Family Therapy: Theories, Modalities, And Efficacy

In general, family therapy is a form of therapy in which an entire family is engaged to reach a group resolution rather than an individual seeking out personalized therapy plans. Family therapy often involves family systems theory, which was introduced by Murray Bowen and views a family as an emotionally connected unit made up of each person in the family as a vital part. A few types of family therapy can include structural therapy, Milan therapy, strategic family therapy, narrative therapy, and transgenerational therapy. Different types of family therapy can be helpful for different families, and online therapy can be an alternative to traditional in-office family therapy.

Family therapy: A definition

It often brings Murray Bowen's family systems theory to light, which paints the individuals as vital parts of one emotionally connected unit. Family therapies can all look very different from one another, both in terms of what is worked on during therapy sessions and the manner of delivery. Some therapies focus on parent-child engagement and interactions, while others have different goals.

Family therapy typically seeks to treat a family unit to improve communication, relations, and dynamics within a family, which can ultimately contribute to a harmonious home life and better mental health for family members. Family therapy is most commonly engaged when children are still in the home, but people of all ages and home lives may come into family therapy and benefit from it. Ultimately, family therapy is a form of therapy that treats relationships without focusing on a romantic relationship.

However, many themes that are present in marital or couples counseling appear in family therapy. The American Association for Marriage and Family Therapy, the professional organization that represents marriage and family therapists, reports a wide range of concerns that family therapists might treat, many of which involve developing greater cohesion between a romantically paired couple. Married and family therapy therapists also sometimes work exclusively with couples or with individual family members.

Family therapy theories

Family therapy theories essentially function as the basis from which all family therapy modalities spring. Theories are often used to identify the most effective forms of treatment, whether that means engaging a family as a single unit, separating a family to treat individual issues, or treating a family through different lenses depending on the day, tackling situations and challenges as they arise.

Some family therapy theories see families as small societies. There may be specific, unique roles and relationships, and deviating from these roles and relationships is often the greatest source of conflict or contention. 

Other family therapy theorists view the family unit as just that: a single unit with working parts that must all work toward the same goal.

Main family therapy modalities

There are five widely recognized family therapy modalities utilized by family therapists: structural therapy, Milan therapy, strategic therapy, narrative therapy, and transgenerational therapy. These forms of therapy normally seek to improve familial relationships, help resolve mental illness, and create a more stable, healthy life at home.

Structural family therapy is usually the most popular form of family therapy, and it tends to see the family as a unit with multiple functioning pieces. Each person in the structural family may have a specific role that they fulfill, and deviating from these roles can be the greatest source of conflict within a family. Structural therapy, then, usually seeks to evaluate any reason for the upset in systemic family roles and works on integrating each family member back into the roles they were originally intended to fulfill. This modality often works to evenly distribute power, communication, and respect, so that the family can move forward as a single, functional system.

Milan therapy can be similar to strategic therapy because it tends to view a family as a single system, with a series of symbiotic systems embedded within it. It usually differs somewhat from Structural therapy, though. It often focuses far more on the natural behaviors within a family and seeks to guide those natural behaviors, focusing on reactions and feedback. 

Strategic family therapy mainly centers on patterns within families and has less of a focus on viewing the family unit differently. Strategic family therapists are usually instructed to focus on any patterns of behavior that have emerged or developed over time and attempt to intercept and redirect these patterns actively.

Narrative therapy generally operates under the notion that individuals being at their absolute best and believing in their power can create the greatest, most effective family dynamics. Conflict resolution can be a simple matter of improving self-esteem and self-perception.

Transgenerational therapy most often works on the conflicts between different generations by breaking down any communication barriers that exist and cultivating understanding, despite different cultural mores or expectations. This particular modality usually suggests that most conflicts among family members come from the differences between generational behaviors and expectations, and soothing these differences can be a simple matter of improving communication and encouraging open-minded attitudes.

Which family therapy theory is best?

As one study concluded, there may be no single form of family therapy that is distinctly advantageous over another; some modalities may work well for some families, and others may work well for other families. Ultimately, it is usually the presence of psychotherapy that consistently demonstrates significantly different outcomes, rather than the use of a single, distinct family therapy theory or modality.

Some forms of family therapy may be more likely to suit a particular problem, however. If communication between different generations is the primary problem, for instance, if grandparents and parents are struggling with it, or parents and children are struggling with it, then Transgenerational Therapy might be the most effective form of therapy to reach a resolution.

If family dynamics are being tested, structural therapy may be the best therapeutic method to repair family dynamics and instill peace. Communication breakdowns and not understanding your role in your family could be helped through Milan therapy, and Narrative therapy could help a family filled with low self-esteem and self-doubt.

Ultimately, though, your family is likely to be better off after completing family therapy, regardless of the exact form of therapy you engage in. The most conclusive study of therapy consistently found that people who enlist therapy as a means of self-improvement and self-help generally report better life outcomes than those who do not, so any type of family therapy may be likely to offer at least some insight into and improvement of familial relationships and family dynamics.

When choosing a modality and a therapist, it can be beneficial to do some research. Consider whether you might want to work with marriage and family therapists or other types of mental health professionals. You can consult the American Association for Marriage and Family Therapists to learn more about how a marriage and family therapist can address your concerns.

You might make sure the modality you’ve chosen to enlist suits your actual needs and ensure your therapist is properly certified for that modality. Because different forms of therapy often require different techniques, therapists are usually not qualified to deliver all forms of therapy but can take on certain specialties.

Family therapy delivery

Just as there can be different family therapy types and mental health professionals that treat family concerns, there can also be different ways therapy can be administered. Some therapists may have entire families come to a session in an office, where families are encouraged to air their grievances and identify any issues they might have. Some therapists may encourage families to be seen in a more natural setting, such as a home or school, to observe the family in their typical environment and get a more accurate feel of how the family interacts. Some therapists may deliver therapy online, where families can feel more comfortable engaging with their therapist and one another. Online therapy can also have the added benefits of convenience and easy scheduling so that it’s not as much of a hassle to figure out a time when the entire family can get together.

As this study explains, online family therapy can be a viable alternative to in-person family therapy. If you feel that working with a licensed mental health professional could be helpful for your family, please don’t hesitate to reach out for the help and guidance you deserve.