Family Therapy Explained

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What Is Family Therapy?

Family therapy, also known as family systems therapy, is a branch of psychotherapy that works with the emotional health of a family by addressing difficulties within the family system. It rests on the view that a person is not fully understood in isolation, because family relationships carry considerable weight in how each member feels and behaves.

Family therapy involves helping family members improve communication, work on family problems, understand and handle particular family situations (such as a death, or serious physical or mental illness), and build a better-functioning home environment. It addresses matters that affect the psychological health of the family, such as major life transitions or mental health conditions; it can be used as a primary form of treatment or alongside other care.

Who Can Benefit From Family Therapy?

Family therapy is used by families looking to work through conflict, improve communication, strengthen family connections, or manage a difficult situation together. It is often considered by families going through stressful events such as separation, divorce, or the death of someone close; families where a mental health condition affects one or more members; and families where relationships or communication have become strained.

The difficulty may be substantial, such as a chronic illness that reshapes family life, or more everyday, such as scheduling conflicts that create tension. In either case, family therapy offers a setting in which those difficulties can be addressed together.

Family therapy aims to improve how family members relate to one another, to work through conflict, and to support the well-being of individuals and of the family as a whole. What it achieves in a given family depends on the difficulty being addressed, who takes part, and the fit between the family and the therapist.

Family therapy has been studied formally, and the strength of the evidence varies by the difficulty being treated rather than being uniform across the field. A Cochrane systematic review of family therapy approaches for anorexia nervosa found a limited amount of low-quality evidence that they may be effective compared with treatment as usual in the short term, and insufficient evidence to say whether they hold an advantage over other psychological therapies. Family approaches also appear in national treatment guidance: the United States Substance Abuse and Mental Health Services Administration sets out how family counselling is used within substance use disorder treatment in Treatment Improvement Protocol 39. Neither of those makes family therapy the right choice for every family, and neither predicts what will happen in yours. They do mean the approach has a research literature behind it that you can look at, and that a therapist should be able to say what the evidence is for the particular difficulty you are bringing.

Core Principles of Family Therapy

Family therapy is grounded in the understanding that family relationships bear on each member's mental health and behaviour. It treats problems less as something located inside one person and more as patterns of interaction between family members.

• Systems Theory: Families operate as systems rather than as disconnected individuals, so a change in one part of the system affects the whole. Therapists help families see how each member's behaviour influences the group, and then work on those patterns together.
• Communication Patterns: Family therapy often focuses on communication within the family. Therapists observe interactions between members to identify patterns that are not working, and encourage more open and supportive ways of speaking to one another.
• Roles and Boundaries: Families may without intending to assign members roles (for example caretaker, or problem child) that restrict individual growth. Family therapy works to identify and adjust these roles and to establish clearer boundaries.

What Happens in a Family Therapy Session?

Family therapy addresses difficulties through structured sessions that make room for open discussion and understanding among family members, and that work towards ways of handling conflict and strengthening family relationships:

• Initial Assessment: The therapist may start with individual meetings to gather history and perspectives before bringing the whole family into sessions. This builds a fuller view of what is happening.
• Interactive Discussions: Much of the work involves guided discussion in which family members put their thoughts and feelings into words. The therapist holds the frame so that the conversation stays productive and respectful.
• Therapeutic Interventions: Approaches such as role-play or family drawings may bring underlying difficulties into view and help family members see one another's position.
• Goal Setting: The therapist helps the family set workable goals, such as addressing a specific conflict or improving communication, which gives the work a clear direction.

The Pros and Cons of Family Therapy

What Family Therapy Can Offer

• Addresses Conflict Directly: Working through conflicts in the consulting room can make daily life at home calmer and more supportive.
• Promotes Understanding: The work offers a view of family patterns and individual behaviour, which can help family members understand one another's position.
• Works on Patterns, Not Only Incidents: Addressing the interactions behind a difficulty, rather than each episode in isolation, can change how family members respond to one another over time.
• Support During Crises: Families dealing with grief, divorce, or another crisis have a supported setting in which to face it together.

Potential Limitations to Family Therapy

• Complex Dynamics: Family relationships are complicated, and therapy has to hold several perspectives and several difficulties at once.
• Resistance to Change: Some family members may not accept that there is a problem, or may not want to change how they act, which can slow the work.
• Time and Commitment: Family therapy asks for a real time commitment from everyone taking part, which can be difficult to arrange.
• Emotional Intensity: Sessions can become emotionally charged, and holding that intensity calls for skill on the therapist's part.

