How Family Therapy Works and How It Can Help

What Is Family Therapy?

You may have heard of family therapy without being entirely sure what it involves or how it differs from individual therapy. In short, family therapy involves multiple family members in treatment together, rather than working with just one person.

Families are unique, complex systems, and the balance within a family depends on how its members interact with one another. That family unit might include parents, children, grandparents, stepparents, stepsiblings, or other extended family. Every family member brings their own beliefs, thoughts, and emotions, and each person's behavior affects everyone else — as well as the family as a whole.

Family therapists pay attention both to the family system as a whole and to each individual within it. In family therapy, the family attends sessions together with the same therapist, and the family itself — not any one person — is considered the client.

How Do I Know If My Family Would Benefit From Therapy?

Life is full of rewarding moments, but it also brings real challenges — no one is immune to stress, and everyone needs support sometimes. When one family member is going through an especially difficult time, whether that's high stress, emotional struggles, or behavioral challenges, it can put a strain on the whole family. Big transitions, like a move, a change in finances, divorce, or remarriage, can also disrupt family routines and rhythms.

When a child is struggling in school, or a family member receives a new mental health diagnosis, it's common for the rest of the family to feel unsure how to help or how to manage their own stress. Communication difficulties can also add strain for families supporting a loved one with a mental health condition (Dattilio & Epstein, 2005). Family therapy can help families understand how to better support a struggling member. If your family has been having a hard time with communication, problem-solving, a new diagnosis, or any new stressor, family therapy may be worth considering.

What Issues Can Family Therapy Help With?

Family therapy can help resolve conflict between family members and support families through difficult transitions, such as a long-term illness or a shift in family dynamics. Looking at problems through a systems lens is often useful, since each family member's behavior influences the others and the family as a whole. Family therapy can address ongoing conflict, communication difficulties, changes in family structure, and major life transitions.

Research also supports family therapy for a range of specific concerns:

•       School refusal and obsessive-compulsive disorder in children (Carr, 2019)

•       Depression in children and early adolescents (Trowell et al., 2007)

•       Anxiety disorders in children, particularly when family members are involved in treatment (de Groot et al., 2007)

•       Adolescent eating disorders, including family-based treatment for anorexia (Le Grange et al., 2015)

•       Behavioral challenges in children and adolescents, with benefits that can last well beyond treatment (von Sydow et al., 2013)

•       Delinquent behavior and substance use in adolescents (Robbins et al., 2003)

Family therapy can also include parent training and skill-building. A number of parent management training programs exist to help parents support children with different mental health diagnoses — these programs primarily focus on training parents, though children may join for some sessions (Reichenberg & Seligman, 2016). This kind of parent training has been shown to help children diagnosed with autism spectrum disorder or ADHD (Reichenberg & Seligman, 2016).

What Happens During Family Therapy?

Your therapist will work with you and your family to build on your existing strengths and move toward shared goals. Treatment usually starts with an assessment to identify sources of individual distress and issues affecting the family system. From there, you'll work together to set both individual and family goals.

Sessions can look different depending on your family's needs — sometimes all participating family members attend together, and other times the therapist may meet with smaller groups or individuals. Your therapist will help the family explore patterns of communication and behavior, build insight, and develop new skills, while tracking progress at both the individual and family level.

Over the course of treatment, improved communication and problem-solving skills can help shift the family system toward healthier patterns — equipping your family to handle both present challenges and whatever comes up down the road. Research supports focusing on problem-solving and communication skills as a way to improve functioning for couples and families alike (Dattilio & Epstein, 2005).

How Long Does Family Therapy Last?

Just as every family is different, the length of treatment varies from family to family. Family therapy tends to be relatively short-term, though treatment may take longer depending on the complexity of the issues involved — for example, families dealing with multiple challenges or particularly complex dynamics may need more time. Your therapist will assess your family's situation, help set individual and family goals, and discuss a treatment plan with you, including an expected timeline.

What Techniques Will a Therapist Use in Family Therapy?

Therapists draw on a range of techniques and tailor treatment to each family's needs. Common approaches include:

•       Communication coaching, such as building active listening skills and learning to express feelings clearly and empathically

•       Psychoeducation, or sharing information about mental health conditions that affect the family

•       Role-playing exercises, which help family members practice new skills and see how their behavior affects others

•       Cognitive restructuring, a technique for identifying and challenging unhelpful thought patterns

Between sessions, family members are often given homework, such as journaling, keeping a thought record, or practicing new skills at home.

How Can I Find a Family Therapist?

Family therapy is offered by a range of licensed professionals, including marriage and family therapists (LMFTs), psychologists (Ph.D. or Psy.D.), clinical social workers (LCSWs), and mental health counselors (LMHCs). You can find a family therapist through a referral from your primary care doctor or your child's school, or through an online search.

Since therapists draw on different techniques depending on their training and approach, it's worth talking with a potential therapist about how they work. Fit matters for successful therapy, which is why many therapists offer a free initial consultation so you can learn more about their approach and see whether it's a good match for your family.

References

Carr, A. (2019). Family therapy and systemic interventions for child-focused problems: The current evidence base. Journal of Family Therapy, 41(2), 153–213. https://doi.org/10.1111/1467-6427.12226

Dattilio, F. M., & Epstein, N. B. (2005). Introduction to the special section: The role of cognitive-behavioral interventions in couple and family therapy. Journal of Marital and Family Therapy, 31(1), 7–13. https://doi.org/10.1111/j.1752-0606.2005.tb01539.x

de Groot, J., Cobham, V., Leong, J., & McDermott, B. (2007). Individual versus group family-focused cognitive-behaviour therapy for childhood anxiety: Pilot randomized controlled trial. The Australian and New Zealand Journal of Psychiatry, 41(12), 990–997.

Le Grange, D., Lock, J., Agras, W. S., Bryson, S. W., & Jo, B. (2015). Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 54(11), 886–894.e2.

Reichenberg, L. W., & Seligman, L. (2016). Selecting effective treatments: A comprehensive, systemic guide to treating mental disorders. Wiley.

Robbins, M. S., Turner, C. W., Alexander, J. F., & Perez, G. A. (2003). Alliance and dropout in family therapy for adolescents with behavior problems: Individual and systemic effects. Journal of Family Psychology, 17(4), 534–544. https://doi.org/10.1037/0893-3200.17.4.534

Trowell, J., Joffe, I., Campbell, J., Clemente, C., Almqvist, F., Soininen, M., Koskenranta-Aalto, U., Weintraub, S., Kolaitis, G., Tomaras, V., Anastasopoulos, D., Grayson, K., Barnes, J., & Tsiantis, J. (2007). Childhood depression: A place for psychotherapy. An outcome study comparing individual psychodynamic psychotherapy and family therapy. European Child & Adolescent Psychiatry, 16(3), 157–167. https://doi.org/10.1007/s00787-006-0584-x

von Sydow, K., Retzlaff, R., Beher, S., Haun, M. W., & Schweitzer, J. (2013). The efficacy of systemic therapy for childhood and adolescent externalizing disorders: A systematic review of 47 RCT. Family Process, 52(4), 576–618. https://doi.org/10.1111/famp.12047