Navigating the Choice: Family Therapy vs. Individual Therapy
The process of establishing clear boundaries within a family system, particularly after a period of ambiguity, can be deeply unsettling and even painful. This discomfort stems from a complex interplay of emotions: regret for past indistinctness, embarrassment at a lack of proactive structure, and a challenging re-evaluation of personal identity when previously relied-upon coping mechanisms – often developed in response to parental dysfunction - no longer serve a purpose. Specifically, individuals who have been “parentified” - burdened with responsibilities beyond their developmental capacity – may experience a loss of self-esteem as they relinquish ineffective attempts to control a system where they lacked genuine power.
This dynamic highlights a crucial point frequently enough overlooked in therapeutic settings. The very lack of clarity that contributes to problematic family behaviors can be inadvertently replicated in therapy itself, when practitioners prioritize client autonomy to an extent that undermines effective intervention. As an example,the author draws a parallel to parents allowing children unrestricted access to dessert,believing they possess the self-regulation skills they haven’t yet developed.
The question of whether individual or family therapy is most appropriate, the author argues, isn’t a new debate, but one often sidestepped due to a decline in therapeutic expertise. Many clinics currently allow clients to dictate the mode of therapy, a practice facilitated by a shift in focus from demonstrable skill to simply obtaining a diploma. This can result in a therapist lacking the necessary training to accurately assess the situation and recommend the most effective approach.
The core principle guiding this decision, rooted in established family therapy practice, is to include in therapy the person who wants change, the person who must change, and the person who can change. The author expands on this, stating that when all three roles are embodied by a single individual, individual therapy is the correct course.
This distinction hinges on understanding the systemic nature of the problem.If the individual presenting for therapy is not the primary driver of the problematic pattern, but rather is impacted by someone else within the system who maintains it, family therapy is indicated. As described by Wachtel (2014), this dynamic can be understood as a “vicious circle” with a “vicious accomplice.” Behaviorally, if the consequences of the client’s behaviour are directly tied to the reactions of specific family members, a family-based approach is warranted.
In essence, if the client’s therapeutic goals are largely defined by their relationship with another person or family unit – such as improving a marriage or creating a more functional home surroundings – couples or family therapy is the logical choice. However, if the client’s goals extend beyond these relational dynamics, encompassing broader life aspirations, individual therapy can be effective, provided the client is not currently living in circumstances that necessitate reliance on the problematic patterns being addressed.
For those seeking a qualified therapist, the Psychology Today Therapy Directory (https://www.psychologytoday.com/us/therapists) provides a valuable resource.
