When Do You Need Family Therapy?

In this transcribed episode of the Shrink Think Podcast, Nathan and Aaron talk about when family therapy might be right and how to get started. 

Aaron Potratz:
Hey everyone, welcome to the Shrink Think podcast. We are excited to be here and in Oregon. It is a sunny day, which <laugh> we are in an unusually great mood because it's the sunny day. We have not seen the sun since 1991, maybe something like that. Oh my word. It feels like it's been forever. So welcome aboard. We're glad to be here. We're gonna be talking today about family therapy because it's kind of one of those things as we were kind of talking about this before we started recording and if you're on YouTube by the way, then you saw all that, you're like, I know I was just there. Like get to the point. I still am there. And if you were not on YouTube then you need to hop on YouTube and watch the video because we're letting the camera roll a little bit before and a little bit after. So you can kind of see some of the behind the scenes stuff. But we were talking about how when people call for family therapy, they don't necessarily know what to do. They're like, here's my situation. And I think if we can all just get into the room and in front of a therapist, then maybe you could help us like sort this thing out and we're like, okay. I mean that's understandable, but like what would you say is going on here, <laugh>, what would you say?

Nathan Hawkins:
Yeah, do here, you

Aaron Potratz:
Do here. Exactly. Thank you. Office space for that classic line. And so as we're unpacking this, we are like asking a bunch of questions and we'll go through this in the episode here to kind of tease out what's going on, what's the right modality for therapy, like is this really gonna be a family therapy or is this maybe gonna be an individual or maybe like a dyad triad, like full blown, everybody in the room we're gonna rent a conference room kind of a situation. We're not sure. So we want to kind of unpack that, um, to hopefully give you our listeners some insight about maybe how to navigate that, whether you are a therapist and these are the kinds of things that you regularly do. I'm sure you have some of these questions already in queue and if not, if you're a newer therapist or you have done some family therapy and not sure about it, then this will hopefully give you some ideas about like how to, I guess, screen maybe how to begin unpacking this complex system issue so that you can navigate it well. And of course if you are, uh, a client and you were considering family therapy, then you'll give you some insight about like, how should I go about this? Cuz again, we're trying to bridge the gap between these two people, these clinicians and the general population here, so that we're all on the same page working well together. So Nathan, let's get us started.

Nathan Hawkins:
Yeah. For, you know what I wanna say first is we, we never talked about this, but we actually have a store. So if you go to shrink think.com/swag or you just click on shrink think.com and then click on swag, you can see stuff that we did and it's cool, we're gonna be adding stuff. The other thing I want to say, there's it's

Aaron Potratz:
Fit for your whole family. Is that the connection we're

Nathan Hawkins:
Getting here? Yeah. Oh, I don't, I'm just, I'm I'm just plugging

Aaron Potratz:
Right. If you're going on a family vacation, you all could have the same Shrink Think hat and then you're like, oh, there's my family. We all have the like that's what

Nathan Hawkins:
Yeah, you could, that's Oh absolutely. Yeah. The other thing, um, I wanna make people wear up is a technical problem that is only happening with one of our cameras. It seems like the camera's adding about 135 pounds per square inch <laugh>. It's only one camera. It's

Aaron Potratz:
Not the one on me.

Nathan Hawkins:
We're good here anyway. Yeah. So family therapy, I think when people come in it, there's kind of two different overall situations. One is you call a therapist because you're thinking, oh I think I need family therapy. Our family's just got all kinds of problems, you know, like whatever those happen to be, we seem to, nobody seems to get along. The other situation for the therapist is when you come in individually and everything you're talking about seems to relate so directly to family members, the therapist is sitting there in her mind going, man, I can get everybody in here. This actually might resolve itself more quickly, but as a therapist, the other thing that you will be also thinking is how, number one, how do I sell that? Like just from a, you know, standpoint of just directness. And then the other thing is how ethical is it? Should I say anything about it? And that's gonna depend quite frankly on to some extent on the vibe and the rapport of the relationship. And as a therapist, you kind of have a short period of time to make that call.

