In the United States, family psychiatrists continue to deal with the fallout from the 1950s and 1960s, when the early family therapists located mental illness within the family and then touted family therapy as the cure. Families felt blamed and shied away from "family therapy."
Yet, research shows that family treatment for many psychiatric and medical illnesses, whether it is family inclusion or psychoeducation, is very effective in reducing morbidity. Stigma and fear about family involvement have resulted in family treatment lagging behind other psychotherapies in its acceptance as a valid therapeutic intervention.
Dr. Alison M. Heru, Dr. Eliot Sorel, and Dr. Ileana-Mihaela Botezat-Antonescu attended the first WPA Congress in Romania in April.
As a contrast, it is therefore interesting to look at Romania, a postcommunist country, where all psychotherapies were deemed "unnecessary" under communism. According to Dr. Ileana-Mihaela Botezat-Antonescu, "Psychotherapy and psychoanalysis were known as the studies of the soul during the communist regime and went underground. Secret psychotherapy meetings were held in Sibiu and Timisoara, but after the 1989 revolution, we had access to information from abroad," she said during a presentation this year at the World Psychiatric Association meeting in Bucharest, Romania.
"In 1990, freedom occurs, but nobody tells you what to do. You cannot count on anything. It alienated people seeking help. It was a process that took time," said Dr. Botezat-Antonescu, a psychiatrist and psychoanalyst who was trained in the mid-1990s by trainers from the Dutch Psychoanalytic Association and serves as chair of the National Center for Mental Health.
Psychotherapists in Romania must somehow address the traumatic environment that lasted a generation. Young people strive to gain their sense of identity and belonging and, at the same time, are challenged with reestablishing a connection between the generations. The sense of intergenerational trauma and loss extends back to grandparents who lost their farms, houses, and social position.
An understanding of the intergenerational transmission of trauma can inform psychotherapists across the globe in their care of young people. Family therapy is a type of psychotherapy that is well suited to address this intergenerational trauma.
Psychological trauma is passed down through the generations in subtle and unspoken ways. It is important for therapists to recognize when this is occurring and work with the whole family. Family therapy that specifically addresses the intergenerational transmission of trauma can help move a family from feelings of helplessness toward resilience.
Development of family therapy
Family therapy developed in Romania through training courses in Cluj, Târgu Mures, and Timisoara. As there were no Romanian trainers, these courses were taught by family therapists from countries such as Ireland, France, and Yugoslavia. Families and trainees spoke Romanian or Hungarian, and during live supervision, simultaneous translation occurred. All courses, readings, and assignments were in English. Family therapy developed in Romania through training courses in Cluj, Târgu Mures and Timisoara.
Trainees saw families in their own work contexts, for example, psychotherapy centers; psychiatry hospitals; and community centers, such as family planning clinics and domestic violence shelters. Currently, there are 16 family therapy professional organizations (Contemp. Fam. Ther. 2013;35:275-87), including:
• Systemic Family Therapy Association in Cluj
• Association of Family Therapy in Bucharest
• Romanian Association for Family and Systemic Therapy in Timisoara
• Association Crisdu Areopagus in Timisoara
• Pro Familia – Family Therapy Association in Miercurea-Ciuc
• Association for Couple and Family Psychotherapy in Iasi
• Association for Family Counselling and Therapy in Iasi
Dr. Zoltán Kónya and Dr. Ágnes Kónya run the family therapy center in Cluj and have written about the challenges of practicing family therapy in Romania (Context 2007;92:2-4 and Contemporary Family Therapy 2013;35:1). Since family therapy training courses developed at different times, in different places, with trainers invited from different countries, the sense of what constitutes family therapy varies across Romania.
The meaning of the word "systemic" has proved particularly contentious. For some, systemic is synonymous with the Milan approach – which is based on the notion that "families are self-regulating systems that function based on self-developed rules tested over time through a process of trial and error" (Case Conceptualization in Family Therapy, Boston: Pearson, 2013). However, others consider family therapy as more than a systemic approach. Some promote systemic thinking as an all-encompassing epistemological frame for consultation with individuals, families, and organizations, but others do not attach much importance to the term "systemic."
The challenge of organizing into one Romanian family therapy institution with one outlook is great. This challenge also replicates one of the major problems in our field – the idea that family therapy means different things to different people. In Romania, well-meaning outside attempts ended up in a fractured national family therapy identity.