problem solving skills in family therapy

Problem-Solving Family Therapy

• Living reference work entry
• First Online: 11 November 2017
• Cite this living reference work entry

• David Hale 4 &
• Dale E. Bertram 5  

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Brief strategic ; Communication approach ; Interactional approach ; MRI

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Problem-solving family therapy began, most notably on the West Coast, as an evolution of the Gregory Bateson Team research project that spawned Communication/Interactional theory and present day family therapy. Jay Haley ( 1987 ) is often associated with this approach because he wrote a book with the title Problem-Solving Therapy . Yet, there are many more people associated with the creation of problem-solving therapy: Gregory Bateson, Don D. Jackson, Milton Erickson, John Weakland, Jay Haley, and William Fry. Don Jackson founded the Mental Research Institute (MRI), one of the first free-standing marriage and family therapy training institute in the United States where he and Richard Fisch, John Weakland, and Paul Watzlawick developed the Brief Therapy Center, as part of the MRI, in which problem-solving family therapy was practiced and...

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Chubb, H. (1995). Outpatient clinic effectiveness with the MRI brief therapy model. In J. Weakland & W. Ray (Eds.), Propagations: Thirty years of influence from the Mental Research Institute (pp. 129–132). New York: The Haworth Press.

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Hale, D., & Frusha, C. (2016). MRI brief therapy: A tried and true systemic approach. Journal of Systemic Therapies, 35 (2), 14–24.

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Haley, J. (1987). Problem-solving therapy . San Francisco: Josey-Bass, Inc.

Haley, J. (1993). Uncommon therapy: The psychiatric techniques of Milton H. Erickson, M.D . New York: W.W. Norton & Company.

Nardone, G., & Watzlawick, P. (2007). Brief strategic therapy . New York: Aronson.

Ray, W., Schlanger, K., & Sutton, J. (2009). One thing leads to another, redux: Contributions to brief therapy from John Weakland, Ch.E., Paul Watzlawick, Ph.D. and Richard Fisch, M.D. Journal of Brief, Strategic, and Systemic Therapies, 3 , 15–37.

Weakland, J., & Ray, W. (Eds.). (1995). Propagations: Thirty years of influence from the Mental Research Institute . New York: The Haworth Press.

Weakland, J., Fisch, R., Watzlawick, P., & Bodin, A. (1974). Brief therapy: Focused problem resolution. Family Process, 13 , 141–168.

Weakland, J., Watzlawick, P., & Riskin, J. (1995). Introduction: MRI – A little background music. In J. Weakland & W. Ray (Eds.), Propagations: Thirty years of influence from the Mental Research Institute (pp. 1–15). New York: The Haworth Press.

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University of Louisiana, Monroe, LA, USA

Abilene Christian University, Abilene, TX, USA

Dale E. Bertram

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Correspondence to David Hale .

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The Family Institute at Northwestern, Evanston, Illinois, USA

Anthony Chambers

Douglas C. Breunlin

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University of Louisville, Louisville, KY, USA

Eli Karam Ph.D., LMFT

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Hale, D., Bertram, D.E. (2018). Problem-Solving Family Therapy. In: Lebow, J., Chambers, A., Breunlin, D. (eds) Encyclopedia of Couple and Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-15877-8_332-1

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DOI : https://doi.org/10.1007/978-3-319-15877-8_332-1

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Counseling and psychotherapy for individuals, couples and families in San Diego.

We all start this life with a family, whether that family is composed of blood relatives, adopted parents, a close-knit neighborhood, 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, for 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.

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, 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 other members of their 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, 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  meanings 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 by assessing and adjusting 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?

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.

“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

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;
• Infertility;
• 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 complete annual continuing education courses.

This education trains therapists 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). To guide a family towards a healthy life, family therapists aim to aid people in improving communication , solving family problems, understanding and handling family situations, and creating a better functioning home environment (Family Therapy, 2017A).

The goals of family therapy depend on the presenting problems of the clients. For example, goals may 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: 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 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 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).

Family therapy enhances the skills required for healthy family functioning, including communication, conflict resolution, and problem-solving. Improving these skills also increases the potential for success in overcoming and 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 good alternatives.

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 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 their 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.

Emotions Ball

This is a simple exercise, requiring only a ball and a pen or marker to write with. 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—big enough to write several emotions on and 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.

Mirroring Activity

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 that you are my mirror. I will go slowly so you have a chance to think about where I will be moving and so that 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. It requires the family members to give each other their full attention, cooperate with one another, and communicate with both words and body language.

It also allows the family members to become more in tune with one another and can be applied with siblings, a parent, a 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 that 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.

You can read more about the genogram here , and learn about how to use them in family therapy here .

Recommended Books

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.

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, 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!

Originally posted at Positive Psychology

References:

• 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/
• http://www.drpatrick.com/
• 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/

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How Family Therapy Works

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Types of Family Therapy

Effectiveness, things to consider, how to get started.

Family therapy is a type of treatment designed to help with issues that specifically affect families' mental health and functioning. It can help individual family members build stronger relationships, improve communication, and manage conflicts within the family system. By improving how family members interact and relate to one another, family therapy can foster change in close relationships.

Some of the primary goals of family therapy are to create a better home environment, solve family issues, and understand the unique issues that a family might face.

There are several types of family therapy. A few that you might encounter include:

• Family systems therapy : This type is an approach that focuses on helping people utilize the strengths of their relationships to overcome mental health problems.
• Functional family therapy : This is a short-term treatment often utilized for young people experiencing problems with risky behavior, violence, or substance use. It helps teens and families look for solutions while building trust and respect for each individual.
• Narrative family therapy : This type encourages family members to each tell their own story to understand how those experiences shape who they are and how they relate to others. By working with this narrative , the person can start to view problems more objectively than just seeing things through their own narrow lens.
• Psychoeducation : This type of treatment is centered on helping family members better understand mental health conditions. By knowing more about medications, treatment options, and self-help approaches, family members can function as a cohesive support system. 
• Supportive family therapy : This type of therapy focuses on creating a safe environment where family members can openly share what they are feeling and get support from their family.

Some therapists may stick with a specific type of family therapy. In contrast, others may take a more eclectic, multimodal approach that incorporates aspects of different types of treatment to suit the needs of the family.

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The techniques utilized in family therapy typically depend on factors such as the theoretical orientation of the therapist and the specific needs of the family. Some methods that may be utilized include:

• Behavioral techniques : These methods often focus on skills training and psychoeducation to help family members address specific problems. For example, modeling and role-playing might be used to help family members resolve communication problems.
• Psychodynamic techniques : These methods involve assessing how each family member interprets and responds to the problems they are facing. The therapist works with the family to develop new emotional insights and explore new ways of responding more effectively.
• Structural techniques : These methods focus on helping family members with boundaries and power dynamics within the family. Such techniques can help families create new boundaries and establish routines that improve how the family functions.

Techniques used in family therapy focus on improving emotional awareness, assisting with major changes within a family, helping people accept things they cannot control, and improving communication and collaboration.

Other specific techniques used in family therapy may include learning to practice empathy , emotional validation , reflective listening, and cognitive reframing .

What Family Therapy Can Help With

Family therapy can help people with many different issues. Some of these include:

• Behavioral problems in children or teens
• Changes within the family 
• Communication problems
• Death of loved one
• Divorce, separation, or marital problems
• Parent-child conflicts
• Problems between siblings
• Parenting issues
• Stressful events or major life transitions

This type of therapy can also address individual mental health problems that can affect the entire family, such as anxiety , chronic illness, depression , and substance use.

Benefits of Family Therapy

Because this form of treatment addresses communication, family members can learn how to better share their thoughts and needs and resolve conflicts in a way that is less likely to damage relationships.

This type of therapy also focuses on how family members can address an individual family member’s difficulties. For example, if one family member has a mental health condition, family therapy can help alter some conditions that sometimes contribute to the problem.

When individuals are affected by mental illness, family members may sometimes lack awareness of how to help. As a result, they may engage in behaviors that maintain or even worsen aspects of the illness. Family therapy can help members of the family learn more about what they can do to support their family member who has a mental disorder while preserving their own mental well-being.

Research suggests that family therapy can be effective for a range of purposes. Some supporting evidence includes:

• A 2018 review found that family therapy could be useful in treating adult-focused problems, including relationship distress, intimate partner violence, mood disorders , anxiety disorders, psychosis , alcohol issues, and adjustment to chronic physical illness.
• A 2019 study found that family therapy helped improve different areas of family functioning to help teens who were experiencing mental health problems.
• One 2019 review found that family therapy demonstrated effectiveness in treating conduct problems, emotional problems, eating disorders , somatic problems, and recovery from abuse or neglect. The study also found that it was useful either when utilized independently or as part of a multimodal treatment program.

Further research is needed to better understand how family therapy may be most effective and how it compares to other forms of treatment.

Because family therapy involves talking about emotional problems and conflicts, it can be difficult and upsetting. In some cases, people may initially feel worse before they begin to improve. It is important to remember that a professional therapist is there to help members of the family work through these conflicts and handle the intense emotions that people may experience.

While family therapy can be useful for various issues, that doesn’t mean it is right for everyone or every situation. Some other types of treatment that may also be useful include cognitive-behavioral therapy (CBT) or child psychotherapy.

Family therapy is often short-term, but it may also take place for a year or longer, depending on the situation and needs of the family. While it frequently involves all family unit members, it may also focus on those who are willing or able to participate in treatment. 

During therapy sessions, the therapist will ask questions to learn more about the problems that have brought the family to therapy. They will also look at other factors contributing to issues, such as underlying mental health conditions and environmental stress.

This type of therapy is often provided by licensed marriage and family therapists (LMFT), but it can also be practiced by other mental health professionals including licensed professional counselors, psychologists , and social workers .

If you are interested in trying family therapy, it can be helpful to ask your doctor for a referral or look for professionals in your area who specialize in this type of therapy. You can also search the online directory at the American Association for Marriage and Family Therapy website.

Varghese M, Kirpekar V, Loganathan S. Family interventions: basic principles and techniques . Indian J Psychiatry . 2020;62(Suppl 2):S192-S200. doi:10.4103/psychiatry.IndianJPsychiatry_770_19

Reiter MD.  Family Therapy: An Introduction to Process, Practice and Theory . Routledge; 2017.

Carr A. Couple therapy, family therapy and systemic interventions for adult‐focused problems: the current evidence base . Journal of Family Therapy . 2019;41(4):492-536. doi:10.1111/1467-6427.12225

Jiménez L, Hidalgo V, Baena S, León A, Lorence B. Effectiveness of structural⁻strategic family therapy in the treatment of adolescents with mental health problems and their families . Int J Environ Res Public Health . 2019;16(7):1255. doi:10.3390/ijerph16071255

Carr A. Family therapy and systemic interventions for child-focused problems: the current evidence base: Child-focused problems . Journal of Family Therapy . 2019;41(2):153-213. doi:10.1111/1467-6427.12226

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Strategic Family Therapy: 9 Effective Techniques

• Fact Checked

Written by:

• Eliana Galindo

published on:

• October 15, 2023

Updated on:

• June 21, 2024

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In the realm of  family therapy , where every family is a unique puzzle, Strategic Family Therapy emerges as an  innovative and solution-focused  approach.

This therapeutic model offers a  structured and strategic framework  to address a wide range of familial challenges. Therapists guide families  toward transformative change  and healthier dynamics through skillful intervention and precise directives.

What is Strategic Family Therapy?

Strategic family therapy (SFT) is a therapeutic approach that addresses relationships and communication patterns within a family unit.

This approach aims to identify dysfunctional interactions and establish new routines, leading to healthier connections among family members.

In SFT, the focus lies on addressing problematic behaviors by identifying and  working with precise family patterns  that contribute to those behaviors.

SFT has proven effective in resolving various emotional and behavioral problems and has been particularly beneficial for adolescents experiencing behavioral issues and substance abuse.

9 Techniques Used in SFT

Strategic Family Therapy (SFT), a  dynamic and solution-focused approach , has revolutionized the field of family therapy by introducing a set of powerful techniques designed to  create meaningful chang e within families.

Joining is a fundamental technique in strategic family therapy (SFT) that involves building  rapport and establishing trust  with the family members.

The therapist’s goal is to create a  supportive, non-threatening atmosphere  that encourages open communication among family members. They may do this by expressing empathy, validating feelings, and  showing genuine interest  in each individual’s perspective.

By joining, the therapist becomes a  neutral and supportive figure  who can help the family navigate the challenges and issues they face together.

2. Reframing

Reframing is another key technique in SFT that helps family members  see their situations in a different light.  By offering alternative interpretations or perspectives, the therapist helps individuals reframe their beliefs, attitudes, and  understanding of the problem , potentially leading to solutions and growth.

This technique is  particularly useful  when family members feel stuck in negative or unhelpful thinking patterns.

For example, a parent who views their child’s behavior as rebellious and disrespectful might be encouraged to see it as a  manifestation of the child’s need  for independence and autonomy. The family can approach the situation with  greater understanding and empathy  by shifting perspectives.

3. Restructuring

Restructuring is a core SFT technique used to alter dysfunctional family patterns and help create more  adaptive and functional relationships .

The therapist focuses on identifying and understanding the  underlying structure  that contributes to the family’s problems. Once this structure is recognized, the therapist can help the family develop strategies to modify their behavior and  adopt new ways of interacting .

This might involve  reassigning roles ,  setting boundaries , or encouraging more effective communication.

For example, if a family is struggling with overprotective parenting, the therapist might help the parents learn to  delegate responsibilities  and encourage their child to take on more independence.

Restructuring the family system allows members to experience  more balanced and healthier relationships , ultimately leading to improved well-being and more effective problem-solving.

4. Prescribing the Symptom

In SFT, therapists may prescribe or encourage the family to continue their problematic behavior or symptom. The idea behind this technique is to make the symptom less appealing or functional, leading the family to seek change.

5. Paradoxical Interventions

Paradoxical interventions involve prescribing the symptom in a way that highlights its absurdity or impracticality , encouraging the family to reconsider their behavior or issue.

6. Circular Questioning

Therapists ask circular questions that focus on the family’s interactions and patterns rather than individual blame. These questions help uncover how each family member contributes to the issue.

