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“Why family therapy… because it deals with family pain.” – Virginia Satir
As the quote from Virginia Satir suggests, family therapy is necessary to address family pain and heal a family’s wounds.
We all start this life with a family, whether that family is composed of blood relatives, adopted parents, or a foster family. This family that we acquire when we are born influences every aspect of our lives, from our first moments to our last.
Our family affects who we are and who we become, both for the better and for worse. We learn our vocabulary, our habits, our customs and rituals, and how to view and observe the world around us.
We also learn how to love, and how to interact with others from these first important relationships. If we are born into a healthy family with healthy relationships, we are likely to learn how to maintain healthy relationships. If we are born into a dysfunctional family that struggles to connect, we may also struggle to connect with others.
While it is certainly unlucky to be born into the second kind of family, it’s not an unchangeable situation. Nearly all families deal with some sort of dysfunction at one time or another, yet most families retain or regain a sense of wholeness and happiness.
Family therapy offers families a way to do this – a way to develop or maintain a healthy, functional family.
This article contains:
What is Family Therapy / Family Counseling?
Family therapy or family counseling is a form of treatment that is designed to address specific issues affecting the health and functioning of a family. It can be used to help a family through a difficult period of time, a major transition, or mental or behavioral health problems in family members (“Family Therapy”, 2014).
As Dr. Michael Herkov explains, family therapy views individuals’ problems in the context of the larger unit: the family (2016). The assumption of this type of therapy is that problems cannot be successfully addressed or solved without understanding the dynamics of the group. The way the family operates influences how the client’s problems formed and how they are encouraged or enabled by the other members of the family.
Family therapy can employ techniques and exercises from cognitive therapy, behavior therapy, interpersonal therapy, or other types of individual therapy. Like with other types of treatment, the techniques employed will depend on the specific problems the client or clients present with.
Behavioral or emotional problems in children are common reasons to visit a family therapist. A child’s problems do not exist in a vacuum; they exist in the context of the family and will likely need to be addressed within the context of the family (Herkov, 2016).
It should be noted that in family therapy or counseling, the term “family” does not necessarily mean blood relatives. In this context, “family” is anyone who “plays a long-term supportive role in one’s life, which may not mean blood relations or family members in the same household” (King, 2017).
According to Licensed Clinical Social Worker Laney Cline King, these are the most common types of family therapy:
- Bowenian: this form of family therapy is best suited for situations in which individuals cannot or do not want to involve other family members in the treatment. Bowenian therapy is built on two core concepts, triangulation (the natural tendency to vent or distress by talking to a third party) and differentiation (learning to become less emotionally reactive in family relationships).
- Structural: Structural therapy focuses on adjusting and strengthening the family system to ensure that the parents are in control and that both children and adults set appropriate boundaries. In this form of therapy, the therapist “joins” the family in order to observe, learn, and enhance their ability to help the family strengthen their relationships.
- Systemic: The Systemic model refers to the type of therapy that focuses on the unconscious communications and the meaning behind family members’ behaviors. The therapist in this form of treatment is neutral and distant, allowing the family members to dive deeper into their issues and problems as a family.
- Strategic: This form of therapy is more brief and direct than the others, in which the therapist assigns homework to the family. This homework is intended to change the way family members interact, assess and adjust the way the family communicates and makes decisions. The therapist takes the position of power in this type of therapy, which allows other family members who may not usually hold as much power to communicate more effectively (King, 2017).
What is a Family Counselor Trained For?
“In this therapy, the therapist takes responsibility for the outcome of the therapy. This has nothing to do with good or bad, guilt or innocence, right or wrong. It is the simple acknowledgement that you make a difference.” – Eileen Bobrow
As the different types of therapy described above show, a family therapist may be called upon to take on many different roles. These many roles require a family therapist to undergo a great deal of training, formal education, and testing to ensure that the therapist is up to the task.
While therapists may have different methods and preferred treatment techniques, they must all have at least a minimum level of experience with the treatment of:
- Child and adolescent behavioral problems
- Depression and anxiety
- LGBTQ issues
- Domestic violence
- Marital conflicts
- Substance abuse (All Psychology Schools, 2017)
In order to treat these and other family issues, therapists must:
- Observe how people interact within units
- Evaluate and resolve relationship problems
- Diagnose and treat psychological disorders within a family context
- Guide clients through transitional crises such as divorce or death
- Highlight problematic relational or behavioral patterns
- Help replace dysfunctional behaviors with healthy alternatives
- Take a holistic (mind-body) approach to wellness (All Psychology Schools, 2017)
In order to gain the skills necessary to perform these functions, a family therapist usually obtains a bachelor’s degree in counseling, psychology, sociology, or social work, followed by a master’s degree in counseling or marriage and family therapy.
