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Circular Causality in Family Issues: How to raise emotionally and mentally healthier children

Circular Causality in Family Issues: How to raise emotionally and mentally healthier children

Written by: Dr Mark Toh, Senior Consultant Psychologist

What Is Circular Causality?: Understanding Your Child’s Reactions

The American Psychological Association defines ‘Circular Causality’ as a sequence of causes and effects that leads back to the original cause and either alters or confirms it, thus producing a new sequence, as in a feedback loop.

This is an important concept that helps to explain certain interactions within relationships better. Relational patterns and rules between family members within the family system dominate how individuals interact and engage with one another. These rules are often silent, unconscious or multi-generational in nature. Within this system, the family operates according to some ‘thermostat’ which sets the ‘desired setting’ for how each member is expected or required to function. The functioning applies to how situations or people are viewed, how much self-disclosure is welcomed or permitted, how personal or interpersonal difficulties are addressed or not, how disagreements or secrets are to be dealt with, or what relational values are being promoted. Families in different cultures may operate with certain predictable rules or patterns, eg. within families sensitive to shame, avoidance or non-verbal disclosure, communication is often practised. Tapping into the honest emotions of members over time tends to reveal the ‘temperature’ within the family system.

Families nurture the psychological ‘birth’ of the sense of self within children during their childhood. In the process, parents shape within their children how young children will engage themselves (intra-personal relationship) to function in later childhood and adulthood (inter-personal relationships). Healthy relational patterns and appropriate rules are important to foster healthy emotional development towards an important psychological milestone for children: healthy identity formation. Because these patterns and rules are so fundamental in the shaping process, it is important for parents to understand how they can shape their children towards this healthy identity. If not, the child could begin a life-long struggle from having accepted an identity that is diffused, confused or distorted in nature. This is usually accompanied by secondary effects of this outcome, eg. a pattern of difficult or troubled relationships with others. This usually adds additional distress to the sufferer and to those who relate to them. 

Instead of understanding interactions within relationships along a linear continuum where there is a definitive start and end, circular causality opens up to appreciating the relational context where interactions can be examined between two events in more useful detail. With an understanding of circular causality, understanding the interactions between two or more individuals can better reveal where an interaction can get stuck. This pattern occurs in all relationships but it is especially within ongoing relationships where being stuck in a negative cycle can lead to particular disappointments, hurt and pain. For children, unhealthy patterns and rules within families can undermine the child’s emotional development over time.

Circular causality is particularly useful to explain conflicts between family members which can become persistent and damaging. Persistent hurts can undermine relationships and lead to how negative expectations of each person are viewed and engaged with over time. They are a concern because of the prospect of children’s sense-of-self being hurt or damaged within certain family systems. Therefore, careful attention is usually necessary in understanding the attribution of cause-and-effect of what is problematic between family members.

Individuals attribute cause and effect or causation in situations and within relationships. Linear cause and effect of A 🡪 B 🡪 C are defined by a specific start and end point. Individuals who operate from understanding relationships based on linear causality tend to assume that problems are caused and maintained by the other individual’s beliefs, biology, emotions or other abnormal factors within the individual, i.e., they are self-generated. Therefore, solutions are found when the individual in question changes their beliefs or emotions within them to respond differently to the situation.

In contrast, circular causality refers to the reciprocal relationship between two events. Family members influence each other in a continuous process within a feedback loop. A vicious cycle is often present when two or more family members have relied on unchecked assumptions to carry out their attributions of cause-and-effect in the situation. The perspective of reciprocal relationships stems from the foundations of cybernetics, which refers to the regulatory action where one part of the system impacts another. Events usually do not happen in isolation. There is a feedback loop which tend to result in a new equilibrium. It is more that A 🡪 B 🡪 A. 

 

Case Studies

Case 1:

Susan refuses to go to school and goes into her room. Mom and Dad raise their voices and lecture her. When they raise their voices, Susan isolates. Mom and Dad’s frustrations or anger heighten Susan’s need for isolation, and Susan’s isolation heighten Mom and Dad’s anxiety, and therefore their escalation.