7. Ordeals and Rituals

SFT may involve creating ordeals or rituals that challenge the family’s problematic behavior. These experiences can serve as catalysts for change and symbolize a commitment to transformation.

8. Externalization

This technique separates the problem from the individual , allowing the family to see the issue as an external force they can work together to combat.

9. Directives

SFT therapists often give specific directives or tasks for family members to complete between sessions. These tasks are designed to disrupt problematic patterns and encourage change.

What issues can be addressed by SFT?

Strategic family therapy is an effective approach that targets conduct problems and risky behavior among individuals,  especially adolescents .

Conduct problems  encompass a range of issues, such as aggression, rule-breaking, and antisocial behavior. These challenges often  co-occur with risky behavior  like substance abuse and delinquency, making it essential to address them within the family context.

Reducing Risky Behavior

Strategic family therapy involves  assessing and modifying family dynamics  that contribute to the emergence and persistence of problem behavior.

The therapy seeks to  disrupt unhealthy patterns  and promote positive communication and problem-solving skills. By fostering an environment that supports  individual growth and healthy relationships , individuals can effectively develop strategies to reduce risky behavior.

Risky Sexual Behavior

One key aspect of strategic family therapy is  addressing the underlying issues  contributing to problem behavior rather than focusing exclusively on symptoms.

In the case of risky sexual behavior, the therapist works with the family to identify patterns that contribute to  impulsivity ,  poor decision-making , and  lack of self-regulation . This  may involve exploring  family attachments, parental involvement, or family structure.

Delinquency

When tackling delinquency, therapists work closely with parents to  establish consistent rules  and  expectations , ensuring they are clear and fair.

Implementing  consequences and rewards  is an essential component in managing and reducing conduct problems. This approach  strengthens parent-child relationships  and fosters a supportive environment where adolescents can thrive.

Substance Abuse Problems

Another  crucial area  in strategic family therapy is addressing substance abuse problems.

In this case, the therapy goes beyond addressing the addictive behavior itself to  explore the contributing factors  within the family dynamic.

The therapist works with family members to  identify and address areas of stress ,  unresolved conflicts , and  communication breakdowns  that can exacerbate substance abuse problems.

Benefits of STF

Strategic Family Therapy has a  set of benefits  for individuals and families seeking positive transformation. Some of these benefits  include:

Therapeutic Setting and Family Environment

Strategic family therapy is a type of therapeutic intervention designed to address specific family-related issues and improve communication patterns among family members.

The therapeutic setting and family environment play significant roles in the success of this intervention.

Therapeutic Setting

The therapeutic setting should be a  comfortable space  where family members feel safe to express themselves openly and honestly.

This setting can be a  professional office , a  home-based environment , or even a  community center . The key is to create an atmosphere that  facilitates trust  and the building of a  strong therapeutic alliance  with the therapist.

Some therapists prefer to offer home-based service delivery, allowing them better to understand the  family dynamics  in their  natural environment .

Additionally, Strategic Family Therapy (SFT) can  effectively adapt  to various therapeutic settings, including online therapy platforms.

Online SFT sessions typically occur via  video conferencing , which allows family members to participate from  their own environments , promoting comfort and convenience.

Online directories  such as  Find-a-Therapist.com could be helpful in finding a strategic family therapist, whether families prefer in-person or online therapy.

Family Environment

Family environment is particularly important in the context of strategic family therapy, as it serves as a  foundation for the development  of healthy family interactions.

A strong, cohesive family unit is essential in promoting  positive communication  and  conflict resolution  among family members.

During the therapy sessions, therapists may work to  replicate typical family interaction s in order to address and modify any maladaptive behaviors or communication patterns.

Family Cohesion

Additionally, family cohesion plays a  significant role in the success  of strategic family therapy.

Cohesive families have strong emotional bonds, a sense of belonging, and a supportive environment that  enables members to work together  during the therapeutic process.

Therapists  may use various techniques , such as brief strategic family therapy, to strengthen family cohesion and help members collaboratively resolve issues.

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Frequently Asked Questions

What are the primary goals of this approach.

Strategic family therapy aims to identify and modify  problematic patterns  within the family system.

The  main goals  of this therapeutic approach are to improve communication, establish healthier family dynamics, address behavioral issues, and ultimately improve the overall functioning and resilience of the family unit.

What are some common interventions used?

Some common interventions in strategic family therapy  include reframing , boundary setting, and implementing behavioral changes.

For example, therapists may require family members to  engage in certain tasks  or activities designed to  disrupt dysfunctional patterns  and promote healthier interactions. They might also use various strategies to  encourage better communication and understandin g between family members.

An important aspect of this approach is directing therapy toward  specific outcomes , as evidenced by the use of strategy in Brief Strategic Family Therapy.

Which techniques are utilized in brief sessions?

Brief strategic family therapy involves an adaptation of traditional strategic family therapy techniques to create a  more time-limited and focused approach .

In these sessions, therapists might utilize  problem-solving exercises ,  role-plays , and  strategic questions  to help the family identify their dysfunctional patterns and address pressing issues.

The idea is to  maximize the impact of each session  and achieve lasting change in a relatively short span of time.

How is reframing used in this therapy?

Reframing is an important technique in strategic family therapy, which helps family members view situations or behaviors  from a new perspective .

By helping family members see issues in a  different light , the therapist can create space for renewed understanding, empathy, and change.

For example, a parent may initially view a child’s defiance as disrespectful, but through reframing, they may come to realize that the  child is merely expressing  a need for respect or autonomy.

By shifting these perspectives, families can often find  more effective ways to resolve conflicts  and engage in healthier interactions.

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Cognitive Behavioral Therapy

Solving problems the cognitive-behavioral way, problem solving is another part of behavioral therapy..

Posted February 2, 2022 | Reviewed by Ekua Hagan

• What Is Cognitive Behavioral Therapy?
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• Problem-solving is one technique used on the behavioral side of cognitive-behavioral therapy.
• The problem-solving technique is an iterative, five-step process that requires one to identify the problem and test different solutions.
• The technique differs from ad-hoc problem-solving in its suspension of judgment and evaluation of each solution.

As I have mentioned in previous posts, cognitive behavioral therapy is more than challenging negative, automatic thoughts. There is a whole behavioral piece of this therapy that focuses on what people do and how to change their actions to support their mental health. In this post, I’ll talk about the problem-solving technique from cognitive behavioral therapy and what makes it unique.

The problem-solving technique

While there are many different variations of this technique, I am going to describe the version I typically use, and which includes the main components of the technique:

The first step is to clearly define the problem. Sometimes, this includes answering a series of questions to make sure the problem is described in detail. Sometimes, the client is able to define the problem pretty clearly on their own. Sometimes, a discussion is needed to clearly outline the problem.

The next step is generating solutions without judgment. The "without judgment" part is crucial: Often when people are solving problems on their own, they will reject each potential solution as soon as they or someone else suggests it. This can lead to feeling helpless and also discarding solutions that would work.

The third step is evaluating the advantages and disadvantages of each solution. This is the step where judgment comes back.

Fourth, the client picks the most feasible solution that is most likely to work and they try it out.

The fifth step is evaluating whether the chosen solution worked, and if not, going back to step two or three to find another option. For step five, enough time has to pass for the solution to have made a difference.

This process is iterative, meaning the client and therapist always go back to the beginning to make sure the problem is resolved and if not, identify what needs to change.

Advantages of the problem-solving technique

The problem-solving technique might differ from ad hoc problem-solving in several ways. The most obvious is the suspension of judgment when coming up with solutions. We sometimes need to withhold judgment and see the solution (or problem) from a different perspective. Deliberately deciding not to judge solutions until later can help trigger that mindset change.

Another difference is the explicit evaluation of whether the solution worked. When people usually try to solve problems, they don’t go back and check whether the solution worked. It’s only if something goes very wrong that they try again. The problem-solving technique specifically includes evaluating the solution.

Lastly, the problem-solving technique starts with a specific definition of the problem instead of just jumping to solutions. To figure out where you are going, you have to know where you are.

One benefit of the cognitive behavioral therapy approach is the behavioral side. The behavioral part of therapy is a wide umbrella that includes problem-solving techniques among other techniques. Accessing multiple techniques means one is more likely to address the client’s main concern.

Salene M. W. Jones, Ph.D., is a clinical psychologist in Washington State.

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12 SMART Goals Examples for Family Therapy

The family is the center of our world, providing us with support and guidance. But sometimes, we struggle to get along, and that’s where family therapy can be beneficial.

Developing SMART goals in family therapy will help you identify problems and work on solutions that benefit the entire family . This post covers examples of SMART goals to help families nurture a stronger intimate connection.

Table of Contents

What is a SMART Goal?

The SMART framework will help you set practical goals for family therapy. SMART is an abbreviation for specific, measurable, attainable, relevant, and time-based.

Here is a deeper explanation of each SMART letter:

Regarding family therapy goals, the more specific you can be, the better your chances of success. You’ll ensure everyone accurately understands what they are striving towards and how it can be achieved.

For instance, instead of setting a goal to “be closer as a family,” try addressing more specific elements like conflict resolution techniques or relationship dynamics.

Measurable goals give you a roadmap for progress , providing constructive feedback and an understanding of what must be done for continued development.

Making your family therapy goals measurable also gives you tangible evidence of success and a baseline for improvement. It will help you identify areas that need further attention.

Goal setting involves acknowledging our limitations while considering what resources are available to reach our desired destination.

Rather than attempting to achieve unrealistic outcomes, we should honor that progress takes time and dedication to reach those objectives. After all, if not accomplished, overly ambitious goals could even lead to disappointment.

Setting meaningful goals will energize you to achieve your aspirations. By embracing your personal values , you’ll remain steadfast even during times of hardship, giving you an extra boost of strength to stay the course.

Realize that establishing a reliable timeline is critical to staying on the path to goal attainment. But remember that success won’t occur instantly—it requires hard work and determination cultivated over time.

Below you’ll find 12 examples of SMART goals for family therapy:

1. Increase Communication

“I will work towards having more open and honest conversations with my family within three months. I want to ensure that all family members feel heard and respected so that we can work through our issues together.”

Specific: The aim is to have more open and honest conversations.

Measurable: You can track the number of successful conversations you’ve had.

Attainable: With practice, it is definitely possible to build better communication skills .

Relevant: This SMART goal will encourage stronger family relationships.

Time-based: Three months gives you enough time to reach success.

2. Develop Problem-Solving Skills

“As a family, we’ll work together to develop our problem-solving skills by trying different approaches and strategies over three months. This will help us to better understand and work through our disagreements.”

Specific: This SMART statement is explicit because the family will focus on developing their problem-solving skills.

Measurable: You could track your success with each problem-solving technique you try.

Attainable: Improving your problem-solving skills is doable with the right mindset and consistency.

Relevant: Enhancing problem-solving skills is crucial for families to resolve conflicts effectively.

Time-based: The goal should be achieved within three months.

3. Strengthen Emotional Connections

“I want to increase the emotional connection between family members and find ways to express support for each other that don’t involve arguments or shut-downs. In four months, I’ll have identified three strategies to strengthen our family’s emotional ties.”

Specific: This goal includes the desired outcome (strengthening emotional connections), the timeline for getting there (four months), and what you’ll do to reach it (identify three strategies).

Measurable: You can measure the emotional connection between family members and track how often the strategies have been implemented.

Attainable: Finding and implementing strategies that improve emotional connections is something the whole family can work towards.

Relevant: Strengthening emotional ties is vital for achieving a healthy family dynamic.

Time-based: The goal should be completed after four months.

4. Foster Healthy Relationships

“I’ll research evidence-based strategies to foster healthy relationships between family members for two months. After I review the research, I will provide a list of recommended activities for family members to participate in together.”

Specific: The goal is well-defined, detailing the objective and how it will be accomplished.

Measurable: By researching evidence-based strategies, the family can check their progress.

Attainable: This can be accomplished by looking into various available strategies, methods, and activities.

Relevant: The goal is relevant to family therapy as it will help promote positive relationships between family members.

Time-based: There is a two-month end date for completion.

5. Improve Parenting Strategies

“I’ll reconnect with my family and work on improving parenting strategies by enrolling in a parenting class within two months. I will commit to attending the classes and putting into practice what I learn.”

Specific: You’ll join a parenting class and commit to implementing the strategies learned there.

Measurable: You can measure your progress by creating a chart to track how often you practice the strategies in your daily life.

Attainable: Two months is enough to learn the concepts and put them into practice.

Relevant: This goal is appropriate because it helps you to become a better parent.

Time-based: You have two months to finish the parenting class.

6. Facilitate Conflict Resolution

“I will create a plan to help family members resolve conflicts healthily and productively within 6 months. That could include implementing a conflict resolution committee, providing training, or setting up meetings with a mediator.”

Specific: This goal includes creating a plan to help facilitate healthily productive conflict resolution.

Measurable: Determine the number of conflicts resolved or the progress made in resolving them.

Attainable: The goal is realistic if given the necessary resources and support.

Relevant: This is an appropriate goal to help family members resolve conflicts and create a healthier family environment.

Time-based: Success will be met in 6 whole months.

7. Promote Respect and Understanding

“For 8 months, I want to encourage open dialogue and create opportunities to discuss differences of opinions in a safe environment. This way, family members can learn to better understand one another and work together to build a strong bond.”

Specific: The SMART goal of promoting respect and understanding is well-defined.

Measurable: You can measure progress by gauging the level of open dialogue and mutual understanding.

Attainable: It’s possible to create an environment that encourages open dialogue and understanding among family members.

Relevant: Promoting respect and understanding is essential for family members to get along.

Time-based: Goal achievement is anticipated after 8 months.

8. Learn to Set Boundaries

“I’ll learn to set better boundaries in my family relationships by the end of 5 months. I will practice non-judgmental communication and actively listen to my family members with an open mind. I’ll also seek help from a therapist if needed.”

Specific: This goal is about actively learning how to set better boundaries.

Measurable: Check if the person can effectively communicate and actively listen to family members with an open mind.

Attainable: Learning to set better boundaries is a complex process, but it can be done with the right tools.

