Family Diagnosis/DSM-IV

Family therapy is based on the theory that healthy systems prevent psychological maladjustment. When the family system functions properly, adequate support is available for individuals in the family to make necessary adjustments to most stressors in life. If the stressors are extreme when self, family, and community resources are weak, symptoms are likely to develop in at least one member of the family system. When resources are sufficiently strengthened, symptoms generally disappear, as the individual is now able to respond effectively to stress and/or demands for change. Intervening to strengthen family functioning resources is the most efficient access point because family members then continue on a daily basis to provide the needed support for the individual(s) under stress. If the cause of the stress is within the family functioning, such as family violence, the patterns of dysfunction must be interrupted and displaced with healthy patterns. Family therapists believe that focusing only on the external symptoms caused by internal system stress is misleading and ineffective.

The association of family functioning and individual symptoms has been defined on four levels (Kaslow 1996):

• The problem is solely in the family functioning and is not manifesting individual symptoms in family members.
• The problem is primarily in the family functioning but individual symptoms are clearly resulting from the family problem.
• The problem is primarily individual but does have critical family functioning components to effectively understand and treat.
• The problem is primarily individual but treating the family functioning component greatly enhances the treatment outcome.

Even if the family functioning is not the cause of the problem, it is a vital component to planning effective treatment. Insurance companies authorizing treatment have not yet understood this. They still require diagnoses based on individual symptoms described in the Diagnostic and Statistical Manual of Mental Disorders.