Aaron Potratz:
Yeah. And it doesn't necessarily mean that if you were, if you were that therapist, that you have to be the one doing the family therapy. I know, cuz some true, you know, if you were seeing an individual, like you probably don't do family therapy. Um, and so you need to actually sell it as like, this would be a good idea for another therapist to get involved because I think there's a whole system thing that's happening here. Like when you are talking to this individual, you're getting the vibe that there's more going on here that I don't, I need to know, but I need everybody in the room to kind of figure out what's going on. So anyway, you don't necessarily have to be the one performing the both

Nathan Hawkins:
Roles. Right, right. Thank you for that. Yeah, I guess I'm so, I'm so in my head about what I'm doing. Generally speaking, that's where I was kind of going in a way you would need to refer if maybe you've, you're meeting with this person you've been meeting for months and the reason why is because of this thing called triangulation, which I don't necessarily wanna go all in the depths of, but the basic gist is the people that you bring in. So if you were to do that, you've got your individual client, the people that you bring in after that are gonna think that you and the, and the, and your original client are teamed up on them. So, oh yeah, of course you agree. You've only heard all of her blah, blah, blah or all of his yada yada. If you are looking at this, like you might need to move into that modality and maybe you've met with them once or twice, it's pretty easy to, to transition at that point.
But the other thing is, is as you're going having the rapport because it's been going on now for months on the other side and you're like, I can't do this ethically, you probably have a little bit more, for lack of a better word, authority to be able to kind of say, you really could resolve a big portion of this if you were to get into family therapy. And typically the problem at that point is <laugh>, and this is the other side of the coin with the family folks calling in in the beginning, is you'll deal with the same issue of well this person will never come, whoever it is, there'll be somebody, it'll be the kid. Oh, they don't wanna drag him in, they don't wanna have that battle. Or it'll be like, honestly, and to challenge you guys out there, it's typically the dude. Yep. It's like the guy's like, yeah, the is for everybody else. Come on, break the wrist, walk away.

Aaron Potratz:
<laugh>. It's true. I mean the, the statistics show that, I mean, men don't go to therapy as much as women do. Just like men don't go to church as much as women do. You know, all these things that are kind of like the relational kinds of things that typically we think of as being female oriented guys are just like, you know, nobody, nobody listens to me. Or like, what, it's just gonna be a bit everybody like talking about their feelings and blah blah blah or whatever. I mean there's all kinds of reasons why

Nathan Hawkins:
Guys, it's because men don't have as much problems

Aaron Potratz:
<laugh> or that Yeah, we think that everybody else is the problem. I guess <laugh> and that's why you should be in family therapy right there. <laugh>, there's your point. If you identified with that guilty as charged schedule an appointment today with somebody else. Um, but it's true. Like, so, so I guess my question then is, okay, moving this ball forward, like what is family therapy? What is involved in it? Like what is the goal of it? Like how help people understand a little bit of like what's happening from the therapist point of view?

Nathan Hawkins:
There is family therapy is very different and if you are a younger therapist listening to this, I'd highly encourage you to check it out because for a therapist that's intimidating because in schools, in grad schools, if you're not in a specific program that's dealing with what's called systems, family systems, right away you're like, I don't know about what I don't know. This is kind of, there's

Aaron Potratz:
A lot of people here, there's a lot, right? Commanded.

Nathan Hawkins:
So if you, if you try to do the typical thing you would do with with an individual, it it's not gonna work. Um, what you end up having to do, the difference in that room is the therapist has to be way more active in the sense of you're monitoring the looks, countenance the little tiny things that's going on with every single human in that room.

Aaron Potratz:
Yeah. And I would even say when you said looks, it's like the looks, the counter looks the counter responses. Like here's a great example when one, and this is just like if there is a, um, a couple so you can then, uh, magnify this, you know, or I should say multiply it if there are multiple people in the room. So one partner is saying something and I'm watching the reaction of the other person while the first one is talking. And when this is a family, I'm doing the same thing where one person is talking and I'm listening, but I'm looking at the reaction of everybody else in the room. Do they shift? Do they shut down? Do they roll their eyes, do they get uptight? Do they like, you know, what's happening? Because everybody is like, this is the system, right? Mm-hmm. <affirmative> one person or one part of the system impacts all the other parts of the system. And that's what you have to pay attention to as a family therapist

Nathan Hawkins:
Inside of that. The other question you're asking yourself is, okay, I just noticed that. Do I call that out? Do I call it out now, do I wait, what's the timing? Because what you're doing is, is you're trying to basically help everyone and you're mindful of everyone, this is gonna sound like a little deviation, but I feel like it's kind of a cool analogy. There is these SSRI medications and different things like that build something in our brains called neurotropic factor. And it's a fancy algorithm or whatever mathematic equation that says, Hey, your brain is stronger now, now that you have these things or whatever. With family therapy, it's similar like that. It's like we are trying to keep your neurotropic factor high, we're <laugh>,

Aaron Potratz:
You didn't know this when you were coming in. You thought you were just talking about feelings and relationships, but we're like, where's the neurotropic levels at right now? <laugh> right. All the time or they just peaked <laugh>.