Relevant: Setting boundaries is crucial for maintaining healthy relationships with family members.

Time-based: There is a deadline of 5 months for this particular goal.

9. Change Unhealthy Habits

“I want to make positive changes by breaking unhealthy habits I’ve acquired during this difficult time. For the next four months, I’ll limit myself to two unhealthy habits per week.”

Specific: The statement outlines the habits that should be changed and the timeline for completing them.

Measurable: The number of unhealthy habits conquered each week can be tracked.

Attainable: Limiting the goal to two habits per week is absolutely doable.

Relevant: This goal is pertinent to promoting healthy lifestyle changes.

Time-based: There is a four-month timeline for achieving success.

10. Create a Positive Home Environment

“I want to create a positive environment in my home by the end of two months. To accomplish this, I’ll reduce stress and conflict, encourage healthy communication, and create time for shared activities, such as playing games or going on family outings.”

Specific: This goal is evident in its mission to foster a positive environment at home.

Measurable: You can note if there is an increase in positive communication and a decrease in conflict.

Attainable: The goal is feasible because you have identified actionable ways to make it happen.

Relevant: Creating a positive home environment is essential for the family.

Time-based: Two months are required to accomplish this goal.

11. Explore Creative Solutions to Issues

“To foster healthy communication between family members, I will have everyone explore creative solutions to issues that arise within the next three months. This could resemble role-playing, drawing out scenarios, or finding a metaphor for the situation.”

Specific: The individual wants to foster healthy communication between family members by exploring creative solutions.

Measurable: Count the number of creative solutions explored.

Attainable: This is reachable because family members can work together to brainstorm solutions to issues.

Relevant: This goal is suitable because it encourages positive communication and engagement between family members.

Time-based: The goal statement has a three-month timeline for success.

12. Take Responsibility for Actions

“I will start taking responsibility for my actions, rather than blaming others or external factors, within 6 months. I hope to develop a better understanding of how my behavior affects others and by being honest with myself about when I’m in the wrong.”

Specific: This goal outlines what needs to be done (take responsibility) and when it should be achieved (within 6 months).

Measurable: You can determine if you are actively taking responsibility for your actions.

Attainable: Taking responsibility is a skill that can be learned and developed.

Relevant: Acting responsibly for our actions helps us become more self-aware and accountable for our behavior.

Time-based: The goal should be accomplished within 6 months.

Final Thoughts

The SMART method is a powerful tool for achieving success in family therapy. Whether you’re a therapist or a family looking to resolve conflicts, SMART goals can provide structure and clarity to your shared journey.

Make sure to take the time to design goals that fit your family situation. Following the examples outlined above should only be a starting point. You’ll be on the right path leading to greater harmony and understanding.

Family Therapy Methods: Exploring Family Counseling

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• For those experiencing abuse, please contact the Domestic Violence Hotline at 1-800-799-SAFE (7233)
• For those experiencing substance use, please contact SAMHSA National Helpline at 1-800-662-4357

Family therapy is a systemic therapy that can target various concerns between family members at any time, including conflict, communication, divorce, stress, or mental illness. Family therapy is often characterized as a strength-based treatment that aims to adjust patterns and identify individual strengths rather than blaming a specific family member or challenges to create healthy relationships for the whole family.

Different approaches 

Family therapy may be less about gathering family members in the same room and more about the methods used to address conflict and unit concerns. Depending on the concerns, your therapist may choose to have the family members meet together or separately. Some methods might involve group therapy with other families to learn new skills. If one or more of the clients present with a chronic mental health condition, these symptoms will have to be addressed as well.

Therapy might also be focused on a family member's mental health needs. For example, suppose therapy has been sought due to a child's struggles at school. In that case, the therapist might meet with the child individually and then call the family to discuss the treatment plan and instruct the parents on how to support their child best. However, the method used can vary depending on a therapist's unique approach. Below are a few standard family therapy techniques.

Bowenian family systems therapy

If you prefer individual therapy to group options, the  Bowenian approach might suit you. This form of therapy focuses on triangulation and differentiation between family members. 

Triangulation method

Triangulation refers to involving a neutral person in a conflict between two individuals. For example, someone may be triangulating if they get into an argument with their sister and try to get their mom to see their sister as the instigator. Although this strategy might momentarily alleviate worry, it may not be a healthy response to a disagreement because it can cause an unfair power balance or misinformation. Bowenian therapy looks at how these dynamics can occur in family units. 

Family therapist take the role of the neutral person when you have the urge to triangulate. By hearing your concerns, marriage and therapists can identify potential errors in your thinking and strategies for connecting with your family. This strategy may be done in individual therapy, with sessions afterward.

Differentiation method

Many individuals seeking family therapy may struggle with how they see others in their family and their world. They may be exhibiting volatile emotional responses and unsure how to handle their feelings or views.

The goal of differentiation in Bowenian family therapy is to free oneself from unwanted beliefs. It is the process of learning how to form your own opinions and live your life in a way that is free from labeling or negative influences. You can learn that you are separate from your parents, siblings, or other family members and that you can have varying personalities and beliefs. 

Seeing yourself and your family as unique individuals and differentiating your views from theirs and the world around you, may help you understand the conflicts you have and offer the family clarity and communication.

Structural method

The  structural family therapy  approach may be an option for those looking to reorganize how power and family dynamics are distributed among individuals within the unit. It often takes a structured problem-solving approach to therapy. 

Structural family therapy might be utilized when a child is involved in a conflict. The therapist may begin by drawing a chart of your family and noting the relationships between you. Once positions of power are identified, they may help clarify potential changes or techniques to address conflicts and communication between each pairing. 

This therapy method was developed based on the belief that the root of many childhood problems comes from concerns that go unsolved, not from the child or their behavior. Many studies back up this belief, showing that children raised with dysfunctional family dynamics are at a greater disposition  for depression and other mental health and behavioral concerns. 

Clients may learn to restructure the family dynamic in structural family therapy after identifying key issues. Your therapist might have you participate in roleplays, acting out problematic situations that occurred in the months or weeks before your session. At times, your therapist may pretend to take certain sides or model how family members relate. This method may break up negative patterns and promote a healthier family dynamic.

Additionally, concerns within a family might come from a power imbalance, such as one parent making all of the decisions and excluding the other parent or a child making choices for their parents. No matter your concerns, reaching out to a mental health professional may help you restructure your family life. 

Strategic method

Strategic family therapy  may be ideal for families seeking a quick approach to conflict resolution. Structural therapy focuses on using specific techniques explicitly tailored toward your family, developed within a few sessions. The therapist may act as a coach or mentor for a family unit looking to learn new skills. 

Strategic therapy may not focus on your past or what has occurred in your life. Instead, it can focus on current patterns, thoughts, and behaviors you want to change and develop an immediate plan to change them, as long as you are willing. 

Your treatment plan might begin with identifying fixable concerns. You can then move on to setting goals and creating pathways to reach those goals. Once you arrive at your plan, your therapist can observe the responses and actions of your family during the session. Based on these observations, they may evaluate the overall goal for therapy as a whole. 

A licensed therapist in family therapy can be heavily involved and hands-on in your treatment. They may remain actively interested in your well-being and do all they can to ensure your outcome is long-lasting and positive. As a benefit, this type of therapy is often highly personalized. If you're looking for a unique therapy form, try strategic family therapy. You can also try strategy psychotherapy in an individual setting. 

Systemic family therapy method

Systemic family therapy believes family conflict may occur from the subconscious influence of the family members rather than actions or behaviors. Systemic therapists may believe that conflict within the family stems from interlocked issues beneath the surface. For example, a therapist might believe that each individual has connections and conflicts on a subconscious level that could contribute to their family role. 

For example, one family member experiencing a breakup in their personal life may bring personal challenges to their relationships with the whole family. Unlike structural therapy, systemic family therapy does not place power on one individual or a group. It may posit that identifying power roles could harm the family members' subconscious beliefs. 

If you choose to engage in the systemic model of family therapy strategies, your counselor or therapist may help you uncover the subconscious issues with your family members and discuss strategies for addressing them. They may help you identify cycles, games, or rituals in which you are participating, and help your family strengthen roles within the family unit. 

Systemic family therapy may offer a fresh perspective on the conflicts that many families experience and how family members interact. If you have tried many other types of therapy without results, consider this form of counseling. 

Functional family therapy method

Functional Family Therapy (FFT)  is a short-term evidence-based family therapy designed to address at-risk youth ages 11-18 years old. The family therapists that use this method will build therapeutic relationships with all members of the family as well as extra-family influences to help establish a better functioning home environment. The family plays a large role in the process, with each family unit seen as completely unique. This is one of the family interventions that can be useful for strengthening the family environment to help an adolescent who may be experiencing a mental health condition, substance abuse, or trauma.

Counseling options 

Individuals may be able to address family conflicts and concerns in individual therapy and family settings. If you are looking for a more personalized therapy focused on your experiences in your family, consider individual therapy. Family therapy can also be combined with individual therapy to address an issue from multiple angles. Even if you face barriers to counseling, such as cost and distance, various options, including online therapy, are available. Family therapy counseling online  is an effective way for people to get their needed help.

The world is increasingly interconnected through technology. The use of technology in psychological care, such as text messaging and video calls, may enhance personalized care for those who seek psychological services for mental health problems. One study on the effectiveness of online therapy found that it was more effective than in-person treatment methods in addressing depression and common concerns like worry, stress, or life challenges. 

Many online platforms offer flexible communication options for talk therapy. For example, you may choose between phone, video, or live chat sessions with licensed therapists. You may also gain a connection to resources like journal prompts or worksheets from your therapist to use at home directly after your sessions. If you are interested in learning more about online counseling but are unsure where to start, consider using resources offered by a platform like BetterHelp , which provides over 30,000 licensed and vetted therapists. 

Family therapy or marriage counseling offers families a deeper understanding of healthy life boundaries and functional family practices. Many types of family therapy are available to those seeking support with conflict, communication, mental health conditions, substance abuse, parenting skills, or other concerns. If you're interested in learning more about how family therapy might serve you, consider reaching out to a therapist for further guidance and support. 

Frequently Asked Questions (FAQs) 

Below are a few commonly asked questions about family therapy. , what are the methods used in family therapy.

Family therapy uses several techniques to help families relate to each other and reach their goals. Many of these techniques are utilized as part of a specific type of counseling. These techniques include:

• Bowenian family therapy, also known as family systems therapy
• Strategic family therapy
• Structural family therapy
• Systemic family therapy

These specific therapy techniques might utilize concepts from popular psychotherapy methods used by mental health professionals, like psychodynamic and cognitive-behavioral techniques.

What are the four stages of therapy?

Counseling can be broken down into four stages, including the following: 

• Preparation: The family therapist helps the family plan a course of action
• Transition: The family members may work through acceptance and transition into the treatment plan 
• Consolidation: The family starts putting the therapy techniques into practice
• Termination: The family prepares for the end of treatment and learns how to retain what they've learned to maintain healthy family functioning long-term 

What are the benefits? 

Counseling may benefit families looking to address and overcome challenges affecting their home environments. The benefits of counseling may include solving family problems, coping with mental illness, improving conflict management, and setting boundaries.

While families often use counseling to address emotional concerns, you do not need to have dysfunctional family patterns or mental illness to see a family therapist. Families may benefit from counseling by learning communication, problem-solving skills, and a different perspective. 

What are the stages of the family life cycle?

The family life cycle may be described through the following stages:

• Independence or leaving home
• Having young children 
• Raising adolescents 
• Having independent adult children 
• Being an older adult, over 50 

What are three goals of therapy?

The goals of counseling will typically depend on the types of counseling being provided, the family members participating, and the mental health professional administering the modality. The three goals of counseling may include the following:

• Improving communication and problem-solving skills
• Addressing conflicts affecting the family dynamic
• Strengthening the family bond and reinforcing family roles

By attending sessions, family therapy may offer families a way to create a healthier family system and functioning home environment. 

What do you talk about in therapy?

You can talk about any subject in family therapy. Like many other forms of therapy, family therapy can proceed differently based on the clients. Sometimes, a family therapist will help members of the family discuss conflicts that have been affecting them negatively. In other cases, family therapists may prompt participants to address the mental health challenges of an individual family member. Whatever the issue is, a qualified family therapist can guide you in the direction of resolution and teach you new skills personalized to your concerns. 

• Eight Situations That Commonly Cause Family Conflict Medically reviewed by Laura Angers Maddox , NCC, LPC
• Six Ways To Thrive As A Blended Family Medically reviewed by Nikki Ciletti , M.Ed, LPC
• Relationships and Relations

Online Family Problem-Solving Training (OFPS)

Session content samples include:

• Overview, identify goals: Learn about family, overview, identify goals
• Positive problem orientation: The importance of attitude
• Steps of problem-solving: Learn steps of problem-solving
• Getting Organized: Identify organizational strategies to increase success
• Self-management, Self-monitoring and Regulation: Learn how to monitor own actions and regulate behavior
• Anger Management & Communication: Identify ways to defuse anger and communicate needs effectively
• Social Skills & Communication: Listening/positive communication strategies
• Social Problem-Solving Skills: Learn appropriate interactions and communication in social setting
• Crisis management skills: Skills for crises, assessment of needs

The Center on Interventions for Children and Youth with Traumatic Brain Injury : Building Capacity of Educators, Community-based Therapists and Families housed at Cincinnati Children's Hospital Medical Center, is an example of a center that is advancing research of interventions to improve the long-term outcomes of children and youth post-TBI.

Wade, S. L., Wolfe, C. R., & Pestian, J. P. (2004). A web-based problem solving intervention for families of children with traumatic brain injury. Behavioral Research Methods, Instruments, and Computers , 36 , 261–269.

Wade, S.L., Carey, J., & Wolfe, C.R. (2006). The efficacy of an online cognitive- behavioral, family intervention in improving child behavior and social competence following pediatric brain injury. Rehabilitation Psychology , 51 , 179- 189.

Wade, S. L., Carey, J., & Wolfe, C. R. (2006). The efficacy of an online family intervention to reduce parental distress following pediatric brain injury. Journal of Consulting and Clinical Psychology , 74 , 445-454.

