Family Systems Therapy

There are many types of therapy, family therapy, and family systems therapy (FST), but most are based on the theory that an individual’s mental health and psychological makeup may only be fully understandable in the context of their relationships. Close familial relationships can be considered especially important. Research supports the idea that dynamics between family members may play a significant role in promoting psychological well-being or mental illness.

Family contributions to mental health may be especially significant in childhood. Interactions with parents and siblings can shape a person’s self-image, thinking styles, emotional reactions, and behavioral habits as they’re growing up. However, FST suggests that these effects can be seen in adulthood too. Changes in any member of a family may have significant psychological impacts on all the others. 

Family systems therapists typically seek to treat the entire family when difficulties with mental or behavioral health arise in any member. Addressing the family as a whole system may offer many advantages, such as:

• Therapists can explore how family dynamics may contribute to illness.
• Therapists receive multiple perspectives on each client’s behavior.
• Participants can learn better ways to communicate as a family.
• All members of a family can have their voices heard.
• Treatment goals can be tailored to the entire family.
• Therapists can directly observe interpersonal dynamics.
• Clients’ loved ones can play an active role in their recovery.
• Families can work together to identify healthy behavioral strategies.
• Research indicates that systemic family therapy can be an effective form of treatment for a broad range of psychosocial challenges in both children and adults. 

In most cases, family therapy, family systems therapy, and other types of therapy focused on structural family dynamics with a trained family therapist, along with homework exercises for clients to complete in between sessions. Treatment providers typically expect all members of the immediate family to attend sessions whenever possible. Sessions typically last between 60 and 90 minutes.

During the first few sessions, a family systems therapist often focuses on learning about the family’s overall dynamics and why the family is seeking help. They may do more listening than talking, encouraging all the participants to share their thoughts about what’s been bothering them and what they hope to gain from treatment.

After this initial evaluation, therapists can employ a variety of techniques to help clients address their psychological difficulties and challenging behaviors. Any or all of the following strategies may be used in family systems therapy:

• Creating a “genogram” tracing how problematic behaviors emerge from a family’s history
• Interviewing family members individually and in groups 
• Identifying “feedback loops” of dysfunctional behavior
• Role-playing to examine habits of interaction and practice constructive behavior
• Discussing precursors and responses to problematic behavior
• Practicing different communication styles
• Educating clients about relevant psychological concepts
• Identifying the strengths of various family members
• Engaging in collaborative discussions on problem-solving strategies

Systemic family therapy is often employed to address conflicts within a family, such as marital difficulties or a breakdown in the relationship between parents and children. It’s also often helpful for treating psychological and/or behavioral challenges in children and adolescents. Research has found that this type of therapy can help young people with the following challenges:

• Conduct problems
• Recovery from abuse
• Eating disorders²
• Diabetes management
• Substance use
• Depression
• Suicidality and self-harm
• Bipolar disorder
• Personality disorders
• First-episode psychosis

In addition to eating disorders and other challenges listed above, family systems therapy may also be helpful for psychological or behavioral conditions in adults. These types of cases have not been studied in as much depth, but evidence is emerging that this type of intervention can be effective. For example, studies have found that involving family members in treatment can enhance the recovery process for adults with substance use disorders. Other adult difficulties that may benefit from family systems therapy include:

• Mood disorders
• Perinatal depression
• Anxiety disorders³

Some families may also find that systemic therapy can help them handle challenges and life stresses more effectively. For example, caring for someone with a chronic illness can place a considerable strain on a family’s psychological health. Research suggests that family systems interventions may reduce stress and improve daily functioning for families with a child who experiences a chronic illness.

As the evidence base for family systems theory continues to grow, many investigators and clinicians are working to identify and improve the therapeutic techniques based on this framework. For example, a 2022 research paper described a novel psychoeducation program using the principles of family systems therapy to help parents better support children with attention-deficit/hyperactivity disorder (ADHD).⁴ The study found that this treatment produced significant improvements in family functioning. 

Another recent paper reviewed the evidence for delivering family therapy in a telehealth format. Remote treatment may be an important way to improve availability for families who have difficulty attending in-person sessions. The results suggest that this could be an effective approach, as multiple studies support the efficacy of telehealth-based family therapy. 

Other researchers are working to clarify what kinds of difficulties can be most effectively treated using a family systems approach. A 2022 study in Clinical Child Psychology and Psychiatry analyzed past trials and reported that family systems therapy led to significantly better outcomes in reducing suicidal thoughts among adolescents, compared to other forms of therapy.

Clients interested in receiving family systems therapy have numerous options for locating treatment providers. For some people, the simplest approach may be to consult their primary care providers for a referral to a qualified therapist. Insurance companies may also provide searchable databases or other methods for finding practitioners.

When seeking treatment, it may be advisable to look for a therapist who works primarily with families rather than individuals. Looking for those with an educational background in family systems treatment may also help. Some treatment providers offer family therapy as a sideline to their primary practice, but they may be less experienced in the specific challenges involved in treating couples and families. The American Association for Marriage and Family Therapy (AAMFT) provides a Therapist Locator tool enabling clients to find licensed marriage and family therapists. 

Clients may want to ask prospective therapists a series of questions. The following are some examples:

• What proportion of your work involves treating families?
• What is your success rate in treating this type of complaint?
• How do you typically approach family treatment?
• Do you have specific training in addressing challenges affecting families and couples?
• What should I expect in a session with you?

Some individuals may also benefit from individual counseling to help them navigate family-related challenges. Online treatment can be helpful in these situations, as it can greatly reduce the difficulty of finding a therapist and attending sessions. The effectiveness of Internet-based treatment is  from controlled trials, and platforms like BetterHelp can connect clients to large networks of licensed providers.