Family therapy has its origins in a family research project with schizophrenic patients.
Over time, family therapy approaches have developed to be used in many different problem areas. These include Systemic Family Therapy, Structural Family Therapy, Strategic Family Therapy, Psychoanalytic Family Therapy, Experiential Family Therapy, Constructivist Family Therapy, Cognitive-Behavioral Family Therapy, Functional Family Therapy, Contextual Family Therapy, Solution-Focused Family Therapy, and Medical Family Therapy, depending on the skills of the clinician and the needs of the family.
What is family?
There are many people who have defined the concept of family throughout history. As common features of different definitions, it can be defined as "an association of individuals who have biological and psychological ties; who have a historical, emotional and economic union between them and who feel themselves as members of the same house".
How should healthy families be?
The communication styles, domestic processes and coping skills of families determine whether they are healthy families or not. When we look at scientific research, we see that healthy families in every society, regardless of culture, adapt to change, set appropriate boundaries, build their relationships on open communication, support taking responsibility, trust each other and are optimistic about the future.
Studies have shown that healthy families exhibit the following characteristics;
- Sharing and understanding their feelings,
- Acceptance of individual differences,
- Communicating a sense of care and love,
- Cooperation,
- Sense of humor,
- Meeting basic needs,
- Solving problems without confrontation,
- Ensuring mutual appreciation,
- To have gained skills to cope with problems,
- Commitment to family members and family,
- Mutual appreciation and closeness,
- Willingness to spend time together,
- Effective communication patterns,
- High level of religious observance,
- Ability to cope with crisis situations,
- Supporting/encouraging family members,
- Clear definition of roles.
Why is the family system breaking down and how can it be fixed?
The development of technology, increased individualization and easier access to information are among the most important reasons for this. Today, it is easy to disrupt harmony within the family. Especially the inability of family members to adapt to their rapidly changing roles (e.g. working parents) disrupts communication and interaction within the family. These changing roles disrupt the social and psychological existence of family members. For these reasons, family therapy is one of the services developed to support families experiencing various problems in modern society.
What should family members do in the face of illness, which is a life event, and how should family dynamics be protected?
Today, our modernized living conditions, the changing cultural structure on the one hand and the irregularity of economic systems on the other, and the widening gap between the socio-economic levels of families lead to various problems. The most important of these problems is the illness of one or more of the family members, the acute development of this disease, its chronicization, and the fact that it causes losses have led to the need to approach families from a different perspective. "Medical Family Therapy" is a therapy method that is involved in the process at this point.
What is Medical Family Therapy?
Medical Family Therapy considers the person as a biological, psychological, social and spiritual being. In practice, it focuses on the patient's relationship with the family, the patient's relationship with other health professionals and cooperation. The main starting point is that there cannot be a psychosocial problem without biological characteristics, just as there cannot be a biomedical problem area without psychosocial characteristics. Medical Family Therapy is a method that can be used not only in the field of psychiatry but also with other disease groups in medicine, and when it is made a part of the treatment, it plays an important role in the patient's struggle with the primary disease and protects family relationships that may be damaged by the disease.
Medical Family Therapy has highlighted a number of shortcomings of existing treatments. These points are as follows;
- Descartes' Fallacy: Descartes made the body-mind distinction. Based on this point, physical and mental health have been separated from each other and their treatments have come to a breaking point. In fact, what is emphasized today is to think of physical and mental health together and to address them in treatment.
- Underestimating the role of the family: Most treatment modalities externalize the family and continue treatment with the patient as their focal point. However, in Medical Family Therapies, the family is seen as "a space with strong interpersonal relationships in which the patient lives". Separating the patient from this power field fragments and complicates the treatment.
- Miscommunication between the family and the treatment team: If there is a chronic disease process and long-term treatments are required, families are excluded from the process, which both worries the family and causes the family, which is an important part of the treatment, to play an incomplete role in the process. Medical Family Therapists act as a link between family members and the healthcare team, which is an important aspect of treatment.
In the 1950s, the inclusion of the family system in treatment, focusing on the interconnectedness of individuals within the social system, was a fundamental shift. The family is the basic unit of care that needs to be included in the treatment, apart from the individual patient. In some disease groups, the care of the sick person alone is not enough. The care of the family is also necessary in the process. Medical Family Therapy practices began in the 1970s and early 1980s with the collaboration of family physicians and marriage and family therapists in the medical field to fill this gap between the biological and psychosocial fields. One of the shortcomings in this field in our country is that marriage and family therapists are not included in the working process alongside family physicians. The fact that marriage and family therapists work primarily in cooperation with family physicians, and that families are included in the process in hospitals will perhaps solve many problems, facilitate treatment, and prevent family tension due to illness.
What have I seen in practice?
In both physical and mental illnesses that come in the form of attacks, which can become chronic, disrupt physical, mental health and social functionality, and interfere with the daily routine of the person, in addition to the fact that the individual struggle with the illness is difficult, the process is made more difficult by families who do not understand the process, do not show sufficient care and support, or exaggerate the situation with too much attention. When the patient is deprived of family support, his/her power to fight the disease decreases and the course of the disease can be negatively affected. For example, when I was working with the MS patient group, I often received feedback from my female patients that their husbands did not understand them, their illness and forced them to do housework. However, in some cases, MS patients have difficulty in motor skills and even have difficulty in walking. It is important to provide psychoeducation to the family at this point, to explain the seriousness of the disease and to get the cooperation of the family. In psychiatric patient groups where medication compliance is important, it is also important to get the support of the family for the treatment to be "complete". At these points, the fact that the support of Medical Family Therapy will continue to increase in our country in the long term suggests that it will be supportive to patients and will provide advantages such as the protection of family relationships, the correct guidance of the effect of the disease on the family, and a healthy treatment process.