Wade, S.L., Walz, N.C., Carey, J., Williams, K.M., Cass, J., Herren, L., Mark, E., Yeates, K.O. (in press) . A randomized trial of teen online problem-solving for improving executive function deficits following pediatric traumatic brain injury. Journal of Head Trauma Rehabilitation .

Wade, S.L., Walz, N.C., Carey, J.C., & Williams, K.M. (2008). Preliminary efficacy of a web-based family problem-solving treatment program for adolescents with traumatic brain injury. Journal of Head Trauma Rehabilitation , 23 , 369-377.

Intervention Issues

• Intervention Models  
• Population Specific Approaches

In the Practice Section

• Common Caregiving Problems
• What do Psychologists Need to Know to Help Family Caregivers?
• How Caregivers Reach Psychologists
• Psychologists as Direct Service Clinicians and Consultants
• Conceptual Models
• Intervention
• Variations for Practice with Culturally Diverse Groups
• Business Pragmatics
• Common Ethical Issues

In the Caregiver Briefcase

• Caregiving Facts

Contact Public Interest Directorate

Family Therapy Activities, Worksheets, & Questions

Discover engaging family therapy activities, practical worksheets, and insightful questions to foster better communication and strengthen familial relationships.

By Karina Jimenea on Jul 04, 2024.

Fact Checked by RJ Gumban.

Why are Family Therapy Activities helpful?

Family therapy activities play a crucial role in resolving conflicts, enhancing communication, and strengthening the bonds among family members. These activities are designed to create a safe, non-judgmental environment where members can freely express their feelings and thoughts.

Through activities for family therapy, family members gain insights into their interactions and behaviors, leading to the identification of unhealthy patterns. Consequently, these realizations pave the way for developing effective coping and interaction strategies. Importantly, these communication activities for family therapy encourage empathy and understanding, nurturing stronger relationships.

Furthermore, family therapy activities for relationship building can foster healthier dynamics and resolve underlying issues. They can also be instrumental in dealing with significant life changes, such as marriage, divorce, or death, which may affect the family structure and dynamics. These activities are powerful tools for addressing family challenges, fostering resilience, and enhancing overall family well-being.

10 Family Therapy Activities

Family therapy activities are therapeutic exercises designed to improve communication, build empathy, and encourage positive behavioral change within the family unit. These activities provide a safe space for families to express emotions, share experiences, and work towards resolving conflicts. 

Here, we will explore ten activities that can significantly strengthen familial relationships and understanding.

1. Role-play

This activity can help members understand the perspective of others by stepping into their shoes in a particular scenario.

2. Family Portraits

Each member draws a picture of the family, revealing how they perceive the family dynamic and their role.

3. Positive Affirmation Jars

Members write positive notes about each other and place them in a jar, promoting self-esteem and positivity.

4. Conflict Resolution Role-Play

This involves acting out conflicts and practicing different resolution strategies.

5. Family Meetings

Regular meetings allow members to express their feelings and thoughts in a structured environment.

6. Storytelling

Each member tells a personal story, promoting empathy and understanding.

7. Values Clarification

Members write down their values, promoting respect for different viewpoints within the family.

8. Colored Candy Go Around

An icebreaker activity that uses candies to promote sharing and communication about family dynamics and personal feelings.

9. Feelings Ball

An engaging game that encourages members to express their emotions.

10. Mirroring Activity

This activity promotes empathy as members mirror each other's movements and gestures.

5 Family Therapy Worksheets

Family therapy worksheets are practical tools that help families navigate the therapeutic process. They encourage reflection, aid in identifying problematic patterns, and facilitate constructive communication. These worksheets can be instrumental in mapping out the family dynamics and highlighting areas of strength and potential growth. 

We will delve into five worksheets that have proven significantly effective in family therapy.

1. Genogram Worksheet

This worksheet is a graphical representation of a family tree with a twist. It not only includes information about kinship ties but also details about relationships and how they have shaped the family's dynamic. Genogram worksheets can reveal patterns, such as repetitive occurrences of divorce, mental illness, or conflict, providing valuable insights for therapeutic intervention.

2. Communication Style Worksheet

Every individual communicates differently, and these differences can often lead to misunderstandings within a family. A Communication Style Worksheet helps identify each member's unique communication style – passive, aggressive, passive-aggressive, or assertive. 

Understanding these styles can enhance communication efficacy, thereby fostering healthier relationships.

3. Family Strengths Worksheet

This worksheet allows family members to identify and explore their collective strengths. These include good listening skills, willingness to support each other, and the ability to work well under stress. Recognizing these strengths can help families feel more connected, encouraging them to leverage these positives during challenging times.

4. Coping Skills Worksheet

Dealing with stress or conflict is an inevitable part of family life. The Coping Skills Worksheet aids in identifying and developing effective strategies for managing these difficult situations. It may involve relaxation techniques, problem-solving strategies, or seeking support. Over time, these coping mechanisms can enhance resilience and improve overall family well-being.

5. Problem-Solving Worksheet

This worksheet helps families effectively approach and resolve conflicts or problems. It encourages family members to define the problem clearly, brainstorm possible solutions, consider the pros and cons of each, and then decide on the best course of action. 

Using a structured approach, families can handle conflicts constructively, reducing the likelihood of escalated tensions or unresolved issues.

10 Family Therapy Questions

Family therapy questions are insightful prompts designed to open up meaningful conversations among family members. They help uncover underlying issues, explore feelings, and foster understanding of each other's perspectives. Asking the right questions can spark open discussions, allowing every member to express their thoughts and feelings, thus promoting healing and growth. 

Let's look at ten common yet impactful family therapy questions.

1. What do you love most about our family?

This question encourages family members to think about the positive aspects of their family, fostering a sense of gratitude and appreciation.

2. What do you think is our family's biggest strength?

This allows members to focus on the resilience of the family unit and how they can leverage this strength to overcome challenges.

3. What's a recent situation where you felt upset with a family member?

Members can express their feelings more openly by discussing specific incidents, leading to a deeper understanding and resolution of conflicts.

4. How can we improve communication within our family?

This question prompts reflection on communication patterns and encourages brainstorming strategies for improvement.

5. What is something you wish our family did more of?

Asking this question can reveal individual needs or desires that might have been overlooked and encourage the family to incorporate more of these activities to strengthen bonds.

6. What is a recent conflict that our family resolved well?

Reflecting on successfully resolved conflicts can help the family identify effective strategies for future reference.

7. What is a recurring conflict in our family, and how do you feel about it?

This question can uncover persistent issues within the family, offering a chance to address them openly and honestly.

8. How can we better support each other during challenging times?

Families can prepare themselves to navigate stressful periods more effectively by discussing how to offer support.

9. What are your family roles, and are you content with them?

This question can help family members express discontent with their roles and discuss possible changes.

10. What family traditions do you enjoy or want to start?

This question encourages families to celebrate their shared history and create new traditions, strengthening their unity and togetherness.

When is it best to conduct Family Therapy Activities?

Family therapy activities are versatile tools that can be deployed at various times and for multiple issues. Timing is essential when considering the best time to incorporate these activities, as their effectiveness can significantly impact a family's emotional health and resilience.

During Transitions

Life is full of changes, some of which can disrupt the dynamics of a family. For instance, remarriage can introduce new family members, which could necessitate adjustments in roles and expectations. Similarly, moving to a new location might create a sense of disorientation and loss. Welcoming a new baby, particularly in cases where there are already other children, can also evoke feelings of jealousy or neglect. 

During such transitions, family therapy activities can aid in smoothing the transition process by facilitating communication, understanding, and acceptance of the new family configuration.

Addressing Persistent Issues

Families may also experience ongoing problems such as communication breakdowns, recurring conflicts, or behavioral issues, particularly among children. These issues can create a tense environment, affecting family harmony and well-being. 

Family therapy activities can provide a structured platform to unearth these issues, understand their roots, and devise strategies to address them, thereby enhancing family harmony.

Dealing with Significant Life Events

Sometimes, a family member may face a significant life event, such as a mental health condition, substance abuse, or chronic illness. These circumstances can be challenging for the individual and their family members, who might feel helpless or confused about how best to provide support. 

In such instances, family therapy activities can play a crucial role. They can promote a better understanding of the condition, develop effective coping mechanisms, and foster a supportive environment. These activities encourage collective strength and resilience, making the challenge more manageable.

Post-Trauma or Crisis

Family therapy activities can be instrumental in the aftermath of a crisis or traumatic event, such as losing a family member or a disaster. They can help process the grief, trauma, and loss experienced, providing a safe space for expressing feelings and fears. They can also help establish a sense of normalcy and develop coping mechanisms during these difficult times.

Families can navigate challenging circumstances more effectively, strengthen their bonds, and foster a supportive, loving environment by conducting family therapy activities at these appropriate times.

How can Carepatron help with Family Therapy-related work?

Carepatron is a versatile platform designed to streamline healthcare and therapy-related work, making it an excellent tool for managing family therapy. It provides a centralized space for organizing therapy sessions, tracking progress, and facilitating communication between family members and therapists.

Its intuitive design allows therapists to quickly and easily schedule sessions, share worksheets and resources, and record notes and observations. Furthermore, it can handle sensitive information securely, maintaining client confidentiality. Carepatron also enables real-time communication, making it a vital platform for remote or online family therapy sessions.

Commonly asked questions

Some everyday activities include role-play, family portraits, positive affirmation jars, and family meetings.

The Genogram, Communication Style, Family Strengths, Coping Skills, and Problem-Solving worksheets are commonly used.

While beneficial, family therapy can initially increase conflict or distress as underlying issues are addressed. Also, its effectiveness relies heavily on the commitment and participation of all family members.

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• Idaho Youth Ranch Website

Collaborative Problem Solving for Parents: A Step-by-Step Guide to Addressing Family Issues

Idaho Youth Ranch May 17, 2023 11:45:00 AM

Collaborative Problem Solving (CPS) is an evidence-based approach that focuses on understanding and addressing the root causes of challenging behavior in children and adolescents. Developed by Dr. Ross Greene, CPS aims to foster empathy, communication, and collaboration between parents and their children to find effective and lasting solutions for family issues This resource guide provides an overview of the CPS model, outlines the key principles and steps involved, and offers practical tips and strategies for parents. Additionally, it includes three real-life family situations to demonstrate how to apply CPS in various contexts.  

Understanding the Collaborative Problem Solving Model 

1. The CPS Philosophy

CPS is grounded in the belief that children do well if they can. The approach posits that challenging behavior is not due to a lack of motivation, attention-seeking, or manipulation but rather a result of lagging skills and unsolved problems. By understanding and addressing these underlying factors, parents can develop more effective, compassionate, and sustainable solutions.  

2. Key Principles of CPS

Empathy: The foundation of the CPS model is empathic understanding, which involves recognizing and validating the feelings and perspectives of all family members.  

Collaboration: CPS emphasizes the importance of working together, rather than relying on unilateral decision-making or power-based approaches.  

Skill-building: The CPS approach focuses on identifying and addressing lagging skills, such as emotion regulation, problem-solving, and communication, to promote lasting change.  

Implementing the Collaborative Problem Solving Process 

1. Identifying Lagging Skills

The first step in the CPS process is to identify the specific skills that your child may be struggling with. This can be done through a combination of observation, communication, and reflection. Some common lagging skills include:  

Emotional regulation  

Flexibility  

Impulse control  

Problem-solving  

Communication

Once lagging skills have been identified, the next step is to determine the specific situations or problems that are causing difficulties for your child and family. Unsolved problems are often characterized by predictability and can be uncovered through discussions with your child.  

The Three Steps of Collaborative Problem Solving

The CPS process involves three primary steps, which can be adapted and tailored to the unique needs and circumstances of each family.  

Step 1: Empathy

Begin by gathering information and understanding your child’s perspective on the problem. This step involves active listening, validating emotions, and demonstrating genuine curiosity.  

Step 2: Define Adult Concerns 

Clearly articulate your concerns and needs regarding the situation. This step promotes mutual understanding and acknowledges the importance of addressing both your child’s and your concerns.  

Step 3: Invitation to Collaborate 

Invite your child to brainstorm possible solutions together. Encourage them to consider a range of ideas and evaluate each option based on its feasibility and effectiveness in addressing both your child’s and your concerns.  

Real-Life Examples of Collaborative Problem Solving 

Example 1: Homework Struggles 

Lagging Skills : time management, sustained attention, and frustration tolerance  

Unsolved Problem : difficulty completing homework independently and on time

Step 1: Empathy 

Ask your child about their perspective on the homework situation, and listen to their concerns and frustrations.  

Share your concerns about the importance of completing homework to support their learning and academic success.  

Brainstorm possible solutions together, such as creating a homework schedule, breaking tasks into smaller steps, and providing support as needed.  

Example 2: Sibling Conflicts 

Lagging Skills : emotion regulation, perspective-taking, and conflict resolution  

Unsolved Problem : frequent arguments and conflicts between siblings  

Talk to each child individually to understand their feelings and perspectives on the conflicts.  

Share your concerns about the impact of the conflicts on the family environment and the importance of fostering healthy sibling relationships.  

Involve both siblings in brainstorming possible solutions, such as setting ground rules for communication, establishing a conflict resolution process, and practicing empathy and active listening.  

Example 3: Bedtime Resistance 

Lagging Skills: transitions, self-soothing, and sleep hygiene 

Unsolved Problem : difficulty settling down and falling asleep at bedtime 

Ask your child about their feelings and thoughts related to bedtime, and listen to any fears or concerns they may have.  

Share your concerns about the importance of a consistent bedtime routine for their health, well-being, and overall development. 

Work together to develop a bedtime routine that addresses both your child’s and your concerns, such as establishing a calming pre-bedtime activity, creating a comfortable sleep environment, and gradually adjusting the bedtime schedule.  

Collaborative Problem Solving offers a compassionate and effective approach to addressing challenging behaviors and family issues. By understanding the underlying causes of these difficulties and engaging in a collaborative, empathic problem-solving process, parents can help their children develop lasting solutions and strengthen their relationships. By following the principles and steps outlined in this resource guide and adapting your approach to meet the unique needs of your family, you can support your children in achieving positive, sustainable change.  

What Are Family Therapy & Family Counseling?

