Family Therapy

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practical

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Family Therapy
« on: August 05, 2018, 01:39:14 PM »
I came across the below recently and wanted to share it as I know this is a topic that comes up again and again here as well as on the PDparents board and causes feelings of guilt and "shoulds" and often more pain.

This line stuck with me in particular:
"Are there certain dynamics that can't typically be helped with family therapy?
Yes, when there is a significant amount of emotional abuse or interpersonal violence. People cannot speak freely with someone they are afraid of for fear of retaliation."
It is from an interview with Jacqueline Hudak, a licensed marriage and family therapist, in the WSJ 8/10/18 "Can Family Therapy Help?"

I have never considered family therapy, short encounters of how M used her personal therapy to blame others, to somehow enhance her status and her T as her ally made this never a tempting option for me. F blankly refuses any kind of therapy, other than using me as a therapist. I never want to hear again what I had to listen to over the years, not even in a setting with a professional present. These are his problems, which had a negative effect on me but I wasn't the cause. Everything he told me was a boundary violation, same is true for M, who used to abuse me as her therapist. Maybe if each had seen a T and really worked on themselves I would have considered family therapy, I'll never know.


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Here is the full interview:

Can Family Therapy Help?
‘In a family there is constant tension because a life cycle is about change.’ An expert explains how marriage and family therapy works—and when it doesn’t.
By Elizabeth Bernstein

Does your family need therapy?

Jacqueline Hudak, a licensed marriage and family therapist, discussed how family therapy works and when it is beneficial. Dr. Hudak has been a family therapist for more than 30 years and has a private practice in Red Bank, N.J. She specializes in helping individuals and families through difficult transitions.

Dr. Hudak teaches family therapy theory to psychiatry residents at the University of Pennsylvania’s Perelman School of Medicine. She also is clinical director of the school’s Center for Couples and Adult Families, which provides clinical services for families. Here are excerpts from an interview:


What is family therapy?

It’s a kind of psychotherapy that is different from individual work, in which the therapist interacts with the patient from a pathology-based model. The family is seen as a system. To understand the individual, I don’t look at a patient and think about what is going wrong inside them; I think about what happened between them and the significant people in their life—their partner, siblings, parents, kids. To me, that is the genesis of so many of their problems.

One of the important characteristics of a system is the perpetual movement toward homeostasis. People like things being the same. The response to change can be a very powerful pushback. In a family there is constant tension because a life cycle is about change. And sometimes the system can’t tolerate it. Some of the changes are expected, such as birth, death, marriage and adolescence. But sometimes life hands us unexpected challenges—people can develop other health issues: psychiatric problems, mood disorders, chronic health problems, addiction.

Think of a family system as a bunch of people dancing together in a particular way. They have been doing this a long time, perhaps generations before they ever got to my office. I have to learn the dance steps of each family member. Then I coach them on new dance steps.


How does family therapy work?

There is no one way. Typically I want to see the parents first. I’ll draw a genogram, or family tree, going back several generations. I want to know who came to this country and when. That elicits stories, maybe of what happened during the war, or persecution or loss, or tragedy or resilience or courage. These begin to tell me some of the things that are important to them. And it helps me understand the context of what they grew up in and how it impacted how they parent.

I think people’s notion of family therapy is you just throw everybody in the room together. That’s not true. I bring in different constellations of the family—sometimes individuals, sometimes pairs, sometimes everyone together.

I say you should give family therapy at least nine months to a year. But I don’t believe in keeping people in therapy. I am pushing people to go out and live their lives and if there are problems to come back.


How do you know when a problem warrants therapy?

Often, whoever is suffering—the symptom bearer, the acting-out child or depressed adolescent—is targeted for treatment. They go to therapy. But sometimes it doesn’t work. When symptoms continue unabated despite other treatments, maybe the family system needs support. You can always come for a consultation, to see if it may work.


Has your therapy style changed over the years?

I have gotten much less attached to a particular theory and way of doing things. And I am much more collaborative with my families, to see them as experts in their own story. I am more interested in how they see it, as opposed to how I see it. I am really interested in getting people to be researchers into their own lives.


