A child’s poor schoolwork may be a cry for help in family relationships. If the family’s request for help is ignored, the school may be left with a refractory educational problem and an angry child who may continue to fail until someone finally gets the message. In most instances, when children fail in school, some form of family therapy is warranted.
The goal of family therapy is to change structures and processes in the family or in its environment so as to relieve existing strains. Family diagnosis based on living systems theory makes it possible to determine whether pathology lies in a family as a whole, in one or more individual members, or in a suprasystein, such as an economically disadvantaged neighborhood or a school with limited resources.
The range of interventions available to families is considerable. The health, mental health, social service, pastoral care, and educational systems all deal with family problems. The field of marriage counseling has specifically focused on one aspect of the family, and family service agencies handle all aspects of the family. For faltering families the marital relationship is the most important locus: marriage counseling or marital couple therapy may be useful. For families with more serious problems, self-help groups such as Alcoholics Anonymous, Parents Without Partners, and Parents Anonymous are available in most communities. Child psychiatrists deal with the range of child, adolescent, and family problems.
The fit between clinical resource and a family is critical. Ethnic and economic factors may override psychological issues. Every clinical resource sets some limit on the range of factors it can work with in both diagnosis and therapy. These limits evolve out of the history peculiar to a given clinical setting, the training backgrounds of professionals, the socioeconomic sur¬roundings, and the nature of the social pressures.
Motivating Families for Therapy
Professionals should be sensitive to the misunderstanding, hesitation, and fear in family members as they approach help.
Each family member’s level of sophistication about psychological problems and openness to using a mental health resource varies. At the least education of the mem-bers of the family is required so that an intellectual understanding of the reasons for working with the family can be achieved. This step often is omitted with resulting misunderstandings.
Troubled families are the most likely to lack insight and even the strength to engage in family therapy. Their defensive maneuvers may he so extreme that engaging the family in therapy may depend upon equally skillful maneuvering by the therapist or the external pressure of agencies, such as the schools and the courts. If given a choice, many of these families would either drop out or limit their involvement to supporting treatment of the identified patient. Their denial and projection are particularly difficult to handle.
Ferreting out the family’s expectations of therapy is an important step toward assessing their motivation For change. For example, because dominated families involve both family and individual psychopathology, they often lodge their concerns upon a single identified patient. The other family members may not be disposed to see themselves as a part of that person’s problem and certainly not as the focus of therapy. When an attempt is made to involve the family, the parents may withdraw and look for someone who will “help”. the family member identified as a patient. As a strategy, the therapist may need to appear to join the family in its efforts to change the symptom bearer as a means of involving the entire family with the passage of time.
Conflicted families usually, require intensive family therapy in addition to consultation to other systems. such as the schools, social services, and law enforcement agencies. Chaotic families are the most difficult to engage in family therapy because their views of reality are not congruent with their social milieu. Hospitalization, medication, and consultation to other agencies may be necessary. in order to provide a foundation for family therapy.
A delicate issue in motivating families for treatment is how to separate a clinician’s responsibility to assist the family from the family’s responsibility for change. This is a problem especially when other agencies are involved with the family. For example, both school personnel and parents may look to a clinician for answers about a child. In these circumstances the clinician must carefully keep the child and the family in the position of responsibility and work through them for inter-system negotiations. Unsuccessful management of this issue can make the clinician a scapegoat by permitting both the parents and school personnel to expect that the therapist is responsible for changing the child.
From the educator’s point of view, it is important to he aware of the complicated role of the family in a child’s school problems over which educators and parents find themselves in conflict. Some parents obtain satisfaction from this fight, because they were embittered by their own past unhappy school experience and find this opportunity to retaliate. The child has an especially important role to play in this manipulative struggle. In the battle over who will control the helping process, if the school and clinical team are not coordinated, a family can find a weak link and defeat both. An effective position for school personnel in these situations is to recognize that no one can help the child until everyone works together.