Indeed, the “family” is considered “a fundamental organizing structure for human life from birth to death” (Wampler et al., 2020, p. 45).

However, like any other system or structure, it is prone to breaking down.

Family therapists aim to improve relationships and resolve conflicts within the family structure by working with all involved rather than individual clients (Metcalf, 2011).

This article explores the nature of family therapy and the many approaches therapists adopt to support positive change and growth.

Before you continue, we thought you might like to download our three Positive Relationships Exercises for free . These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.

This Article Contains

• What Are Family Therapy & Family Counseling? Definitions

Types of Family Therapy

• Online Marriage & Family Therapy Programs: Do They Work?

Recommended Family Counseling Books

Related resources from positivepsychology.com, a take-home message, frequently asked questions, what are family therapy & family counseling definitions.

Family therapists recognize that changing a family system (usually) means disrupting existing relationship patterns and interpersonal communications (Metcalf, 2011).

While family therapists adopt many approaches, they are each typically underpinned by the following four principles (Goldenberg, 2017):

• Family members are intimately connected, so therapy must focus on the beliefs of every member.
• Over time, family members living in close proximity “set up patterns of interacting made up of relatively stable sequences of speech and behavior” (Goldenberg, 2017, p. 26).
• The presenting problem’s context typically comprises the “interactions, beliefs, and behaviors that therapists observe and engage with” and can be considered the cause and effect (Goldenberg, 2017, p. 26).
• Family problems are often the result of challenges resulting from facing environmental shifts or life changes.

Family therapy and family counseling are closely related terms and often used interchangeably, but with the latter sometimes used as a broader term encompassing various therapeutic approaches and techniques adopted by psychologists, social workers, and other professionals to enhance communication, resolve conflict, and support families facing challenges (American Psychological Association, n.d.; Goldenberg, 2017).

Marriage and family therapy

Marriage and family therapy are forms of psychotherapy that help individuals, couples, and families improve their relationships and resolve conflicts. Their scope involves working with the couple or the entire family rather than one individual (Metcalf, 2011).

Despite differences in how family therapists go about providing opportunities for families to change, all attempt to create a therapeutic environment that (Goldenberg, 2017):

• Encourages self-examination in order to reduce discomfort and conflict
• Mobilizes family resilience and empowerment
• Helps the family members improve their overall functioning

Within marriage therapy, counselors may use various techniques, such as talk therapy, role-play, and homework assignments with the couple (Metcalf, 2011).

Family therapy for mom and son

Family therapy for mothers and sons can be an effective way to address issues that are affecting their relationship and the family as a whole. The therapist will identify communication and behavior patterns within the relationship that contribute to broader problems and suggest approaches to encourage greater understanding and reduce conflict (Metcalf, 2011).

Communication theory and its impact on family therapy

Communication theory involves studying how people exchange information and meaning through verbal and nonverbal messages (Fitzpatrick & Ritchie, 1993).

The impact of communication theory on family therapy and family counseling is significant and can be used to understand how communication patterns within the family structure contribute to or alleviate problems.

Therapists can use communication theory to identify patterns of communication causing conflict or distress within the family and to develop strategies for improving communication and resolving disputes, such as active listening, empathy, and assertiveness.

As a result, clients may be seen from very different perspectives depending on the type of family therapy adopted (Metcalf, 2011; Goldenberg, 2017).

The following is a list of several of the most influential types, but there are others present in the literature.

Structural and strategic family therapy

Structural family therapy and strategic family therapy approaches “are foundational in the field of systemic family therapy due to their emphasis on systemic process over content and altering family interaction patterns that create, maintain, or exacerbate problems” (Wampler et al., 2020, p. 460).

Developed in the late 1960s by Salvador Minuchin, and along with contributions from Charles Fishman, Maryanne Walters, and others, structural family therapy recognizes the importance of the individual within their social context (Wampler et al., 2020).

As such, individuals do not exist in isolation but in relation (both acting and reacting) to the family, with the “family seen as the vehicle for producing individual change” (Wampler et al., 2020, p. 462).

Consequently, rather than one individual being the “guilty party” or “symptom owner,” problems are distributed and often the result of a dysfunctional hierarchy or poor functioning within subsystems (Wampler et al., 2020).

Strategic family therapy arose out of the work of the Mental Research Institute in California in the mid-1950s. Unlike other therapeutic approaches that assume insight leads to change (changing through knowing), the strategic approach suggests change happens before understanding (knowing through changing; Wampler et al., 2020).

Shifts in perception and understanding the system’s rules and family interactional patterns are required to facilitate lasting change (Wampler et al., 2020).

Psychodynamic/psychoeducational therapy

According to psychodynamic theory, “humans have an unconscious mind that influences a person’s behavior” (Wampler et al., 2020, p. 417). As a result, we are often driven by simple, unconscious desires — such as pleasure — that are self-serving.

As far back as Sigmund Freud in the early 20th century, the impact of family on the individual’s character formation and unconscious mind was clear. Therefore, the psychodynamic approach to family therapy emphasizes the importance of exploring family members’ past experiences and relationships to gain insight and understanding into existing problems (Metcalf, 2011).

The psychoeducational therapeutic approach supports providing education and information to families about mental illness and challenging behavior patterns while developing treatment plans for the whole family (Metcalf, 2011).

Narrative family therapy (contextual)

Narrative therapy is recognized as being at the forefront of today’s family therapy and family counseling, “signifying that our knowledge of reality is organized and maintained through stories we tell about ourselves and the world we inhabit” (Goldenberg, 2017, p. 370).

After all, the stories — or narratives — we tell ourselves are the context of our lives. And yet, families often build and maintain self-defeating and harmful narratives about their members.

Narrative therapy involves “respectful, non blaming conversations in which clients are the experts in their own lives and assumed to have the skills and competencies needed to construct more positive stories about themselves” (Goldenberg, 2017, p. 371).

Narrative therapists support families in reframing problems from an internal deficiency or issue within the individual, couple, or family to an unwelcome narrative dominating their lives. The family is encouraged to unite against the problem as a separate entity — with its own political and social context — to be overcome (Goldenberg, 2017).

Circular questioning is a powerful technique used in narrative therapy. It involves asking questions about interactions and relationships within the family system to explore how family members perceive each other’s behaviors, emotions, and thoughts (Rogers & Cooper, 2020).

Systemic and systematic family therapy

Systematic family therapy (also known as systemic family therapy) focuses on the family as a whole rather than individual members. As such, it recognizes that individual psychological issues and conflicts are often influenced by and embedded within the more extensive family system (Goldenberg, 2017).

Using this approach, therapists and counselors consider the family as an interconnected system with unique communication patterns, roles, and dynamics. The approach requires them to establish an alliance with multiple individuals at once and manage various views of the therapeutic alliance (Goldenberg, 2017).

Ultimately, they aim to identify and address dysfunctional patterns within the family system that contribute to individual problems by challenging mental models, accepting ambiguity, and considering multiple generations (Goldenberg, 2017).

Functional family therapy

Functional family therapy is a well-researched approach to the family that “fosters both cognitive and behavioral changes in individuals and their families” (Goldenberg, 2017, p. 335), integrating learning, systems, and family therapy.

This form of therapy aims to go beyond behavior change, helping clients understand that how they act regulates relationships.

Studies have found functional family therapy to be particularly helpful in treating adolescents with problems with substance abuse, violence, and delinquency (Goldenberg, 2017).

Bowenian family therapy

Murray Bowen was a crucial figure in the development of family therapy and one of the developers of the family systems theory. His approach emphasizes both the significance of past relationships (psychodynamic approach) and the family as a unit (systems approach; Goldenberg, 2017).

According to family systems theory (or Bowenian family therapy ), there are eight interlocking concepts (Goldenberg, 2017):

• Differentiation of self
• Nuclear family emotional system
• Family projection process
• Emotional cutoff
• Multigenerational transmission process
• Sibling position
• Societal regression

Bowen preferred to think of himself as a coach, helping family members “become objective researchers into their own ways of functioning” (Goldenberg, 2017, p. 214).

Behavioral and cognitive-behavioral family therapy

“Behavioral and cognitive‐behavioral models for understanding and treating problems in couple and family relationships are well supported empirically” (Wampler et al., 2020, p. 493).

Cognitive interventions that encourage clients to identify those aspects of their thinking that contribute to negative emotional and behavioral responses within the family system have proven valuable, along with testing the validity of cognitions and replacing unhelpful thoughts with more helpful ones (Wampler et al., 2020).

Emotionally Focused Therapy for families

Emotionally Focused Therapy (EFT) combines a focus on the self with a systems outlook.

EFT “views couples and families in both intrapsychic and interactional terms, helping them gain access to what is emotionally significant for each person” (Goldenberg, 2017, p. 248) while guiding their actions and explorations with the therapeutic relationship .

EFT practitioners focus on what is going on between people rather than what is inherent within each person. They help clients focus on their moment-to-moment inner experiences and relationship events.

Other approaches worthy of note include family constellation therapy and internal family systems therapy . The former focuses on events that have led to family breakdowns to restore balance within the family constellation, and the latter addresses individual healing and growth, recognizing the mind as a system composed of multiple distinct parts (Konkolÿ Thege et al., 2021; Sweezy & Ziskind, 2013).

Download 3 Free Positive Relationships Exercises (PDF)

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Online Marriage & Family Therapy Programs: Do They Work?

With marriage and family therapy and counseling programs increasingly moving online, it is vital that therapists have the necessary digital skills and competencies to support their clients.

In addition, they must consider the impact of remote treatment on the ethical and regulatory codes associated with their work, potentially across multiple borders and states (Blumer et al., 2015).

Equally important is the efficacy of online marriage and family therapy programs.

While the academic literature is limited, research confirms online treatment’s positive value and impact on marriage and family therapy for various issues. Studies have shown remote treatments’ positive effects as equivalent to in-person delivery, benefiting both relational and mental health outcomes (McLean et al., 2021).

World’s Largest Positive Psychology Resource

The Positive Psychology Toolkit© is a groundbreaking practitioner resource containing over 500 science-based exercises , activities, interventions, questionnaires, and assessments created by experts using the latest positive psychology research.

Updated monthly. 100% Science-based.

“The best positive psychology resource out there!” — Emiliya Zhivotovskaya , Flourishing Center CEO

Family counseling is a vital aspect of therapeutic treatment, with many valuable books to support new and existing therapists.

The following books are some of our favorites and help teach the theory, background, and practical steps involved in practicing family therapy and family counseling.

1. It Didn’t Start With You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle – Mark Wolynn

Mark Wolynn shares his deep understanding of inherited trauma in this groundbreaking book and offers new, powerful tools for relieving client suffering.

Wolynn’s extensive experience as a pioneer in inherited family trauma, coupled with his “Core Language Approach,” empowers readers to uncover hidden emotional legacies and provides practical techniques for reconnecting, integrating, and reclaiming life and health.

Find the book on Amazon .

2. Family Ties That Bind: A Self-Help Guide to Change Through Family of Origin Therapy – Ronald W. Richardson

This practical and easy-to-read book offers valuable insights into family dynamics and actionable techniques from family therapy and family counseling to help readers create healthier relationships.

This book explores topics such as self-esteem, spousal dynamics, birth order, and communication skills while guiding readers in understanding the impact of family background on interactions.

The authors offer step-by-step exercises to foster positive changes in all aspects of clients’ lives.

3. Family Therapy: An Overview – Irene Goldenberg

This engaging and comprehensive book equips therapists and interested readers with the knowledge and skills necessary for competent and effective family therapy.

With its practice-oriented approach, this ninth edition delves into essential viewpoints, intervention techniques, and the goals of family therapy, from evidence-based practice research to addressing issues of diversity, gender, culture, and LGBTQ families.

We have many resources available for therapists and counselors providing support to families wishing to improve communication and repair damaged relationships.

Why not download our free positive relationships pack and try out the powerful tools contained within? Some examples include:

• Identifying Our Expert Companions This exercise helps clients discover what they need from an expert companion and how to identify them among the variety of people they know.
• Connecting With Others by Self-Disclosure In this exercise, clients learn how to practice self-disclosure to increase their feelings of being understood, accepted, and cared for, boosting relationships and wellbeing.

Other free resources include:

• Mind the Gap Use this exercise to identify the values the client wants to instill in the family and make plans for their implementation.
• Meeting Our Family’s Needs Each family member is given the opportunity to have their needs heard, understood, and ultimately accepted in this helpful activity .

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit© , but they are described briefly below:

• Building Social Capital

An individual’s social capital is an accumulation of their positive network connections.

Clients can expand their social capital by focusing on their relationship quantity, strength, intensity, and density.

To do so, ask the client to try out the following steps:

• Step one – List the most important people in your social network.
• Step two – Assess existing connections’ strength, density, and intensity.
• Step three – Identify elements of your social capital that require attention.
• Examining Rituals of Connection

Rituals of connection are relationship-enhancing behaviors essential in family therapy and family counseling that symbolize intimacy and provide couples with a sense of stability, commitment, and purpose.

Nurturing a shared sense of meaning and maintaining commitment through rituals of connection is integral to a happy, satisfying, stable, and enduring romantic relationship.

Try out the following steps:

• Step one – Identify and reflect on your connection rituals with your partner.
• Step two – Assess whether the rituals are currently working for you both.
• Step three – Identify what you can do to improve or replace those rituals that require attention.

17 Positive Relationships Tools

If you’re looking for more science-based ways to help others build healthy relationships, check out this collection of 17 validated positive relationships tools for practitioners. Use them to help others form healthier, more nurturing, and life-enriching relationships.

17 Exercises for Positive, Fulfilling Relationships

Empower others with the skills to cultivate fulfilling, rewarding relationships and enhance their social wellbeing with these 17 Positive Relationships Exercises [PDF].

Created by experts. 100% Science-based.

Family therapy and family counseling recognize that families are organized systems and aim to improve relationships and resolve conflicts by working with all family members.

It disrupts existing unhealthy relationship patterns and communication styles and promotes positive change and growth within the family unit.

In doing so, family therapy emphasizes the importance of understanding family members’ beliefs and the sometimes-unhealthy sequences of behavior that can develop along with the contextual shifts and life challenges that contribute to family problems.

