Family Therapy and Family Conferences: How They Help

As a family physician, I often see one person fall ill while the whole household is affected. A teenager with behaviour problems often lives in a home where the parents are in conflict. An older person who is seriously ill often has children and grandchildren who disagree about treatment. In these situations, talking to one person is usually not enough; we need to talk with the whole family.

What is family therapy?

Family therapy is a way of helping that sees the family as a system: one person's behaviour always affects the others and is affected by them. The goals are:

• for family members to understand each other better
• to communicate safely, without hurting each other
• to adjust roles and find solutions together

It is not mediation or judging who is wrong, and it does not treat the person with the "symptoms" as the only cause.

Who provides it?

Family therapy is provided by people trained in this work, such as family therapists, clinical psychologists, psychiatrists and family physicians, who are trained in caring for patients in the context of their families and in running family meetings. In very complex situations, such as violence or severe mental illness, professionals work together as a team.

What can it help with?

Reviews by Alan Carr (2019) in the Journal of Family Therapy concluded that systemic family therapy has supporting evidence across many problem groups in both children and adults, such as behaviour problems, eating disorders, alcohol problems and marital conflict.

What happens in therapy

• Everyone gets to speak from their own point of view in a safe space.
• The therapist helps you see repeating patterns, such as one person nagging more while the other withdraws more.
• You practise listening and expressing your needs.
• Roles are reviewed: who is carrying too much, and who is being shut out.
• You make agreements that everyone can realistically keep, and then follow up.

1. 1
   One person nagsFeels unheard
2. 2
   Other withdrawsFeels blamed
3. 3
   Nagging increasesBecause there is no response
4. 4
   Withdrawal deepensThe cycle continues

Therapy helps you see the pattern without judging who is at fault.

Family conference: a structured family meeting

A family conference, or family meeting, is a sit-down conversation between the medical team and the family to plan important matters, such as:

• caring for someone who is seriously ill or near the end of life; read palliative care
• decisions about treatment or life support, and making a living will under section 12 of Thailand's National Health Act
• sharing out care responsibilities for an older person or someone with dementia
• planning for after discharge from hospital

The main steps

1. Prepare. The team agrees beforehand on the goal of the meeting and who should attend, and asks the patient who they want to receive information.
2. Introductions and a shared goal. Everyone knows what today's conversation is about.
3. Ask how the family understands the situation before giving new information.
4. Give information honestly and in plain language, pausing so the family has time to feel and to ask questions.
5. Explore the patient's values and wishes. If the patient cannot speak for themselves, ask, "If they could speak, what would they want?"
6. Discuss the options and plan together: who does what, and when.
7. Summarise and record. Arrange follow-up and give contact details for questions.

The clinical practice guidelines for family meetings in palliative care by Hudson and colleagues (2008) state that well-prepared meetings reduce family distress and help decisions match the patient's wishes more closely.

1. 1PrepareSet goals, who attends, who the patient wants informed
2. 2Ask what they understandHow the family sees the situation before giving new information
3. 3Give clear informationPause to allow feelings and questions
4. 4Explore patient's valuesIf they could speak, what would they want?
5. 5Plan and summariseWho does what, when; record and schedule follow-up

Hudson et al. (2008): well-prepared meetings reduce family distress.

When to seek help

• Arguments at home are so bad that someone avoids coming home
• A child or teenager's behaviour has changed a lot
• The family disagrees about caring for a sick or older relative
• There has been a loss and the family cannot move on

Getting help at Dr. Kris Clinic and Kris Care Space

We provide family counselling and help arrange family conferences, drawing on family medicine together with Kris Care Space's activity therapy, which helps family members who find talking hard to communicate in other ways. Sessions can be held in English. Read more in family medicine: one doctor for the whole family.