Filial Therapy
While many types of counseling focus on the interactions between therapists and clients, filial therapy is a form of child-centered play therapy that focuses on the relationship between a child and their parents or guardians.
During filial therapy, therapists instruct parents on how to interact with their children and then oversee sessions where the parent(s) and child play. As the children play with their parents, they may develop a stronger attachment that translates into a healthier relationship in their everyday life and improved family functioning.
What is filial therapy?
Filial therapy is defined as “a short-term intervention that incorporates a combination of play therapy and family therapy,” overseen by a therapist. In essence, filial therapy is a form of child parent relationship therapy that can help parents and children better connect, address family problems or traumatic events, and prevent undesirable behaviors from reoccurring in the future.
While this child-centered play therapy technique was developed in the 1960s, research has since demonstrated that it is an effective strategy for creating a more healthy family system, as well as improving treatment outcomes for mental health conditions in younger children, such as ADHD and certain anxiety disorders.
What conditions can filial therapy help treat?
Filial therapy was originally developed to help treat social, emotional, and behavioral conditions in children, as described in the seminal text on the topic, Strengthening Parent Child Relationships Through Play, published by Professional Resource Press. However, filial therapy is now recognized as an effective method for helping not only children, but also their caregivers and the entire family as a whole, including children and families in foster care situations.
Conditions associated with filial therapy
Some of the conditions filial therapy can help with include:
- Anxiety
- Depression
- Oppositional defiant disorder (ODD)
- Aggression disorders
- Inattention and hyperactivity including attention deficit hyperactivity disorder (ADHD) and its subcategories
- Attachment issues
- Trauma, including symptoms of post-traumatic stress disorder (PTSD)
Explaining age limits for filial play therapy
Filial therapy aims to help children ages three to twelve through the use of play and imagination. The counseling may prove ineffective for children younger than three years old as children in that age range typically have not yet begun to engage in imaginative play. Children over the age of 12 may no longer be able to engage in the kind of imaginative play where they freely express themselves. Teenagers are often best helped by taking a verbal approach to their counseling, rather than filial therapy or any form of play therapy.
How does filial therapy work?
Though it is a form of play therapy, filial therapy is different from most other forms of play counseling. In most types of traditional play therapy, a counselor will meet with a child’s parents first to discuss concerns with the child's development, behavior, or learning, as well as the parent or guardian's involvement and parental techniques. After the initial discussion, the therapist will work with the child over a matter of weeks or months during individual weekly play sessions.
Although parents receive regular progress reports, they are rarely directly involved in those therapy sessions, though communication between the child and parents about the counseling sessions is encouraged.
In contrast, with filial therapy, the parents are present during every session and will even run most of the sessions themselves. In the first few sessions, the counselor will instruct parents on how to participate in interactive play and mindful play with their child. The counselor practicing filial therapy will also focus on training parents and caregivers on effective parenting methods and basic play practices. For the first few play sessions, the therapist will demonstrate play practices with the child, and then the parents will take the therapist’s place and the therapist will assume the role of quiet observer and coach.
General steps of filial therapy
The general steps of filial therapy are as follows:
- The therapist provides the parents with a detailed explanation of filial therapy—what it entails, the research behind it, and what it sets out to achieve. During this process, the therapist takes any cultural perspectives into account and provides culturally sensitive interventions.
- The child engages in play sessions with the therapist while the parents observe the basic steps and skills required.
- Parents take charge of a play session as the counselor supervises their progress. After the session, the counselor provides feedback. The sessions are conducted with one parent and one child at a time as each parent-child relationship is unique.
- The play sessions are moved to the family home, but the parents still have the opportunity to visit or talk with the counselor to discuss their concerns.
Parents may also choose to join a support group to give and receive encouragement as they continue to work on strengthening family relationships.
The entire therapy process normally includes 15 to 20 sessions of one hour each. This process can take anywhere from three to six months and may last longer depending on whether the family desires follow-up sessions. The counseling may also be conducted in a group setting, such as a community support group intended to help strengthen families.
A mental health professional may utilize various therapy techniques when providing filial therapy. Filial therapy may also be paired with other types of interventions, typically incorporating other professional psychology and adolescent psychiatric nursing care approaches.
Just as with other forms of play counseling, the counselor and parents will have regular meetings throughout the counseling. This connection allows them to assess the progress being made and to address any challenges or concerns. The parents and counselor may also discuss themes or patterns of behavior that become evident during the family's sessions. It cannot be overemphasized that the entire point, purpose, and focus of filial therapy is to promote the growth of all involved and to strengthen familial relationships.