Communication theory plays a significant role in family counseling by analyzing how communication patterns within the family structure impact their problems. Therapists use the approach to identify and transform conflict-causing connection patterns and encourage conflict resolution.

There are various types of family therapy and counseling, each offering different perspectives and models for understanding clients. They offer diverse views that guide therapists in providing tailored interventions for families in need.

Ultimately, family therapy is a practical approach to improving relationships and reducing discord within the family system. Through its use, therapists can disrupt existing dynamics and promote positive change by considering all family members’ needs, beliefs, and values.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free .

Ed: Updated July 2023

The basic principles of family therapy involve:

• Working collaboratively with families to understand their relationships and interactions
• Identifying and building on strengths
• Developing more effective communication and problem-solving skills

There are many different techniques used in family therapy and counseling, such as:

• Genograms (visual representation of a family’s relationships and history)
• Mindfulness techniques
• Play therapy
• Homework assignments

One of the most commonly used types of family therapy is structural family therapy (SFT).

SFT focuses on the interactions between family members and how these interactions shape the family’s structure.

• American Psychological Association. (n.d.). Family counseling. In APA dictionary of psychology . Retrieved July 19, 2023, from https://dictionary.apa.org/family-counseling.
• Blumer, M. L. C., Hertlein, K. M., & VandenBosch, M. L. (2015). Towards the development of educational core competencies for couple and family therapy technology practices. Contemporary Family Therapy , 37 (2), 113–121.
• Fitzpatrick, M. A., & Ritchie, L. D. (1993). Communication theory and the family. In P. Boss, W. J. Doherty, R. LaRossa, W. R. Schumm, & S. K. Steinmetz (Eds.), Sourcebook of family theories and methods (pp. 565–589). Springer.
• Goldenberg, I. (2017). Family therapy: An overview . Cengage learning.
• Konkolÿ Thege, B., Petroll, C., Rivas, C., & Scholtens, S. (2021). The effectiveness of family constellation therapy in improving mental health: A systematic review. Family Process , 60 (2), 409–423.
• McLean, S. A., Booth, A. T., Schnabel, A., Wright, B. J., Painter, F. L., & McIntosh, J. E. (2021). Exploring the efficacy of telehealth for family therapy through systematic, meta-analytic, and qualitative evidence. Clinical Child and Family Psychology Review , 24 (2), 244–266.
• Metcalf, L. (2011). Marriage and family therapy: A practice-oriented approach . Springer.
• Rogers, M., & Cooper, J. (2020). Systems theory and an ecological approach. In M. Rogers, D. Whitaker, D. Edmondson, & D. Peach (Eds.), Developing skills and knowledge for social work practice (2nd ed., pp. 259–268). Sage.
• Sweezy, M., & Ziskind, E. L. (2013). Internal family systems therapy: New dimensions . Routledge.
• Wampler, K. S., Miller, R. B., & Seedall, R. B. (Eds.). (2020). The handbook of systemic family therapy (vol. 1). Wiley Blackwell.

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What our readers think.

very excellent description orderly arranged information was easy to understand the context

This is an excellent, and in-depth article that explains the multiple uses and strategies that a family therapist near you uses to help your family overcome obstacles and become closer to one another. With family therapy in Calgary, you and your loved ones will be feeling more in tune with each other than ever before, and you will likely learn something about yourself as well.

Hi, We are concerned for an adult 37 year old daughter and the therapy she is receiving from a particular Psychologist. We are located in NJ. Since she has been seeing this Psychologist for nearly 2 years, our daughter’s relationships with our family – parents and siblings have been going from bad to worse and now almost non existent. She has been angry about the past family issues and cannot seem to shed the past. She is a schoolteacher, a parent to a 9 and 12 year old daughters, and remarried last October. We are not a perfect family, however we are good people. Everyone has had their issues at one time or another but our daughter’s siblings have moved past the issues from when they were younger. Any advice you could give us would be a good start to improve our family. Thank you,

Hi Roseann, I’m sorry to hear that you are feeling disconnected from your daughter. What’s important (and constructive) is that she is working through her experiences of her childhood with a psychologist. When undergoing long-term therapy, people may find that they need space or emotional distance, at least temporarily, from those they feel are associated with their negative feelings so they can process them and decide how to move forward with those relationships. Here are some important questions to ask: Does your daughter have social support/people she can lean on elsewhere in her life (e.g., friends, her partner)? Does she have stability in her work and personal life? Does she seem healthy and happy? I cannot know your personal situation, but my suggestion would be to gently reach out, let her know that you’re there for her if/when she wants to reconnect, or chat about anything from the past, and then allow some space. We all process our past experiences differently, and for some, this may take a little more time than for others. I hope this helps, and best of luck. – Nicole | Community Manager

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The impact of family interventions on communication in the context of anxiety and depression in those aged 14–24 years: systematic review of randomised control trials

Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, UK

Amy Broadbent

Member of the Young People's Advisory Group

Edmund Brooks

Member of the Parents and Carers' Advisory Group

Karen Bulsara

Kim donoghue, rouhma saijaf, katie n. sampson.

National Collaborating Centre for Mental Health, The Royal College of Psychiatrists, London, UK

Abigail Thomson

Department of Experimental Psychology, University of Oxford, UK

Pasco Fearon

Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, UK; Department of Psychology, University of Cambridge, UK; and Developmental Neuroscience Unit, Anna Freud Centre, London, UK

Peter J. Lawrence

School of Psychology, University of Southampton, UK

Associated Data

The data that support the findings of this study are available from the corresponding author, P.J.L., upon reasonable request.

The ability to communicate is integral to all human relationships. Previous research has specifically highlighted communication within families as both a risk and protective factor for anxiety disorders and/or depression. Yet, there is limited understanding about whether communication is amenable to intervention in the context of adolescent psychopathology, and whether doing so improves outcomes.

The aim of this systematic review was to determine in which contexts and for whom does addressing communication in families appear to work, not work and why?

We pre-registered our systematic review with PROSPERO (identifier CRD42022298719), followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and assessed study quality with the Risk of Bias 2 tool.

Seven randomised controlled trials were identified from a systematic search of the literature. There was significant heterogeneity in the features of communication that were measured across these studies. There were mixed findings regarding whether family-focused interventions led to improvements in communication. Although there was limited evidence that family-focused interventions led to improvements in communication relative to interventions without a family-focused component, we discuss these findings in the context of the significant limitations in the studies reviewed.

Conclusions

We conclude that further research is required to assess the efficacy of family-focused interventions for improving communication in the context of anxiety and depression in those aged 14–24 years.

Anxiety disorders and depression are common mental health problems affecting approximately 3.6% and 4.4% of the global population, respectively. 1 A significant proportion of these common mental health problems emerge before or during adolescence (51.8% for anxiety disorders and 11.5% for mood disorders 2 ). Effective pharmacological and psychological treatments exist, 3 , 4 but their effectiveness is only moderate and do not work for everyone. 5 Furthermore, ‘how’ these treatments work and, more specifically, what their ‘active ingredients’ are, remains relatively unclear. The focus of our insight review is on improving communication in families as an active ingredient in the effective treatment of anxiety disorders and/or depression in young people aged 14–24 years. Focus on family communication has historically been rooted in biosocial models of psychopathology, which emphasise that mental health problems are embedded in the individual's social context. 6 On these accounts, relationships, and the communication between individuals within those relationships, are implicated in the aetiology and possible treatment of psychopathology, including anxiety disorders and depression.

Communication is an essential component of human social functioning. To define communication within a family context, we draw on seminal work by Fitzpatrick and Ritchie, 7 who argue that family communication can be understood within the dimensions of ‘openness and emotional accessibility’ and ‘structural traditionalism’. For the purposes of this review, we focus on openness and emotional accessibility, which describes the extent to which family members exhibit ‘openness in deployment of emotional resources, receptivity to new information, and shared responsibility for coping with daily emotion and social crises’. 7 Within this framework, family communication can be measured as the extent to which family members reciprocate feelings to one another, solve problems together and are open to new information without it causing conflict. 7 Indeed, psychometric studies that have developed scales to measure family functioning incorporate the definitions established in this early work. 8

Given the ubiquity of communication in human relationships, it has been argued that negative patterns of communication can contribute to the onset of mental health problems, as they exacerbate risk factors that may predispose the individual to psychopathology. 6 Longitudinal 9 and cross-sectional evidence 10 – 12 suggests that open and respectful communication between parents and their adolescent offspring reduces the risk common mental health problems. Furthermore, influential developmental models of anxiety and depression implicitly implicate communication. For example, Bowlby's attachment theory assumes that ‘internal working models’ of attachment are generated in the context of goal-corrected partnership with primary attachment figures, where communication of emotional needs is central. 13 Similarly, cognitive–behavioural models assume that experiences in key relationship influence the development of schemas that influence cognition and emotion. These schemas embed interpersonal experiences, within which communication is likely to be central. Psychological abuse, which is strongly associated with risk for psychopathology, largely involves forms of highly pathological communication on the part of the perpetrator. 14

Family systems theory provides arguably the most comprehensive theoretical framework for understanding the role of communication in psychopathology. The theory takes a systemic approach to mental health, placing emphasis on the dynamics within the family system rather than the individual themselves. 15 Family systems comprise individuals within the family (e.g. parents or siblings) as well as wider networks that influence family members, including peers, grandparents, colleagues and other environmental factors such as socioeconomic status and school climate. 16 , 17 Within these systems are further subsystems, such as parent–child dyads or sibling dyads. The relationships between individuals within families are influenced in a cyclical manner, such that positive interactions perpetuate positive patterns, whereas negative interactions perpetuate negative patterns. Communication, which we restrict to verbal modes of interaction in the current review, is the means by which patterns of interactions are created, maintained or perpetuated in the family systems framework. 18

Consistent with the family systems framework, empirical evidence has demonstrated that family climate and communication styles are a predictor of depression and anxiety in adolescence. 19 – 22 Indeed, one study found that a lack of family cohesion was associated with increased risk for any mental health disorder (including depression and anxiety). 23 The mechanisms that link poor family communication to adolescent anxiety and depression are likely to be multifaceted and heterogeneous across individuals. 24 For example, poor communication patterns can reduce adolescents’ problem-solving capabilities, 21 which may heighten vulnerability to depression via increased rumination. 25 Further, familial discord resulting from poor communication can remove an important support system for the adolescent, as parental support is associated with reduced anxiety and depressive symptoms. 26 , 27 In contrast, good communication within families has also been demonstrated to be a protective factor in adolescent mental health. For example, positive family communication predicts higher self-esteem in adolescence, which is negatively associated with symptoms of anxiety and depression. 28 , 29 Moreover, parent–adolescent communication is positively associated with well-being and life satisfaction, but negatively associated with internalising and externalising symptoms. 30 Together, these empirical studies suggest that poor family communication is an important and multifaceted risk factor for psychopathology in adolescence.

Another route through which poor communication may increase the risk of poor mental health outcomes is by acting as a barrier to treatment. Parents are often key figures in supporting young people's engagement with mental health services, and the quality of communication between young people and their parents is therefore likely to be crucial in accessing treatment and engaging with the support offered. Parents are often involved in shared decision-making about interventions their child receives, 31 and qualitative work has identified familial conflict as a barrier to parents and adolescents collaboratively seeking mental health treatments. 32 Further, encouraging parental support for therapeutic treatment improves adolescents’ attendance and adherence to these interventions, 33 which may be partly because of the dependence adolescents have on parents for accessing support (e.g. facilitating travel to the treatment site 34 ). As such, good family communication may have general mental health benefits and may enhance the efficacy of other interventions; and, where problems exist, it may be necessary to address family communication before other interventions can be successfully implemented (akin to the need to treat high blood pressure before conducting major surgery).

Despite evidence that family communication is a multifaceted risk and protective factor for depression and anxiety disorders, there is limited understanding of whether interventions can improve communication within families, and whether this has positive implications for adolescents’ mental health. The aim of the current systematic review was to determine in which contexts, and for whom, addressing communication in families appears to work, not work and why. We also aimed to examine factors that may moderate the efficacy of these family-focused interventions (e.g. gender, culture, structure of the family unit, family knowledge of anxiety and depression). Throughout the review, we have worked with experts by experience to co-produce the views presented in this article.

Advisory group involvement

We created two groups of experts by experience: a Young People's Advisory Group (YPAG) and a Parents and Carers' Advisory Group (PCAG). The YPAG comprised four regular members (aged 16–23 years) and met four times for 90 min. The PCAG comprised three regular members and met three times for 90 min. There was one joint 90 min meeting between the PCAG and YPAG. YPAG and PCAG members received £20 per hour for attending meetings, and £15 per hour for work between meetings.

Following our first YPAG meeting, we pre-registered our systematic review with the International Prospective Register of Systematic Reviews ( PROSPERO; identifier CRD42022298719) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PICO framework (population, intervention, control and outcomes) was used to establish inclusion/exclusion criteria and search strategy.

Eligibility criteria

A study was eligible for inclusion if (a) it was a randomised controlled trial; (b) participants were aged between 14 and 24 years; (c) participants had a diagnosis of anxiety disorder and/or depression, as established by DSM or ICD diagnostic criteria or a validated scale; (d) the study intervention involved family members as well as the young person themselves, and family was broadly defined as parents, carers or guardians, siblings or extended relatives; (e) the study included a control group (e.g. treatment as usual or waitlist); (f) the study reported outcomes relating to family communication (improving communication, specifically verbal communication, was defined in terms of reductions in critical, hostile or isolating interactions, or increases in supportive or warm verbal interactions); and (g) the study was available in full text in the English language in a peer-reviewed journal.

Search strategy

EMBASE, Medline and PsycINFO were searched via the OVID interface, and the Cochrane Central Register of Controlled Trials database was also searched. Searches were completed on 20 January 2022, combining MeSH and free-text terms for our population (children and adolescents aged 14–24 years), intervention (family-focused interventions for common mental disorders), outcome (family communication) and study design (randomised controlled trials). There were no restrictions on the publication date. The reference lists and citations of included articles were also searched. The full search strategy is presented in Supplementary Table 1 available at https://doi.org/10.1192/bjo.2023.545 .

