Family Therapy

What is family therapy?

Family therapy is an effective tool for improving familial relationships that are strained, broken, or otherwise troubled. In some cases, family therapy is needed because the family system isn't functioning in a healthy way. In other cases, family therapy is used in situations in which the problems experienced by one family member are negatively impacting the rest of the family.^[1]

For example, family therapy is a popular option in cases of separation or divorce. It addresses the "thing" - in this case, divorce - causing strife in the family. Each family member gets to explore their feelings and examine their actions and attitudes to effectively deal with the stress and tension brought about by the divorce.

Types of family therapy

Many types of family counseling have been developed over the years as a means of addressing different struggles families face. Some of the most popular types of family intervention strategies are outlined below:

• Behavioral or cognitive behavioral family therapy focuses on why the family system isn't operating in a healthy manner. Specifically, this type of family intervention looks at the relationship between thoughts and behaviors and how they affect the family's ability to communicate and cope with difficult situations.^[2]
• Structural family therapy explores each family member's roles within the family unit. Structural therapy aims to examine family members' interactions with one another. This form of therapy then uses those interactions to explore how they can be vehicles for further change in the family unit.^[2]
• Narrative family therapy seeks to evaluate and rewrite the events in the family's life in a more positive light. Narrative therapy also explores the narratives attached to each family member's behavioral patterns and challenges the constructs of what is or should be traditional or customary.^[3]
• Strategic or systemic family therapy takes a problem-solving approach. First, significant family dysfunctions are examined and unpacked. Then, solutions to each problem that are agreeable to the members of the family are identified. This type of family counseling also looks at the contexts in which each family members exists (e.g., your role in the family, your political views, your religion, etc.) and how each family member's contexts can conflict and lead to difficulties in the family unit.^[2]
• Transgenerational family therapy brings multiple generations of the family into a session to explore the repeating patterns between generations that cause distress in the family unit.^[2]
• Functional family therapy is a short-term, solution-focused, in-home treatment designed to address specific problems of childhood, such as drug abuse, conflict with parents, etc. This type of therapy looks at family dynamics and identifies the issues that might cause the child’s maladaptive behavior. Additionally, this type of family counseling teaches parents improved parenting strategies and enhances inter-family communication.^[4]

What techniques are used in family therapy?

The techniques and activities used in this type of therapy depends on the specific needs of the family, the family’s strengths and weaknesses, and the theoretical orientation of the therapist, among other factors. However, some commonly used techniques include the following:^[5]

• Psychoeducational activities revolve around educating each family member on a given topic. For example, suppose the family is seeking therapy because a child has autism spectrum disorder. In that case, several sessions might be devoted to explaining what autism is, possible treatments, and what each family member can do to assist their loved one.^[5]
• Role-playing is often used to help family members develop new patterns of interacting with one another. Role-playing helps people understand how others perceive them and facilitates greater empathy for other family members.^[6]
• Genograms are effective tools for exploring a family’s history, including genetics, environmental influences, traumas, medical histories, social factors, and family relationships.^[7]
• “I statements” are one of the most common family therapy activities because they help improve communication between family members. By using "I statements," each member of the family focuses on sharing how specific situations affected them without being judgmental or accusatory toward other family members.^[8]
• Draw my family is a visual activity in which each family member draws the family and places each person in the family according to the closeness of their relationship. This helps the therapist explore the bonds and quality of those bonds between family members.
• Family play therapy is often used in the intake process with families with young children. It is an effective tool that gives that helps reveal communication patterns, interactions, and conflicts that need to be explored in therapy.^[9]

What is family therapy used to treat?

Family counseling is an effective approach for treating various day-to-day problems or serious mental health disorders within families.

