Psychotherapeutic Change


The idea of change is definitely a central one in family therapy. The main question explored in this paper concerns whether dealing with past issues from childhood and family of origin are necessary to bring about personal and systemic changes. While the research shows that nearly all types of therapy are effective, regardless of past or present focus, the very meaning of “effective” must be addressed. Factors of mind and personality, such as the subconscious, must be taken into account to gain a more comprehensive understanding of what change means, and the significance of the past for a person and a system moving through time.

Family therapy and the Question of Delving into the Past to Bring about Change

The field of psychology branched off from philosophy over one hundred years ago. Since its inception, many theories have been created to explain the nature of humans. Human nature is of course a diverse topic, encompassing a wide range of human phenomena, such as thoughts, emotions, motivations, personality, values, and behavior.

Specifically though, each theory of human nature contains a certain view of change, that is, what it means to change psychologically. But is it necessary for a person to gain insight into his or her past in order to change present functioning? Naturally the past can be reflected on, and a plethora of memories, symbols, and images—all wrapped in various types of emotional packages—can impinge on a person’s manner of dealing with self, others, and the world.

The latest analysis tells us that virtually all therapies are equally effective in helping clients (Miller, Duncan, & Hubble, 1997). And many of these therapeutic types do not delve into the past. So, given the effectiveness of all sorts of therapies, is it really necessary to examine family of origin issues in order to bring about change in a person or a family system?

While the research says probably not, the efficacy of most of the marital and family models has yet to be investigated through empirical outcome studies with a control group (Sandberg, et al., 1997). A key observation here concerns what sort of change is actually brought about? Is it the same type of change with different therapies, regardless of what issues one works on in therapy involving the past or the present? The research is presently lacking concerning answers to these questions.

Working with a family can be quite different than working with an individual. The type of history the individuals in the family have had will influence the type of system existing presently. It turns out that certain family therapies can be just as effective, even when they eschew any focus on or insight gained about the past. But of course “effectiveness” depends on one’s view of change, and whether the sort of expansion of awareness brought about by insight into the past is empowering for all people in all respects.

An argument can be made, however, that all types of family therapy deal with the past, if only in an indirect manner—which also may explain why different therapeutic concentrations appear to be equally effective. For example, Structural and Strategic therapy both focus on present situations, albeit from somewhat different perspectives. The very actions of reformulating the family’s roles and rules and establishing clear boundaries not only provide a new way of being for the family members. They also provide a reshaping of each member’s interpretations of memories about how the family should function. In turn, Strategic techniques like prescribing the symptom, assigning ordeals, and using cooperative hierarchies seek to establish new ways of functioning that differ from the past; so, the past eventually fades into the far background of one’s present interactions. Narrative therapy also constitutes a reformulation of the past through the creation of a new positive story about one’s present situation. This seeks to reassess the clients’ old conceptions of their predicament (and implicitly how they got there).

The Subconscious Component

The degree to which one believes that the past may reflect itself in the present hinges on one’s views of the power of the subconscious and the nature of mental health. Cognitive and Behavioral theorists see the subconscious as having a much smaller role in a person’s present actions than the “deeper” psychodynamic theorists. Nonetheless, even Cognitive therapy has addressed the significance of dealing with family of origin issues with clients from dysfunctional families (Bedrosian & Bozicas, 1994). These practitioners understand the impact family systems (especially dysfunctional ones) can have on adults’ later views of self, others, and the world. Recent studies have contributed to this opinion (Gumbiner, Flowers, & ST Peter, 1996).

There is still great debate among many as to what precisely the subconscious is, and whether it can be incorporated within a parsimonious model of the mind. If we define the subconscious as “all mental events, processes, and content (e.g., memories) that are out of conscious, focused awareness at any given time,” we are also able to describe mental content that lies on the periphery of focused awareness as part of the subconscious. This definition is different from the somewhat ineffable workings of the “unconscious” postulated by Freud and embraced by certain depth psychologists.

While not endorsing multiple personalities, it is not untrue to say that we can have many minds thinking at once, on different levels; mixed emotions, for instance, can be an outcome of this. Such complexity neither denies nor prevents incorporating the subconscious within a parsimonious model of the mind. What it does instead is open up a broad range of possible reasons for people’s behavior. It helps explain why two people can pursue the same activities, with one being happy and the other being depressed. The subconscious also explains why grown adults are sometimes reduced to a state of inarticulateness, nonexpressiveness, and even defensiveness, when interacting with their parents. It explains why people can have very rational conscious beliefs, insights, and convictions, and yet conspicuously lack behavioral congruence. One can call it learned behavior or flawed information processing, but the evaluations, assessments, expectations, and images of the subconscious are what are involved.

Dealing with the Past in the Present

Working with a family may implore one to examine the nature of personality in general—to discover exactly what subconscious aspects of a person are a reflection of the past. The issues (both troublesome and beneficial) a person carries with him or her from childhood, the formative years, can play a major role in personality and therefore behavior.

The question here remains one of degree. Some persons may be less affected by their past than others. Some may dwell subconsciously on issues from childhood in virtually every interaction with people and in most choices in their lives. Others have found ways to compartmentalize painful early experiences—or to amplify positive experiences—and move on to creating a better life for themselves. In terms of memories, some may remember a lot, while others have only sketchy fragments and broken images. The main issue, then, concerns how a person thinks and feels about these particular memories, and especially how they are involved—or being utilized, consciously or subconsciously—in shaping who that person is, and what he or she does as a consequence.