Nathan Hawkins:
That's why we use needles. I'm just kidding. I don't use any needles. But what I mean by that is, is like we're trying to make sure that we can help you be vulnerable in a safe way. Basically, each person is already vulnerable. So we're trying to understand in that moment the tolerance your family has to navigate things because the reality is, and this is what's cool about family therapy, just right on the surface level, probably you have not had the conversations you need to have. So the mere fact that you show up for like family sessions can vary. They can go to 90 minutes or two hours and some therapists just do an hour and that's fine. But just the fact that you're spending that time and you're having a conversation means that you're gonna feel like you dealt with more than you've dealt with in a year. Mm-hmm. <affirmative> because you've had the conversation

Aaron Potratz:
And it, and in reality you're just scratching the surface because there's so much more. I I like what you're saying. It's like you are talking about more than what you are used to talking about, but you still have not talked about enough. There's more to, it's more complexity of, you know, how does this impact everybody? How does everyone feel and respond to this? Because in a certain sense also, I like what you're saying about trying to like increase the tolerance levels of everybody so that everybody can kinda manage these conversations. I think there's also like this a center point. Like if you have, you know, multiple like dots on a sheet of paper and then you have one uh, dot that is like the focus or the center of it, that's way off to the side of the sheet of paper. Like if that's one person that's basically anchoring the family in the, on that corner of the page, that's not a really good thing. You want it kind of in the center here where there's like balance where everybody kind of has some, I guess I kind of wanna say equal, say equal value, equal authority, and I mean appropriately so, right? Mm-hmm. <affirmative> where parents are still parents and children are still children, there's that higher hierarchical structure that's appropriate and developmentally necessary, but you've got the ability where a kid can speak and be heard by a parent and their input is considered, right? That's the, you're sort of bringing balance back to the system.

Nathan Hawkins:
The other thing is there's, so there's usually the person who calls originally for family therapy, let's just call that person the wife and mother <laugh>. It's

Aaron Potratz:
Just way oftentimes,

Nathan Hawkins:
Oftentimes, yeah. You know, you probably, if you're the person calling, you probably are right about a few things. Uh, you know, you, you're right about that. It's probably gonna be helpful. And you're right about some of the stuff of that's actually going wrong. You're

Aaron Potratz:
Probably right about a lot of things outside of you,

Nathan Hawkins:
Right, <laugh>. Right. That's kind of where I'm going. So what's happening in family therapy is the therapist might even agree with you, but the reality that information's not gonna be, that stuff cannot come up yet because they're trying to respect the vulnerability of everybody in the room and kind of figure out how when a person can actually hear what's going on, that might frustrate you because you're like, oh no, no, why we're not getting like, you should be mom, blah. You know? And it's like, well, yeah, but your folks, they can't tolerate it. And if you, if we wanna just say it, haven't you already said it. Well, yeah. And it's like, okay, when they're not hearing it, right.

Aaron Potratz:
Another example would be if the system does not do a good job of listening and honoring what people are saying, then people might actually be communicating and saying all the things that need to be said, but because nobody's listening to your point, it's, it's pointless. Right? You can't get anywhere. Those things can't be said because we haven't dealt with this listening issue. If nobody's listening, what's the point of talking?

Nathan Hawkins:
All right, little campers. I'm gonna share a little thing with you. It's weird and interesting.

Aaron Potratz:
Is that why you're using creepy uncle voice <laugh>?

Nathan Hawkins:
Yes, I am <laugh>. Okay, so around the little campfire, the relationships have their own identities, which also means your family does. For example, if one person in the family is just too angry, man, they're too angry, okay? So let's say that we help this, this individual stop being angry, but the relationship of your family dynamic is that anger accomplishes something. So now this one person's not doing it and all of a sudden little Johnny's angry about everything. So as, as family systems therapists we're trying to understand how yours, what your system is using to accomplish what you're trying to accomplish, even though it's not working because we have to figure out something else for you to do. Like, which by the way, you have to tell us in a weird way, it's like making these suggestions going, what do you, what about this? What about this?

