Family Therapy

What is family therapy?

Family therapy is a form of psychotherapy that involves family members working together with a therapist. Rather than treating one person in isolation, it looks at how relationships, communication and roles within the family affect everyone’s well-being.

When it’s used

• Ongoing conflict or communication problems
• Major changes such as divorce, blended families, illness or loss
• Supporting a child or teen with a mental health condition
• As part of treatment for eating disorders and substance use in young people

Approaches

Approaches include structural, strategic, systemic and family-based treatment (FBT). FBT — sometimes called the Maudsley approach — engages parents in supporting a young person’s recovery from an eating disorder.

What to expect

Sessions typically involve two or more family members and focus on understanding patterns, improving communication and building problem-solving skills. The number of sessions varies with the family’s goals.

Family sessions are usually arranged through a local practice or clinic. For support for yourself alongside family work, online services such as BetterHelp offer individual therapy, and its sister service TeenCounseling works with 13- to 19-year-olds.

A family systems view

Family therapy treats the family as a system in which each member affects the others. Rather than locating a problem in one person, such as a teenager with anxiety or a parent with depression, it looks at patterns of communication, roles, rules and relationships, and how the whole family can change to support wellbeing. That doesn’t mean blaming parents or anyone else; it means recognizing that families both shape and are shaped by what’s happening, and that involving them can strengthen recovery. A therapist may meet the whole family, subgroups or individuals at different points.

Common reasons families seek therapy

• Conflict between parents and children, or between siblings
• A child or teenager’s depression, anxiety, behavior or school problems
• Adjusting to separation, divorce, remarriage or blended families
• Grief, illness or loss in the family
• A family member’s mental illness or addiction; see addiction
• Eating disorders, where family involvement is central to treatment; see eating disorders
• Caregiving strain, or major changes such as a move, job loss or new baby
• Cultural, generational or communication differences

Approaches you may meet

• Structural family therapy looks at how the family is organized, including boundaries, hierarchy and roles, and helps adjust them.
• Strategic and systemic therapies focus on repeating patterns of interaction and how to interrupt them.
• Family-based treatment (FBT) for adolescent eating disorders empowers parents to help their child restore healthy eating.
• Cognitive behavioral family therapy teaches communication and problem-solving skills; see CBT.
• Narrative therapy helps families “re-author” stories about themselves and separate the person from the problem.
• Multisystemic and functional family therapy are structured programs used for young people with serious behavior difficulties.

What happens in sessions

Early sessions are about understanding each person’s view and agreeing on goals. Therapists often invite each person to speak while others listen, and may ask questions that help family members see each other’s perspective. You might practice new ways to communicate, set family agreements or try tasks between sessions. Sessions usually last about an hour and may be weekly or every other week for a few months, depending on the issue. It’s common for people to feel uncomfortable at first, and a good therapist makes sure everyone feels heard and safe.

Does it work?

Research supports family therapy for a range of problems, including adolescent depression, eating disorders, substance use, conduct problems and schizophrenia, where family psychoeducation lowers relapse. Results depend on the family’s engagement, the problem and the therapist’s training. It tends to work best when it is part of a wider plan that includes individual treatment as needed.

Getting the most out of it

• Come with an open mind; the goal is understanding, not winning.
• Allow each person, including children, to have a voice.
• Be patient; change can take time.
• Practice new habits at home.
• Speak up if the therapist seems to be taking sides or if something feels unsafe.

When family therapy isn’t appropriate

Family sessions aren’t suited where there’s ongoing abuse, violence or coercion, because joint sessions can put someone at risk. A therapist should screen for this and may recommend individual support first. If you or a family member is in danger, see Get Help Now. Learn more about related approaches in psychotherapy and couples therapy, and our guide to finding the right therapist.

Questions to ask before you start

It helps to ask a prospective family therapist about their training and the models they use, who they will want to see and how often, how they handle confidentiality when children or teenagers are involved, and how progress will be reviewed. Ask what to expect if a family member is reluctant to attend; many therapists will begin with those who are willing and invite others in over time. Families can also ask about costs, insurance coverage and whether online sessions are available if schedules or distance make meeting in person hard.

Support between sessions

Change in a family happens mostly at home, between sessions. Small, regular habits such as a weekly family check-in, a shared meal without screens or an agreed way to pause a heated argument can reinforce what you practice in therapy. Be patient with each other, notice progress as well as setbacks and keep the therapist informed about what is and isn’t working. If one person’s distress becomes severe, or there are thoughts of self-harm, seek urgent help right away through the resources on Get Help Now.