If you’re thinking about starting family therapy, you may be wondering how it works, and how it could make things better for you and your family. Or, you might be worried that family therapy could make things worse. As a Licensed Marriage and Family Therapist who has had the privilege of working with dozens of families over the years, I understand that often people have a limited understanding of what to expect in family therapy, and this can keep them from engaging. I hope this post sheds some light on what happens in family therapy, how and why it works differently than individual therapy, and why it can be helpful.

First, I’ll let you in on a little secret – family therapy is tough! That doesn’t mean I don’t love what I do – it is totally rewarding and worth it, especially when I get to participate in families make meaningful changes in their patterns, dynamics, and relationships. But I also won’t sugar coat it – while family therapy can help, it is often difficult, messy, and tiring work for the clients involved. In my experience, families who have the best outcomes have the best understanding of not only what engaging in family therapy really means, but they also have the willingness to tolerate the uncomfortable-ness that happens along the way.

To talk about how family therapy works (and hopefully how it can work for you), let’s start with what family therapy is and what it is not.

What is Family Therapy?

Family therapy is not just having multiple people in the room having their same arguments in front of a therapist. Family therapy is not mediation. Family therapy is not everyone in a family trying to get one person to change.

Family therapy is about attending to the relationships, patterns, and dynamics that happen between people. Family therapy is focused on changing unhelpful cycles that families feel stuck in. Family therapy is something that requires each participant to look internally, be willing to make changes, and be willing to see the changes being made in others.

How is Family Therapy different from Individual Therapy?

In family therapy, most or all sessions will have more than one person present. At the beginning, the therapist will help the family identify who will be a part of sessions. For some family therapists, all family members living in the household are expected to attend, yet this varies amongst each family therapist’s style, modality they are practicing from, and context of the family presenting.

This differs from individual therapy in that most or all sessions in individual therapy will just be the therapist and one identified client. Sometimes in individual therapy, a partner or family member will join for a session. Like some others, I like to refer to this as a “guest in session” to make clear that this is still the client’s individual therapy, and the other person in joining as a guest on a limited basis to share information or have a conversation with the intention that this will help the individual therapy progress.

The reason it is important to make the distinction between true family (or couples) therapy and “guest in session” of individual therapy, has to do with the therapist’s role in the process. To make changes in family therapy, the therapist must be able to remain aligned with the system as a whole, paying careful attention that they do not over or under-align with any individual. In individual therapy, the therapist is wholly aligned with the one individual client, and therefore is unable to take an unbiased or neutral stance needed to address relationship issues.

“To make changes in family therapy, the therapist must be able to remain aligned with the system as a whole…”

What is Systemic Change?

Family therapists are trained in systems theory and in their work with families are working to make systemic change. Systemic change (or second-order change) in a nutshell is changing the rules that keep the rules and cycles of the current family dynamics in place. This is in contrast to behavioral (or first-order) change, which focuses on changing individual behaviors.

The reason systemic change is important in family therapy is because family systems are complex and often difficult to change, even when the change is desired by members of the family. We’ve all experienced this in our own relationships – even if we can identify a behavior our family member is doing that we don’t like, and even if they change that behavior, it often doesn’t solve everything. Think about a husband who leaves his dirty clothes next to the laundry basket instead of putting them in, and a wife who primarily does the laundry feeling frustrated about this. The husband could, theoretically, change this behavior and start putting his clothes in the basket. This behavioral change may solve the problem and may not. For the wife, the clothes next to the basket may signal to her that the husband doesn’t care, and even if he changes this behavior the underlying feeling and strain to the relationship may not have been addressed.

Family therapists are uniquely attuned to what is happening between people and between their behaviors. We do this in several ways, one of which being that we pay attention to the cycles of interaction occurring in family systems. When we notice a pattern occurring in family dynamics, we look for the cycle that is keeping that pattern happening. For example, a common cycle could look like

Teen shares a feeling with parents -> Parents are (unintentionally) dismissive of the feeling -> Teen shuts down and shares less -> Parents attempt to get more information out of the teen -> (back to the beginning)

In family therapy, family therapists are working to identify these types of cycles and patterns, and then create systemic level change to them. This means family therapists are trying to gain an understanding of the spoken or unspoken rules of the family that are keeping this cycle in place. In the example above, a rule keeping this cycle in place could be that the teen views their parent as invalidating and lacking understanding, so even when the parent is trying to do something different with their behavior in their interactions with the teen, the teen is unable to see it. Once identified, family therapy can assist the family in recognizing this dynamic, and helping the parents to see the importance of communicating in a validating way with their teen, and help the teen see their parents as supportive and safe people to share emotions with.

Why is Family Therapy a Specialty Therapy Service?

As you can see by the examples above, family therapy is complex. Because of this, family therapy requires a therapist who has been specifically trained to navigate the complexity of family and couples systems. Someone who does not have a specialization in family therapy may not be able to effectively address the larger systemic patterns that keep families stuck in unhelpful and undesired patterns.

A common understanding in systems theory (the theory that informs family therapy) is “The whole is not equal to the sum of its parts.” To understand this, think of a clock. If we dumped out all the parts of a clock on a table – all the gears and cogs, hands and springs, screws and wood – this would not make a clock just by these pieces existing on a table together. A clock is a clock because of the specific interactions of all of these pieces with and between one another. The whole of the clock is not equal to just the sum of all the parts used to create it. This is meaningful for family therapy because it speaks to the complexity of what happens between people in their relationships. None of us exist in a bubble, and for better or worse, we are all impacted by and directly impact our relationships with others. Family therapists are always thinking of and working with the whole, and not just the sum of the parts of the family system.

“The whole is not equal to the sum of its parts.”

In order to become a family therapist, we are required to learn systems theory and second-order change. We are also required in our clinical experience to gain 250 relational hours – these are client contact hours with more than one client in the room (COAMFTE requirement). This is part of a requirement of a minimum 500 client contact hours required for graduation. We are also required to be supervised by an AAMFT Approved Supervisor – someone who has gained this designation by years of experience working with families and couples and creating systemic change with their clients, and who also has specific training on how to train and support students and new therapists from a systemic lens. By the time family therapists have graduated, they have a deep theoretical and solid clinical knowledge of families, family systems, and relational/systemic change. Other programs that are not MFT programs do not have the same relational hours requirements, and may place their focus on a broader range of client areas.

Family therapy also often requires that the therapist spend additional time outside of the session conceptualizing the case and coordinating care with multiple other providers. For example, if I’m working with a family and they have been referred to me by one of the members’ individual therapist, I’m going to likely want to connect with that therapist to make sure we’re supporting the family as a whole towards the same goals. I may do this several times over the course of working with the family. To be clear, individual therapists also commonly spend time working on their cases outside of sessions and coordinating with other providers! Family therapists just have more people involved in family cases, so that can mean more pieces to manage/coordinate, which can be time consuming. These reasons and more are why you may see family therapists charging a higher session fee for family or couples sessions vs individual sessions.

Finding a Family Therapist

Licensed Marriage and Family Therapists (LMFTs) have been trained in systemic change and are uniquely qualified to assist families make meaningful changes. If you are interested in getting started with family therapy, I recommend using the “find a therapist” tool through AAMFT – the American Association of Marriage and Family Therapists. https://www.therapistlocator.net/

If you’re located in Georgia and are interested in learning more about my services as an LMFT, visit my website www.evergreentherapy-ga.com

I hope this has helped you to make sense of what family therapy is, how it works, and hopefully how it could work for you.