Family Relationships and Mental Health: What, Me Go for Therapy?

Posted on Tue, Apr 26, 2011 @ 11:17 AM

Image by Régine DebattyThis summer marks the 100th anniversary of the American Psychoanalytic Association, founded in 1911 on Sigmund Freud's approach to psychotherapy. Perhaps this is as good a time as any to untangle some of the misconceptions we may hold about our options for addressing mental health issues, now that a century has passed since his theories began to be disseminated.

For many people, the word "psychotherapy" is synonymous with Freud, bringing to mind terms such as sexual repression, oedipus complex, transference, anal retention, and the unconscious. These concepts may invoke the ubiquitous image of a patient reclining on a couch while a psychiatrist with a goatee taps a pencil on his knee and frowns up at the ceiling. No doubt we owe the persistence of this stereotype to media representations, but many people fail to realize that Freud's specific approach to therapy, known as psychoanalysis, has steadily lost popularity since its heyday in the 1960s. Today, only a small percentage of psychotherapists use psychoanalysis in mental health treatment. Extremely time-consuming in many cases and expensive to complete in comparison to modern therapies, psychoanalysis has  been forced to change significantly as modern research has failed to uphold many of Freud's original assumptions. One thing that hasn't changed however, is the fact that now, just as in the past, its admittedly few but faithful practitioners are most likely to be psychiatrists (who hold medical degrees) rather than psychologists or other mental health clinicians.

The thought of psychoanalysis certainly does not appeal to everyone, but it doesn't need to. There have always been alternative therapeutic approaches, such as those founded by Freud's contemporaries, Alfred Adler and Carl Jung, and new treatments have continuously evolved as advances in the field of neuroscience have reinforced certain aspects of therapeutic practice and weeded out others.

Considering that there are many different approaches to psychotherapy and that some therapists use combinations of them, choosing a therapist ls a very personal process and should not be taken lightly. Ideally, it would begin with recommendations from trusted family, friends, clergy, or health professionals. Whether to choose a therapist who works with individuals or one who works with couples, families, or issue-focused groups will naturally depend on the specific needs of the client or clients, but in any case it is important to be confident that the therapist will respect and be sensitive to the client's cultural identity, which includes areas such as ethnicity, gender, social class, and religion.

Modern approaches to psychotherapy, such as the cognitive behavioral therapy for obsessive-compulsive disorder (OCD) developed by UCLA's Jeffrey Schwartz, generally focus on changing the thoughts, emotions or behaviors that contribute to mental distress or dysfunction. Because of their focus on personal change, psychotherapies can be extremely useful, not only for helping people who suffer from mental disorders like OCD, but also for helping to resolve those relatively minor but maddeningly persistent and disruptive interpersonal issues that arise in family relationships. There is no doubt that learned behaviors and styles of relating to one another can be very difficult to change, even when we understand that change is necessary and are strongly motivated to achieve it.  Psychotherapy is only one of many tools—albeit a very useful one—that can help us as we work to replace habitual unwanted thoughts and behaviors with those that are more constructive.


Three Guys From Vienna
Sigmund Freud, Alfred Adler, and Carl Jung were associates for a period of time in Vienna as each developed his own approach to psychotherapy. In this collection of articles, Vision examines how well these three approaches have withstood the test of time.

Tags: family relationships, psychology children, family psychology

Bringing It All Back Home

Posted on Thu, Jun 04, 2009 @ 08:54 AM
UCLA study examines how outside stressors affect family relationships
stress and family relationships

A common theme of this blog is that much of who we are and what we do can be traced back to the quality of our family relationships. Positive, supportive family relationships contribute to our well-being in countless ways—while negative, abusive ones can be deadly.

Most parents would love to give their children the best possible environment in which to develop physically and emotionally: they understand that it's not only the immediate well-being of children that is at stake, but their future well-being—and that of the wider community as well.

But however ardently parents may hope to ensure that positive environment, it isn't always easy for them to do so. In Western society it is increasingly necessary for families to have two wage earners, and school, extracurricular activities and other obligations also encroach. Could there be an effect on family interaction as a result? If so, how? This was essentially the question explored by Rena Repetti and her colleagues at the University of California, Los Angeles, in a peer reviewed study published in the April 2009 issue of Current Directions in Psychological Science

"The family is popularly imagined as a stable haven, a place where individuals come together to recuperate from the ups and downs of the outside world," wrote the researchers. "But the family has ups and downs of its own; it is a dynamic system, not impermeable to outside influences but porous and continually in flux. For example, parents' job schedules and children's homework shape family time, activities, and routines. Other effects of work and school on the family are less overt." 

Certainly, as the researchers explain, we may continue to react to a particular stressor long after the event has occurred. As a result, we may continue to nurse our wounds after returning home. How does the fallout affect our family relationships?

"We have found that, following more stressful days at work, spouses and parents adjust their social behavior at home in two ways. One common pattern is an overall reduction in social engagement and expression of emotion," says the report. In a series of studies, Repetti and her colleagues found that mothers as well as fathers withdrew emotionally and disengaged socially from their children after stressful or exceptionally demanding work days, and spouses "were more distracted and less responsive" toward one another. Children also showed lingering reactions to school stress. Both elementary-school-age children and teens initiated more conflict with other family members after a day characterized by problems in academics or with peers.

"A second short-term response to job stress resembles the stereotypic image of an agitated employee kicking his dog after an argument with his boss," write the researchers. This plays out as "an increase in irritability and displays of anger with both spouse and children."  Ripetti and her colleagues note that this second pattern usually occurs in a particular subset of people: particularly those with a history of psychological distress.

How harmful is all this take-home stress in the long run? It depends. If the short-term effects are allowed to build up over time, there may be more lasting effects. Especially within families with high levels of conflict, or where one or more family members have a history of depression and anxiety.

We do know from other studies explored in this blog that family support and parental engagement are crucial to the well-being of children, so if our coping style in reaction to stress at work involves withdrawing from our families at home, it can't be good over the long haul. As difficult as it may be to push ourselves out of our comfort zone, resilience experts suggest that connecting rather than withdrawing is our best bet for handling stress. Rapetti's research is fascinating and important in several respects: but perhaps the most important thing parents can take home from this study is a new awareness of what they may be bringing home to their children at the end of their work day.

Tags: psychology children, research family, social relationships, children emotional, development children, families and children, job and family, resilience research, stress child, stress children