Aaron Potratz:
Yeah. And I get that's a great point because a lot of people will come in, whether it's individuals, couples or families, and they'll look to us and be like, you know, what do we do? I'm like, I don't know. I'm not in your family, I'm not in your system. I don't know what you guys want or need or are okay with because what might be good or right for me, you might be like, that's weird. Like right in my family, we like to talk in like little creepy Uncle Jill and you might be like, that's weird. Keep away from me, don't smell my hair. We be talking about <laugh>. And so it depends on what your family can tolerate, right? And what your family enjoys or appreciates our values. So you guys do have to kind of give us that feedback so that we can say, okay, well your family does it this way and so this might be a good way of going about it. How does that feel? Like you have to try it on?

Nathan Hawkins:
There's kind of a lot going on. The other thing that can happen in the inside of the system is we can realize, and, and this is actually pretty common, um, but it has to be, this is why some of the experience you get as a family therapist where you'll realize, okay, I need to bring this person in by themselves. We need to do a one-off. And here's the reason why. In a one-off type of thing, this person has a lot of buildup about some particular issue. That is probably not even gonna be helpful for the family to hear. Cuz it doesn't really apply other than the fact that it's causing a problem in the family. And it might not be good for the family to hear it because the reality is, is this person needs to be able to just kind of vent in a way.

It's not really a vent, but for example, a parenting related issue, I don't want little Johnny in the room if the mom or dad or whoever it is, is freaking hacked off and they, they kind of need to talk about how they feel really about the kid. And they'll, they'll say things, I think he's a little blank, you know, like, whatever. I don't want them saying that in the room. You know, what's going on. So I'll figure out a way to separate that out, deal with what's going on, to figure out different language. Sometimes family members use stuff and they don't understand how diminishing it is, and I'm not, I'm not necessarily going to bring that up with everybody in the room. 

Aaron Potratz:
One way of looking at this is like, this whole family system in some ways is kind of like a ball of yarn that's kind of nodded up, right? Um, or string that's sort of knotted up. And as you're pulling pieces apart, you know, you're untangling this knot. Sometimes you pull one string that's got a, a unique kind of a knot that's just between two people in the family system. And maybe that that's not the whole problem, but maybe that's a large part of the problem. And so you just need those two people in their room to deal with their own issues. Like, okay, you know, maybe it's like the siblings or maybe it's like, you know, mom and daughter. Like, okay, what's the deal here? Why is there so much like hostility going on between what happened? You know, and that's like untangling that one part of it so that the rest of that knot can get untangled so much more easily. There's still stuff to untangle after that, but that might be one major piece of it.

Nathan Hawkins:
The other thing is, we're kind of heading for home here is this reality of sometimes you get into a situation like meaning the family systems counseling process and you realize, okay, this person has an an anxiety disorder. It is, it is real. It is, uh, it is something that they need to learn how to manage because what's happening is they are denying that they have anything and they're making the family manage that anxiety for them. Yeah. And the family's sick of

Aaron Potratz:
It in some ways. It's like this individual is putting their issues and the weight of that problem, that personal problem onto the relationship and you know, within the family and the family can't hold it, right? It's, it's not meant for them to hold. It's

Nathan Hawkins:
Not, they can't, they can't solve it. They can respond and respect it, but they can't solve it. So in those situations, it's not that you necessarily would quit family therapy, but it could be because the therapist could go, look, you really need to do individual therapy with this. And that's not with the family therapist. It'll be with another therapist.

Aaron Potratz:
And, and this is where I think a lot of people might say, family therapy didn't work or doesn't work, or it failed or it was unsuccessful. And that's not necessarily true. It's, there are other issues that also needed to be addressed that those individual people or those dyads or whatever maybe didn't address or everyone's expectations were something. And it didn't go that way. And it actually ended up being a bigger problem and we were just impatient and we were gonna need to sink our teeth into dealing with this anxiety disorder or this depression at a bigger level than we wanted to, and it didn't resolve things. And so we say, well, it failed. No, it didn't necessarily, it just revealed and exposed the problems that needed to be worked on.

Nathan Hawkins:
Yeah, I would encourage you that the reality is, is that the, remember how we started this, if you show up, you're probably getting more done than you've got done in a long time. So the failure situation may be just that you didn't get all the way to the end because you're still on your journey. So with that, for those of you who love that, we end abruptly. Have a great day.

Aaron Potratz:
Thanks for listening to our show. Don't forget to head over to Apple Podcasts, Spotify, Stitcher, or wherever you get your podcast to leave us a review and subscribe to our podcast so you never miss an episode. You can also visit our website at www.shrinkincpodcast.com/course and sign up for our free email course, nine Ways to overcome Fear and self-Doubt. And you'll get nine weeks worth of customized, practical strategies you can use to get past the fear that's holding you back in your life. Thanks again for listening.