Study selection and data extraction

Identified articles were imported into the online software Rayyan (Rayyan Systems, Cambridge, Massachusetts, USA; http://rayyan.qcri.org ), 35 and duplicates were removed. Two reviewers (K.N.S. and K.D.) independently screened the titles and abstracts against the eligibility criteria with Rayyan. Any disagreements for inclusion were discussed by K.N.S. and K.D., and consensus reached. Full texts were then retrieved and screened for eligibility independently by K.N.S. and K.D., using a form developed in Microsoft Excel (2019, for Windows). Any disagreements for inclusion were discussed and resolved between the two reviewers. A data extraction form (available from P.J.L.) was created in Microsoft Excel and data was extracted independently by K.N.S. and K.D. The following data were extracted:

• study characteristics: author, year, country, study design features, recruitment method, allocation method, inclusion/exclusion criteria, follow-up period and sample size;
• participant characteristics: age, gender, ethnicity, diagnosis and method of ascertainment;
• intervention: description of intervention, duration of intervention, number and length of sessions and family involvement (percentage of total time);
• comparison: comparator intervention and characteristics of control group;
• outcomes: data collection points, primary family communication outcome and method of measurement, analysis method, main results, missing data and loss to follow-up;
• potential moderators: gender, culture, structure of the family unit, family knowledge of anxiety and depression, duration of the intervention and percentage of family involvement;
• general: limitations as identified by study author(s) and funding.

All included studies were assessed for risk of bias with the Cochrane Risk of Bias 2 tool. 36 The two reviewers assessed studies independently with the Risk of Bias 2 tool, and consensus was reached through discussion.

Data extraction began on 31 January 2022.

Data synthesis

The data available from the included studies were insufficient to support a robust or meaningful meta-analysis. Improving family communication was highly heterogeneous across studies with regards to how interventions attempted to alter patterns of communication and how communication was measured. Therefore, the results of the systematic review were synthesised narratively.

Summary of studies

Seven studies met our inclusion criteria (see Fig. 1 ). These studies included 440 participants in total, with a mean age of 15.71 years (note, Bernal et al 37 did not report participants’ mean age and was excluded from this calculation). Depression was the primary outcome measure in the studies reviewed; all studies measured depressive symptoms. 37 – 43 Five studies additionally measured whether participants met the diagnostic criteria for major depressive disorder (see Table 1 ). 37 , 41 – 43 Five studies recruited participants from the community 37 – 39 , 41 and two studies recruited participants from out-patient clinics. 42 , 43

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart of systematic literature search.

Details of the studies examining family communication in context of anxiety and depression included in the current review

RCT, randomised controlled trial; MDD, major depressive disorder; SBFT, systematic behavioural family therapy; CBT, cognitive–behavioural therapy; NST, nondirective supportive therapy; IPT-AP, interpersonal psychotherapy for adolescents and parents with depression; IPT-A, individual interpersonal psychotherapy for adolescents with depression; CBQ, Conflict Behaviour Questionnaire; ACQ, Areas of Change Questionnaire; FAD, Family Assessment Device; TAU, treatment as usual; TAU + FPE, treatment as usual plus family psychoeducation; OCD, obsessive compulsive disorder; PTSD, post-traumatic stress disorder; SSRI, selective serotonin reuptake inhibitor; SSAI, Structured Social Adjustment Interview; SAS-SR, Social Adjustment Scale - self-report version; CWD-A, Coping with Depression Course for Adolescents; TEPSI, CBT plus parent psychoeducational intervention; FEICS, Family Emotional Involvement and Criticism Scale.

Five studies included measures of comorbid anxiety. 37 – 40 , 42 , 43 However, only one study included analyses involving anxiety. 40 There was significant variation in the interventions used to improve family-focused communication across studies, which included systematic behavioural family therapy (SBFT), 38 , 40 interpersonal psychotherapy (IPT) for adolescents and parents with depression, 39 treatment as usual plus family psychoeducation, 43 IPT for adolescents with depression, 42 coping with depression course for adolescents and a separate parent group, 41 and cognitive–behavioural therapy (CBT) plus parent psychoeducational intervention. 37 Because of the variation across studies, there was considerable heterogeneity in the structure of the interventions. For example, some interventions only included parents in a single 45 min session, 42 whereas in others parents attended every session (18 h in total 43 ).

Effectiveness of family-focused interventions at improving symptoms of anxiety and depression

Several of the studies found evidence that family-focused interventions reduced depressive symptoms (β = 1.02, P  < 0.001; 37 P  < 0.001; 39 P  < 0.001; 41 P  < 0.05 42 ) and major depressive disorder diagnoses (β = –1.11, P  < 0.001; 37 χ 2  = 9.41, P  < 0.01; 41 P  < 0.02 42 ). However, a caveat is that these studies found similar improvements to depressive symptoms and major depressive disorder diagnosis when using interventions that did not focus on family involvement ( 37 ; η 2  = 0.00, P  > 0.10; 39 major depressive disorder: χ 2  = 0.001, P  > 0.05 41 ) or did not include a comparative intervention. 42 One study did, however, find that the family-focused intervention led to better parent-reported outcomes on adolescents’ depressive symptoms relative to an intervention without a focus on family communication ( P  < 0.01 41 ), although these differences were no longer present at a 6-month follow-up. In contrast, one study found that an intervention that did not include a focus on family communication was better than an intervention focused on family communication at reducing symptoms of depression (CBT: P  = 0.003, SBFT: P  = 0.99 38 ). A study that compared treatment as usual versus treatment as usual with family psychoeducation found no effect of familial involvement on depressive symptoms or major depressive disorder diagnosis ( P  = 0.052 43 ). Therefore, these studies do not provide clear evidence that family-focused interventions are more effective at improving symptoms of depression relative to interventions without a focus on family communication.

The one study that did include analyses of anxiety symptoms found that CBT was more effective than a family-focused intervention at improving symptoms at a 24-month follow-up. 40

Key information on family communication measures

The majority of communication measures included in our review were self-report ( n  = 7); only one measure of communication was recorded by observing interactions between adolescents and their parent. Also, several studies ( n  = 3) included both adolescent and adult reports of communication. Four studies only included either adolescent or parent reports. The most commonly used measure was the Conflict Behaviour Questionnaire ( n  = 2), which assesses conflict and negative communication between adolescents and their parents. We recommend future research aims to develop measures that capture the subjective experience of communication, along with objective patterns of communication between family members, and that such measures are completed by both adolescents and their parents.

Do interventions aimed at improving communication work, for whom do they work, in what contexts and why?

Although the studies reviewed provide limited evidence for the effectiveness of family-focused interventions in improving symptoms of anxiety and depression, there was significant variation across studies in how communication was measured and the features of communication treated as outcome measures ( Table 1 ). Although this may reflect the multifaceted way in which we presume communication to affect mental health, this heterogeneity means that we have structured our results to address what features of communication are improved by psychological intervention. Once we have identified the features of communication that are amenable to intervention, we can establish for whom these interventions work, in what contexts and why.

Interventions examining familial involvement

Family involvement describes the degree to which the adolescent feels able to communicate their emotions to their family and the degree to which they perceive their family's communication toward them to be critical. Drawing on Fitzpatrick and Ritchie's conceptualisation of communication in families, this feature of communication could reflect the extent to which families deploy emotional resources toward one another. 7 This feature of communication was examined by three studies, 37 , 38 , 40 which provided limited evidence that family-focused interventions improved perceptions of familial involvement. Bernal et al 37 found that adolescents assigned to a CBT-only group that did not involve family reported greater family emotional involvement after the intervention, whereas adolescents that completed CBT with additional parent psychoeducation reported no change in family emotional involvement ( P  < 0.05, effect size 0.77). Two studies 38 , 40 found that neither SBFT, CBT or nondirective supportive therapy (NST) was associated with changes in familial involvement from pre- to post-intervention. SBFT is a therapy that intends to clarify concerns and identify dysfunctional patterns of family communication, teaching communication and problem-solving skills, whereas NST aims to provide support for adolescents to identify their feelings and consider options to address their issues (see Table 1 ). However, one study 43 found a significant difference in the trajectories of affective involvement, with adolescents who completed treatment as usual plus family psychoeducation reporting greater familial involvement compared with those who only completed treatment as usual ( P  < 0.05).

Interventions examining problem-solving

Problem-solving reflects the aspect of family communication that describes how the family shares responsibility for solving daily emotional and social crises. 7 Three studies examined adolescents’ problem-solving communication behaviours as outcomes (i.e. behaviours where adolescents generated solutions to interpersonal problems). 38 , 40 , 42 Two studies found that family-focused interventions improved problem-solving abilities relative to interventions without a focus on family involvement (β = 0.30, P  = 0.04; 38 P  < 0.05 42 ), whereas one study found no difference between interventions with and without a focus on family involvement. 40 Although Dietz et al 38 found that completing SBFT improved problem-solving in adolescent–mother dyads relative to CBT and NST, Kolko et al 40 found no difference between SBFT, CBT and NST on problem-solving immediately after the intervention and at a 24-month follow-up, despite the emphasis in SBFT on teaching problem-solving skills. Notably, Dietz et al 38 coded adolescent–mother dyads, whereas Kolko et al 40 used a self-report measure completed by parents and adolescents. Of note, the findings by Dietz et al 38 were rated as having low risk of bias in the measurement of outcomes, whereas Kolko et al 40 had a high risk of bias in their measurement of outcomes. CBT does, however, include psychoeducational content on problem-solving, which may improve interpersonal problem-solving skills. 40 Although two of the three included studies found evidence that family-focused interventions improved adolescents’ problem-solving skills, these studies suffered from a high overall risk of bias. Therefore, we suggest that the strength of evidence for the effectiveness of family-focused interventions at improving problem-solving skills is weak, based on the studies included in this review.

Interventions examining conflict behaviour

Familial conflict is an aspect of communication that reflects the inverse of receptivity to new information, as described by Fitzpatrick and Ritchie. 7 The four studies examining conflict behaviour between adolescents and their parents 38 – 41 provided mixed evidence regarding the efficacy of family-focused interventions for improving conflict behaviours. Participants who completed IPT for adolescents and parents with depression reported less adolescent–father conflict (reported by adolescents; P  < 0.100, η 2  = 0.24) and adolescent–mother conflict (reported by mothers; P  < 0.050, η 2  = 0.29) relative to individual IPT. 39 Consistent with these findings, parents of adolescents who completed SBFT reported greater improvements to dyadic behaviour compared with parents of adolescents who completed CBT at 24 months follow-up ( P  < 0.001, χ 2  = 12.64 40 ), although similar improvements were found for participants who completed NST relative to CBT in this study. 40 Two further studies did not find a difference between interventions with or without a family-focused component on conflict behaviour. 38 , 41

Interventions examining family functioning

Three studies examined general family functioning, 37 , 40 , 43 which describes the organisational properties of families and patterns of transactions between family members. For example, measures of general family functioning ask how responsive family members are toward the emotions of other family members, and how accepted the individual feels within the family dynamic. 44 Communication is integral to measures of family functioning, as they focus on verbal ways in which issues are resolved within the family (e.g. talking to people directly rather than going through go-betweens). 8 These studies provided limited evidence that family-focused interventions improved general family functioning to a greater extent than interventions without a family-focused component. Although one study found a family-focused intervention improved family functioning relative to NST (χ 2  = 12.64, P  < 0.007 40 ), improvements to general family functioning were similar between treatments with or without a family-focused component. 37 , 40 , 43 Therefore, although family-focused interventions may improve general family functioning, there is an absence of evidence to suggest this improvement is greater than interventions that do not explicitly include families.

Interventions examining social adjustment

Two studies examined social adjustment, 42 , 43 which describes the extent to which individuals adjust to social roles (i.e. professional or educational roles, social and leisure activities, and role within the family 45 ). Poor adjustment to social rules can lead to friction, and measures of social adjustment ask how well the individual is able to communicate to others around them in their role (e.g. as the child of their parent). 46 These studies suggested that family-focused interventions were effective at improving adolescents’ social adjustment, as both studies reported greater social functioning scores after completing a family-focused intervention compared with treatment as usual ( d  = 0.93–0.96 43 ) or clinical monitoring ( P  = 0.01 42 ). However, these studies did not compare a family-focused intervention to another psychotherapeutic intervention. Therefore, although family-focused interventions appear successful at improving social adjustment, we cannot assess whether they are more successful than other types of interventions.

The current systematic review examined the efficacy of family-focused interventions to improve communication within families for adolescents with anxiety disorders and/or depression. Across the seven studies reviewed, we found mixed evidence regarding the effectiveness of family-focused interventions to improve any facet communication within families, at least compared with existing interventions that do not include families within the intervention. Yet, we were struck by the absence of high-quality research into improving communication in families of young people with anxiety disorders and/or depression. Our systematic literature search yielded a small number of highly heterogeneous studies, which, despite being randomised controlled trials, had a high risk of bias ( Table 2 ). 36 Therefore, in answer to the question, ‘Do family-focused interventions improve communication within families, for whom does this work, in what contexts, and why?’, our team of experts by lived experience, researchers and clinicians suggest that there is insufficient evidence to provide an authoritative answer to this question and encourage further research on this important topic.

Cochrane Risk of Bias 2 tool

A represents bias arising from the randomisation process, B represents bias owing to deviations from intended interventions, C represents bias owing to missing outcome data, D represents bias in measurement of the outcome, E represents bias in selection of the reported result and F represents overall bias.

Do family-focused interventions improve communication within families within context of anxiety disorders and depression?

We found substantial variation in the ways in which family communication was conceptualised (as conflict, family functioning, familial involvement or problem-solving). This heterogeneity prevented us from drawing firm conclusions about whether improving family communication is an active ingredient in the treatment of anxiety disorders and/or depression in 14- to 24-year-olds. However, most of the studies found that family-focused interventions did not lead to significant improvements in features of communication relative to existing psychotherapeutic interventions. Although this could be interpreted to suggest that family-focused interventions do not improve communication, we instead propose that in context of the significant limitations of the included studies (which we discuss below), there is insufficient evidence to conclude whether family-focused interventions can improve communication within families. Indeed, this perspective was reflected by our advisory group, who all agreed that communication within families was a topic worthy of further study in the context of anxiety disorders and depression. There was some promising evidence that communication can be improved (relative to treatment as usual/waitlist), but the mixed findings, heterogeneous measurement and non-specificity of the results (e.g. compared with other treatments) make it impossible to recommend an approach to improving communication at this stage.

