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Family Systems, Part One: What is family therapy, and why is it part of mental health treatment?

This article is the first in a series about family systems and the reciprocal relationship between family therapy and mental health treatment.  If nothing else, the pandemic has brought each of us a greater understanding of how we relate to one another: we miss our co-workers, we miss simple interactions with our neighbors, we start to see our children and significant others differently, and in many cases, we come to understand just how comfortable (or uncomfortable) we are with isolation.  In other words: we have started to look at the systems in which we live and operate, and we start to see how meaningful these systems are to us.  As the pandemic has progressed, researchers and treatment professionals have come to closely examine the impact that addiction has on the family system – and the effect that family system has on the cycle of addiction.

When therapists and clinicians talk about “family therapy” or “family systems,” they are referring to a field of psychotherapy pioneered by psychiatrist Murray Bowen and psychotherapists John and Julie Gottman.  While their clinical philosophies and models differ somewhat, it is their collective bodies of research – beginning in the 1970’s – which have produced numerous clinical titles, training programs, research studies, and treatment centers which incorporate family systems in their treatment of patients.  In the following years, other researchers have expanded this dynamic field of study, with foundations influenced by these pioneers (Brown, 2013).

The innovators in family systems therapy observed that families developed consistent patterns in order to neutralize anxiety; specifically, anxiety caused by perceived distance or closeness in familial relationships.  External stress and sensitivities over time within a family system intensify these anxieties, leading to repeated patterns handed down from one generation to the next within the family.  Family members who react emotionally to conflict or angst instead of responding with a healthy sense of emotional awareness can fall victim to a state of chronic anxiety or reactivity.  Both Bowen and the Gottman’s sought to resolve this family anxiety by “1) facilitating awareness of how the emotional system functions; and 2) increasing levels of differentiation, where the focus is on making changes for the self rather than on trying to change others,” (Brown, 2013).  In other words, this therapeutic approach first helps families become aware of these patterns, and second empowers them to understand why these patterns have been used.  

It is through this treatment approach that we come to understand the coping mechanisms and survival instincts we have developed in reaction to familial stress.  Once we understand these reactions, and why we have used them, we begin to develop the ability to take responsibility for developing our own healthy responses within the family system, instead of trying to fix each other. 

Is there a connection between mental health treatment and family therapy?

Engaging the family in mental health and addiction treatment is far from a revolutionary idea. Over thirty years ago, McNabb and Der-Karabetian conducted a controlled research study of three groups which differed only in amount of family involvement in therapy.  Those individuals with the most family participation and engagement reported the highest long-term abstinence rates, and perhaps most telling: individuals from that group also reported to have better family relationships and higher self-esteem (McNabb, Der-Karabetian, & Rhoads, 1989).  Consequent research has confirmed this connection between family attachment and mental health – emphasizing the direct relationship between family wellness and long-term recovery from addiction both in adolescents (Liddle, Rowe, Dakof, Henderson, & Greenbaum, 2009) and adult couples (Kelley & Fals-Stewart, 2002).  

The key concepts of family systems

There are several key concepts to the collective body of research in family systems.  

  • Differentiation of self, 
  • Triangles, 
  • Nuclear family emotional system, 
  • Family projection process, 
  • Emotional cutoff, 
  • Multigenerational transmission process, and 
  • Sibling positions 

are all important topics. In the coming weeks we will discuss these further and what the role of family systems work is in mental health and addiction treatment.  While some of these concepts are fairly common in how we understand certain behaviors, others are less familiar; these concepts provide an important framework to explore the family communication dynamics, and how they affect the family system. 

In this series of articles about family systems and mental health we hope to continue the discussion about the theories, practices, and philosophy behind why we believe family therapy is a vital component of healthy family systems, and the establishment of lasting recovery.  We focus heavily on family therapy as a key component of each comprehensive treatment plan we develop at our intensive outpatient program.  It has been through the experience of working with many families that the founders and clinicians at New Paradigm Recovery have come to embrace the innate value of attachment.  We hope that you’ll continue to read with us and develop a better understanding of why we do what we do at our clinic in Northern Virginia.  Stay tuned!


Brown, J. (2013). Bowen Family Systems Theory and Practice: Illustration and Critique. The Australian and New Zealand Journal of Family Therapy, 20, 94-103. doi:10.1002/j.1467-8438.1999.tb00363.x

Kelley, M. L., & Fals-Stewart, W. (2002). Couples- versus individual-based therapy for alcohol and drug abuse: Effects on children’s psychosocial functioning. Journal of Consulting and Clinical Psychology, 70(2), 417-427.

Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E., & Greenbaum, P. E. (2009). Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(1), 12-25.

McNabb, J., Der-Karabetian, A., & Rhoads, J. (1989). Family Involvement and Outcome in Treatment of Alcoholism. Psychological Reports, 65(3_suppl2), 1327-1330.

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