Next, the therapist will most likely need to complete two years of supervised work after graduation, for a total of 2,000 to 4,000 hours of clinical experience. When these requirements are met, the therapist will also likely need to pass a state-sanctioned exam, as well as completing annual continuing education courses.
This education and training will allow a therapist to help the clients who come to the therapist for guidance with a wide range of problems, including:
- Personal conflicts within couples or families
- Unexpected illness, death, or unemployment
- Developing or maintaining a healthy romantic relationship at any stage
- Behavioral problems in children
- Divorce or separation
- Substance abuse or addiction
- Mental health problems like depression and anxiety
This wide range of problems makes it clear that the answer to “What is a family therapist NOT trained to do?” may be shorter than the question of what they ARE trained to do!
To learn more about how marriage and family therapists are trained and how they practice their craft, the following websites are great resources:
- The American Association for Marriage and Family Therapy website
- The All Psychology Schools website
- The Careers in Psychology website
- The Marriage and Family Therapist Licensure website
- The Learn website
What is the Goal of Family Therapy?
“To put the world right in order, we must first put the nation in order; to put the nation in order, we must first put the family in order; to put the family in order, we must first cultivate our personal life; we must first set our hearts right.” – Confucius
In a nutshell, the goal of family therapy is:
To work together to heal any mental, emotional, or psychological problems tearing your family apart. (Lee, 2010)
In order to help a family work together towards a healthy family life, family therapists aim to aid family members in improving communication, solving family problems, understanding and handling special family situations, and creating a better functioning home environment (Family Therapy, 2017A).
More broadly, the goals of family therapy depend on the presenting problems of the clients. For example, the goals differ based on the following scenarios:
- A family member is suffering from schizophrenia or severe psychosis:
The goal is to help other family members understand the disorder and adjust to the psychological changes that the patient may be undergoing.
- Problems arising from cross-generational boundaries, such as when parents share a home with grandparents, or children are being raised by grandparents:
In this case, the goal is to improve communication and help the family members set healthy boundaries.
- Families deviating from social norms (unmarried parents, gay couples raising children, etc.):
The goals here are not always to address any specific internal problems, but the family members may need help coping with external factors like societal attitudes.
- Family members who come from mixed racial, cultural, or religious backgrounds:
The goal, in this case, is to help family members further their understanding of one another and develop healthy relationships.
- One member is being scapegoated or having their treatment in individual therapy undermined:
When one family member is struggling with feeling like the outcast or receives limited support from other family members, the goal is to facilitate increased empathy and understanding for the individual within their family and provide support for them to continue their treatment.
- The patient’s problems seem inextricably tied to problems with other family members:
In cases where the problem or problems are deeply rooted in problems with other family members, the goal is to address each of the contributing issues and solve or mitigate the effects of this pattern of problems.
- A blended family (i.e., step-family):
Blended families can suffer from problems unique to their situations. In blended families, the goal of family therapy is to enhance understanding and facilitate healthy interactions between family members (Family Therapy, 2017B).
Family Psychotherapy: Taking it One Step Further
We tend to think of therapy and psychotherapy as two different forms of treatment, but in fact, they are the same thing. This ambiguity is enhanced when we introduce the term “counseling” as well.
In truth, therapy is simply a shortened form of the word “psychotherapy” (www.drpatrick.com). However, counseling is sometimes called “talk therapy,” blurring the lines even further (Eder, “What is the Difference”).
Generally, counseling is applied in situations where an individual (or, in the case of family counseling, a family) engages the services of a counselor or other mental health professional to help with a specific problem or set of problems. Therapy, or psychotherapy, is a more in-depth and usually long-term form of treatment in which the client or clients discuss a wider range of issues and chronic patterns of problematic feelings, thoughts, and behaviors (Eder, “What is the Difference”).
A family who is struggling with a situation that brings added stress, such as the death of a family member, addiction, or dire financial straits, may benefit from counseling to help them through their struggles to emerge on the other side as a stronger and more cohesive unit.
If a family is struggling with more chronic mental or behavioral problems, such as a father dealing with schizophrenia, a mother fighting depression, or a child who has been abused, psychotherapy is likely the better choice.
This type of therapy is appropriate for families with problems such as these because a family therapist has a different perspective on treatment than an individual therapist. While the individual therapist works with one client on solving or curing a problem, the family therapist views problems in the context of the “system” of the family. To solve a problem in a system, you need to consider all parts of the system.
