Psychoanalytic family therapy

Domain I · Psychodynamic & depth psychology · Richter, Stierlin · 1963 · Giessen

What it is

A psychoanalytic approach in which the family, not the identified patient, is the unit of understanding and often the unit of treatment. Richter argued that a symptom can fill a role the family unconsciously needs. Treating only the individual can therefore fail, or move the disturbance to another…

Format

• Format notes. Richter distinguishes shorter family counselling (Familienberatung, clarification over a few sessions) from analytic family therapy (longer, working through). He devotes chapters to which families (ch. 10) and which therapists (ch. 11) are suited to family psychotherapy. Indication…
• Version followed: Richter's Giessen psychoanalytic family model (Eltern, Kind und Neurose, 1963; Patient Familie, 1970), combined with Stierlin's early Heidelberg, psychoanalytic and family-dynamic phase (about 1974 to 1980). That phase covers Von der Psychoanalyse zur Familientherapie (1975), Das…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• A summary that quietly blames the parents. That drives them out, and the referral collapses.
• Your own family history being activated, a concern Richter raises in his chapter on therapist suitability.
• The family using outside factors to avoid their own patterns, or you using the family's patterns to ignore real harm.
• Over-labelling. Treat the types as working hypotheses about the shared defence, not as diagnoses to report to the family.
• Empathy that only goes to the identified patient. Look for softening faces, a member adding to what you said, and less interrupting.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.