The capacity to remember may not be quite so significant as the types of evaluations and assessments a person makes of memories of early occurrences and how they affected him or her—and in what way they remain intact as an adult (for example, in the form of what Gestalt therapy calls “body armor”). The degree to which the person chooses to examine and address these experiences, and the ways they may be influencing his or her present behavior, are important therapeutic considerations. The current family system in which he or she is embedded may actually be well suited to perpetuating them, serving as a special kind of lubricant.

The idea of self-worth may be another very important consideration here. Developing the feeling, the emotional foundation, that one is worthy of happiness, is a crucial factor in how one deals with past family issues. One could have had an atrocious past, and yet one could still perceive it differently—positively—in the present (deriving the best from a bad situation). On the other hand, one could have had a relatively functional early family environment, but for unspoken reasons one focused on a few negative occurrences and blew them out of proportion to what really happened; numerous cognitive distortions can supersede clarity.

The question then concerns what one does with these beliefs and perceptions, how one utilizes them—in what way does a person use them to define his or her present being (consciously, but more likely subconsciously). It seems that the fundamental choice is whether to deal with these beliefs and perceptions so that they do not deleteriously influence present functioning—or to try to run from them, simultaneously conceding that one is powerless over them. Those who are still searching for a way to generate the feeling that they are worthy of happiness and able to maintain it—in the midst of whatever family (and eco-) systems they are involved in—are paying attention to their self-respect.

Some family therapies hold that the problem of change lies not so much in how the adult chooses to deal with his or her own childhood, as on how he or she chooses to interact with (and react to) his or her spouse, son or daughter, and other family members. Yet children’s experiences with parents and others may be the crucial factor in the issue of individual and systemic change. Past childhood psychological issues within the adult can be imposed on the next generation. Children may find the path of least resistance the best route for them in their given context. After all, it might be easier to model those who are in close proximity to oneself. The intergenerational transfer of information is part of the family system.

The Idea of Mental Health

The idea of mental health raises the issue of how much change is necessary, and what types of changes are important for overall functioning. Outcome studies of family therapies rely on self-report measures to indicate pre- and post treatment functioning. While giving cursory acknowledgement to the questionable validity of these measurement tools, they proceed to determine whether significant changes were caused by therapy—as derived from statistical computations of groups of data (typically from self-report responses). Statistics, however, leads one to only speaking in terms of probabilities. Further, it does not account for individual differences and the reasons for those differences. It tries to smooth over the essential elements involved in the personal changes within each individual.

Family therapy was designed to deal with issues involving the system in which most persons have spent their time. Each of the numerous family theories present their own view of how one should understand and treat the overall system. Hardly any empirical research has been done showing that therapists who work on their own family of origin issues are more effective (Johnson, Campbell, & Masters, 1992).

Nevertheless, a choice must invariably be made in treatment about whether it is at all helpful to deal directly with the past. Some therapies, like Bowenian, do so by inspecting (for instance through genograms) the historical nature of the family and how different themes were passed from one generation to another. How the family members interacted in the past, and particularly the influence those behaviors had on the client seeking therapy, are of paramount importance in generating insight into present problematic circumstances.

In fact Framo (1992) sees these dynamics best dealt with “live,” in therapy. In Family-of-Origin therapy the adult child and his or her family of origin discuss the nature of their past and present relationships during two intense two-hour sessions. In the months following this therapy, clients typically report key changes not only in their relationship with Mother and Father, but with their spouse and present family as well. They become free from the old evaluations and expectations that sought to undermine present authentic functioning with their parents; they can now see their parents eye to eye, as real persons, and thus better understand the needs of their own children (Framo, 1992).

Of course other therapies, like Strategic, deal primarily with the present circumstances of the family, working on the nature of present relationships. Emphasis is placed on how changing these interactions facilitates change in the system and thus a return to overall health.

Ultimately, the therapist and the client are the best judges of what sort of mental health should be sought—keeping in mind that many components of self-esteem are usually involved (Branden, 1994). Only the therapist and client can identify the kinds of changes needed and whether adequate change has occurred. However, only the client can ensure whether such change will be maintained far into the future. Often the kind of future created involves inspecting seemingly forgotten patterns of the past. Becoming more cognizant of these patterns can facilitate the creation of a new future—and, to some extent, a new person.


Bedrosian, R. C., & Bozicas, G. D. (1994). Treating family of origin problems: A cognitive approach. New York: The Guilford Press.

Branden, N. (1994). The Six Pillars of Self-Esteem. New York: Bantam Books.

Framo, J. L. (1992). Family-of-origin therapy. New York: Brunner/Mazel, Inc.

Gumbiner, J., Flowers, J. V., ST Peter, S., & Booraem, C. D. (1996). Adult psychopathology on the MMPI and dysfunctional families of origin. Psychological Reports, 79,1083-1088.

Johnson, M. E., Campbell, J. L., & Masters, M. A. (1992). Relationship between family-of-origin dynamics and a psychologist’s theoretical orientation. Professional Psychology: Research and Practice, 23(2), 119-122.

Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997). Escape from Babel. New York: W.W. Norton & Company.

Sandberg, J. G., Johnson, L. N., Dermer, S. B., Gfeller-Strouts, L. L., Seibold, J. M., Stringer-Seibold, T. A., Hutchings, J. B., Andrews, R. L., & Miller, R. B. (1997). Demonstrated efficacy of models of marriage and family therapy: An update of Gurman, Kniskern, and Pinsof’s chart. The American Journal of Family Therapy, 25(2), 121-137.