Fixing the alternator in a car will not fix the problem if it also has flat tires, a faulty transmission, and a plugged exhaust pipe.
Issues within a family are similar to the car with several problems. A parent struggling with alcoholism is not a problem in isolation; the parent’s struggle has likely affected their spouse and their children as well. A family therapist believes that problems must be addressed at the level of the whole family rather than on an individual level (Schwartz, 2009).
What are the Benefits of Family Therapy?
This more holistic approach to treating problems within a family has proven to be extremely effective in many cases. In family therapy, families can work on their problems with the guidance of a mental health professional in a safe and controlled environment.
The benefits of family therapy include:
- A better understanding of healthy boundaries and family patterns and dynamics
- Enhanced communication
- Improved problem solving
- Deeper empathy
- Reduced conflict and better anger management skills (10 Acre Ranch, 2017)
More specifically, family therapy can improve the family relationships through:
- Bringing the family together after a crisis
- Creating honesty between family members
- Instilling trust in family members
- Developing a supportive family environment
- Reducing sources of tension and stress within the family
- Helping family members forgive each other
- Conflict resolution for family members
- Bringing back family members who have been isolated (American Addiction Centers, 2017).
In addition, family therapy can enhance skills required for healthy family functioning, including communication, conflict resolution, and problem-solving. Improving these skills for each member of the family increases the potential for success in overcoming or addressing family problems. In family therapy, the focus is on providing all family members with the tools they need to facilitate healing (Teen Treatment Center, 2014).
6 Examples and Exercises
If family therapy sounds like a treatment that would benefit you and your loved ones, the best course of action is to find a licensed professional with whom you can build a good working relationship and address the problems your family is facing. However, if you’re not quite ready for this step or there are obstacles between you and getting treatment, there are many exercises and suggestions that you may find to be a good alternative.
The exercises and techniques below are meant to be used within the context of a therapeutic working relationship, but some also have applications for those who wish to explore the possibilities of family therapy before committing to a long-term treatment with a therapist. If you are a therapist or other mental health professional, you may find these exercises to be useful additions to your therapy toolbox.
The Miracle Question
This exercise can be used in individual, couples, or family therapy, and is intended to help the client(s) explore the type of future they would like to build. We all struggle at times, but sometimes the struggle is greater because we simply do not know what our goals actually are.
The Miracle Question is an excellent way to help the client or clients probe their own dreams and desires. When used in the context of couples or family therapy, it can aid clients in understanding what they significant other or family member needs in order to be happy with their relationship.
This Miracle Question is posed as follows:
“Suppose tonight, while you slept, a miracle occurred. When you awake tomorrow, what would be some of the things you would notice that would tell you life had suddenly gotten better?” (Howes, 2010)
While the client may give an answer that is an impossibility in their waking life, their answer can still be useful. If they do give an impossible answer, the therapist can dive deeper into the clients’ preferred miracle with this question: “How would that make a difference?”
This question aids both the client and the therapist – the client in envisioning a positive future in which their problems are addressed or mitigated, and the therapist in learning how they can best help their client in their sessions.
You can learn more about this exercise at this link.
Colored Candy Go Around
If you’re looking for a fun and creative icebreaker or introduction to family therapy, this exercise can be a great way to start.
To engage in this exercise with your family, you need a package of Skittles, M&Ms, or a similar colorful candy. Distribute seven pieces to each family member, and instruct them to sort their candy by color (and refraining from eating it just yet!).
Next, ask a family member to pick a color and share how many they have. For however many candies of this color they have, instruct them to give the same number of responses to the following prompts based on the color:
- Green – words to describe your family
- Purple – ways your family has fun
- Orange – things you would like to improve about your family
- Red – things you worry about
- Yellow – favorite memories with your family
When the first family member has given their answers, tell them to choose the next family member to answer the same prompt based on the number of candies that person has. Once the prompt has been answered, the candies can be eaten.
When all family members have responded to these prompts, initiate a discussion based on the answers provided by the family. The following questions can facilitate discussion:
- What did you learn?
- What was the most surprising thing you learned about someone else?
- How will you work towards making changes/improvements?
Given the high sugar content in this exercise, you can see that this is a great game to play with young children! If this sounds like a useful exercise that you would like to try with your family, you can find further information and instructions on page 3 of this PDF from therapist Liana Lowenstein.
This is a simple exercise, requiring only a ball and a pen or marker to write with. You may even recognize it, as it is frequently used with children and teenagers in many contexts, as it takes the pressure off of talking about emotions for those who may be uncomfortable sharing their feelings.
