The Family Guy & The Relationship Doctor

The Family Guy & The Relationship Doctor

The Value Added of the Family Psychiatrist

I’m just a soul whose intentions are good
Oh Lord, please don’t let me be misunderstood
– The Animals

“In family psychiatry a family is not regarded merely as a background to be modified to help the presenting patient alone. Family psychiatry accepts the family itself as the patient.” (HOWELLS, M.D., D.P.M., JOHN G. Family Psychiatry.)

I’ve noticed that my vocabulary is sometimes misunderstood. Herein I will focus on (1) what is a family, (2) what is a system, and finally (3) what is a family system in hopes of clearly differentiating conjoint family therapy from a family systems orientation.

In conjoint family therapy, the clinician works with the entire family on its structure and process in the treatment room setting. If one or more family members do not attend, the session is not held. Unless the attendees can get the non-attendees to come to a session, no one gets help. In this case the people who want the help don’t get it.

In contradistinction, a systemic approach does not require that all family members be actively engaged in the therapeutic process. Systemic therapy focuses on the most motivated members of the family, who are more likely to engage in the difficult work of self-differentiation, rather than the most symptomatic. Thus the people who want the help do get it and everyone benefits because a change in any one family member’s behavior creates change in the entire family’s relationships.

A family is a relational unit, a team that can work together to improve the lives of all of its members. The formal definition of a biological system is “a regularly interacting or interdependent group of items forming a unified whole.” Thus a family is also a social system, a distinct entity onto itself with indelible connections between its component parts.

A family is a combination of “emotional” systems or motivational forces and “relationship” systems which refers to the ways in which emotions are expressed. The value of a systems approach far exceeds the artificial categories of family, couples, or multifamily group treatment modalities. The systemic worldview is defined by:

  1. Attention to individuals and problems in context;

  2. Prioritizing the interaction between individual symptoms and surrounding systems

  3. Circular versus linear processes;

  4. Family relationship patterns that connect over time and space.

Ronald B Cohen of Family Focused Solutions ( explains family systems therapy.The Bowen Family Systems approach is applicable whatever the presentation or however many people from a family are sitting in the therapy room. The family system resides in the self as much as the self resides in the system. If we think deeply about it, individual therapy does not exist. A person is inseparable from his/her relationship networks. The negative side of the triangle is merely a symptomatic expression of a total family problem.

All families can benefit from relational therapy. The good news is if one motivated family member changes in the context of relationship dynamics, the entire family’s functioning improves. The goal is to change your relationships with other members of your family of origin to improve your life and your family’s life regardless of what anybody else does. Taking responsibility for what you can take responsibility for and attending to your needs in the context of intimate relationships, opens the door to facilitating healing of the entire family.

As emotional distress is so often a family affair, a single systemically oriented therapist/psychiatrist is more likely to perceive the nature of the trouble than separate practitioners for each individual. Relationships matter.

Please share your thoughts and experiences in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here. If you found this post useful, don’t keep it a secret. Go ahead and share this article with your own networks. You are encouraged to click on the buttons in the second to the right hand column at the bottom of the page.

Ronald B Cohen, MD, PC Ronald B. Cohen, MD
Bowen Family Systems Coach
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530

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  1. Diane Neal on July 27, 2013 at 4:14 pm said:

    This was very succinct and extremely helpful. Thanks

  2. Heidi Roeder on July 28, 2013 at 12:00 pm said:

    So true! I work on relationships with clients in any way that presents itself. I get adults in unhappy marriages that ask if anything will change if their spouse refuses to attend, teens who manifest symptoms so that they can enter therapy only to tell me that it is their relationship with family that is causing them distress. Rather than insisting that others be present in the session, I work with who is in front of me. Once I get the client to see what changes are possible for them to make, it becomes more of a possibility that others may join once they experience the positive changes in the “identified client.” Relationships are the core of our human experience. There are so many ways that we can learn to have more fulfilling relationships. Thanks for your article and the work that you do!

    • Ronald B Cohen, MD on July 28, 2013 at 9:20 pm said:

      Hi Heidi,

      I applaud your approach. Bowen Family Systems Coaching, or family therapy with one person, offers individuals a process for making change in their relationships even without the participation of other family members. A systems viewpoint can be utilized regardless of how many people are physically present in the consulting room.



  3. Pradeep K Chadha on July 30, 2013 at 6:20 am said:

    Very informative article by Dr Cohen. I am in total agreement with Dr Cohen that changing one member of the family changes the dynamics of the whole family. I work in individual therapy using meditation and imagery as healing tools. I help my clients on one on one basis working with negative emotions attached to almost every traumatic memory in their life. It changes their relationships with others and with themselves. In every case the family dynamics change with this one person. I often jokingly describe this change as ‘one person family therapy’. I speak from my experience as Dr Cohen speaks from his.

    • Ronald B Cohen, MD on August 1, 2013 at 10:13 am said:

      Hi Pradeep,

      Thank you for contributing to the conversation. Bowen defined the phrase “Family psychotherapy with one motivated family member” in his 1972 essay On the Differentiation of Self. Carter & McGoldrick subtitled their 2001 influential paper on Therapeutic CoachingFamily Therapy with One Person”.



  4. Jillian Beverstock, MS, LMFT on August 7, 2013 at 11:13 am said:

    Thank you Ron. That is right on and very succinct.

  5. Kevin on August 20, 2013 at 2:19 pm said:

    Good stuff. Always great to gain insight into the concepts that I inherently know but need to be updated on and reminded of.

  6. Katherine Allen, LMFT on August 20, 2013 at 4:01 pm said:

    Great summary and perspective. It is so amazingly refreshing to hear a systemically oriented Psychiatrist who really gets it. I so wish you were closer so I could refer my clients to you!

    • Ronald B Cohen, MD on August 20, 2013 at 6:01 pm said:

      Hi Katherine,

      Thank you for your kind and supportive words. Connecticut is really not that far away. Kudos on your continuing work with Sandy Hook survivors.

      All the best,


  7. Muhammad Saifudin, MS, RN, NP on August 22, 2013 at 2:54 am said:

    The systemic approach makes sense. As a quality professional it fits into the systems and process approach of quality and safety. If a person makes an error, we believe that problems in system/process design, function, etc., lead, or helped lead that person to make the error. So to in the family, generally one person is not the (total) cause of family strife. Others play their part, such as the roles in a unit where one person has an addiction disorder. I really like the concept of the family psychiatrist approach and your counseling role. Many of us see the role of the psychiatrist as merely applying pharmacological treatment, which is not always the case.

    • Ronald B Cohen, MD on August 22, 2013 at 3:05 pm said:

      Hi Muhammad,

      Making changes “in your own life, which will in turn impact positively on the family system” is the essence of Bowen Family Systems Coaching. Change yourself and you change the relationship. Bowen Family Systems Coaching, or family therapy with one person, offers individuals a process for making change in their relationships even without the participation of other family members. The beauty and value of Bowen Family Systems Coaching is its near universal applicability in promoting personal growth, individual responsibility, improved productivity, and maturity.

      As to your last sentence, that is why I am NOT that kind of psychiatrist.



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