For parents who operate on assumptions of linear causality, their perception can easily overlook other reasons to explain the child’s original presenting problem, eg. Susan may be bullied at school, she has an unhappy relationship with her teacher, or she may be afraid of facing exams but is afraid to tell anyone. Parents who operate based on linear causality tend to see their child as the source of the problem, and to overlook their contribution or other reasons leading to the child’s presenting problem.

Instead of being quick to judge the situation as the child choosing to misbehave, parents should focus first on establishing a safe, trusting relationship with their daughter before their intervention.  They can raise concerns about what their child may be fearful of with empathy. The following statement could be as follows, “Hey Susan. You usually would enjoy attending school. But something unpleasant or uncomfortable may have happened to make you afraid of returning to school. I remember that when I went to school, I have at times been uncomfortable going to school because I was afraid of meeting someone I did not like, or having to face an exam I was not prepared for, or having to face a teacher who was mean. Can you tell me what is going on for you at school that you are uncomfortable facing? I will like to help you.” 

Case 2: 

John struggles in completing his homework and his poor grades. The father Mr. Lim responds to him with harsh criticism. Hurt and demoralized by his father’s criticism, John does not put in his best effort at school. His father’s criticism then intensifies and John puts in even less effort to learn. 

Family difficulties are often not rooted by a simple mistake made by the child (mistakes are common for children and instrumental for how they learn).  In this scenario, the father’s response to John may be reflective of how Mr. Lim was regarded as a child himself by his own parents when he was growing up. Criticism then is an extension of how he was treated as problematic as a child (to regard himself as stupid, inadequate, irresponsible) so as to repeat the cycle here. Without knowing all this history, John becomes hurt and angry against his father’s accusation. He can try to defend himself and retaliate with, “I am not useless. You are.” Mr. Lim who is outraged by John’s apparently disrespectful reply can bear down on John for what he considers to be John’s defiance to intensify his attack: “You are not only useless but disrespectful.”  This pattern can then set up a loop that becomes self-perpetuating or self-reinforcing based on their view of each other. John is seen by his father not only as stupid or irresponsible, he is also viewed as disrespectful and defiant. In turn, John sees his father as unloving and hurtful whom he needs to distance himself from. If they had a positive relationship earlier in John’s life, this relationship can deteriorate over time if the underlying issues are not addressed.   

In reciprocal relationships, circular causality is often revealed in the course of the interplay between emotional experiences, false or valid expectations and eventually how we experience each other. It often reveals how one or both parties perceive and interpret their individual world, and there is usually a historical reason  behind their perception. Our current experiences, perspectives and approach to relationships are often already influenced or shaped by our previous significant relationships with our family-or-origin and culture. 

[ In this situation, Mr. Lim should be advised to consult a child clinical psychologist when he sees no improvement with his son’s behavior. He needs to be alerted to the importance and quality of the parent-child relationship in impacting the child’s self-esteem, emotional conditions for what children need to thrive and the nature of the unconscious. If Mr. Lim was armed with the appropriate knowledge and possibly obtain personal help to address his relationship with himself as defective or inadequate, he could approach his son with, “Hey son. Studying in Singapore can be challenging or difficult. The workload can be heavy and the material can be difficult. I struggled with it too when I was a student. What struggles are you facing at the moment?” ]

 

Case 3

In the midst of ongoing conflicts between parents, their child Ben develops anxiety because the two people he loves appear to be hurting each other. Ben acts out with anxiety and/or depression, eg. temper tantrums, excessive withdrawal from school or play, trouble at school. This draws the attention of his parents who attend to him. In the process, their own conflict decreases. From this, Ben learns that he can influence his parents’ conflict through his anxiety. 

Circular causality helps to explain why family members may be stuck arguing about the same subject every time through communication traps or failures. Understanding cause & effect on a linear perspective in relationships can result in an artificial understanding: one cause & one effect or multiple causes & the same effect. In this scenario, Ben’s parents may wish to see Ben as having difficulties coping with school. Their solution may be to improve Ben’s responses to become more resilient. But if Ben attempted to communicate his difficulties with his parents’ conflict, they may not wish to believe that they contribute to his struggles. In so doing, they fail to capture the root of the problem for what it is. A child’s struggles may be defined by their parents because the child’s limitations reflects the parents’ limited emotional insights on themselves or their children. This lack of emotional insight and understanding is often expressed through circular causality to reveal that children can be misunderstood often and that the parent-child relationships can often be negatively impacted.  The parents’ own limitations are often overlooked in the situation.

