Comparing family support methods of counseling

There was a time when psychology was entirely individually focused. There was no such thing as “couples counseling” or “family therapy.” All emotional distress and mental illness were viewed as individual problems solved by exploring the repressed emotions, subconscious desires, core beliefs, and ego defenses of the patient.

Today, many therapists are trained to not only be curious about the inner-world of the patient, but also to view the person as existing in the context of their family “system”, as well as the social-political location at the intersection of race, gender, class, ability, sexuality, and age. This views each person as being influenced by - and influencing on - their relationships, family, and community. You can imagine the individual view as how an architect would approach a remodel - by looking at the blueprint of a house and deciding where to make changes. You can imagine the systems view as how a biologist would approach an improvement project on a pond, aware of how changing any aspect of the eco-system might have positive or negative consequences for the whole system and each flora and fauna that lives there.

The development of family-systems thinking in psychology made the way for many new ways of providing counseling to individuals experiencing mental illness, and also ways of providing counseling to their family members. Through the second half of the 20th century, this family-systems thinking had trouble infiltrating the corner of psychology that treats Substance Use Disorders. This was largely because that space was filled entirely by the detachment-focused approach of Alanon that was born in the 1950s and the confrontational and demand approach of Johnson method Interventions (like the ones you see on TV) that began in the 1960’s, with little wiggle room to accommodate diverse ideas.

That is no longer true today. Today, there are many family based interventions for people with mental illness and Substance Use Disorders. Some of these approaches, like Community Reinforcement and Family Training (CRAFT) have decades of research demonstrating their effectiveness, even if the community of counseling providers have been slow to adopt these practices. Others approaches are newer and are just beginning to have a research base being published, but show much promise in consistently and effectively helping families.

I recently sat down to compare some of these approaches, as I expand my own training to make sure I keep up to date on emerging and promising approaches. [find the comparison here] I want to share my comparisons so that families and providers can better understand the array of tools that are available to support the loved ones of people with mental illness and addiction. This comparison is not exhaustive. I did not include approaches for “at risk youth” such as MST and FFT or approaches aimed at parents of children such as SPACE or Incredible Years. This comparison focuses on approaches appropriate for partners/spouses and parents of emerging adults. If you are a practitioner of one of these approaches, and have comments or edits to add, please contact me and I will continue to update and improve the comparisons.