Family therapy is a form of counseling intended for families who may be struggling with a variety of concerns affecting the family unit. While there are many types of family therapy techniques to choose from, keep in mind one of the most important factors in therapy is finding a therapist who the entire family is able to build rapport with.
Types of Family Therapy
There are many types of family therapy techniques to choose from. When selecting a therapist, be sure to find someone who specializes in your family's specific area of concern. While some therapists follow one specific technique, many therapists choose to use more of an eclectic approach. This means that they may take exercises and perspectives from several therapeutic techniques in order to best meet the needs of their specific client. In family therapy, family therapists:
- Ask questions to get to know each member of the family
- Observe and document who is participating, who isn't participating, communication styles, as well as observable power dynamics
- Use the family therapy session as a microcosm for how the family interacts at home and within the world
- Diagnose members of the family if applicable
- Provide psychoeducation to help family better understand the situation or pattern
- Provide helpful resources and referrals
- May give the family exercises to do at home and/or within the therapy session
- May meet with different subgroups or individuals within the family to better assess the entire family unit
- Treats the entire family unit as the client
- Shares observations with the family regarding unhealthy patterns or pervasive behaviors and allows the space for the family to explore possible solutions
Cognitive Behavioral Family Therapy
Cognitive behavioral family therapy posits that the thoughts, emotions, and behaviors of each family member impact each other in a cyclical way leading to negative core beliefs. Core beliefs can be both conscious and unconscious negative beliefs that each family member holds true about themselves. These core beliefs interact with the cyclical pattern of each individual and subsequently impact interactions with other family members. For example:
- Sibling 1 (core belief- I'm alone): Thought: I'm hungry; Behavior: I'll make myself a snack; Emotion: neutral
- Sibling 2 (core belief- I'm unlovable): Thought: Why didn't Sibling 1 make me a snack too; Behavior: Distance myself; Emotion: Upset, irritated
- Sibling 1: Thought: Sibling 2 is acting upset but isn't saying why; Behavior: Ignore them; Emotion: Upset, isolated
With this interactional pattern, you can see that each sibling thinks and behaves in a way that confirms their negative core belief. The therapist will assist these siblings in identifying their individual pattern, as well as help them connect how their individual patterns impact their treatment of each other. Becoming aware of unhealthy patterns of interaction means that there is now room to disrupt these cycles and create healthier ones. This also means there is room to challenge negative core beliefs.
Pros of Family CBT
Pros of CBT for families:
- Each individual works on their own growth as a means to help the family.
- Because therapy is solution-focused, it may be brief.
- Cognitive-behavioral therapy (CBT) teaches strategies that can be useful in other areas of life.
- Teaches each family member how to observe their own behavior, how their behavior and thoughts impact their emotions, and how this impacts other family members.
- Therapists are very direct and guiding.
Cons of CBT for Families
Cons of CBT for families:
- Each individual must commit to being open and examining their own behavior.
- May be too much homework for some families (journaling, thought recording).
- Does not deep dive into emotional process.
- Does not address deeper generational issues.
- Is highly structured.
- Mostly focuses on measurable goals.
- Therapists are very direct and guiding.
Systemic Family Therapy
In systemic family therapy, an individual mental health diagnosis or unhealthy behavior is viewed as a symptom of the entire family unit, with members of the family unconsciously behaving in a way that allows this unhealthy pattern to continue. It is believed that changing the family structure, belief patterns, and interactions can make the entire family healthier. For example, if a teenager is struggling with drug abuse, this is not viewed as their individual problem, but rather a symptom of a larger family issue that only the entire unit can resolve while cooperating together.
Systemic Family Therapy Pros
Pros of systemic family therapy:
- Blame is never placed and there is no direct identification of a single root cause to any problem.
- The whole family attends therapy together as a group, so it becomes a shared experience.
- The therapist is not given the role of the expert, but rather acts as a catalyst for the family's own change.
Cons Associated With Systemic Family Therapy
Cons of systemic family therapy:
- The time commitment can be high.
- Everyone must buy into the approach in order for it to work. For instance, if one individual refuses to see the family unit as unhealthy, but rather places blame on only one individual, therapy will be more challenging.
- The entire group has to be willing to participate.
- The therapist is less direct and may have family sit with their thoughts and emotions.
Structural Family Therapy
Structural family therapy views individual issues or mental health diagnoses as symptoms of a dysfunctional family unit. The goal of structural family therapy is to shift the entire family structure by focusing on healthy communication and setting appropriate boundaries. For example, if there are multiple children in the household and only one parent seems to be able to appropriately parent them, the goal for this family may be to re-align both parents at the top of the family structural hierarchy, giving them both equal power as parents, and more power than their children.
Pros and Cons of Structural Family Therapy
Pros of structural family therapy:
- Therapist is very direct and will even shift the power dynamic by temporarily siding with someone to make a point.
