What is Family Therapy?

By Laney Cline King, Licensed Clinical Social Worker (LCSW)

Family therapy is a form of psychotherapy that seeks to reduce distress and conflict by improving the systems of interactions between family members. While family therapists often seek to have all family members (affected by the problem) in the room, that is not always possible or necessary. What distinguishes family therapy from individual counseling is its perspective or framework, not how many people are present at the therapy session. This type of counseling views problems as patterns or systems that need adjusting, as opposed to viewing problems as residing in the person, which is why family therapy is often referred to as a “strengths based treatment.”

“Family” is defined by the modern family therapist as 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. Family relationships are viewed as important for good mental health, regardless of whether all family members are participating in the therapy.   It is an ideal counseling method for helping family members adjust to an immediate family member struggling with an addiction, medical issue or mental health diagnosis. It is also recommended for improving communication and reducing conflict.

Other common reasons for seeking family therapy include:

• When a child is having a problem such as with school, substance abuse, or disordered eating
• A major trauma or change that impacts the entire family (i.e. relocation to a new house, natural disaster, incarceration of a family member)
• Unexpected or traumatic loss of a family member
• Adjustment to a new family member in the home (i.e. birth of a sibling, adoption, foster children, a grandparent entering the home)
• Domestic violence
• Divorce
• Parent Conflict

Overview of Most Common Types of Family Therapy:

Family therapy is a very specialized skill set, and one should seek a therapist who has received both training and credentials qualifying them to perform this type of counseling. All MFT or Marriage Family Therapists are required to do some family counseling as part of their training. Many LCSW (Licensed Clinical Social Workers) are trained in family counseling, but not all. Use the following overview as a guide for selecting the type of family counseling right for you.

Bowenian (Murray Bowen) – This form of family therapy is the best for those who cannot or do not want to bring family members into the therapy room. Bowenian family therapy utilizes two core concepts, triangulation and differentiation. Triangulation involves the natural tendency to divert anxiety or conflict by involving a third party (i.e. a mother complaining to her daughter about her husband). Differentiation has to do with learning to become less emotionally reactive in one’s relationships with family members. Strategies such as letter writing are used to decrease levels of emotional reactivity and increase connectedness among family members.  See the following page for a very detailed description of the Bowenian Model of Family Therapy.

Structural (Salvador Minuchin) – Focuses on reordering the family system according to how the roles and power are distributed amongst family members. Issues of hierarachy are addressed, making sure the parents (or adult caretakers in the home) are in control and work as a team in setting appropriate boundaries for children. The therapist strengthens adult and sibling relationships by “joining” with the family to help make sure no one person or dyad (two people) in the family system have too much power. “Joining” the family may even involve having one or more family members step behind a one-way mirror so that the therapist can point out patterns of interactions amongst other family members. Click here for an in depth description of Bowenian Family Therapy.

Systemic (Gianfranco Cecchin-Milan Model) – This model focuses on the meaning behind family member’s behaviors and proposes that family communications are happening on an unconscious level. The therapist takes a neutral and distant approach, yet confronts the family with rituals and behaviors that allow family members to attribute different insight and understanding as to why a problem is occurring. Power is not seen as belonging to any one person in the family, but rather to the unconscious “game” that family members participate in to keep a problem going.

Strategic (Jay Haley) – This is a direct and brief family therapy approach, suited to those who want results in a short period of time. In this direct approach, the family therapist prescribes homework meant to change they way family members interact with the person identified as having the “problem” or “symptom”. Hierarchies, coalitions and communication systems are assessed, similar to that in the other family counseling approaches. Common techniques used in strategic family therapy are prescribing the symptom to the family (i.e. telling them to yell at each other more) and reframing the family’s problem from a negative to a positive one. The therapist takes over authority from the family member who tends to dominate and control family interactions, making it possible to shift patterns of communication in a way that allow for the “holder” of the family’s symptom to get better.

Positive Outcomes of Family Therapy

Family therapy can be helpful on many levels.  A good course of family therapy helps:

• Develops and maintains healthy boundaries
• Fosters cohesion and communication among family members
• Promotes problem solving through understanding of family patterns and dynamics
• Builds empathy and understanding.
• Reduces family conflict

Cost and Duration:

The specific number of family therapy sessions depends on the situation and type of family therapy, but the average is 5-20 sessions. A family is not billed more for a family therapy session, even when there are multiple parties in the room. However, most insurance plans will not cover a couples or family session unless one of the individuals has a mental health diagnosis. These benefits can be reviewed before seeking out a family therapist. Feel free to ask a prospective therapist what type of approach they like to use. Often, institutes that train family therapists will offer family therapy at a reduced rate when provided by an intern in training. This route is especially useful when seeking out a specific type of family therapy since institutes are often specialized and experts in the field supervise interns. It is worth searching for any Family Therapy Institutes or training programs in your area or conducting an internet search for agencies that provide a “sliding scale” for family therapy services.

Below are a few resources to get you started.

Affordable Family Therapy online directory – connects individuals with affordable, local family therapists.

Mental Research Institute Family Therapy Clinic – offers brief, strategic family therapy on a sliding scale basis. MRI is one of the first and foremost family therapy training institutes in the country.

Family Therapy Institute of Santa Barbara – provides family therapy training and sliding scale services to families in a range of family therapy approaches.

About this Contributor: Laney Cline King received her Bachelor of Science in Psychology at the University of California, San Diego and her Masters in Social Work from Columbia University, New York.  She is an LCSW (Licensed Clinical Social Worker) with over 10 years of experience helping children and families in a variety of nonprofit settings.  As a certified LEAN nutrition coach, she currently provides workshops to families wanting to lead healthier lifestyles.  At this time, Laney is most involved with the toughest job of her career, raising her three children in the San Francisco Bay Area. For more information on Laney’s work, visit http://laneyclineking.com/.

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