For example, family therapy can address:^[1]

• Issues of parenting (e.g., conflicting parenting styles, poor communication between parents and their children)
• Relational issues (e.g., separation or divorce, sibling rivalry)
• Challenging circumstances (e.g., a physical or mental illness)
• Child behaviors (e.g., temper tantrums, manipulative behaviors)
• Traumatic issues (e.g., a death in the family, abuse, or neglect)

Family intervention strategies can also be used to treat diagnosable disorders, such as:^[10]

• Depressive disorders like major depression
• Eating disorders such as anorexia or bulimia
• Anxiety disorders like generalized anxiety disorder and social anxiety disorder
• Obsessive and conmpulsive disorders like OCD
• Traumatic stresss disorders like post-traumatic stress disorder (PTSD)
• Addictions like substance use disorder or gambling disorder

Benefits of family therapy

A host of benefits can be derived from participating in family therapy. On the one hand, families can learn skills that enhance their ability to communicate, share feelings, and support one another. These and other benefits directly impact the family’s daily functioning and the overall health of each relationship within the family unit.

On the other hand, as noted earlier, family therapy benefits families dealing with mental health issues like addiction. For example, family therapy helps people with addictions stay in treatment and reduces the likelihood of continued substance abuse.^[11]

Additionally, family members not experiencing a mental health issue can benefit from therapy. Using our addictions example from above, people with a family member who abuses drugs can feel less stress and anger after completing family therapy. Furthermore, family therapy can help prevent other family members from using drugs.^[11]

Of course, family therapy can be beneficial at a fundamental level because it's an opportunity to learn about (and from) one another. For example, a family that enters therapy because the father has paranoid schizophrenia can learn about what schizophrenia is, how it affects their father, and strategies they can use to help him cope with his symptoms.^[5]

As another example, families benefit from this type of therapy when one or more family members have an eating disorder. Family members without a disorder can learn about their loved one's experience, learn better ways to support their loved one, and gain insight into how their current behaviors may or may not be helping the situation.

Family therapy has some weaknesses, though. For example, it isn’t as effective if everyone in the family isn’t present and participates.^[11] Likewise, sometimes the presenting issue that brought the family into therapy can intensify in the short term, though this is common in all types of therapy.

Another feature of family counseling to consider is that therapists can sometimes be sucked into the family dynamic or dysfunction. As such, family therapists must commit to consistent reflection and be open to supervision or consultation with other therapists to process their client interactions and the feelings that arise in therapy with their clients.

How effective is family therapy?

Family therapy is generally considered adequate for addressing various issues, ranging from children's behavior, poor communication, and severe mental health disorders. The efficacy of the treatment depends on many factors, though, not the least of which is the type of treatment.

For example, functional family therapy is highly effective in reducing recidivism of juvenile offenders. Multidimensional family therapy reduces adolescent drug use by as much as 45 percent. And brief forms of family therapy promise to reduce children's behavioral difficulties and improve family functioning.^[12]

Other research shows that family therapy isn’t just effective, but it doesn’t take long to be effective. More than 65 percent of family therapy cases conclude within 20 sessions, but the average is just nine sessions.^[13]

What to consider when looking for a therapist

Choosing the right therapist for you and your family requires considering several factors. Certainly, word of mouth and reviews about therapists can help you narrow down the field of possibilities. Unfortunately, the expense of therapy also plays into the decision-making process.

Additionally, you might consider the following factors and questions as critical components of your decision-making:

• Convenience - Is the therapist’s office nearby or easy to get to? Do they offer remote treatment options?
• Theoretical orientation - Does the therapist's theoretical orientation speak to your values, beliefs, or goals?
• Trust and comfort - Do you feel at ease with the therapist and as though you can trust them?
• Licensure and experience - What is the therapist’s educational and work experience? Are they licensed to practice?
• Cultural considerations - Is it essential that your therapist has a similar racial, ethnic, religious, social, or cultural background as you?

Ultimately, it can be challenging to determine if a therapist is the right fit until you meet. Sometimes, you'll know immediately if they're the therapist for you and your family. In other cases, it will be apparent that they are not the right therapist for you. The important thing is to stay positive and keep looking for the right therapist if the first one doesn't quite work out.