Weighing these against one another: family therapy can ease conflict at home, help family members understand one another, address the patterns behind a difficulty, and provide support during a crisis. Against that, it asks for time, willingness to take part, and tolerance for difficult sessions. Both sides are worth discussing as a family before starting.

Is Family Therapy Right for You?

Here is what to consider, and how a consultation with a professional can help you decide whether this approach suits your situation:

• Nature of the Issues: Family therapy is generally used for difficulties that involve several family members, such as communication that has broken down, a shared traumatic event, or a child's behaviour that affects the whole household. Consider whether your difficulties are rooted in, or significantly affect, family relationships.
• Willingness of Family Members to Participate: The work depends on key family members taking part. Consider who is willing and available to attend.
• Openness to Change and Feedback: Family therapy asks participants to be open to feedback and to change. Families need to be prepared to look at existing roles and habits, and to try different ways of relating.
• Emotional and Logistical Commitment: Consider whether your family can commit both to the emotional work of the sessions and to the practicalities of scheduling and attending regularly.

If you have other concerns and feel that family therapy may not be the right fit, other forms of therapy are worth exploring.

The Next Step

If family therapy seems like a suitable option for your family, the next steps involve:

• Research Therapists: Look for therapists with experience and training in family therapy. Online directories such as TherapyRoute carry professional profiles where therapists set out their areas of work and their approach.
• Initial Consultation: Arrange an initial consultation, sometimes offered free or at a reduced fee, to discuss your family's situation and what you hope to address. It is also a chance to see how your family finds the therapist.
• Questions to Ask: Ask about the therapist's experience with similar difficulties, their approach to family therapy, the likely frequency and length of the work, and how they handle a family member who is reluctant to attend.
• Setting Goals: Work with the therapist to set out what your family hopes to address. This might range from communication to a specific conflict, or working through a shared loss or traumatic event.

Conclusion

Family therapy offers a structured way of working on family relationships and conflict. It is used by families facing a range of difficulties, including communication that has broken down, grief, and a child's behaviour that affects the household. It asks for commitment and openness from those taking part. If you are considering it, research qualified therapists, arrange an initial consultation, and discuss with the therapist whether the approach fits your family's situation.

Key Takeaways

• Family therapy works with difficulties in family relationships rather than treating them as located in one person.
• Communication is a central focus, and often the first thing the work addresses.
• How much the work achieves depends heavily on who takes part and how consistently they attend.
• It offers families a supported setting during a difficult transition or crisis.
• Sessions can be demanding and emotionally intense, which is worth knowing before starting.

FAQ

How often do we need to attend family therapy sessions?

Sessions are commonly held weekly, though the frequency is adjusted to the family's situation and the therapist's way of working.

How long does family therapy last?

The length varies with the nature and complexity of what is being addressed. Sessions are commonly weekly and may continue for several months or longer.

Can family therapy address individual issues?

The focus is on family relationships, but an individual difficulty that bears on the family can be taken up within the work. A family member may also see a therapist individually alongside the family sessions.

What if a family member refuses to participate?

Therapists can suggest ways of approaching a reluctant family member, and useful work is often possible with those who do attend.

Is family therapy confidential?

Therapists treat what is said in sessions as confidential, but the detail matters and it is worth asking about directly. Therapists differ in how they handle something a family member tells them privately: some work to a no-secrets policy, under which private disclosures may be brought into the family sessions, while others hold them separately. Confidentiality also has legal limits, including circumstances in which a therapist is required to report a concern, and those limits differ from one country to another. So does the question of whether one family member can later rely on what another said in the room during legal proceedings, which in many jurisdictions cannot be prevented between participants. Where children are involved, what is shared with a parent or guardian varies as well. Ask the therapist to set out their policy at the first session, before you decide what to bring.

Additional Resources

• American Association for Marriage and Family Therapy (AAMFT)
• APA Dictionary of Psychology: family therapy, American Psychological Association
• The Gottman Institute
• Family Therapy, Centre for Addiction and Mental Health (CAMH), Canada
• Substance Use Disorder Treatment and Family Therapy (Treatment Improvement Protocol 39), Substance Abuse and Mental Health Services Administration (SAMHSA), United States, 2020. Free full text.
• Family therapy approaches for anorexia nervosa, Fisher CA, Skocic S, Rutherford KA, Hetrick SE, Cochrane Database of Systematic Reviews, 2019. Plain-language summary of the evidence.