Repeated over time, the negative rituals expressed in circular causality can be locked in place by ignorance, emotional hypersensitivity, defensiveness, contempt for one or more family members, hopelessness, hurt, anger, blame, fear and avoidance or stonewalling. Emotional cut-offs may be used frequently. If this happens, the effects of circular causality in an unhealthy family system can be experienced as intolerable. If there was previously a positive bond that bound the relationship, it can now be worn down by pain and the relationship may become damaged.

In this situation, the parents should consult a clinical psychologist familiar with children and family issues when they notice their child struggling with school or presents with anxiety in the midst of their conflict. 

How To Break The Cycle

Raising healthy children require establishing healthy relationships and healthy boundaries. Because the goal of raising healthy children is so worthwhile and essential to their future growth and success, parents need to be concerned that their relationship with their children are not defined by misunderstandings and conflict which are painful. To foster family unity and raise healthy children, three important values and practices are essential to promote certain patterns and rules in the family system: 

  1. Parents need to learn about child development. They should also remember that children function at a disadvantage because they tend to lack the emotional insight to explain their fears, their confusion, and what they need. Subsequently, children often have difficulty articulating what they feel or need. They need parental help to develop their emotional insight and offer them a broad emotional vocabulary to learn to express and communicate themselves clearly and honestly. When this is offered by parents who are emotionally mature and aware, intentional to raise children in their best interests, and when these parents are trusted by their children, the groundwork is being laid for the healthy formation and development of the child’s emerging identity.
  2. Parents need to develop the courage to have honest conversations with each other and their children. This courage needs to be accompanied by the believe that each member has important value so that each person is treated with respect. With courage and respect, each person can be approached with caution about making inaccurate or false assumptions of each other, and engaging in a self-serving bias. Being honest and courageous is important to clarify if inaccurate attributions are being made. Being ready to listen without judgment prior to making honest inquiries would further help to avoid misunderstandings or address misunderstandings when they occur.
  3. The willingness to develop healthy emotional intimacy promotes the value of sharing for each family member to know one another and to being known by the others in the family. This offers the basis for bonding and closeness. When communication is constructive, affirming and respectful, it can establish the sense of security within children and trust between family members. For children, this is particularly important since secure attachments contribute significantly to the child’s emotional development and mental health. This in turn offers a basis for them to acquire a healthy approach to future relationships and healthy functioning.

    To promote relationships which are safe and nurturing, words are powerful to convey that each family member is highly valued. They should be deliberately selected to promote each other’s well-being. Having a pattern of honest and constructive communication with healthy rules where individuals are affirmed and supported help to promote a family system where each member can safely practice saying what they mean and mean what they say. Misunderstandings are not left to stay but are promptly corrected. This offers the most fertile ground for healthy personal and interpersonal growth to happen. When parents notice they have difficulty delivering these practices, they should consult a clinical psychologist.

 


References:

American Psychological Association. (n.d.). Apa Dictionary of Psychology. American Psychological
Association. Retrieved October 22, 2022, from https://dictionary.apa.org/circular-causality 

Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. W W Norton & Co.

 

How To Get The Most Out Of Therapy

How To Get The Most Out Of Therapy

Written by: Andrew da Roza

Deciding to see a therapist is a big step – and staying in therapy requires a commitment to effect real change.   

It is not surprising that many hesitate before starting therapy. 

Some may be wondering how talking to a stranger can change their lives for the better. 

They may not know which therapist they ought to approach – and what they should be looking for in a therapist.

Others may hesitate because they are anxiously thinking ahead: “what happens if I don’t like the therapist?”; “what if the therapist doesn’t understand my struggle?”; “what if I don’t think that enough progress is being made?”.

They may also be wondering if they can change their therapist and if they can have more than one therapist. 

If you are struggling with these questions, thankfully, there may be some answers that put your mind at rest and give you the confidence to seek a therapist and engage in the healing process. 

 

Choosing the Therapist – The Qualifications 

Most clients can articulate why they wish to seek therapy – and have clear ideas about what is causing them distress or difficulty.

