Why Family Therapy Doesn't Work And What We Can Do About It

Throughout my years as a therapist,  I have learned that the most deeply-rooted fears of an individual of any age must be calmed, otherwise he or she will never be able to deal successfully with another person.  The fears can be hidden,  “gated away” by the brain to protect itself.  Often the client himself may not even realize the extent to which fears are driving everyday behavior.   It is the therapist's job to coax these fears into the open and calm them.

All behavior is goal oriented;  people are trying to achieve something.  Behavior is a form of interpersonal negotiation.  Under normal circumstances this is o.k., but sometimes these negotiations and  behaviors can take some very odd and unsuccessful approaches.

For example, a deep lack of self-confidence could cause a spouse, or a parent, to present anything of importance to another family member in a scolding and shaming manner, perhaps because this person has deeply embedded fears about not being taken seriously or not being an important person.  The "scolder/shamer" may have fears of abandonment if he is not in control, and the scolding or shaming style of interaction assures him that he has attained the status of an important person and that he will be taken seriously, i.e., the much-desired control.  The fears are deeply embedded.  There is no value in trying to teach the “scolder” to communicate.  He is communicating.  Nor does the other family member need to learn to adjust to the scolding.  Effective treatment can calm both individuals so that they can successfully negotiate with each other and get their needs met without using coercion or capitulating to the will of another in a way that breeds resentment.

There are two main causes of failure in therapy.   Many treatments just recreate the old arguments and have the clients argue in front of the therapist.  The therapist fills the role of “teacher” and the clients vie to tell on one another and “be right”.  The key fears of the clients must be rooted out and calmed.  If they are not, in spite of any communication “rules” given, when the stress becomes high enough, each client will revert to old behavior, the same behavior that brought them into therapy in the first place.

The second cause of failure is fairly simple.  The efforts to change the mind, calm the fears, have not been applied with enough determination and the effort has not been consistent enough.  People often give up just short of a real healing.

Our wonderful minds are very much things of habit.  We think what we have thought before.  To change any habit requires a very determined effort.  I once heard the process of changing beliefs compared to the task of  moving the position of a huge ocean liner.  The boat is very heavy, thus there is huge inertia.  Tug boats push from all sides.  The tides may shift, again causing the liner to shift, perhaps not in the desired direction.  Again and again, I used to watch this process from my apartment in New York, which overlooked the Hudson River docks.  Impatience could bring disaster: a precipitous crash into the dock.  Consistent, patient effort was the only way to get the ocean liner into the slip.  It also takes consistent, patient effort to change one's beliefs. 

This is not necessarily a plea for a long time in treatment.  In my experience, effective therapy will begin to take hold, and move a person’s beliefs within three months of regular visits.  Treatment may not be complete in three months, but some beginning shifts in attitude and behavior should appear if treatment reaches the deep core beliefs and fears.  If the deep fears of the person are not reached, change will not appear.

Serious fears are firmly bound even within body tissues and they exist on a level well below reason.  Therapists monitoring quarrels between clients can see the heavy breathing, raised voices and rapid vocal cadence, and even reddened faces.  Clients will report upset stomachs, racing hearts, and tightened muscles.  Many modern therapists feel memory, or a form of it, may be stored in body tissues and not relegated to the brain only; and therefore, many current therapies make an effort to deal with the body and move away from simply “chatting” with the client.

Well-intentioned therapists cannot rationally ask people not to be afraid.  I can imagine disgruntled clients hearing therapists’ pleas that must sound very smug, thinking, “Yeah, well I already THOUGHT OF THAT.  I JUST CAN’T DO IT.  Thanks for nothing.”

Interactions with parents and children and between spouses are activating deep fears within each individual.  Again, that very scolding, shaming person may fear being abandoned, or fear he or she is not worthy of being listened to, which causes the inappropriate behavior.  As the interaction intensifies, so do the fears which are tapping into old memories of being abandoned or discounted.  These fears must be calmed before interpersonal negotiations can reasonably continue.

This is why so many people hate to be in marital therapy.  The fears are repeatedly stirred, often with no resolution.  The “scolding” person feels more afraid than ever, and now is additionally shamed by having the behavior seen by a stranger (the therapist).  In ess