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All in the Family

by | Relationship

During a recent session with a couple, one partner lamented an aggravating and ongoing dynamic within his family-of-origin. I paused, sighed, and said, “Family.” To which he replied, “Yeah… the other ‘F’ word”. Later, I reflected on my client’s evocative rendering of the family and how it suggests shadow. Where there is shadow, there is also light.

In his book, Care of the Soul, writer and psychotherapist, Thomas Moore, characterizes one’s family of childhood as the “raw material from which we can make a life.” Indeed, the family-of-origin is a paramount starting point to the lives we create and a stirring portrayal of the vastness of shared experiences and emotions.

At NCCT, we support the family through our therapeutic work with couples – a subset of the larger family system. While family therapy and couples therapy possess distinction, there is an inseparable quality that keeps them allied. That quality or “glue” is Family Systems Theory – a set of principles that views the family system as larger than the sum of its parts.

I recently had the pleasure of interviewing the newest member of our NCCT team, Kasia Novak, a licensed marriage and family therapist (LMFT), who brings a bounty of insight into this very topic. Discussing the intersection of family systems and couples therapy, we unpacked the fundamental principle that when one person in the couple or family is struggling, so is everyone else.

And, sometimes that impact hurls shock waves through the entire family, requiring added support from the outside.

Cue the therapist.

How does Family Systems Theory hold relevance and show up in your work as a therapist?

I always explore the client’s family-of-origin, ideally going back three generations. This practice of assessment is critical for me because I can’t see my clients as separate from their families. I use the genogram, a powerful information-gathering tool, and rapport-building intervention, to discover and understand the family system’s patterns, roles, boundaries, and cultural norms impacting their functioning.

Looking at stress in a multi-dimensional way is also helpful. Stressors due to life events and unpredictable events through the life span are known as horizontal stressors. Conversely, connected to the dynamics of our lives, values, beliefs, secrets, rules, and norms are classified as vertical stressors. Each person brings those vertical-stressor influences to their relationship. Looking at both dimensions of stressors impacting the couple can be enlightening.

Can you say more about why this appraisal is so critical?

When I meet with a client, the first thing I do is assess how the family system relates and functions. I want to know how the family is set up structurally. Because I see the couple as a subsystem of the family hierarchy, I start with them. For instance, in Structural Family Therapy, the family is believed to best function in a type of hierarchy, with the adults “at the top.” Particularly for couples with children, this concept ensures care, protection, and guidance rather than authoritarian dominance. The current functioning of the family tells me how well-constructed it is, starting with the couple’s relational health. This understanding guides my work from the moment I begin.

Who are some of the “greats” in Family Therapy that you love, and why? How do you incorporate their ideas into your work?

I have so many favorites. And, as I said before, I want to see what shows up in the session in terms of the family or couple’s needs and goals. Once I understand the issue(s), then I can decide which model will work best. Of course, we can’t know right away what exactly is going on or causing the presenting issues, that’s why I come up with my systemic hypothesis and work from that point with curiosity and care. I’m gathering and waiting with the clients to see what continues to rise to the surface.

For couple’s therapy, I think John Gottman’s model of treatment and Sue Johnson’s Emotionally Focused Therapy (EFT) are universally applicable because they speak to attachment, connectedness, and chronic pitfalls. Additionally, they offer practical interventions that are doable. For instance, Gottman’s Dreams within Conflict exercise is the perfect complement to the work of reinforcing the couple’s connection and genuine support of one another’s hopes and dreams.

Do you think a family struggling with a “problem child” could benefit from couples therapy?

Of course! In my work with families and children, I often notice a mentality to get the child to behave better. But, if I look around and only see the child in my office, I quickly realize that I need to get the adults there, too. Children don’t necessarily exhibit negative behaviors without reason. If they are here with me, then their caregivers being there can be very helpful, too. I’m very direct in that way because I understand a child’s negative behaviors can often be connection-seeking, and that requires caregivers to be part of the therapy. Even if the parents are not a “couple” – maybe they are not together but rather a co-parenting dyad – I want them there just the same.

What have you gained from your work with families, and how will you incorporate this into your work with couples at NCCT?

In working with families, I’ve seen how crucial it is to strengthen the couple’s partnership to generate a change in the family. Often a child becomes the “symptom bearer” for the family, and parents want me to extinguish the negative behaviors. So, I include the parents to deepen insight into possible repeated, maladaptive family-of-origin patterns. I take note of any tendencies that might look like conflict avoidance, for example, and I examine the attachment or lack thereof within the couple. I’ll continue to practice this way at NCCT with a focus on the partnership and relational health of the couple.

How is working with families the same as working with couples, and how is it potentially different?

The way I see it, one system is encompassed within the other. The couple is part of the family, yes. But, the family we grew up with also enters into the newly formed couple. You can’t have a couple without the influence of the family, and you can’t regard them as separate.

With both families and couples, I endeavor to deepen insight and gather information to understand what is currently impacting the system’s functioning. I focus on building rapport and trust. I notice how the system functions and where they are getting stuck.

There are differences in working with couples, too. The most significant distinction for me is that one system is voluntary while the other is not. We don’t get to choose our families we are born into, but we do get to choose our partners.  

I attend to these differences of choice and how that impacts the couples functioning. I emphasize these choices when I teach couples about repair, communication, conflict management, and connection. That’s fun work, reminding them that they can say “I choose you” again and again.

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