A beach ball is a perfect ball for this activity, as it is big enough to write several emotions on and it is easy to throw back and forth in a circle. Write several emotions on the ball, such as “joyful,” “lonely,” “silly,” or “sad.”
Gather your family into a circle and begin to toss the ball back and forth between family members. When a family member catches the ball, have them describe a time when they felt the emotion facing them. Alternatively, you could have the catcher act out an emotion, an activity specially suited for children.
The intent of this exercise is to discuss emotions with your family and practice listening to one another and expressing your feelings.
You can read more about this exercise here.
The Family Gift
This exercise can help a therapist to get to know a family better. If you are using it without the guidance of a therapist, it can help you to further your understanding of your own family and provoke thoughtful discussion.
To give this exercise a try, gather a variety of art supplies and a gift bag. Explain to the family that they are going to create a gift from the materials provided. This gift will be a gift for the whole family, that everyone in the family wants. They must decide together on this gift and how it can be used within their family.
They have 30 minutes to decide on this gift and craft it. Once they have created the gift, they must place it in the gift bag.
Within the context of family therapy, this exercise provides the therapist with a look at the inner workings of the family, how they make decisions and complete tasks as a unit.
If you are engaging in this exercise as a family without the presence of a therapist, it can help you to start a meaningful conversation.
Use these questions or prompts to facilitate the discussion:
- Describe your gift.
- Tell how you each felt as you were creating your gift.
- Who made the decisions? For example, who decided what the gift should be?
- Were two or more people in your family able to work well together?
- Did anyone cause any difficulties or disagreements, and if so, how was this handled?
- Is there anything about the way you did the activity that reminds you of how things work in your family at home?
- How can the gift help your family? What else can help your family?
There is a wealth of information to be gained from observing these types of interactions or engaging in these kinds of discussion.
To read more about this exercise, see pages 3 and 4 of the PDF mentioned earlier.
This fun exercise is a great way to help family members relate to each other and work together.
The activity can be explained to a family by the therapist with the following instructions:
“I want you to stand in front of me just right there (pointing to a spot about two feet in front of the practitioner). You are going to be my mirror. Everything I do you will try to copy, but the trick is to copy me at exactly the same time that I am doing it, so you are my mirror. I will go slowly so you have a chance to think about where I will be moving so we can do it exactly at the same time. We can’t touch each other. I will lead first and then you will take a turn leading. Ready? Here we go!”
First, the therapist can model this exercise with one of the family members, then that person can take a turn leading another. This is an especially useful exercise for children, but it can be used with family members of any age.
Engaging in this exercise requires the family members to give each other their full attention, cooperate with one another, and communicate with both words and body language. It allows the family members to become more in tune with one another and can be applied with siblings, a parent, and child, or even couples in marriage counseling.
To see the instructions and read more about this exercise, see page 20 of this booklet, also from Liana Lowenstein.
A genogram is a schematic or graphic representation of a client’s family tree. However, unlike the typical family tree, the genogram provides far more information on the relationships among members of the family.
It can be used to map out blood relations, medical conditions in the family, and, most often in the case of family therapy, emotional relationships.
Genograms contain two levels of information, that which is present on the traditional family tree and that which provides a much more comprehensive look at the family:
- Basic Information: name, gender, date of birth, date of death (if any).
- Additional Information: education, occupation, major life events, chronic illnesses, social behaviors, nature of family relationships, emotional relationships, social relationships, alcoholism, depression, diseases, alliances, and living situations (GenoPro, 2017).
By including this additional information, the therapist and client(s) can work together to identify patterns in the family history that may have influenced the client’s current emotions and behaviors. Sometimes the simple act of mapping out and observing this information can make clear things which were previously unnoticed.
The information on emotional relationships can include points of interest and any aspects of the relationship that may have impacted the client(s), such as whether the relationship is marked by abuse, whether a marriage is separated or intact, if a relationship is characterized by love or indifference, whether a relationship could be considered “normal” or dysfunctional, etc.
This exercise could be completed individually, but it is likely to be most effective when completed in conjunction with a qualified professional.
- The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert by John M. Gottman
This is an excellent read for any non-professionals who wish to learn more about what family therapy can do for couples. Although this is intended for married couples, any individuals in a long-term relationship can benefit from this resource of practical wisdom. The Seven Principles for Making Marriage Work comes from renowned author and relationship expert Dr. John M. Gottman.
