Marriage And Family Therapy

The foundation of marriage and family therapy is often based on systems psychology. Systems psychology is the concept that the behaviors of everyone within a unit (family, couple, organization, etc.) are interrelated. This means that the behaviors of one individual interact with and influence the behaviors of others.  A marriage and family therapist utilizes systems theory to interrupt unhelpful relationship patterns and behaviors to improve relationships and mental health. 

During MFT, therapists act as neutral third parties, providing a nonjudgmental and supportive space for open communication. The therapist can help each person listen to others and express themselves more effectively.

There are several types of MFT approaches, which build off systems psychology to address unique challenges, such as:

• Functional family therapy (FFT): This type of therapy is often used to address behavioral challenges in children. 
• Marriage or couples therapy: Therapists specializing in marriage or couples therapy are often experienced in navigating complex communication challenges, infidelity, stressors, and mental health conditions. 
• Structural family therapy:¹ This form of MFT emphasizes family boundaries² and relationship structures. 
• Systemic family therapy: In systemic family therapy, focus is often placed on the context of family roles, culture, religion, and socio-economic status and their impact on thoughts, feelings, and behaviors. 
• Strategic family therapy: This is often a short-term therapy that focuses on making positive structural and behavioral changes within the family unit. The belief is that the family may be a significant indicator of how children develop.

Regardless of the specific approach, most of the work of MFT often happens outside of the therapy sessions. If individuals in the group are unwilling to practice skills outside of therapy, marriage and family therapy may not be effective.

MFT is often a short-term therapy that includes around 12-20 structured and solutions-focused³ sessions, though more sessions may be required depending on the type and severity of the challenges. 

Many marriage and family therapists dedicate the first appointment to observing group dynamics and understanding the perspectives of everyone in the system. They may do this in a group setting, by meeting with individuals within the group, or both. During this time, the therapist may ask various questions to help them assess challenges.  

As sessions continue, the therapist may help clients understand the perspectives of others in the group, and they may spend time helping the group develop communication skills, coping skills, and stress reduction techniques. 

The therapist may recommend using a communication technique called “I” language, which expresses needs and desires without placing blame or criticism. For example, instead of saying, “You never text me when you’ll be home later than usual,” you might say, “I worry when I don’t hear from you at the end of the day.” 

You may be assigned homework or guided through group activities to help identify and practice new communication skills.

According to the American Psychological Association, many challenges can be addressed through MTF, including the following: 

• Substance use
• Child behavioral challenges, conduct issues, or hyperactivity 
• Relationship conflict between two or more people 
• Developmental disorders 
• Depressive disorders 
• Schizophrenia 
• Bipolar disorders 
• Abuse
• Physical health challenges 
• Grief 
• Relationship dissatisfaction 
• General mental health 
• Infidelity 

Marriage and family therapists frequently work with couples, families (including immediate and non-immediate family), communities, and organizations to improve relationships, behaviors, and overall functioning. 

Signs that couples may benefit from MFT

Many people believe that couples therapy is only for couples on the brink of breaking up. However, Anthony Chambers, Ph.D., suggests that anyone can benefit from couples’ therapy. He argues that, although people are social beings, we are often not formally taught how to communicate effectively. 

Still, there are some challenges that may require professional help more than others, including the following: 

• Repeat arguments that go unresolved 
• Criticism
• Defensiveness 
• Contempt 
• Stonewalling
• Infidelity
• Physical or emotional intimacy challenges 
• Major life events, like moving, starting a new job, or having a child
• Differences in parenting styles

Signs that families may benefit from MFT

Like couples, families are complex units that may benefit from the unbiased perspective of a professional. The following challenges may indicate that MFT could be beneficial: 

• There are high levels of family conflict or reactivity
• Time spent with family feels energy-intensive, draining, or burdensome
• People in the family avoid conflict, withdraw, or disengage 
• There are signs of abuse (financial, emotional, physical, or otherwise) 
• Sudden behavior changes or challenges in children 
• Traumatic experiences, such as natural disasters or the loss of a loved one

Many studies have evaluated the effectiveness of MFT for specific mental health challenges. For example, a 2018 study published in the Indian Journal of Psychiatry aimed to assess the impact of marriage and family therapy on substance use disorder. The authors found that dysfunctional family dynamics can be a risk factor for substance use, whereas supportive family can aid recovery. They also found that spouses attending couples therapy together benefitted from lower rates of substance use, higher rates of abstinence, and improved marital functioning compared with those attending individual therapy for substance use disorder.

A 2022 systematic review and meta-analysis of 10 randomized controlled studies compared family therapy versus other forms of psychotherapy for adolescents with depressive disorders or suicidal ideation. The authors found that there was not a significant difference between family therapy and other psychotherapies for depressive disorders but that family therapy resulted in a more significant reduction in suicidal ideation. Though these results may indicate the use of family therapy for suicidal ideation in adolescents, the authors state that further research is needed.  

Many recent studies on marriage and family therapy have evaluated the potential of online therapy. For example, a 2021 study published in Frontiers in Psychology evaluated the effects of online couples therapy on mental health and relationship outcomes. Through evaluations at pre-therapy, post-therapy, and three-month follow-ups, the authors found significant improvements in relationship satisfaction, depression, anxiety, and stress.

For those with thoughts of suicide, contact the 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

If you’re interested in working with a licensed marriage and family therapist, you may find the following resources and tips helpful: 

• Use a directory: The American Association for Marriage and Family Therapy (AAMFT) provides a locator for providers near you. The National Registry of Marriage-Friendly Therapists also provides a directory of licensed providers across the United States. 
• Consider online therapy: Online platforms like ReGain have large networks of licensed marriage and family therapists (LMFTs) trained to provide couples therapy. Online therapy may be beneficial if couples feel more comfortable attending sessions from home or if conflicting schedules make it difficult to meet with an in-person therapist during business hours. 
• Enroll in a support group: Support groups can provide peer support, encouragement, and helpful insight from people experiencing similar challenges. Mental Health America provides a directory of many specialized support groups, including AA, Caregiver Action Now, Parent-to-Parent Family Training for ADHD, CoDA, and Postpartum Support International. These support groups are often free and typically offered in-person or online.
• Evaluate your therapists’ credentials: Once you’ve found a marriage and family therapist, consider taking some time to learn more about their background, education, training, experience, and specializations. They should provide you with their licensing information, which you can review to ensure they’re up-to-date and in good standing.