Can a person go to family therapy alone?

Absolutely. A lot of individual, family-oriented work is around coaching that person to change how they behave in difficult relationships with their family members. Because one person’s change does impact the system. Think of the mobile that hangs over a crib: When you touch one piece, it moves the entire mobile. Such is the case with a family system. Even happy events—going off to college, the birth of a child—can throw a system into a state of disequilibrium. And one person going to therapy and making changes in their role in the family is going to impact that system and effect change.


How can you get someone in the family to go if they refuse?

It is almost like the laws of physics: If you are pushing, you are giving someone the opportunity to resist. So I say invite the person and if they don’t come, tell them you are going anyway. This is very powerful, because it is threatening for that person to be left out. Imagine that shift in energy. I coach clients to say: “We really like working with this doctor and we are going back. And I don’t know what is going to happen but I think we are going to start changing.” The person who has been resisting will probably show up because he wants to know what is happening. And even if he doesn’t, this approach will effect change.


Do you share information from each family member with the others?

The question is not if we share but when and for what purpose. I tell young adults that everything you tell me is confidential unless you’re going to hurt yourself or someone else. But I am going to tell you when you need to talk to your parents. It’s really about selling the idea of family members having a conversation, not me sharing the information. I am the least important person in the room.


Do you take sides?

No, unless there is a case of interpersonal violence or emotional abuse. If someone is calling someone a name, I say you need to stop that, it is going to make things worse. But otherwise I practice multi-partiality—the capacity to see everybody’s point of view. I try to understand why people feel so strongly about something.


Do you give homework?

Yes, a lot. One assignment is letter writing. Sometimes I have them write letters for their own edification, sometimes the letters are meant to be shared.

Sometimes I will say: “Here is a great question. I want you to think about it. What will life be like when all of your kids are gone from the house?” Sometimes I ask them to do more research on their own. I might say: “Call up your mother and ask her what happened in the family in 1962. You got really symptomatic then.”


Has being a therapist affected your own family?

I erred on the side of caution. I had a lot of stories in my mind about what could go wrong, especially from a safety point of view. I think I also have high expectations around our capacity to have conversations, and feel connected to each other.


Are there certain dynamics that can’t typically be helped with family therapy?

Yes, when there is a significant amount of emotional abuse or interpersonal violence. People can’t speak freely with someone they are afraid of for fear of retaliation.

But, in general, I think most problems can be mastered, which is different than being solved. Mastered means you understand what this is and recognize it and can tolerate it. Not everything is resolvable. You can’t always change the circumstances. But you can master the situation.
« Last Edit: August 05, 2018, 01:41:32 PM by practical »
“If I’m not towards myself, who is towards myself? And when I’m only towards myself, what am I? And if not now, when?” (Rabbi Hillel)

"I can forgive, but I cannot afford to forget." (Moglow)

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openskyblue

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Re: Family Therapy
« Reply #1 on: August 05, 2018, 04:25:11 PM »
This part is also so worth reflecting upon?

"But, in general, I think most problems can be mastered, which is different than being solved. Mastered means you understand what this is and recognize it and can tolerate it. Not everything is resolvable. You can’t always change the circumstances. But you can master the situation."
Even a blind man can tell you when he is standing in the sun.  (Percy Sledge)

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Moxie890

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Re: Family Therapy
« Reply #2 on: August 06, 2018, 05:43:11 PM »
Thank you for posting this. Family therapy had been a "what if" of mine. Last year uBPDNm suggestest I go to therapy with her. At first I refused, but about 6 months later I agreed. It was almost as if I didn't say anything, or she didn't hear me. She never said another word about it, or set up an appointment. I think she only offered for show, and my eventually agreeing to go called her bluff. I found myself wondering what if I pushed harder, and we did go to therapy instead of me limiting our contact. This article helped alleviate some of my guilt.

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carrots

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Re: Family Therapy
« Reply #3 on: September 08, 2018, 05:48:38 PM »
This line stuck with me in particular:
"Are there certain dynamics that can't typically be helped with family therapy?
Yes, when there is a significant amount of emotional abuse or interpersonal violence. People cannot speak freely with someone they are afraid of for fear of retaliation."