- Why Marriages Succeed or Fail: And How You Can Make Yours Last by John M. Gottman
Another entry from Dr. Gottman, this book provides an in-depth look at the inner workings of marriage and gives advice on how to ensure that your marriage is one of the successful ones.
- Family Therapy: Concepts and Methods by Michael P. Nichols and Sean Davis
Those with only a casual interest in family therapy may not find much of interest in this book, but anyone who wishes to gain a deeper understanding of the theory and practice of family therapy will find this book invaluable. It gives the reader a solid foundation in the techniques, methods, and academic foundations of family therapy. If you are interested in becoming a family therapist, or simply learning more about the practice of therapy within the context of the family, this book is a perfect place to start.
- Essential Skills in Family Therapy: From the First Termination by JoEllen Patterson, Lee Williams, Todd M. Edwards, Larry Chamow, Claudi Grauf-Grounds, and Douglas H. Sprenkle
This book is a fantastic resource for those with little or no experience in family therapy. The language is simple and accessible, and each chapter provides a guide for students and newly minted therapists who wish to prepare for their first sessions. Topics include intake and assessment, treatment planning, relationship on building and maintaining the therapeutic relationship, and problem-solving when treatment is not progressing.
- The Family Therapy Treatment Planner by Frank M. Dattilio, Arthur E. Jongsma, Jr., and Sean D. Davis
This is another helpful resource for new therapists. The Family Therapy Treatment Planner will aid the therapist in planning treatment for clients, dealing with health insurance companies and health providers, and navigating the complex ocean of rules and regulations. In addition, this book includes many treatment plan options, a sample treatment plan, and guidelines on dealing with the most common presenting problems for family therapists.
A Take Home Message
Family therapy is a way for you and your family to learn how to maintain healthy family relationships, communicate effectively with family members, and work cooperatively to solve family problems. This type of therapy is unique, in that problems are viewed through a broader lens and as part of the complex system of the family.
This perspective allows family therapists to help families get to the root of their problems and facilitates healing for all members of the family, whether the problem is related to substance abuse or addiction, abuse, mental health disorders, unexpected or dire circumstances, or just the ordinary everyday stress we all struggle with on occasion.
This piece described the benefits and goals of family therapy, introduced four of the most common types of therapy, contrasted family counseling with family psychotherapy, and provided examples of the exercises and techniques used in family therapy.
My hope is that you find this information useful whether you are interested in engaging with a family therapist, becoming a family therapist, or just learning more about family therapy.
If you have ever participated in family therapy or if you have practiced family therapy in your work as a mental health professional, we’d love to hear about your experiences in the comments. Did you find engaging in family therapy helpful? Did you get to reap the benefits described here? If you have practiced family therapy, what are some of the most valuable things you have learned from your practice?
Thank you for reading!
- 10 Acre Ranch. (2017, January 23). 10 Acre Ranch. Retrieved from https://www.10acreranch.org/blog/2017/01/23/5-benefits-family-therapy/
- American Addiction Centers. (2017). The benefits of family therapy. Forterus. Retrieved from http://forterustreatment.com/therapy/family-therapy/
- Eder, A. What is the difference between counseling & psychotherapy? Ashley EderCounseling & Psychotherapy. Retrieved from http://www.ashleyeder.com/counseling-psychotherapy/
- “Family Therapy”. (2014, January 14). Good Therapy. Retrieved from http://www.goodtherapy.org/learn-about-therapy/modes/family-therapy
- Family therapy. (2017A). In Encyclopedia of Children’s Health. Retrieved from http://libguides.dixie.edu/c.php?g=57887&p=371718
- Family therapy. (2017B). In Encyclopedia of Mental Disorders. Retrieved from http://www.minddisorders.com/Del-Fi/Family-therapy.html
- GenoPro. (2017). Introduction to the genogram. GenoPro. Retrieved from https://www.genopro.com/genogram/
- Herkov, M. (2016). About family therapy. Psych Central. Retrieved from https://psychcentral.com/lib/about-family-therapy/
- Howes, R. (2010, January 17). The ten coolest therapy interventions: Introduction. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/in-therapy/201001/the-ten-coolest-therapy-interventions-introduction
- Schwartz, A. (2009, March 31). Family therapy: A different approach to psychotherapy. Mental Help. Retrieved from https://www.mentalhelp.net/blogs/family-therapy-a-different-approach-to-psychotherapy/
- Teen Treatment Center. (2014, March 20). The benefits of family therapy. Teen Treatment Center. Retrieved from https://www.teentreatmentcenter.com/blog/the-benefits-of-family-therapy/