Clients with clinically diagnosable mental illnesses may have already sought help from a family member, friend, doctor, psychiatrist or religious leader. They may have even “Googled” their symptoms.  

If specialist help is needed, choosing a therapist with the relevant qualifications and experience will be the first step. 

In addition, you may wish to choose a therapist you are more likely to be comfortable with based on the therapist’s language ability, gender, culture and so on. 

 

What should I look for in a Therapist?

Research has shown that the positive connection a client makes with their therapist accounts for 36%-50% of the changes clients experience as a result of treatment. (1)(2) 

Sometimes called the “therapeutic alliance”, this is experienced by clients as liking and trusting their therapist.  

Some will bond strongly with therapists if they demonstrate empathy, warmth, unconditional regard and respect. They would like their therapist to be open, non-judgmental and curious about the clients’ struggles – to have a strong desire to “walk in the clients’ shoes”. 

Such clients make good progress in therapy when they feel understood and heard – as well as valued. 

Others may seek therapists who are good communicators and are well informed about the issues the clients are facing. They tend to bond with therapists who are able to impart and discuss information; offer practical suggestions; articulate action plans, goals and timelines; and support the clients in their motivation to take action to effect positive change. 

Many also seek insights into themselves, their emotions, the ways they react to people or situations; and their perspectives and intrusive thought patterns. 

By being more present with what arises in themselves, they seek to take more control over their own lives – to respond to people and situations instead of habitually reacting to them – and to accept and let go what they cannot control. 

These clients appreciate therapists who can assist in self-discovery. Therapists who are able to help articulate their “inner worlds,” and to reframe them. Therapists who empower them to navigate this “world” with more ease and confidence by playing to their strengths, rather than dwelling on what they perceive as their weaknesses. 

Interestingly, studies have repeatedly shown that the type of therapy used for individual therapy (such as cognitive behavioral therapy, psychoanalytic or psychodynamic therapy, dialectical behavioral therapy, person centered therapy and so on) has only a marginal effect on the outcomes of therapy (3)(4)(5).     

So, the key to choosing a therapist involves articulating what you expect from therapy and your therapist, and what kind of person you think will best meet your emotional and other needs. 

It would be helpful to articulate what you want the therapist to do (and not do); and what your end goal or “vision” for therapy is. You can do this by first asking yourself the question: “what changes am I seeking that will make a real positive difference in my life?”. 

Many benefit from putting all this in writing and bringing it to the first therapy session to discuss it with the therapist. 

 

Beginning Therapy – And then Changing the Therapist 

On the first meeting with a therapist, some clients – though this may be rare – simply do not like or trust the therapist, or that they do not have the experience or knowledge to assist them.

It also sometimes happens that a client feels that the therapist is not present or really hearing the client’s narrative. 

Worst still, they may see the therapist jumping to conclusions – or solutions. They may feel disrespected and “unheard” – and that they are being left behind, while the therapist is “racing” ahead of them. 

Other clients may feel that the therapist is judging them or telling them what to do, think or feel – and not to do, think or feel. The clients may feel anxious, disempowered, dismissed, angry or offended. 

If this happens to you, let your therapist know. If you don’t see any change in their approach, rest assured that changing therapists is likely to be helpful. 

 

Changing Therapists Along the Way 

One situation that you may wish to avoid though, is changing therapists regularly. This is because continuity in therapy is one of the keys to progress. 

Therapy is very much a journey. 

Whether the goal is self-discovery, empowerment, executing action plans to change behaviour, building confidence, or managing anxiety or depression. The journey has stages, and keeping the same guide on this journey is likely to facilitate progress.

If you are in the middle of your therapeutic journey, and you wish to change therapists, it would be helpful to articulate clearly why you want to do this. 

Is the therapeutic bond broken – and cannot be fixed? Is there little or no progress in your clearly articulated goals? Have you changed the goals and discussed them with your therapist – and it is clear that the therapist will not be able to assist? 

Some clients simply feel that therapy has become “stale”; or they feel as though they are attending therapy to “tick the box” and to show others that they are willing and able to change. 

Whatever the reasons, write them down. Discussing them openly and honestly with your therapist is likely to help. 