For whom do family-focused interventions work?

We believe that a conceptual shift is required to advance our understanding of for whom improving communication in families works. The analogy from physical health – of the accepted importance of addressing high blood pressure – is useful here in at least two ways. First, high blood pressure is itself a risk factor for other health problems (such as hardened arteries, which, in turn, are a risk factor for heart failure). Second, effective treatment of high blood pressure can be a pre-requisite for other medical interventions to be conducted safely (such as before elective surgery). Ineffective communication might similarly be a non-specific risk factor for common mental health problems, as indicated by the multifaceted way in which studies have linked poor family communication to mental health outcomes, 22 , 23 , 27 , 32 and therefore may be an appropriate target for prevention. Further, for interventions to be effective, communication within families might need to be addressed as a pre-requisite for some individuals. For example, as one of the members of our YPAG stated ‘effective communication is really important. Without it, young people, who may require only very minimal support to reduce their anxiety, can't get that fulfilled’. Indeed, the inability to express the need for support is consistent with empirical evidence that poor communication with parents can create a barrier to the access of treatment. 34

In what context do family-focused interventions work?

We are also unfortunately unable to draw conclusions about how to best target communication in psychological therapy. There was significant heterogeneity in the interventions used to deliver family-focused content (including CBT, family psychoeducation, IPT for adolescents with depression and SBFT) and often embedded in programmes with significant additional content. A number of these interventions are time-limited and highly structured, established for individual delivery rather than delivery to adolescent with their parents (e.g. CBT, IPT for adolescents with depression). As such, we raise the question of whether content aimed at improving communication should be integrated within, and therefore potentially replace or shorten, existing treatment programme elements or be the focus of a separate and distinct intervention; and, in either case, how should this be practically implemented?

Four studies in our review included a family-focused component to an intervention that traditionally did not involve family members. 37 , 39 , 41 , 43 Of these studies, only one found the addition of the family-focused intervention improved communication (specifically conflict behaviour 39 ). In this study, an adaption of IPT for adolescents with depression was delivered with parents attending several sessions. Given the existing emphasis of IPT for adolescents with depression on communication, 47 it may be that some treatments are more amenable to the inclusion of family-focused content compared with interventions that focus on other mechanisms of change (e.g. cognitive restructuring in CBT). Indeed, the missed potential for family-focused interventions to benefit adolescents was highlighted by one study that found participants in classical CBT reported greater feelings of family emotional involvement compared with participants in CBT supplemented with a family-focused component. 37 One interpretation of this finding is that increased parental involvement following a family-focused intervention may be incongruent with adolescents’ desire for increased autonomy from caregivers, 48 producing adverse outcomes. Certainly, care needs to be taken with adding elements to existing evidence-base interventions, as it may inadvertently reduce the therapy's effectiveness by incurring a kind of opportunity cost. Furthermore, a key question that we hoped to address but could not, is when a focus on communication might be indicated or not; further research is urgently needed to establish this.

Strengths and limitations

The included studies were all randomised controlled trials, with all but one 43 utilising blinded allocation to the treatment condition when compared with a control condition. Furthermore, three studies compared the family-focused intervention to another intervention and a control condition, 38 , 40 , 41 which provided stronger evidence for the efficacy (or lack thereof) of family-focused interventions.

However, we also identified several limitations in the studies reviewed. Of critical importance is the small sample size in half of the studies included in the review, 38 , 39 , 42 , 43 meaning these studies most likely did not have statistical power to identify differences between treatment arms. Furthermore, there was a disproportionate focus on adolescent–mother dyads, either because of an explicit design choice 38 or fathers not attending as often. 37 , 39 If the reason for poor family communication was a result of adolescent–father conflict, this could be one possible explanation for the absence of evidence regarding the efficacy of family-focused interventions at improving communication. This view was endorsed by our advisory group who suggested that it is the ‘underlying dynamics [of the family] that need to be looked at’.

Finally, our focus was limited to children and young people with diagnoses of anxiety disorders and/or depression as part of the project to assess active ingredients in the treatment of these disorders. 49 Thus, we were unable to examine the importance of addressing family communication in the face of a more general sense of severe emotional distress. This important issue was emphasised by our experts by lived experience:

‘… it was clear that there was more emotional distress that went unrecognised and untreated [in child and adolescent mental health services]. It wasn't until DBT [dialectical behaviour therapy] skills were offered at aged 18+ (in adult services), which directly addressed communication skills, that both my daughter and I benefitted from greatly improved communication.’

Recommendations for policy makers, clinicians and funders

In the light of our findings, the theoretical and practical importance of communication, and our advisory group discussions, we call for funders to prioritise studies that will develop measures that capture essential features of communication. One such feature, emphasised by our experts by lived experience, is that ‘Communication is not clear cut, straightforward, it can be a way of connecting, rather than a way of putting some message across.’ Thus, affective dimensions like connection must be captured in addition to definitions that rely on the transmission of information. We do not expect this to be simple. Indeed, as another expert by experience explained, ‘Effective communication is more than just exchanging information. It's about understanding the emotions and intention behind the information. That's the bit that's hard to measure. There's much more going on, especially in families.’ Consistent with this view, empirical studies have demonstrated that discrepancies between the adolescent's and parents’ perceptions of the effectiveness of their communication with one another are associated with greater internalising problems. 50 Therefore, the objective act of exchanging information may not be sufficient to measure communication. Rather, we propose that measures should be developed that capture the affective experience of connecting through verbal exchanges to examine communication within families.

In conclusion, it is important to acknowledge limitations of the current systematic review. Although our definition of family communication was guided by theoretical work on this topic 7 , 16 and was endorsed by our advisory group of lived experience experts, these theoretical definitions did not map exactly onto the outcome measures used in the included studies. Indeed, this issue further emphasises the need for the development of new tools to measure family communication that reflect both theory and the lived experience of communication within families.

Communication is of central theoretical and practical importance to young people's mental health, yet we have found an absence of evidence about the role of improving family communications as an active ingredient in the treatment of anxiety and/or depression in young people aged 14–24 years. As a team of clinicians, experts by experience and scientists, we call for future studies to be designed to conceptualise communication more rigorously, to capture young people's lived experience of what communication is; to identify how to improve communication within families and to better understand for which young people and families this will be most beneficial. As stated by a member of our advisory group:

‘If you get it wrong at the foundational stage, if young people don't feel that they can speak openly and be heard and validated for their experiences, then that's a really shaky start and where do you get that if it doesn't start in the family home?’

Supporting information

Lloyd et al. supplementary material

Acknowledgements

The authors would like to acknowledge the support of the McPin Foundation for their assistance in creating the Young People's Advisory Group and the Parents and Carers' Advisory Group.

Supplementary material

Supplementary material is available online at https://doi.org/10.1192/bjo.2023.545

Data availability

Author contributions.

A.T., K.D., K.N.S., P.F., P.J.L., the Young People's Advisory Group and the Parents and Carers’ Advisory Group were responsible for study conception and data acquisition. A.T., A.L., K.D., K.N.S., P.F., P.J.L., the Young People's Advisory Group and the Parents and Carers’ Advisory Group were responsible for data analysis and interpretation, drafting and reviewing the manuscript, final approval of the manuscript and accountability.

This research was supported by a grant from the Wellcome Trust Mental Health Priority Area Active Ingredients Commission, awarded to P.J.L. at University of Southampton, Southampton, UK. The funder had no role in study design, data collection, data analysis, data interpretation, writing of the report or decision to submit manuscript.

Declaration of interest

Functional Family Therapy (FFT): Things You Need To Know

Functional Family Therapy (FFT) is an evidence-based approach to improving communication, problem-solving, and conflict-resolution skills. In this blog, we will explore what is functional family therapy, when to seek FFT services. We will discuss how it is delivered and how its teachings can be beneficial. You will also find the answer to your question “How to find functional family therapy near me?”.

• 1 What is Functional Therapy?
• 2 Is Functional Therapy Delivered For Family?
• 3 When To Seek Functional Family Therapy?
• 4.1 Engagement
• 4.2 Motivation
• 4.3 Assessment
• 4.4 Intervention
• 4.5 Generalization
• 4.6 Maintenance
• 5 Key Teachings Of FFT
• 6.1 Ask for referrals
• 6.2 Online search
• 6.3 Insurance provider
• 6.4 Recommendations
• 7 Conclusion

What is Functional Therapy?

Functional therapy involves exercises and activities that are designed to help a person regain strength, mobility, and endurance, as well as develop new skills and strategies to perform tasks more efficiently and effectively. It is typically administered by a physical or occupational therapist .

Is Functional Therapy Delivered For Family?

Functional therapy can be delivered for families, but it would typically involve a different approach than individual therapy . In family functional therapy, the focus would be on improving the family’s ability to function together and achieve their goals, rather than on addressing an individual’s physical or mental health needs. Family functional therapy would involve working with the family as a unit to identify areas of dysfunction, establish goals, and develop strategies to improve communication, problem-solving, and decision-making. It may be delivered by a family therapist or a trained healthcare professional, depending on the specific needs of the family.

When To Seek Functional Family Therapy?

One must seek help if they face any of the following issues:

• Communication problems: Families may seek FFT if they are struggling with communication issues. Such as frequent misunderstandings, conflicts, or breakdowns in communication.
• Behavioral problems: Families may seek FFT if they are dealing with behavioral problems in one or more family members. Such as substance abuse , delinquency, or other problem behaviors.
• Family conflict: Families may consider FFT if they are dealing with persistent and unresolved conflicts or tension between family members.
• Mental health issues : Families may seek FFT if one or more family members are experiencing mental health issues. Such as depression , anxiety , or PTSD , which is impacting the family’s functioning.
• Major life transitions : Families may seek FFT during major life transitions, such as divorce , remarriage, or the birth of a new child. Other life transitions like injury or illness can also be addressed. These transitions can often lead to stress and disruption in family relationships .

How Is FFT Delivered?

Functional Family Therapy (FFT) is typically delivered through a structured and evidence-based approach that involves the following steps:

In this first step, the therapist establishes a rapport with the family and creates a safe and supportive environment for them to discuss their concerns. Moreover, the therapist seeks to understand the family’s values, beliefs, and communication patterns. As a result, it helps the family to feel comfortable and motivated to participate in therapy.

In this step, the therapist works with the family to identify the reasons why they want to make changes and improve their family functioning. The therapist helps the family to recognize the impact of their behaviors on themselves and others. Additionally, he helps them to understand the potential benefits of making changes.

In this step, the therapist conducts a comprehensive assessment of the family’s strengths and weaknesses, as well as the contextual factors that contribute to the problem behaviors. The therapist may use a variety of assessment tools, such as interviews, questionnaires, and observations, to gather information about the family’s dynamics, communication patterns, and problem behaviors.

Intervention

In this step, the therapist develops a customized intervention plan that is tailored to the family’s specific needs and goals. The therapist teaches the family new skills and strategies. This is done to improve communication, problem-solving, and conflict resolution . Ultimately, they learn to apply these skills to real-life situations as well.

Generalization

In this step, the therapist helps the family to generalize the skills they have learned in therapy to other areas of their lives, such as school, work, and community. This helps them in bringing up behavioral changes that are needed for recovery.

Maintenance

Key Teachings Of FFT

Given below are some teachings of FFT that are beneficial:

• Communication Skills: FFT teaches families how to communicate more effectively by using active listening, empathy , and assertiveness . The therapist helps family members to express their feelings and needs clearly and respectfully. He also encourages them to listen and respond to each other in a non-judgmental way.
• Problem-Solving Skills: FFT teaches families how to work together to solve problems in a constructive and collaborative way. The therapist helps family members to identify the root causes of problems and brainstorm potential solutions. He will help evaluate the pros and cons of each solution and select the best course of action.
• Conflict Resolution Skills: FFT teaches families how to manage conflict positively and productively. The therapist helps family members to identify and understand the underlying sources of conflict and teaches them strategies for resolving conflict in a way that is respectful, fair, and mutually beneficial.
• Goal Setting: FFT helps families to set realistic and achievable goals for improving their family functioning. The therapist works with the family to identify their strengths and weaknesses and helps them to develop a plan for achieving their goals.
• Family Empowerment: FFT emphasizes the importance of empowering families to take an active role in their treatment. The therapist encourages them to take ownership of their progress. Additionally, he also encourages them to make decisions that are in their own best interests.

How To Find Functional Family Therapy Near Me?

To find Functional Family Therapy (FFT) near you, there are several steps you can take:

Ask for referrals

One of the best ways to find an FFT provider near you is to ask for referrals from people you trust. You can start by asking your doctor, therapist, or other healthcare providers. They may be able to recommend an FFT provider in your area.

Online search

Insurance provider

If you have health insurance, you can contact your insurance provider to get a list of FFT providers who accept your insurance. This can help you find a provider who is covered by your insurance plan and may be more affordable for you.

Recommendations

You can ask for recommendations from friends or relatives who have had experience with FFT providers. They may be able to provide valuable insights into the effectiveness of the providers they worked with. Moreover, they can also provide their experience during the therapy process. This can be a helpful way to find an FFT provider who meets your needs.

In conclusion, Functional Family Therapy (FFT) is an evidence-based approach. It can be helpful for families who are experiencing a range of challenges and difficulties. By focusing on improving communication, problem-solving, and conflict-resolution skills, FFT can help families build stronger relationships and overcome the challenges they face. If you are struggling with family issues, consider seeking help from a qualified FFT provider in your area. With the right support, you can work towards improving your family relationships and creating a healthier, happier home environment.

For more information, please contact MantraCare.  Parenting  is a challenging yet rewarding experience that is crucial for the development and well-being of a child. If you have any queries regarding  Online Parenting Counseling  experienced  therapists  at MantraCare can help:  Book a trial therapy session .

Mantra Care aims at providing affordable, accessible, and professional health care treatment to people across the globe.

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