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Depression: Looking at it from a family perspective

As a family therapist working extensively with families, in my experience depression is a prominent theme within families.

First and foremost, let’s start with a basic definition of what depression is. Depression is a common and serious medical condition that affects how a person feels, the way they think and how they act. Depression causes feelings of sadness and/or a loss of interest in activities that before used to be enjoyed. Depression can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home (Stahl & Briley, 2004).

Depression symptoms can vary from mild to severe and can include (Lebrow, 2005):

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite – weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g. pacing) or slowed movements and speech (actions observable by others)
  • Feeling worthless or guilty
  • Having difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

It has to be kept in mind that depression is different from sadness or grief/bereavement. The death of a loved one, loss of a job or the ending of a relationship are difficult experiences for a person to endure. It is normal for feelings of sadness or grief to develop in response to such situations. Those experiencing loss often describe themselves as being “depressed.” But being sad is not the same as having depression. The grieving process is natural and unique to each individual and shares some of the same features of depression. Both grief and depression may involve intense sadness and withdrawal from the usual activities (Lebrow, 2005).

Research (McCann, Lubman, & Clark, 2012) has indicated that therapy carried out within relational systems (i.e. working within the family systems) is so effective, that it is often not necessary to understand where a problem such as depression came from. More often we need to understand what is preventing the problem from being resolved, and to find out what resources the relational system can bring to the table. Resolving it within the web of relationships, as opposed to outside of them, is particularly more effective. Research (McCann, Lubman, & Clark, 2012), supports a claim that working in this way has been shown to have benefits for all family members both at the time and for how they handle difficulties later on in the future.

Theories (Nichols & Davis, 2016) in family therapy are unique, since they look at symptoms of depression in relation to the family. They believe that the family system maintains the symptoms of its members and their relationship patterns are maintained by the symptoms. For example, a parent or child is withdrawn and depressed. Thus, the depression and withdrawal are viewed by a family therapist, as being maintained by the structure, patterns and beliefs of the family. In turn, the depression and withdrawal permit the family to operate with the least amount of change and the most amount of predictability.

The Family Systems theory (McCann, Lubman, & Clark, 2012) takes an ecological approach, viewing problems as things that occur between people. This theory tends to see individual problems as manifestations of larger relationship problems occurring within families (or within communities or society). This means that when a family member becomes depressed, the effects of that depression are not localised within the depressed person, but rather affect all family members. It is thus a family problem, not an individual one. Depression may even be a consequence of some other family circumstance. For example, a father/mother empty nest results in being withdrawn from the family so the child will return home and interrupt their life course development, in order to emotionally support their parent.

Family Systems theorists (McCann, Lubman, & Clark, 2012) pay careful attention to the boundaries between family members, because such boundaries are exactly where problems tend to occur. A boundary is a sort of definition and psychological perimeter that people draw around themselves and around other relationships they are involved in. Boundaries mark off where one person or group ends and another begins. Healthy boundaries act as containers (imagine a food container) where things that need to stay apart are indeed kept apart. They also act as roles that help people know how to act. The boundary around the family as a whole helps family members know who is a member and who is not. The boundary around the parents helps them keep their adult sexuality and communication apart from their children.

Family problems occur when boundaries become strained or break and members are put into situations that may harm them. Families dealing with spousal abuse often fail to protect their children from that abuse, resulting in traumatised children and adults. Parents with addiction problems may be incapable of taking care of themselves, influencing their children to become “parentified”, thus they take the role of the parent (Palombi, 2018).

Families are frequently blind to how much they are ecologically interdependent with one another. It is very difficult for most people to realise that they might be contributing to a problem. For this reason, that is why some families are often quick to blame individuals within the family for their anguish, falsely localising the cause of their pain into a scapegoated (someone blamed for the wrongdoings and mistakes) member. This way the family creates an “identified patient” (a member of the family who exhibits the symptoms of a mental health issue and for whom treatment may be sought by the other group members).

In conclusion, here is some food for thought that helps paraphrase for us the important information discussed in this article:

  • The problems people have frequently reflect problems experienced by the families and groups, to which these people form part of;
  • It is necessary to address family or group problems at the family or group level (the “system” level) if they are to be resolved;
  • The way to identity what is going within a family or group is to pay attention to how the boundaries, roles and belief systems governing the family or group members are functioning.


  1. McCann, T.V., Lubman, D.I., & Clark, E. (2012), Views of young people with depression about family and significant other support: Interpretative phenomenological analysis study. International Journal of Mental Health Nursing. Vol. 21 Issue 5, p453-461. 9p.
  2. Stahl, S., & Briley, M. (2004). Understanding pain in depression. Hum Psychopharmacol Clin Exp., 19: S9–S13. Human Psychopharmacology.
  3. Lebrow, J.L. (2005). Handbook of Clinical Family Therapy 1st Edition. ISBN-10: 9780471431343.
  4. Palombi, M. (2018). From Gestalt Therapy to Family Systems: How Theoretical Frameworks Inform Clinical Applications. Australian and New Zealand Journal of Family Therapy. Australian and New Zealand Journal of Family Therapy 39, 514–527.
  5. Nichols, M.P., & Davis, S. (2016). Family Therapy: Concepts and Methods. 11t Edition. ISBN-13: 978-0133826609.

Maria Mifsud

About Maria Mifsud

Maria graduated with a Bachelor of Psychology (Hons) in 2008, then went on to read for a Masters in Probation Services at the University of Malta. After years of being part of the Government workforce, she realised that to better understand her clients and be more equipped, she had to further her studies by enrolling in a Masters in Systemic and Family Psychotherapy with IFT-Malta. Some years later, she continued to pursue her studies in Clinical Supervision with IFT-Malta. Maria is also a qualified Victim Offender Mediator.

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