If you wish to make a change, ask the therapist for a referral to another therapist, and give permission to the current therapist to brief the new therapist. You may wish to join in this discussion.  

This is more likely to ensure that your therapeutic journey continues without disruption. 

One situation you may wish to be conscious of, is changing therapists solely because the therapeutic work has become difficult. “Jumping ship” may not be the answer. 

There is no doubt that therapy can be very challenging – perhaps the most challenging thing you have ever done. 

The challenge could arise because the insights are uncomfortable (or even painful); the changes in behaviour require a lot of motivation to sustain; a change in perspective seems counterintuitive; or because the anxiety, intrusive rumination or low mood seem relentless.  

Changing therapists may not be the answer – and may simply delay or disrupt the difficult therapeutic work ahead of you.

It is likely to be more helpful to articulate these challenges, write them down and discuss them with your therapist.    

 

Having more than one therapist

Some clients may need more than one therapist. 

A client may have an individual therapist who assists the client on their own personal journey. 

They may also have a couples’ therapist to address their relationship with their partner. In that event, the therapist treats the couplehood as “the client” – and provides equal support to both parties and works towards their joint goals.  

Other clients may also have a family therapist to address the relationships within the family. Again, the therapist will see the family as “the client” and assist with the family goals.

Couples and family therapists tend to provide specific modes of therapy, which have proved effective for couples and families.  

In the case of individual, couple and family therapy, in most cases, it is generally considered unethical and a conflict of interest for one therapist to play all three roles. 

The therapist cannot best serve the client’s, couples’, and family’s interests while wearing all three “hats”. 

Once a therapist tries to do this, they may (for example) feel obliged to keep secrets from one person in the couplehood or others in the family. This may reinforce the unhealthy dynamics of secrets and deceit that brought the clients to therapy in the first place.

Conflicts of interest create confusion, anxiety, anger and disappointment for clients. 

Keeping to ethical boundaries is more likely to ensure that the therapeutic journey is not sabotaged. 

Unethical conflicts of interest also arise if a client is seeing two different individual therapists.

Broadly, therapists are obliged to decline to see a client if they already have an individual therapist they are actively working with. 

Having two therapists engaged in the same work exposes clients to confusion, anxiety and conflict, and is likely to disrupt a client’s progress in their therapeutic journey. 

If you are considering seeing two therapists for individual therapy, it would be helpful to clearly articulate why you think this will assist – and to discuss this openly with the therapists.

Some clients may change therapists to “find the right answer”; the “best answer”; or the answer that fits their “view of the world”. That “view” may be the same “view” that has been causing them the trouble – and motivated them to seek therapy in the first place. 

All this is worthy of open and honest discussion and exploration. 

Another situation in which other therapists may be involved occurs when a client has an individual therapist and also attends group therapy. Group therapy can be a very effective way to continue the therapeutic journey, once progress has been made in individual therapy. 

Again, therapists commonly use specific modes of therapy for groups. 

 

Working with Multiple Therapists 

If you are working with multiple therapists, it is helpful to let them know who else you are working with, and what goals you (e.g. as an individual, couple or a family member) have agreed to pursue with the other therapists.

From time to time, it will assist to share with your therapists what you took away from the other therapy sessions, how the sessions are progressing and what plans you have agreed with the therapists.

It is always open to you to ask the therapists to communicate with each other and to coordinate treatment. 

It is also your right to maintain confidentiality and not to coordinate treatment – but “dovetailing” these different therapy sessions is more likely to help optimize your outcomes.

The Promises Healthcare website provides assistance to clients to identify their issues and provides photographs, names, languages, qualifications and experience of the specialists who can assist: https://promises.com.sg/about-us/our-team/

We hope that you will be able to find the right help from us.