Benefits of group filial therapy
Filial therapy was first used in group counseling sessions that involved clusters of unrelated families, all seeking therapeutic change. It is still practiced in this way in some instances.
During group sessions, each caregiver directly works with and focuses on their child, but they also find emotional support in being among other parents who are learning the techniques with their children. In this setting, parents can see how other caregivers directly employ the techniques and play therapy activities, and may be better able to evaluate their own attempts. In addition to observing other families, parents benefit from being able to give and receive constructive feedback within the group.
Techniques taught in filial therapy
Parents are in charge of leading filial therapy sessions, which may seem intimidating, but filial therapy techniques are straightforward and simple to employ.
Four basic skills a filial therapist may teach parents
The four basic skills taught to parents in the filial therapy flexible model are:
- Structuring - The parent sets the stage, so to speak, by identifying the play area and its boundaries. They also decide what toys to include.
- Empathic Listening - The parent learns how to be in tune with and reflect the emotions of the child. In other words, the parent discovers how to be more sensitive to the child's emotions and more empathetic when responding to them.
- Child-Centered Imaginary Play - The parent watches the child at play and takes part only by following the child's lead. This is called non-directive play or child-centered imaginary play. The child is not pushed toward exploring any particular topic—not even the ones parents think may be affecting them the most.
- Limit Setting - The parent learns to set rules as to what will and will not be accepted during the play session. Limit-setting should typically encourage safe and responsible play; but the rules should be few and not too limiting. For example, displays of aggression should be allowed, within reason.
Socioemotional benefits of working with a filial therapist
Research suggests that filial therapy may help reduce feelings of depression in children, and decrease parental concerns with children's behavior.
During nondirective filial therapy, children have a safe and fun outlet to express themselves, communicate with their parents, and learn useful skills. Likewise, parents can increase their listening skills, which may help them better understand their children. Parents often become more attentive and understanding, which can help to establish trust between them and their child. Parents may also develop more confidence in their parenting skills during nondirective filial therapy, which can result in an improvement in parent child relationships.
Within the setting of the child-centered play area during filial therapy, the child feels empowered to explore feelings they may not otherwise express. The parents have the opportunity to see and understand the underlying emotions which might be driving the child's behavior in nondirective play sessions. This bonding time can boost the child's self-esteem, reduce troubling behavior, and improve the relationship between the child and parents.
Filial therapy also allows the parents to learn how to handle frustrating situations by using the parenting techniques they learned from therapists in earlier sessions.
Online therapy as an option for parents’ mental health
Filial therapy isn’t the only option for parents who are coping with doubts or issues related to parenting. If you find yourself overburdened or insecure in your role as a parent, you may benefit from discussing your concerns with a licensed therapist. Online therapy through a service like BetterHelp makes it easy to connect with a therapist from your home, so you can sneak a session in while your child is at school or taking a nap.
A literature review found that the effectiveness of online therapy was similar to that of traditional in-person therapy for a wide range of conditions. The results of this research suggest virtual therapy may help parents facing challenges including inter-relationship difficulties with their children and spouses, as well as their choice of parenting style.
Takeaway
What is the filial approach to therapy?
Filial play therapy, first developed in the late 1950s, sought to leverage techniques of play therapy that were known to be effective at treating social, emotional, and behavioral problems in children. Although it is a child-centered approach, filial therapy mainly focuses on training parents to use evidence-based techniques to conduct special play sessions with their children. The creators of filial therapy believed that, because of the emotional bond parents share with their children, having parents apply play therapy techniques could significantly increase their effectiveness. Filial therapy was one of the first approaches that focused on parent-child conjoint sessions, where both parents and children attend therapy together.
What are the four skills of filial therapy?
The four main skills taught to parents in filial therapy include:
Structuring. Parents are taught how to begin and end a play session, indicating clear transitions to their child.
Empathic listening. Parents learn to set aside their own feelings and attend fully to their child’s behaviors and emotions.
Child-centered imaginary play. Parents are taught to engage in pretend play and adopt their child-assigned role in accordance with the child’s wishes. The child is allowed to lead the play session and develop the “scene” for the imaginary play.
Limit setting. Parents carefully set limits to encourage safety and boundaries. Parents are taught how to give the child a chance to correct misbehavior before enforcing a consequence.
