What Is Family Therapy?

The term “family” is evolving, especially in the United States. Today’s American families don’t always consist of the traditional “two parents and their children.” Family relationships now include grandparents and cousins, emancipated adolescents and their peers, unmarried couples, same-gender spouses, adopted or fostered children, dear friends, and or any other social unit treated by someone as their traditional family ecosystem. Today’s families are more about long-term supportive relationships than blood, and more about love and care than DNA.

However, even though the definition is changing, some things remain the same. Families will inevitably have conflicts and communication issues, endure stress or trauma together, and get on one another’s nerves. For those reasons, family therapy emerged as a valuable complement to marriage counseling and individual therapy.

Why not try individual or couples therapy instead?

Sometimes a family struggles because of one family member’s specific issue. For instance, maybe someone is dealing with substance abuse or a mental health disorder like schizophrenia or major depression. Or perhaps a child is exhibiting behavioral problems in school or at home. Maybe a couple is arguing, separating, or divorcing.

You might think that these issues would be better dealt with through individual therapy sessions for the person with the problem, or couple therapy in the case of divorce. Keep in mind, though, that within a family system, one person’s problem often impacts other family members within the unit or household, if not the entire family.

Therapy sessions designed for the individual or couple are certainly recommended and are often part of a family therapy treatment plan. However, family therapy is a specialized branch of psychotherapy. Counselors who focus on family therapy are usually versed in behavioral couples therapy as well. The “MFT” acronym many counselors have as part of their title stands for “marriage and family therapist.” Additionally, most licensed clinical social workers (LCSW), licensed professional counselors (LPCs), and licensed psychologists are trained in family counseling.

According to Psychology Today, family therapy sessions address “the behaviors of all family members and the way these behaviors affect not only individual family members but also relationships between family members and the family unit as a whole.”

Reasons to See a Family Therapist

Families may seek out therapy to deal with one major issue or a combination of problems. A few common reasons for family therapy intervention include:

• An adolescent is having discipline or behavior issues at school or home.
• You suspect your teen is dealing with problematic illegal substance use.
• A new family member has entered the family structure through birth, adoption, foster care, or an extended family member like a grandparent in the home.
• One spouse is a victim of domestic violence.
• The family has lost a loved one to death.
• The family group is dealing with a significant adjustment, like relocation or long-term incarceration of a family member.
• One person has a mental illness.
• A spouse has lost a job, or the family is experiencing financial issues.

Even though some of these issues revolve around or stem from one person, sometimes referred to as the identified patient or IP, the goal of family therapy is to benefit every member of the family, not just the IP.

What to Expect From Family Therapy

Typically, family therapy is short-term — maybe around 12 visits — and not all family members have to attend every therapy session. Every member of the family can benefit from participating, though. Family therapy, says the Mayo Clinic, can help participants to:

• “Examine your family’s ability to solve problems and express thoughts and emotions in a productive manner,
• Explore family roles, rules and behavior patterns to identify issues that contribute to conflict — and ways to work through these issues, and
• Identify your family’s strengths, such as caring for one another, and weaknesses, such as difficulty confiding in one another.”

Your first session of family therapy will allow you and your family members to explain to your MFT, social worker, psychologist, or counselor what brought you to therapy. At the same time, this session allows your therapist to observe how family members interact with one another. From there, your therapist will design a treatment plan using the most appropriate and effective therapeutic process for your family’s particular needs.

Family Systems Therapy

The family therapy approach in itself is different from other types of therapy not because of “how many people are in the room,” but because of the methods used to help members of the family heal and grow stronger as a unit.

“The focus of family therapy treatment is to intervene in these complex relational patterns and to alter them in ways that bring about productive change for the entire family,” write the authors of the textbook Substance Abuse Treatment and Family Therapy. “Family therapy rests on the systems perspective. As such, changes in one part of the system can and do produce changes in other parts of the system, and these changes can contribute to either problems or solutions.”

Most family therapists use this systems theory concept, although some also use the cognitive-behavioral therapy (CBT) approach that has proven effective in individual counseling. Family systems therapy was developed by United States psychiatrist Murray Bowen in the 1950s. Bowen, according to Psychology Today, “believed that the personalities, emotions, and behaviors of grown individuals are a result of their birth order, their role within their family of origin, and the coping skills they have developed for dealing with emotional family issues.” Bowen’s family system approach is based on the idea that in order “to understand the family system, the family must be viewed as a whole, and that what defines a family is more than the people who make it up but also how they interact with each other to create a unique family dynamic.”

Other Family Therapy Approaches and Tools

Although all family therapy approaches have the common goal of improving the family dynamic, each method has a slight differentiation. One such approach to family therapy is structural family therapy or SFT. SFT is based on the work of psychiatrist Salvador Minuchin, who worked with troubled adolescents in institutes and drug abuse programs in New York City. He theorized that most childhood problems developed as a result of the family unit. Therefore, changing the adolescent’s behavior is key to changing the way family members interact with one another. Minuchin studied family subsystems and the boundaries within the family system.

Family therapists using Minuchin’s structural family approach often draw a genogram, or a chart of the family structure, including its subsystems. A genogram includes detailed information about family tree structure, intimate relationships, rituals, attachments, and interactions among family members to help the therapist understand the family dynamics. It may include information about several generations to provide an even bigger, more thorough picture.

A big part of any family therapy approach is studying and improving communication issues among family members. Communication was the focus of the work of psychotherapist Virginia Satir, who is sometimes referred to as the “Mother of Family Therapy.” Satir was one of the first family therapy practitioners and invented the Satir Transformational Systemic Therapy (STST). STST, also called the Satir Growth Model, encourages open, honest, and “straight” communication — basically saying what you mean and doing what you say. Virginia Satir’s approach was useful because it quickly identified each person’s communication style and helped them to change to a healthier method. 

Improving communication is also integral to the strategic therapy approach, which was originated by researcher Jay Haley. Using Haley’s method, family therapists ask family members to work specifically on the “symptom” or “problem” of the identified patient (IP), whether that’s substance abuse, a conduct disorder, a mental health issue, or a relationship conflict. The strategic family therapist “takes over authority from the family member who tends to dominate and control family interactions, making it possible to shift patterns of communication” and allowing the “symptom holder,” or IP, to get better.

Positive Potential Outcomes of Family Therapy

Psychotherapy for families is a relatively new concept in the United States. Still, it continues to evolve as a positive and effective intervention for a variety of family-based issues and conflicts. Family therapy can help you and your loved ones cope with your relationship breakup, your adolescent’s conduct disorder, your parent’s declining physical health, or your spouse’s mental health issues. You’ll learn techniques for healthier communication with your family members, coping skills to deal with issues outside of your control, and better care for one another.

Healthy family relationships are happy family relationships, and there are many, many mental health professionals who are well-versed in the family therapy approaches that will get you and your loved ones to a healthy place. When looking for a therapist to help your family, keep in mind that the particular techniques your family therapist uses may not be as important as the level of comfort your family members feel with that person. A “marriage and family therapist” (MFT) or “licensed clinical social worker” (LCSW) title is a good place to start. Still, ultimately, your family has to have a therapist who helps you achieve your goals and feel better in a safe, comfortable environment.

Therapy Group of NYC’s caring clinicians including psychologists and therapists who understand the unique stressors of families in New York City. We offer therapy for teenagers and couples and marriage therapy. No matter which of our NYC mental health professionals you choose, you and your family members will find your therapy gets you past “normal” and all the way to “great.” Don’t hesitate. Reach out today to learn more and schedule your first family therapy session.