 


  1. Horvath, A.O., Del Re, A.C., Fluckiger, C., and Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9-16. Doi:10.1037/a0022186
  2. Duncan, B. (2014). On becoming a better therapist – evidence-based practice one client at a time. (2nd Ed.) Chapter 1, pp.23-24. The American Psychological Association, Washington DC. 
  3. Stiles, W.B., Barkham, M., Mellor-Clark, J., & Connel, J. (2008). Effectiveness of cognative-behavuoural, person-centred and psychodynamic therapies in the UK primary-care routine practice. Psychological Medicine, 38, pp 677-688. Doi:10.1017/S0033291707001511
  4. Benish, S.G., Imel, Z.E., & Wampold, B.E. (2008). The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: A meta-analysis of direct comparisons. Clinical Psychological Review, 28, 746-758. Doi:10.1016/j.cpr.2007.10.005. 
  5. Duncan, B. (2014). On becoming a better therapist – evidence-based practice one client at a time. (2nd Ed.) Chapter 1, pp.9-12. The American Psychological Association, Washington DC. 
June Fong shares with Straits Times on her thoughts about the uptick in young people seeking help for mental health issues

June Fong shares with Straits Times on her thoughts about the uptick in young people seeking help for mental health issues

The Straits Times spoke with Senior Forensic Psychologist June Fong about her thoughts about “Some clinics see an uptick in young people seeking help for mental health issues”.

She shared: “I think the incident… has actually opened a lot of parents’ eyes to the stressors that children are facing, while previously in the past, they might have just brushed them aside and dismissed them.”

Follow the link to read the whole article: https://www.straitstimes.com/singapore/some-clinics-see-uptick-in-young-people-seeking-help-for-mental-health-issues-in-the-past-year

 


Photo by Christian Erfurt on Unsplash

Benefits of Family Therapy in the Caregiving Process

Benefits of Family Therapy in the Caregiving Process

When one has to live with debilitating chronic conditions or even degenerative disorders, it is natural that we place emphasis on seeing that the afflicted recover and receive the appropriate management. As our society rapidly ages, the number of elderly living with medical conditions or dementia is also increasing exponentially. However, the care should extend beyond the patients themselves. More often than not, there are other individuals involved, including family members and friends dedicated to supporting their recovery. Is it time we acknowledge their efforts and ensure they are coping well? 

 

Caregiving can be exceptionally draining – both physically and emotionally – when a family member becomes a patient at home. Needless to say, we are unable to predict such unfortunate circumstances, and caregivers are often thrown into their roles without prior knowledge and preparation. This leaves them with no choice but to adapt and pick up new skills in order to commit to their caregiving responsibilities. However, this can take a toll on the primary caregiver as well as family relationships. 

 

With a large part of their time allocated to caring for another person, caregivers are much more susceptible to fatigue and prolonged stress, with little or no time for self-care. It can be a big problem if the caregiver feels that there’s no support – family and social relationships can be compromised, thereby further reducing any support network that a caregiver can receive. This can lead to burnout and immense feelings of helplessness. 

 

A survey by the Singapore Management University (SMU) with the support of Caregivers Alliance Limited (CAL), Enable Asia and the Singapore Association for Mental Health (SAMH), reveals that 3 in 4 caregivers are tired and exhausted caring for a person with mental health issues. Furthermore, the Family Caregiver Alliance estimates that close to 20 percent of family caregivers suffer from some form of depression. In addition, mental health disorders are even more common among dementia caregivers. A study conducted on mental health issues in those caring for Alzheimer’s patients found that the prevalence of depression was an alarming 34 percent, anxiety was 43.6 percent, and the use of psychotropic drugs was 27.2 percent.

 

Some other common problems that caregivers face include (but are not limited to):

 

Mental health concerns Physical health concerns  Secondary Stressors
  • Depression
  • Anxiety
  • High rates of negative affect including guilt, sadness, dread, irritation and worry
  • Ambivalence about care
  • Witnessing the suffering of relatives
  • Feeling isolated or abandoned by others
  • Anticipatory grief
  • Fatigue
  • Sleep problems
  • Risk of illness, injury, mortality
  • Adverse changes in health status
  • Dysregulation of stress hormones

 

 

  • Work/employment (e.g., reduction in work hours, family to work spillover, and work to family spillover)
  • Financial strains
  • Relationship stress
  • Loss of time for self-care
  • Reduced quality of life

 

 

 

This is where family therapy comes in. Families might find therapy useful when they are adapting to a major change in the family such as dealing with a chronic illness or death in the family, or conflicts between family members in the caregiving process. Family therapy is a method to engage family caregivers in active and focused problem-solving approaches related to family caregiving to improve the quality of care, reduce burden and improve family functioning. Family therapy for caregivers, in particular, encompasses six core processes – naming the problem, structuring care, role structuring, role reverberations, caregiver self-care and widening the lens. Therapy is conducted in a way that is tailored to each household. Depending on the needs that caregivers and their families must address, the aspects that are challenging them will become the focus of intervention. Not covering all six areas doesn’t mean that the therapist isn’t taking a comprehensive approach – the core processes simply act as a guideline, and do not imply a rigid prescription of intervention work. 