Yes, that quote really struck me too.

Thanks for posting this practical! I've read it a few times. It's interesting to see what family therapy can be. There's no way I'm going to therapy with FOO though imho they all need it. In fact, it's the only way they could have more than vvvvlc with me. But it won't happen, FOO won't be going to family therapy.

It reminded me of what B1 told me when we were in our 20's: that of course back then in our teens the whole family should have been in family therapy and that the family therapist would have congratulated him on getting on so well with a really difficult sister. At the time I just listened, sad and speechless and unbelieving at the degree of cluelessness. Too bad B1 will never read the responses under Do you share information...? and Do you take sides? He would get a shock. Except he won't remember he ever said that to me. He also did worse than just calling me names.

Anyway maybe somebody can have a laugh at such a ridiculous remark. I saw the irony the first time I read but now I feel the sadness especially knowing that family therapy couldn't have helped my FOO. There's just too much FOG and denial. In retrospect it's also hard for me to believe that a therapist would have remained neutral and not ended up believing FOO and blaming me. But that's all water under the bridge now. Therapists have changed in the past decades anyway, understand e.g. more about cptsd beginning in childhood due to dysfunctional families.

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Gaining Clarity

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Re: Family Therapy
« Reply #4 on: September 08, 2018, 06:58:28 PM »
Practical: Thanks once again for posting this article here as well as on my recent post. It has helped me and undoubtedly, will help others.

Carrots: The same quote of the article resonated with me as well. There is just too much emotional abuse in my FOO to be overcome with therapy.

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all4peace

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Re: Family Therapy
« Reply #5 on: September 08, 2018, 07:00:27 PM »
Same quote stuck with me also. UNBPDm actually requested I go to therapy with her. It makes me shudder to even consider it.

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Gaining Clarity

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Re: Family Therapy
« Reply #6 on: September 08, 2018, 07:13:12 PM »
I can relate to the request thing. Mine demanded an answer on the spot as to whether I would go, not just once but twice. Not exactly the best way to convince people you're sincere, right?

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all4peace

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Re: Family Therapy
« Reply #7 on: September 08, 2018, 07:46:49 PM »
Mine is working from the premise (stated by her) that we each share half of the responsibility for the state of our current relationship. I don't know how to explain that when you behave as she did in our childhood she set off a bomb in our relationship, in our nervous systems, in our self-esteem and brains, our marriages, our parenting. How would I even begin therapy with someone who literally never stops lying, who admits to nothing more than mere imperfection, who hasn't listened to a single thing 3 out of her 4 children have brought to her attention (#4 doesn't bother)?

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Gaining Clarity

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Re: Family Therapy
« Reply #8 on: September 08, 2018, 08:09:24 PM »
All4peace,

I understand where you're coming from. Hope you and your sibs find peace.

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all4peace

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Re: Family Therapy
« Reply #9 on: September 08, 2018, 08:12:30 PM »
You too :) We're working on it, and I imagine uNBPDm is wondering why her offspring are so cruel as to not have her at the center of our lives... I have offered my perspective to any future therapist she might want to work with for her own sake. Crickets.

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VeryUncertain

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Re: Family Therapy
« Reply #10 on: September 11, 2018, 12:53:41 PM »
This line stuck with me in particular:
"Are there certain dynamics that can't typically be helped with family therapy?
Yes, when there is a significant amount of emotional abuse or interpersonal violence. People cannot speak freely with someone they are afraid of for fear of retaliation."

I tried to go through family therapy (FT) with NPDm as an adult, I was not  afraid of retaliation, and there was obviously no way for me to instill fear, nor would I want to, and we were already at an impasse of minimal contact.

For me, FT was a heartache and largely a waste of time.  I think that PDs have internal extreme fear that connot be addressed and these fears well up and overwhelm them in situations that threaten their self-image.  I now believe that successful FT can only happen if people are willing to accept responsibility for their own actions, and accepting responsibility is always threatening to one's self-image.

So if you've never seen any glimmer of personal self-accounting or personal responsibility, FT won't produce the results you hope for -- it will not result in a positive change in the "dynamics."

