Combining Individual and Couple/Family Therapies

My undergraduate education as a psychology major at UCLA in the 1960s was pretty standard for that time, with an emphasis on normal child and adult development, brain processes, psychopathology, assessment methods, and other aspects of individual functioning. To a significant degree, those foci were similar in the clinical psychology graduate program I completed at UCLA, with an emphasis on individuals’ diagnosable psychological disorders. However, in a case of being in the right place at the right time, that traditional psychology training was enhanced by the faculty’s pioneering work on family therapy.

My first case as a therapist trainee (teamed with an advanced student co-therapist) was a family consisting of a mom, dad, 8-year-old son, and 5-year-old daughter. They had sought help for the son’s “misbehavior” at home and in school, and he clearly was on the hot seat in our first session. As the junior therapist, I sat quietly and observed my co-therapist interacting with the family. While the parents described their son’s transgressions (especially being aggressive toward his little sister), I noticed that the daughter was subtly poking and provoking her brother, until his attempts to ignore her failed and he yelled at her and kicked her leg, resulting in her screaming. The parents immediately chastised the son and told us therapists, “See, he’s so mean to her!”

I was so energized by the opportunity to do something therapeutic, that I pointed out what I had observed. Suddenly our therapy expanded from a focus on figuring out what was wrong with the son to understanding and intervening with family relationships. I became hooked on family therapy! Although treatment of individuals’ psychological problems has continued to be an important part of my work, understanding and intervening with problematic family dynamics have continued to be major parts of my clinical work, teaching, and research ever since.

Paying attention simultaneously to individual psychological functioning and patterns in couple and family relationships can feel like living in two worlds. As a result, my impression has been that many mental health professionals tend to devote most of their time to only one of those areas. Although the tendency to work in professional “silos” has decreased over the years, integration of intrapsychic and interpersonal models of treatment is still in a fairly early stage. A major barrier to such integration has been the need that members of professions such as psychology, psychiatry, social work, counseling, and family therapy have felt to establish their own special expertise, justifying their existence and access to people seeking help.

As relative newcomers to the mental health scene, family therapists initially eschewed the intrapsychic model favored by psychologists, emphasizing ways in which family patterns elicited and maintained individuals’ psychological symptoms. In turn, psychologists argued that family therapists were missing a big part of the picture by ignoring individuals’ personalities, psychopathology, etc. However, people’s well-being actually is influenced by multiple factors (intrapsychic characteristics, relations with significant others, and societal contextual factors such as cultural traditions, being a victim of discrimination, etc.). All of those factors need attention in order to achieve the most effective treatment.

Developing and applying knowledge and clinical skills that address those multiple factors is a lot of work! If a clinician’s training focused mostly in one realm, what would they need to do in order to be adequately attuned to the other realms? Most often, clinicians deal with this issue by referring their clients to specialists. For example, an individual psychotherapist whose client describes family stressors that contribute to their distress may make a referral to a family therapist for concurrent treatment. Similarly, if a family therapist identifies that a member’s individual depression is influencing family relations, a referral for individual therapy might be pursued. Nevertheless, the more each clinician knows about individual functioning, relationship dynamics, and contextual factors affecting people’s functioning, the more likely they can take those factors into account in their treatment plan and be open to collaborating with other professionals to meet clients’ needs.

The ability to take an integrative approach is facilitated if each mental health field provides their trainees some courses and supervised experience regarding factors typically emphasized by the other fields. In addition, it is important that both individual and family therapists be familiar with the rapidly growing body of research showing a bi-directional link between problems in individual functioning (e.g., depression, anxiety) and problems in significant relationships (Baucom et al., 2020; Epstein & Falconier, 2024; Whisman & Baucom, 2012). It is also reasonable for consumers who are looking for an individual therapist or family therapist to ask prospective therapists about their views on integrating intrapsychic and relational factors in treatment, and how they feel about collaborating or making referrals to clinicians from other disciplines.

Furthermore, it is helpful for clients who are seeking help for problems in their lives to be aware of how relationship stresses can contribute to individual psychological symptoms, as well as how harnessing the strengths of supportive family relationships can enhance one’s well-being. In turn, although it may be uncomfortable at times for an individual to think about ways that their personal struggles with depression, anxiety, or other personal issues may be creating stress in their intimate relationships, making a decision to take personal responsibility for seeking professional assistance for those issues can make a significant positive contribution to the quality of the relationships.

Because I strongly believe in the value of integrating the perspectives and methods of individual and relational approaches to clients’ life problems, I am committed to doing whatever I can to contribute to integrative efforts, and I strongly encourage clinicians of all backgrounds to lend a hand. I intend to discuss a variety of topics related to integrative approaches in my Stronger Bonds blog on therapeutic approaches for couples and families.