 

Conflicts and resentment often arise for anyone in the role of family caregiver, and these are exacerbated when trying to share tasks with siblings or other members of the family. Many a time, caregivers tend to bottle up their feelings and put up a positive front so as to avoid passing on any negative feelings to their care recipients. However, this can be extremely detrimental to their own mental and physical health in the long run. The main part of family therapy for caregivers, therefore, involves helping the caregiver and family members sort through challenging emotions and reach resolutions. Speaking about your feelings can help you find comfort, and allows you to gain further insight and through the guidance of the therapists, various emotional-coping strategies. Implementing them will certainly take some weight off your shoulders, and perhaps give you some enlightenment with regards to discovering new problem-solving strategies. 

 

Undeniably, caregivers will benefit tremendously from any assistance in their caregiving responsibilities from family members. Family therapy is extremely beneficial in helping to improve the interactions and support network among family members, especially in providing new perspectives on problems that are seemingly unmanageable (part of which involves building trust, mutual respect and openness). This hence reduces the level of stress within the family and the level of caregiver burden, on top of enhancing communication skills and boosting a positive sense of empowerment. 

 

Family therapy is focused on achieving precisely what is best for the whole family and its cohesiveness, and sorting out obstacles or issues challenging the family dynamics. It is important that you take the important step toward seeking help from professionals in order to achieve a better quality of life for yourself and your family. 

 

While face-to-face consultations are the norm, we understand that as caregivers, you may be faced with time constraints or other concerns. Thankfully, with technological advancement, virtual consultations are also becoming increasingly popular. They are equally effective and allow for more individuals to connect with their family therapists with greater ease. Of course, the decision is entirely yours to make. If you find yourself struggling, or simply feel that you need a trustworthy individual to speak to, feel free to get in contact with us

 


References:

  1. https://news.smu.edu.sg/news/2020/12/09/3-4-caregivers-persons-mental-health-issues-highlight-need-temporary-separation#:~:text=This%20survey%20by%20the%20Singapore,person%20with%20mental%20health%20issues. (Accessed 16/03/2022)
  2. https://au.lifestyle.yahoo.com/caregivers-take-care-of-person-with-mental-health-condition-help-wellness-031845657.html (Accessed 18/03/2022)
  3. https://www.apa.org/pi/about/publications/caregivers/practice-settings/common-problems (Accessed 18/03/2022)
  4. https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/family-therapy (Accessed 18/03/2022)
  5. https://www.agingcare.com/articles/counseling-for-caregiver-burnout-126208.htm (Accessed 18/03/2022)
Family Therapy 101 in the context of the pandemic.

Family Therapy 101 in the context of the pandemic.

The year 2020 saw a rise in uncertainties. Many have experienced anxiety, job loss, a strain on finances and family relationships due to the impact of the pandemic. By default, couples need to adjust to working from homes, with blurred boundaries between work and family, lesser personal space and challenges in new routines. They may not have readily communicated effectively about their roles, given the constant changes in adjusting to tightening and lifting measures.  Coupled with the labour crunch, families may find it increasingly formidable or costly to hire a helper to care for children, who are required to stay home for home-based learning or the care of elderly parents who may be weak and frail.  This may inevitably lead to unresolved conflicts between the couple due to the stress and demands of constant transition and change. In 2020, a survey for mums showed that 60% of the participants rated their stress level at a 7 out of 10. In addition, 3 out of 10 of the participants felt sad most of the time.   