What is the difference between filial therapy and play therapy?
Play therapy
Filial therapy relies on many of the techniques used in play therapy. The main difference is found in the parent-child interactions. In many types of therapy, play therapy techniques are used by the therapist when they directly interact with a child.
Filial therapy
In filial play, the therapist does not apply the techniques directly but rather teaches parents how to use those techniques, effectively taking on the therapist’s role in sessions with their children. The theoretical foundations of filial therapy suggest that the emotional bonds parents have with their children can offer greater relationship enhancement between parent and child compared to other types of family therapy.
What are the stages of filial therapy?
Filial therapy uses a flexible approach that can change from family to family based on the therapist's discretion. The number of sessions varies based on family needs, but most filial therapy approaches follow a similar structure.
General stages of filial therapy
Initial intake and play observation. This stage allows the therapist to get an understanding of the family’s concerns and observe how the child interacts with their parents.
Play demonstration. The therapist demonstrates play techniques with the child.
Parent training. The therapist and parents work together to give the parents appropriate skills and education related to filial therapy.
Direct supervision of play. The therapist observes the parents and child play together, providing redirection and instruction when needed.
Transition to home. Parents become progressively more independent as the therapist continues to prepare them to continue therapy sessions at home.
What is an example of filial therapy?
Filial therapy refers to a process wherein a mental health professional helps parents learn play therapy techniques to enhance their relationship with their children. Generally, therapists teach play techniques directly, observe the parents applying the techniques, and provide feedback until the parents are ready to practice them at home. Continuing education may be provided to ensure that the parents are able to apply the therapeutic techniques effectively.
Is filial therapy effective for improving mental health?
A meta-analysis of filial therapy indicated that it is an effective method of therapy that can help manage behavior concerns of children aged 2 to 12. Researchers demonstrated the effectiveness of the therapy by reporting the effect size, a common measure of a treatment’s impact. The larger the indicated effect size, the more effective the treatment is considered to be. In the present meta-analysis, researchers found that traditional play therapy, led by a therapist, had an effect size of 0.72, indicating a medium to moderate effect. Filial therapy, however, led by parents, had an effect size of 1.15, significantly larger than therapist-led play therapy. This may support the assertion of the original creators of filial therapy: the emotional bond between parents and children can significantly enhance the effectiveness of play therapy techniques.
When should filial therapy be used for a child?
Filial therapy is used to help manage behavioral concerns in children aged 2 - 12. A therapist initiates the process and may recommend other therapeutic approaches based on specific needs.
What are the limitations of filial therapy for children?
In filial therapy, strengthening bonds between parents and children is a primary goal. Because of this, one of the limitations may be the willingness of parents to become involved in the process. Parents who are unwilling to play with their children, apply techniques based on therapist instructions or are unable to dedicate the considerable time it takes to produce improvement are unlikely to be good candidates for filial therapy. Filial therapy may also face fidelity concerns, as parents may struggle to correctly apply play therapy techniques with the same repeatability and accuracy as a professional.
What is good filial therapy?
Good filial therapy is based on the person defining the term. For many, good filial therapy is likely based on outcomes. The therapy is good if the child’s behavior successfully improves when the therapeutic techniques are applied.
What is filial anxiety?
Filial anxiety refers to fear and apprehension in children caused by their relationship with their parents. It commonly occurs when adult children consider and anticipate their potential caregiving responsibilities as their parents reach old age.
What is the difference between family therapy and filial therapy?
Family therapy and filial therapy both aim to improve family dynamics, but they differ in their focus and approach. While family therapy addresses broader family dynamics, filial therapy hones in on enhancing the parent-child connection through guided play.
Family therapy involving a child
Family therapy is a broader intervention that involves multiple family members working together to address issues within the family system. The therapist actively engages with the family, helping them identify and change unhealthy communication patterns, resolve conflicts, and improve overall relationships. Techniques in family therapy may vary depending on the specific approach, but the goal is to foster a healthier family environment by addressing systemic issues that affect the entire family.
Filial therapy for children
Filial therapy is more specific in its focus, centering primarily on the parent-child relationship. It involves training parents to conduct therapeutic play sessions with their children, using play as a medium to strengthen emotional bonds, improve communication, and address the child's behavioral or emotional issues. In filial therapy, the therapist acts as a coach, teaching parents how to effectively carry out these sessions, but the actual therapeutic work is done by the parents with their children.
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