Family Therapy

What Is Family Therapy?

Family therapy is a branch of psychotherapy that focuses on finding solutions to a family’s problems. Family therapy often occurs in a clinical setting but can also be provided at the family’s home or at school. Sessions typically last from one to two hours, starting with brief check-ins to see how each family member is doing and determining if specific issues need to be addressed. Therapists guide conversations and encourage positive communication throughout the session, using therapeutic techniques to help families express themselves, including activities like role-playing for adults or art therapy for children.

Family therapy’s goals include educating everyone on the issues they face, such as mental health or substance use disorders. Once the family understands the basis of their issues, therapists offer guidance and counseling on improving their situation. This type of therapy gives families the tools to have healthy and meaningful relationships. It reduces stress and teaches families to resolve problems in a way that brings them closer together and strengthens their bond.

How Does Family Therapy Work?

Family therapy occurs in phases, beginning with assessing each family member separately and together. The assessment shows how the family functions and the dynamics leading to their issues. Once the assessment is complete, therapists work with families to create a treatment plan. Everyone involved signs a contract agreeing to follow the plan.

The next phase includes therapeutic interventions to improve family relationships, interactions, and skills. Some therapists may choose only one intervention, while others employ a mixture. Therapists often close each session with a review and give the family homework before the next session. Homework helps families practice what they learn. They may be given a list of questions to answer as a family, asked to draw their family’s portrait, create a family genogram or family tree, or hold family meetings. Therapists assess the family’s progress and adjust treatment plans as needed.

The termination phase takes a couple of sessions and focuses on setting goals for after treatment, maintenance sessions, and connecting families with outside resources.

Types Of Family Therapy

There are many different types of family therapy, each created for specific family issues. Below is specific information regarding the most common family therapies.

Functional Family Therapy

Functional family therapy (FFT) is a short-term treatment that involves intensive family counseling. It effectively motivates youth and families to change unhealthy behaviors. It can take place in various environments, including home, school, or clinical settings. FFT has five phases:

• Engagement: helping the family develop a positive perspective of the program and increasing their willingness to participate
• Motivation: increasing a family’s hope that change can happen and replacing risk factors that lead to dropping out of the program with protective factors
• Assessment: identifying how the family functions, roles each member plays, hierarchy, and problems to address
• Behavior change: focusing on teaching youth and families the skills they need to make changes necessary to reduce conflicts, poor decisions, and harmful behaviors
• Generalization: connecting the family with community resources that can help them maintain the changes they made

FFT is one of the best forms of therapy for treating behavioral problems, specifically youth behaviors that may reflect how a family functions. For example, suppose a teenager is misusing drugs or alcohol. In that case, a functional family therapist’s first efforts will be to engage the youth and their family to help them understand the risks of substance misuse and motivate them to change. Once engaged, the therapist will help the teen find appropriate substance abuse treatment and will work with the family to change their behaviors to support the teen. For instance, they may teach them to stop enabling and setting boundaries. Finally, the therapist will teach the family strategies to maintain their changes.

Each session may have a different goal. In one session, the therapist may teach the family conflict resolution skills, and another may involve connecting the family with community resources.

Brief Strategic Family Therapy

Brief strategic family therapy (BFST) is an intervention for families with youth who have behavioral problems. In less than 16 weeks, the family works with a trained therapist who identifies the patterns of interactions among family members that lead to distress. Therapists work in phases that include allying with all family members, identifying problem interactions, and helping the family improve their interactions.

BFST sessions typically occur in the home and last up to 90 minutes. Therapists engage families and help them understand how the family’s dynamic influences why a youth behaves the way they do. They implement techniques such as reframing, where the family presents the problem in a new light or perspective. Another technique is boundary setting, which defines roles and responsibilities in families. Therapists may ask family members to act out conflicts or create a strategic map to show how the family interacts, which can help identify the primary conflicts.

Structural Family Therapy

Structural family therapy (SFT) focuses on rebalancing the family hierarchy. When the hierarchy is out of balance, unhealthy boundaries often exist. Therapists work with parents to establish authority. They learn the skills they need to be family leaders, such as parenting techniques, discipline, and boundaries.

Structural family therapy involves the therapist observing the family’s dynamics to find the source of the problem. Circular questioning is a popular method that focuses on the family’s relationships and how they contribute to a problem rather than focusing on the problem itself. Family mapping creates a visual diagram of the family structure, which can help families see connections that may be contributing to their problems.

Role-play is an effective form of SFT. It helps family members recognize patterns of behavior and areas for improvement. They act out scenarios of problems they face at home. Therapists can also use reframing methods to help family members find better ways to handle difficult situations. Additional techniques include genograms, setting boundaries, and restructuring.