The one positive note is that FT helped me achieve some clarity about the depth of the problem, though I still struggle fully internalizing the lessons.


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Gaining Clarity

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Re: Family Therapy
« Reply #11 on: September 12, 2018, 12:51:12 PM »
You are so right, VeryUncertain. I'm glad that FT helped you personally, if not your own FOO situation.

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SaltwareS

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Re: Family Therapy
« Reply #12 on: September 23, 2018, 07:55:36 PM »
Thank you for posting. My npdParent dragged me to FT and I did not want to go. NPDParent did not know at the time I had a personal T. My Personal T urged me to go without any precautions or game plan and IT WAS NOT A GOOD EXPERIENCe.

I tried to explain privately to the Family Therapist that this relationship could not be fixed. I tried to limit FT to one session. But the therapist did not hear me and it dragged on. When privately I said to the therapist we need to confront my npdParent about x, the family therapist would nod her head. Then when my npdParent was there, the family therapist grew timid and did not confront my npdParent on anything, but proposed we keep extending therapy for a few more months.

It was such a disaster - why "talk it out" with someone who lies. They will never see the light. I want that family therapist's license pulled and I have determined she has npd herself. When I tried to confront her a few months after therapy wrapped, trying to understand why my request to end therapy wasn't heard by her, this therapist was so convinced she'd helped me tremendously and was convinced I was returning to her office to seek more of her wise counsel. She was really resistant and impervious when I made my "constructive criticism" more explicit.

A few therapists out there are good at what they do. Quite a few however have npd themselves. I am sorry but people need to be warned.

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SaltwareS

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Re: Family Therapy
« Reply #13 on: September 23, 2018, 09:25:14 PM »
I have to add something because in the years since this all went down, I've tried to talk to people in the profession and when you look at the structure of the entire profession, it's not going to reform itself. Think about it - if you hate the idea of answering to a boss, one job you might look into is being a therapist. After you get your license you have no supervision.

When I was talking to my personal T about my resistance to going to family therapy with my npdParent, my personal T who specialized in CBT (where you challenge black-and-white thinking, or challenge negative beliefs) said "just because your parent lied in the past it doesn't mean your parent will like in therapy."

OK those were not his exact words. I said I didn't want to go to therapy he said why not. I said because npdParent lies. CBT therapist replied just because something happened in the past it doesn't mean it will happen again.

It shows the *bug* in CBT, which at first seems like a miracle form of therapy to people who have tried other forms to little avail. After a while the simplistic challenge by the therapist to every thought the client has can break down. And how did I not catch that myself? I have been living basically in a traumatic trap since that time, mad at myself that the dialog with my personal T went by so fast and that I caved to his very very faulty reasoning. I have not forgiven myself. I will now.

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SnugglyHedgehog

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Re: Family Therapy
« Reply #14 on: September 24, 2018, 11:17:11 AM »
My Aunt suggested mediation the last time we discussed it.
I explained that my uNM would not agree to that as that would require admittance that she had done something wrong.
I also explained that I wouldn’t be able to talk freely and be honest in front of her because of her reaction.
This article pretty much hits that nail on the head.

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openskyblue

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Re: Family Therapy
« Reply #15 on: September 24, 2018, 12:59:41 PM »
I went to extensive couples counseling with my NPD exhusband, and I can concur that therapy did absolutely nothing to change his thinking or his behavior. Actually, I think the therapy hurt me and delayed my healing and understanding of what was happening in our marriage -- for years.

It's been my experience that most family and couples therapists are trained to bring people together, heal relationships first and foremost. On top of that, many therapists are just not trained or equipped to handle someone with a PD. Since PDs can't be treated effectively with medication and therapy methods don't work with them, therapists tend to focus on the person in the equation who can change and self-reflect on their behavior - the nonPD. This happened over and over in our sessions --- confirming to my NPD exhusband that I was the one at fault and he was just fine. He was great at convincing the therapists that I was exaggerating his behaviors or he flat out lied. He was such a pro at circular arguments, most sessions devolved into one big upsetting NPD mess.
Even a blind man can tell you when he is standing in the sun.  (Percy Sledge)