- Works well for families with children who are exhibiting unhealthy behaviors.
- Challenges negative family patterns as a means to help everyone.
- Helps change the family dynamic for long-term sustainability.
- Is helpful for parents who feel like they are struggling with parenting.
Cons of structural family therapy:
- Uses active interventions such as role-playing, requiring active participation from each member, which some may not feel comfortable with.
- Some strategies may cause an individual to feel singled out or sided against.
- Weekly sessions take place until restructuring happens, which can be a huge time commitment.
Strategic Family Therapy
Strategic family therapy avoids in-depth analysis of the problems and instead uses focused strategies to help the family communicate and problem-solve better. With strategic family therapy, the therapist may ignite debates during the session to help the family conceptualize their problem and begin to problem solve as a unit. Strategic family therapy tends to focus on the here and now.
Pros and Cons of Strategic Family Therapy
Pros of strategic family therapy:
- The belief that change can occur quickly.
- Therapists encourage change based on the family's own awareness, which makes the changes feel more natural.
- Families can use the successful strategies to problem-solve on their own in the future.
- Therapist is very direct and often assigns homework.
- Not in depth emotional exploration.
Cons of strategic family therapy:
- Family goals must be clearly defined and agreed upon.
- Family members must take an active role outside the counseling sessions.
- Therapist is very direct and often assigns homework.
- Not in depth emotional exploration.
Narrative Therapy
In narrative therapy, issues that a family may be dealing with are externalized and processed in a way that allows all members to tell their story. Narrative therapy assists families in externalizing their problems so they are a bit easier to discuss. It also posits that individuals and families are capable of rewriting their stories and therefore changing an unhealthy narrative into something healthier. For example, a family may have the narrative that they are a distant family. The therapist will help them externalize "distance" so they can process it and create a new, healthier narrative that better reflects who they are or want to become as a family. "Distance" is viewed as a problem that served some sort of purpose, but is not part of their identity.
Narrative Therapy Pros
Pros of narrative therapy:
- Allows each person within the family to share their story.
- Therapist witnesses the family's narrative, which can be healing.
- The family's story is seen as a treasure trove of valuable lessons, untapped goals, and potential skills.
- Issues are externalized and seen as learning opportunities.
- Therapist gently guides clients and witnesses their process.
- Helps families highlight their strengths.
Cons Associated With Narrative Therapy
Cons of narrative therapy:
- Therapist may not be direct enough for some family's taste.
- Can be difficult for families who do not like or aren't comfortable leading the sessions.
- Can be a significant time commitment depending on the family's pace.
- Can feel as if progress is slow moving.
Bowen Family Therapy
Bowen theory views the entire family unit as connected and notes that emotional connectedness or distance can profoundly impact everyone within the family unit. Bowen therapy also examines multi-generational issues that have been passed down and uses a genogram to chart out these pervasive relational and behavioral patterns for the family to visually see. The goal of Bowen theory is to help each individual client achieve their ultimate level of mental health, as that will positively impact the entire family unit, as well as reframe familial issues as multigenerational patterns that have been passed down.
Pros and Cons of Bowen Theory
Pros of Bowen theory:
- Gives a holistic perspective when it comes to familial issues and examines them from a multi-generational point of view.
- Helps each member of the family work towards self-differentiation.
- Can work even if not everyone has bought in to therapy.
- In depth emotional processing and insight building.
- Improves communication and highlights unhealthy communication patterns (triangulation).
- Therapist acts as a guide, but encourages family to develop their own insight.
Cons of Bowen family therapy:
- May be too intense for some families, especially if the parent(s) or caregiver(s) aren't ready to examine their own family or origin patterns.
- Not a brief therapeutic theory.
- Can be difficult for individuals who are not into deep emotional processing.
- May not be appropriate for families who have younger children.
What Are the Disadvantages of Family Therapy?
While family therapy can be incredibly helpful for some families, it may not work for others. Families who are not fully committed to family therapy may struggle with seeing real change occur long term. Some families may also not be ready to dig into the issues that they are dealing with, and that's okay.
What Are the Three Goals of Family Therapy?
While the goals of family therapy will vary for each unique family, in general some goals may include:
- Create a healthier family unit
- Improve communication skills
- Understand appropriate patterns of interaction (healthy problem solving, conflict resolution, and safe boundaries)
What Are the Three Types of Therapy?
Three types of therapy include family, couples, and individual. In terms of therapeutic techniques, there are far more than three options to choose from, but keep in mind that many therapists will use an eclectic or integrative approach and incorporate multiple theoretical orientations depending on their clients' needs.
What Techniques Are Used in Family Therapy?
Each family therapy technique will come with some pros and cons. When selecting a family therapist, keep in mind that the most important factor when it comes to predicting a successful outcome is selecting a therapist who the family feels they have a good relationship with.