Children and young people are not spared from the raging wave of anxiety. According to a survey conducted by Focus on the Family, kids are more anxious about exams than Covid 19 (The Straits Times, 18 Sep 2020). However, in an international study of 72 countries (including Singapore), only 6% of teens share their problems with their families (Impact of the Pandemic on Family Life Across Cultures 2020, Namad Bin Kalifa University). No wonder the CEO of the Institute of Mental Health says that “Gen Z faces different forms of stress, maybe more anxious, depressed than others before them (Today, updated on 1 Mar 2021).” President Halimah also urged Singapore to step up efforts to protect children’s mental health early (The Straits Times, 2 Dec 2020).    

Given the tremendous stress that kids and adults are facing, families are stretched very thinly. Therefore, they ought to rise above their concern of seeking a mental health facility to deal with their issues early, so that family members can get the professional help they need.   

It is timely for the family to consider attending family therapy to address and deal with the mental well-being issues, be it stress or anxiety collectively.   

You may have some questions about family therapy, and here are some FAQs that seek to answer your questions. 

 

Why Family Therapy? 

Having to deal with unhealthy family dynamics constantly puts a toll on one’s mental wellness. Family therapy focuses on improving family communication; it deals with family conflicts, seeks and creates better functioning and environment. It provides family members with an opportunity to talk about how they think and feel, being affected by the issue they face. It enhances skills to facilitate healing. Therefore marriage and family therapy are essential. 

Family therapy shifts the focus from blame, diagnostical lens, linear causality, and looks at circular causality in an issue. For example, a teen who exhibits school refusal may be staying home because of his worry and caregiving role to his mum, who is in chronic health and has a strained marital relationship with her spouse. It helps the family understand the issue confronting them in the family context and the larger contexts, i.e. the pandemic. 

Family Therapy is often used to help treat an individual’s problem that has dire effects on the entire family, i.e. depression, anxiety and behavioural issues. This type of psychotherapy is also helpful in addressing family-centric problems, i.e. conflicts between spouses, siblings, parents and children. 

 

What is Family Therapy? 

Family therapy is psychotherapy designed to identify family patterns that may have contributed to behavioural or mental well-being concerns. The idea is to help family members break those habits as the family therapist involves the family in discussion and problem-solving. 

 

What can I expect when my family and I attend a Family Therapy session? 

During family systems therapy, the family therapist works individually and collaboratively to resolve their issue, which directly affects one or more family members. Each family member has the space to say what they think and how they feel as the issue affects them. For example, when a teen has anxiety issues, a family member gets to talk about how this issue impacts them.  

 

How long is each session and how long is the therapy period? 

1.5 hours per session over a period of 4-8 sessions, subject to review with your family therapist. Family therapy is a specialised counselling process. No one is a miracle worker. It takes time and commitment for the family to work through their issues. 

 

Are family therapists trained? 

Yes, systemic family therapists are trained with a Masters in Family and Systemic Psychotherapy, a specialised skills competency in systemic couple and family work. It draws on systems thinking and views the family as a unit. It evaluates the parts of the system (individual) in relation to the whole (family) and examines how an issue of one or more members of the family affects the whole family. It suggests that a family member’s behaviour or issue may be embedded in the family dynamics and influenced by the family of origin issues. 

Family Therapists would have undergone at least 560 hours of academic instruction and supervised clinical practice, accompanied by years of experience. 

 

When should my family and I attend Family Therapy?

It is always helpful to seek family therapy early before the issue snowballs and becomes more difficult or complicated to manage at the later stage. 

 

Who should attend Family Therapy? 

Immediate Family members in a family nucleus should attend Family Therapy, i.e. couples, parents, children (includes teens and adult children) siblings.

 

Does my whole family need to attend? What happens if I am unable to get all my family members to attend Family Therapy? 

It will be helpful if your family can attend therapy together. However, it is okay if not all family members can turn up for therapy. The family therapist will collaborate with the members who come for therapy sessions. 

 

How do I prepare for Family Therapy? 

Discuss with your family members about attending therapy together. Think and write down what you want to discuss before each session. Then, ask your family therapist how you want to improve the communication in the family. 

 

Is there confidentiality? 

Yes, the session is confidential under the Singapore Data Protection Act 2012 (“Act”). 

 

Where can I attend Family Therapy? 

Promises Healthcare provides family therapy service, so feel free to visit our website or contact us at Tel: 6397 7309 to make an appointment.