Systemic Family Therapy

Family members influence one another. So, when one person is dealing with problems, it often affects the entire family. Systemic family therapy suggests that improving how the family functions as a whole will improve how the individual faces challenges.

As family dynamics change and become more inclusive, systemic family therapy is adaptable enough to meet the needs of most families. It aims to improve relationship skills, identify each family member’s strengths, and teach families how to work together. Techniques often used in other family therapies work well with systemic family therapy, including reframing, enactment, circular questioning, and solution-oriented activities. However, strength orientation prevents focusing on problems for too long and instead recognizes family members’ strengths. Positive connotation is an activity that asks families to describe the positive reasons a person may behave negatively.

Marriage Counseling And Couples Therapy

Marriage counseling and couples therapy aim to enhance the quality of intimate relationships. It addresses the factors or stressors causing problems between spouses or partners. These same problems affect children and other family members, too.

Several types of marriage or couples therapies have evidence of their effectiveness, such as:

• Cognitive-behavioral couples therapy (CBCT)
• Integrative-behavioral couples therapy (IBCT)
• Emotionally-focused couples therapy (EFCT)

Couples therapy typically begins with an assessment to discover the areas of the relationship causing distress. Therapy then focuses on changing and maintaining the relationship after treatment.

Session activities will vary but may include solution-focused goal setting to resolve specific issues creating tension in the relationship, such as:

• Focusing on improving intimacy
• Getting to know one another better
• Showing respect or appreciation
• Discovering love languages

Couples therapy typically begins with an assessment to discover the areas of the relationship causing distress. Therapy then focuses on changing and maintaining the relationship after treatment.

Family Therapy For Children

Young children need family therapy that is age-appropriate and relative to their mental and physical abilities. They aren’t able to communicate their emotions in the same way as older children and are too early in their developmental stages to participate in family therapies for teens and adults. Therapists who work with children are specially trained and certified in play therapy techniques, such as the mad game that teaches a child it is okay to feel anger and other emotions. Other methods include the slow-motion game, which teaches self-control; the magic wand, which lets children make three wishes related to a real issue; and puppet play, which allows children to mimic family behaviors using puppets.

Hundreds of therapy techniques can be adapted to meet each child’s needs. In addition to play therapy, therapists may use the following with families:

• Parent-child interaction therapy (PCIT)
• Mentalization-based therapy (MBT)
• Supportive therapy (ST)
• Cognitive behavior therapy (CBT)
• Mindfulness
• Positive reinforcement

An initial assessment of the child and the family will help therapists create an effective treatment plan that will likely include multiple therapeutic techniques.

What Issues Can Family Therapy Help Treat?

Family therapy teaches families the skills they need to improve how their family functions. Fixing issues depends on family motivation and willingness to participate in treatment and make changes individually and as a group.

Family therapy can effectively treat the following:

• Depression
• Anxiety
• Bipolar disorder
• Eating disorders
• ADHD
• Post-traumatic stress
• Substance abuse
• Major lifestyle changes
• Communication skills
• Family roles

Many family therapy interventions are adaptable to a variety of situations. Therapists will determine which ones will work best.

What Are The Benefits Of Family Therapy?

Each type of family therapy offers unique benefits. One study published in the Journal of Clinical Child and Adolescent Psychology lists the benefits of various interventions, including

• Improves communication among family members
• Directs and elicits new behaviors
• Enhances family attachment
• Connects with all family members
• Provides information for educational purposes
• Teaches relationship and behavioral skills

Ultimately, family therapy aims to help everyone in the family (as opposed to focusing on just one person) recover from problems that have reverberating negative impacts. When everyone works together to overcome difficulties, the odds of success drastically increase.

What Are The Risks Of Family Therapy?

While the benefits outweigh the risks, some factors can hinder the outcomes of family therapy. Things to consider, include then following:

• If one family member refuses to make positive changes, there is a risk that other family members will do the same.
• Family therapy can bring up painful emotions from past incidents. Revisiting those emotions may lead some family members to disengage in treatment.
• Not all families decide to stay together after family therapy. There is a chance that couples or family groups may choose separation.

Even with the risks, family therapy is often worth it. A therapist can help family members work through painful emotions, re-engage the family, and assist in peaceful separations.

How Long Does Family Therapy Take To Work?

The time it takes family therapy to work depends on factors such as the intervention, family participation, and a family’s willingness to make changes.

Many family therapy interventions are designed to last between 12 and 16 weeks. Brief interventions usually last up to 90 days. However, depending on the issues and needs of the family, they may extend their time in therapy. The initial assessment will give a therapist a good idea of how long treatment will last.

How Do I Find A Family Therapist?

There are many ways to find a family therapist, such as asking your family doctor for a referral, contacting your insurance company, or asking other families who have sought help for similar issues for referrals. You can also search for licensed family therapists online.