a better relationship with my child” the therapist might also have the goal of bringing to light the issues and also the ways of overcoming them in a manner that best fits the family. While for some families this may be gently pointing out the issues, for others it might be a case of facilitating the family to discover the “real” issues for themselves.

While a consultation in a traditional sense would concentrate on the problem and focus on finding a solution using the expert knowledge of the clinician, modern family therapists also try to help parents become experts about their own issues and solutions. There is a tendency to concentrate on the “space between people”: What is the interaction like; how does it affect the family, and how can a better outcome be possible within this interaction, are all questions that cross the therapist’s mind.

Family therapists may also use their interactions with the clients to be a catalyst for the clients to interact differently as well. Although family therapy emphasises this, all “therapies” to varying levels, are based on interactions. There is the well known experience of getting similar medication for similar ailments from different practitioners but having a “feeling” that one is better than the other.

Human nature (or nurture!) is such that we have a tendency to concentrate on problems. Look at the news and this will become apparent! So for many, the narratives we have about ourselves are linked by problems. As such the things we see, dream and tell are linked together with this “problem story” about ourselves. Narrative therapists help people discover a better alternative story line about themselves. Again, this would be similar to one news programme having one version of a news item and another having a different interpretation, or narration of the same incident. Michael White, one of the founders of narrative therapy said “that the problem is the problem”. Although stating the obvious this highlights that not infrequently, we identify with the problem and then, we become the problem. So for example in the case of a teenager not talking to parents, the teenager can become the problem rather than the real problem (i.e the issue leading to him not talking). Narrative therapy, tries to create distance from the problem, so that we are able to see the problem for what it is.

While some aspects of therapy focus on the “here and now”, the past too is sometimes important, because a part of how we feel, think and act now, has been affected by our past experiences and the interactions. Thus, it may be that the way we interact with our children has something to do with how our parents interacted with us. Thus, ways of interacting can have consequences across generations. While, this is easily understood in terms of genetics, (e.g. your father is bald so you are bald!), it is the interactional component that is of interest in family therapy (e.g.My father was afraid of closeness so I adapted and became distant because I didn’t want to be rejected, and the same happens in my interaction with my son).

Family therapy provides useful models for understanding complex human interactions. However in mental health disorders this should always be in used in conjunction with treatment and medication where needed. Considering the dependent nature of the physical, social and emotional interactions of children, and also the struggles of adolescents in Sri Lanka today, working with families, used correctly can be an especially important tool when helping troubled children and adolescents.

(The writer is a Child and Adolescent Psychiatrist and Family therapist)

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